Ziprasidone as adjunctive therapy in severe bipolar patients treated with clozapine.

Natalia Bartolommei,Lorenzo Lattanzi,Luca Cosentino,Antonella Benvenuti,Federica Luchini,Antonello Di Paolo,Laura Pensabene,Francesco Casamassima,Mauro Mauri

doi:10.1155/2014/904829

Natalia Bartolommei, Lorenzo Lattanzi + Show 7 more

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https://doi.org/10.1155/2014/904829

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Abstract

Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course.

Highlights

Atypical antipsychotics have proven effective in the treatment of schizophrenia and schizoaffective disorder yielding improvements in both positive and negative symptoms [1,2,3,4,5,6,7,8,9,10,11].Many SGAs are indicated for the treatment of the different phases of bipolar disorder (BD) in monotherapy and in association with mood stabilizers
Eight patients with psychotic bipolar disorder were tested with the Brief Psychiatric Rating Scale items (BPRS), the Hamilton Depressive Rating Scale (HAM-D), and the Clinical Global Improvement (CGI) at T0 and retested after 2 weeks (T1)
We have previously reported that the augmentation of clozapine with aripiprazole may be safe and effective in severe psychotic schizoaffective and bipolar disorder which failed to respond to SGAs [51]

Summary

Introduction

Atypical antipsychotics ( known as second generation antipsychotics, SGAs) have proven effective in the treatment of schizophrenia and schizoaffective disorder yielding improvements in both positive and negative symptoms [1,2,3,4,5,6,7,8,9,10,11].Many SGAs are indicated for the treatment of the different phases of bipolar disorder (BD) (i.e. acute mania and depression and maintenance) in monotherapy and in association with mood stabilizers. The “gold standard” of SGAs, has never been approved for the treatment of bipolar disorder, though it has showed efficacy in acute mania [18,19,20,21,22] and in the treatment of severe psychotic bipolar disorder This latter has been suggested to represent a possible intermediate clinical phenotype placed in the continuum of major psychoses bridging typical bipolar disorder to schizophrenia through schizoaffective disorder [9, 20, 21, 23,24,25,26,27,28]

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