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Aksoy Poyraz C, Turan Ş, Demirel ÖF, et al. Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series. Ther Adv Psychopharmacol. 2015;5(4):237-42doi: 10.1177/2045125315584871.
Aksoy Poyraz, C., Turan, �. �., Demirel, �. �. F., Usta Sağlam, N. G., Yıldız, N., & Duran, A. (2015). Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series. Therapeutic advances in psychopharmacology, 5(4), 237-42. https://doi.org/10.1177/2045125315584871
Aksoy Poyraz, Cana, et al. "Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series." Therapeutic advances in psychopharmacology vol. 5,4 (2015): 237-42. doi: https://doi.org/10.1177/2045125315584871
Aksoy Poyraz C, Turan Ş, Demirel ÖF, Usta Sağlam NG, Yıldız N, Duran A. Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series. Ther Adv Psychopharmacol. 2015 Aug;5(4):237-42. doi: 10.1177/2045125315584871. PMID: 26301080; PMCID: PMC4535045.
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Ther Adv Psychopharmacol. 2015 Aug;5(4):237-42. doi: 10.1177/2045125315584871.

Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series.

Therapeutic advances in psychopharmacology

Cana Aksoy Poyraz, Şenol Turan, Ömer Faruk Demirel, Nazife Gamze Usta Sağlam, Nazım Yıldız, Alaattin Duran

Affiliations

  1. Department of Psychiatry, Cerrahpa?a Medical School, Halaskargazi cad. No: 81 Çiçek apt. daire: 8, Osmanbey Istanbul, Turkey.
  2. Department of Psychiatry, Cerrahpa?a Medical School, University of Istanbul, Turkey.

PMID: 26301080 PMCID: PMC4535045 DOI: 10.1177/2045125315584871

Abstract

Treatment of severe and refractory manic episodes in hospital settings can occasionally be very difficult. In particular, severely excited patients showing aggressive, hostile, impulsive behaviours frequently require physical restraint and seclusion, high doses of antipsychotics and benzodiazepines, and sometimes, electroconvulsive therapy. Hospital stay is generally prolonged and such patients cause great emotional distress for other patients in the ward and clinical staff involved in their care. Here we report on three patients with a diagnosis of bipolar disorder and one patient with a diagnosis of schizoaffective disorder bipolar subtype, all of whom were hospitalized for severe manic episodes with psychotic features. These patients were extremely difficult to manage in the ward as no response could be obtained in the first week of treatment despite high doses of antipsychotics and benzodiazepine administration. The introduction and rapid titration of clozapine proved remarkably effective and was well tolerated in the acute management of these patients. We observed that clozapine had a superior and fast mood stabilization effect with rapid titration and could be extremely helpful in the management of such patients.

Keywords: bipolar disorder; clozapine; mania; rapid titration

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