Uso de clozapina en trastorno bipolar refractario
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2010
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es
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Sociedad de NeurologÃa, PsiquiatrÃa y NeurocirugÃa
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Abstract
Antecedentes: La combinación de múltiples agentes incluyendo el litio, los estabilizadores del ánimo y los antipsicóticos, representa la estrategia más común en el tratamiento del trastorno bipolar. La falta de respuesta, la irrupción de nuevos episodios durante un adecuado tratamiento de mantención, el deterioro funcional incluyendo la re-hospitalización, los intentos de suicido y la intolerancia a la medicación se consideran criterios clÃnicos de inclusión para establecer la resistencia al tratamiento en el trastorno bipolar. En el trastorno bipolar, la Clozapina como terapia única o en tratamiento combinado, se mantiene como un agente de segunda lÃnea eficaz, con pocos datos clÃnicos disponibles, incluyendo principalmente perÃodos cortos de observación, muestras pequeñas y ensayos no controlados. Métodos: Analizamos datos clÃnicos en forma retrospectiva de cinco pacientes mujeres bipolares refractarias que se sometieron a tratamiento combinado que incluyó antipsicóticos atÃpicos. Debido a resistencia a este tratamiento de primera lÃnea, se indicó Clozapina como antipsicótico asociado al tratamiento. Se establecieron perÃodos de análisis equivalentes para cada paciente, previo y durante el uso de Clozapina. Estos perÃodos se extendieron de 8 meses a 5 años y 2 meses. Resultados: La dosis diaria promedio de Clozapina fue de 260 mg. No se observaron efectos adversos. Los dÃas de hospitalización totales disminuyeron de 979 dÃas a 118 dÃas y los intentos de suicidio disminuyeron de 14 episodios en el perÃodo previo a Clozapina a 1 episodio durante el perÃodo de tratamiento con Clozapina. En tres pacientes no se informó de re-hospitalizaciones ni de intentos de auto agresiones con el tratamiento agregado de Clozapina. Conclusión: La eficacia de Clozapina en pacientes bipolares con resistencia al tratamiento debiera considerarse como una opción de segunda lÃnea en terapia combinada con respuesta insuficiente. Los beneficios terapéuticos de Clozapina pueden incluir la potencial disminución de la conducta auto-agresiva enpacientes bipolares como en esquizofrenia y en el trastorno esquizoafectivo.
Background: The combination of multiple agents including lithium, mood stabilizers and antipsychotics, represents the most commonly strategy in bipolar disorder treatment. Lack of response, breakthrough episodes during adequate maintenance treatment, functional impairment, including re-hospitalization, suicide attempts and intolerance of medication are considered clinical inclusion criteria for treatment resistance in bipolar disorder. In bipolar disorder, Clozapine as mono-therapy or in combination treatment, remains as a efficacious second line agent, with few clinical data available, mainly including short observational periods, small samples and uncontrolled trials. Methods: We analyze retrospectively clinical data about five female bipolar refractory patients who were under combined treatment including atypical antipsychotics. Due to this combined first line treatment resistance, Clozapine was indicated as an add-on agent. Equivalent analysis periods were established for each patient, previous and under Clozapine use. These periods extends from 8 months to 5 years and 2 months. Results: Clozapine average daily dose was 260 mgs. No adverse effects were noticed. Total hospitalization days decrease from 979 days to 118 days andsu icide attempts decrease from 14 ep isodes in pre Clozap ine period to 1 episode in the Clozapine treatment period. No re-hospitalization neither self harm attempts with Clozapine add on treatment were reported in 3 patients. Conclusion: Clozapine efficacy, in treatment resistance bipolar patients, should be considered as a second line option in combination therapy with insufficient response. Therapeutic benefits of Clozapine may include potential decrease of self harm conduct in bipolar patients as in schizophrenia and schizoaffective disorder.
Background: The combination of multiple agents including lithium, mood stabilizers and antipsychotics, represents the most commonly strategy in bipolar disorder treatment. Lack of response, breakthrough episodes during adequate maintenance treatment, functional impairment, including re-hospitalization, suicide attempts and intolerance of medication are considered clinical inclusion criteria for treatment resistance in bipolar disorder. In bipolar disorder, Clozapine as mono-therapy or in combination treatment, remains as a efficacious second line agent, with few clinical data available, mainly including short observational periods, small samples and uncontrolled trials. Methods: We analyze retrospectively clinical data about five female bipolar refractory patients who were under combined treatment including atypical antipsychotics. Due to this combined first line treatment resistance, Clozapine was indicated as an add-on agent. Equivalent analysis periods were established for each patient, previous and under Clozapine use. These periods extends from 8 months to 5 years and 2 months. Results: Clozapine average daily dose was 260 mgs. No adverse effects were noticed. Total hospitalization days decrease from 979 days to 118 days andsu icide attempts decrease from 14 ep isodes in pre Clozap ine period to 1 episode in the Clozapine treatment period. No re-hospitalization neither self harm attempts with Clozapine add on treatment were reported in 3 patients. Conclusion: Clozapine efficacy, in treatment resistance bipolar patients, should be considered as a second line option in combination therapy with insufficient response. Therapeutic benefits of Clozapine may include potential decrease of self harm conduct in bipolar patients as in schizophrenia and schizoaffective disorder.
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Keywords
Bipolar, Refractariedad, Clozapina, Bipolar (bipolar), Refractory (refractariedad), Clozapine (Clozapina)
Citation
Rev. chil. neuro-psiquiatr. v.48 n.4 Santiago dic. 2010