Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports

Mohamed Habib Aoun; Rabaa Jomli; Hend Jemli; Dorsaf Habbachi; Yosra Zgueb; Uta Ouali

doi:doi:10.11648/j.ajpn.20210903.15

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Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports

Mohamed Habib Aoun, Rabaa Jomli, Hend Jemli, Dorsaf Habbachi, Yosra Zgueb, Uta Ouali

Published in American Journal of Psychiatry and Neuroscience (Volume 9, Issue 3)

Received: 13 July 2021 Accepted: 24 July 2021 Published: 7 August 2021

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Abstract

Bipolar mood disorder (BD) is a severe debilitating mental disorder, and a number of patients are resistant to standard treatment. We report two clinical cases of treatment resistant mania (TRM) responsive to clozapine. Mrs. A and Mrs. B are two BD patients aged 30-year-old and 34-year-old respectively. They had a similar age of BD onset at 16 years old. They both had five manic episodes at least before they had the TRM. Mrs. A had a history of allergy to haloperidol. She presented a manic episode that was unresponsive to olanzapine 20 mg daily, risperidone 4 mg daily and lithium 1,250 mg daily. Mrs. B had a history of a mania non-responsive to the association of lithium and olanzapine 20 mg daily and a history of severe depression under lithium and haloperidol 30 mg daily. She presented a manic episode resisting the association of lithium 1000 mg daily, carbamazepine 600 mg daily, quetiapine 100 mg daily and chlorpromazine 150 mg daily. They both eventually received clozapine uptitrated gradually to 300 mg daily with lithium (1,000-1,250 mg daily) with satisfactory clinical response within three weeks of starting clozapine. Clozapine seems to be efficacious in TRM. Further randomized clinical trials are needed to strengthen its evidence based indication in TRM.

Published in	American Journal of Psychiatry and Neuroscience (Volume 9, Issue 3)
DOI	10.11648/j.ajpn.20210903.15
Page(s)	107-109
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Bipolar Disorder, Antipsychotic, Treatment, Effectiveness

References

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[2]	Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011; 68 (3): 241-251. doi: 10.1001/archgenpsychiatry.2011.12.
[3]	Li XB, Tang YL, Wang CY, de Leon J. Clozapine for treatment-resistant bipolar disorder: a systematic review. Bipolar Disord. 2015 May; 17 (3): 235-47. doi: 10.1111/bdi.12272. Epub 2014 Oct 27. PMID: 25346322.
[4]	Bastiampillai T, Gupta A, Allison S, Chan SK. NICE guidance: why not clozapine for treatment-refractory bipolar disorder? Lancet Psychiatry. 2016; 3 (6): 502-503. doi: 10.1016/S2215-0366(16)30081-5.
[5]	Fountoulakis KN, Yatham LN, Grunze H, et al. The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder. Int J Neuropsychopharmacol. 2020; 23 (4): 230-256. doi: 10.1093/ijnp/pyz064.
[6]	Fornaro M, Carvalho AF, Fusco A, et al. The concept and management of acute episodes of treatment-resistant bipolar disorder: a systematic review and exploratory meta-analysis of randomized controlled trials. J Affect Disord. 2020; 276: 970-983. doi: 10.1016/j.jad.2020.07.109.
[7]	Green AI, Tohen M, Patel JK, et al. Clozapine in the treatment of refractory psychotic mania. Am J Psychiatry. 2000; 157 (6): 982-986. doi: 10.1176/appi.ajp.157.6.982.
[8]	Ciapparelli A, Dell'Osso L, Bandettini di Poggio A, et al. Clozapine in treatment-resistant patients with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder: a naturalistic 48-month follow-up study. J Clin Psychiatry. 2003; 64 (4): 451-458. doi: 10.4088/jcp.v64n0416.
[9]	Suppes T, Webb A, Paul B, Carmody T, Kraemer H, Rush AJ. Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am J Psychiatry. 1999; 156 (8): 1164-1169. doi: 10.1176/ajp.156.8.1164.
[10]	Calabrese JR, Kimmel SE, Woyshville MJ, et al. Clozapine for treatment-refractory mania. Am J Psychiatry. 1996; 153 (6): 759-764. doi: 10.1176/ajp.153.6.759.
[11]	Tang YL, Mao PX, Jiang F, et al. Clozapine in China. Pharmacopsychiatry. 2008; 41 (1): 1-9. doi: 10.1055/s-2007-993224.
[12]	Wilkowska A, Wiglusz MS, Cubała WJ. Clozapine in Treatment-Resistant Bipolar Disorder With Suicidality. Three Case Reports. Front Psychiatry. 2019; 10: 520. Published 2019 Jul 19. doi: 10.3389/fpsyt.2019.00520.
[13]	Arafat SM, Rahman SM, Haque MM, Shah MA, Algin S, Nahar JS. Clozapine Can Be the Good Option in Resistant Mania. Case Rep Psychiatry. 2016; 2016: 3081704. doi: 10.1155/2016/3081704.
[14]	Arafat SMY, Fariduzzaman AM, Uddin MS, Shah MA, Rahman Chowdhury MH. Clozapine in resistant mania: Two case reports. Asian J Psychiatr. 2020; 49: 101953. doi: 10.1016/j.ajp.2020.101953.
[15]	Masi G, Mucci M, Millepiedi S. Clozapine in adolescent inpatients with acute mania. J Child Adolesc Psychopharmacol. 2002; 12 (2): 93-99. doi: 10.1089/104454602760219135.
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APA Style

