The Effects of Long-Term Clozapine Add-On Therapy on the Rehospitalization Rate and the Mood Polarity Patterns in Bipolar Disorders
J Clin Psychiatry 2006;67(3):461-467
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: We investigated the effect
long-term clozapine add-on therapy has on
rehospitalization rate and mood polarity patterns in
patients with bipolar disorders.
Method: Clinical data from medical records
of 51 patients with bipolar disorder (DSM-IV) treated with clozapine add-on for more than
6 months at the Refractory Bipolar Disorders
Clinic of Seoul National University Hospital were
retrospectively analyzed. Patients had been
registered from 1995 to 2004. Rehospitalization rates
were compared before and after clozapine add-on.
The clinical polarity of episodes resulting in
hospitalizations was also compared. Twenty-seven
bipolar patients treated with clozapine add-on for more than 3 years were further analyzed for
Results: The number of hospital days per
year was reduced in 90.2% of patients after
clozapine add-on. Total number and duration of
hospitalizations per year decreased, and the effect size
of clozapine add-on was substantially large (Wilcoxon z = -5.48, p < .01 for number of
hospitalizations/year; Wilcoxon z = -5.32, p < .01 for
hospital days/year; r = -0.54 and -0.53,
respectively). Significant reductions were found in the
number and duration of hospitalizations associated
with manic, depressive, and hypomanic episodes. Number and duration of hospitalizations
associated with mixed episodes did not show
significant changes. The long-term efficacy of clozapine
add-on was supported by continuous reduction in
hospital days per year in the 27 selected patients.
Conclusion: Long-term clozapine
add-on therapy was effective in reducing the number
and duration of rehospitalizations of bipolar
patients resistant to conventional treatment. A
significant reduction was found in rehospitalizations
associated with manic, depressive, and hypomanic
episodes, whereas mixed episode-associated rehospitalizations did not show significant changes.