Mohamed Habib Aoun, Rabaa Jomli, Hend Jemli, Dorsaf Habbachi, Yosra Zgueb, et al. (2021). Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports. American Journal of Psychiatry and Neuroscience, 9(3), 107-109. https://doi.org/10.11648/j.ajpn.20210903.15

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ACS Style

Mohamed Habib Aoun; Rabaa Jomli; Hend Jemli; Dorsaf Habbachi; Yosra Zgueb, et al. Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports. Am. J. Psychiatry Neurosci. 2021, 9(3), 107-109. doi: 10.11648/j.ajpn.20210903.15

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AMA Style

Mohamed Habib Aoun, Rabaa Jomli, Hend Jemli, Dorsaf Habbachi, Yosra Zgueb, et al. Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports. Am J Psychiatry Neurosci. 2021;9(3):107-109. doi: 10.11648/j.ajpn.20210903.15

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@article{10.11648/j.ajpn.20210903.15,
  author = {Mohamed Habib Aoun and Rabaa Jomli and Hend Jemli and Dorsaf Habbachi and Yosra Zgueb and Uta Ouali},
  title = {Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {9},
  number = {3},
  pages = {107-109},
  doi = {10.11648/j.ajpn.20210903.15},
  url = {https://doi.org/10.11648/j.ajpn.20210903.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20210903.15},
  abstract = {Bipolar mood disorder (BD) is a severe debilitating mental disorder, and a number of patients are resistant to standard treatment. We report two clinical cases of treatment resistant mania (TRM) responsive to clozapine. Mrs. A and Mrs. B are two BD patients aged 30-year-old and 34-year-old respectively. They had a similar age of BD onset at 16 years old. They both had five manic episodes at least before they had the TRM. Mrs. A had a history of allergy to haloperidol. She presented a manic episode that was unresponsive to olanzapine 20 mg daily, risperidone 4 mg daily and lithium 1,250 mg daily. Mrs. B had a history of a mania non-responsive to the association of lithium and olanzapine 20 mg daily and a history of severe depression under lithium and haloperidol 30 mg daily. She presented a manic episode resisting the association of lithium 1000 mg daily, carbamazepine 600 mg daily, quetiapine 100 mg daily and chlorpromazine 150 mg daily. They both eventually received clozapine uptitrated gradually to 300 mg daily with lithium (1,000-1,250 mg daily) with satisfactory clinical response within three weeks of starting clozapine. Clozapine seems to be efficacious in TRM. Further randomized clinical trials are needed to strengthen its evidence based indication in TRM.},
 year = {2021}
}

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TY - JOUR
T1 - Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports
AU - Mohamed Habib Aoun
AU - Rabaa Jomli
AU - Hend Jemli
AU - Dorsaf Habbachi
AU - Yosra Zgueb
AU - Uta Ouali
Y1 - 2021/08/07
PY - 2021
N1 - https://doi.org/10.11648/j.ajpn.20210903.15
DO - 10.11648/j.ajpn.20210903.15
T2 - American Journal of Psychiatry and Neuroscience
JF - American Journal of Psychiatry and Neuroscience
JO - American Journal of Psychiatry and Neuroscience
SP - 107
EP - 109
PB - Science Publishing Group
SN - 2330-426X
UR - https://doi.org/10.11648/j.ajpn.20210903.15
AB - Bipolar mood disorder (BD) is a severe debilitating mental disorder, and a number of patients are resistant to standard treatment. We report two clinical cases of treatment resistant mania (TRM) responsive to clozapine. Mrs. A and Mrs. B are two BD patients aged 30-year-old and 34-year-old respectively. They had a similar age of BD onset at 16 years old. They both had five manic episodes at least before they had the TRM. Mrs. A had a history of allergy to haloperidol. She presented a manic episode that was unresponsive to olanzapine 20 mg daily, risperidone 4 mg daily and lithium 1,250 mg daily. Mrs. B had a history of a mania non-responsive to the association of lithium and olanzapine 20 mg daily and a history of severe depression under lithium and haloperidol 30 mg daily. She presented a manic episode resisting the association of lithium 1000 mg daily, carbamazepine 600 mg daily, quetiapine 100 mg daily and chlorpromazine 150 mg daily. They both eventually received clozapine uptitrated gradually to 300 mg daily with lithium (1,000-1,250 mg daily) with satisfactory clinical response within three weeks of starting clozapine. Clozapine seems to be efficacious in TRM. Further randomized clinical trials are needed to strengthen its evidence based indication in TRM.
VL - 9
IS - 3
ER -

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Author Information

Mohamed Habib Aoun

Psychiatry Department, Mahdia Hospital, Mahdia, Tunisia
Rabaa Jomli

Psychiatry Department (A), Razi Hospital, La Manouba, Tunisia
Hend Jemli

Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
Dorsaf Habbachi

Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
Yosra Zgueb

Psychiatry Department (A), Razi Hospital, La Manouba, Tunisia
Uta Ouali

Psychiatry Department (A), Razi Hospital, La Manouba, Tunisia

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Mohamed Habib Aoun, Rabaa Jomli, Hend Jemli, Dorsaf Habbachi, Yosra Zgueb, et al. (2021). Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports. American Journal of Psychiatry and Neuroscience, 9(3), 107-109. https://doi.org/10.11648/j.ajpn.20210903.15

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ACS Style

Mohamed Habib Aoun; Rabaa Jomli; Hend Jemli; Dorsaf Habbachi; Yosra Zgueb, et al. Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports. Am. J. Psychiatry Neurosci. 2021, 9(3), 107-109. doi: 10.11648/j.ajpn.20210903.15

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AMA Style

Mohamed Habib Aoun, Rabaa Jomli, Hend Jemli, Dorsaf Habbachi, Yosra Zgueb, et al. Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports. Am J Psychiatry Neurosci. 2021;9(3):107-109. doi: 10.11648/j.ajpn.20210903.15

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@article{10.11648/j.ajpn.20210903.15,
  author = {Mohamed Habib Aoun and Rabaa Jomli and Hend Jemli and Dorsaf Habbachi and Yosra Zgueb and Uta Ouali},
  title = {Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {9},
  number = {3},
  pages = {107-109},
  doi = {10.11648/j.ajpn.20210903.15},
  url = {https://doi.org/10.11648/j.ajpn.20210903.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20210903.15},
  abstract = {Bipolar mood disorder (BD) is a severe debilitating mental disorder, and a number of patients are resistant to standard treatment. We report two clinical cases of treatment resistant mania (TRM) responsive to clozapine. Mrs. A and Mrs. B are two BD patients aged 30-year-old and 34-year-old respectively. They had a similar age of BD onset at 16 years old. They both had five manic episodes at least before they had the TRM. Mrs. A had a history of allergy to haloperidol. She presented a manic episode that was unresponsive to olanzapine 20 mg daily, risperidone 4 mg daily and lithium 1,250 mg daily. Mrs. B had a history of a mania non-responsive to the association of lithium and olanzapine 20 mg daily and a history of severe depression under lithium and haloperidol 30 mg daily. She presented a manic episode resisting the association of lithium 1000 mg daily, carbamazepine 600 mg daily, quetiapine 100 mg daily and chlorpromazine 150 mg daily. They both eventually received clozapine uptitrated gradually to 300 mg daily with lithium (1,000-1,250 mg daily) with satisfactory clinical response within three weeks of starting clozapine. Clozapine seems to be efficacious in TRM. Further randomized clinical trials are needed to strengthen its evidence based indication in TRM.},
 year = {2021}
}

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