S Clozapine Hypomania: case reportA 54-year-old woman developed hypomania while receiving clozapine for schizophrenia.The woman had a history of a surgically removed intraventricular meningioma, and was admitted for treatment of a urinary tract infection with fever. Because of prominent positive and negative symptoms, she was started on clozapine at an initial dosage of 50 mg/day, titrated up to 150 mg/day [route not stated]. Once the fever had resolved, she was transferred to a psychiatric ward due to behavioural disturbances, and referential and persecutory delusions. Clozapine was titrated up to 200 mg/day on day 6. Over the next 4 days, she experienced an exacerbation of agitation and psychotic symptoms, talkativeness, a decreased need for sleep, and hyperactivity. On day 10, clozapine was titrated up to 250 mg/day, and zolpidem was added for insomnia. The following night, she became more agitated, hyperactive and talkative at night. Delirium and mania were both considered.The woman's zolpidem was withdrawn, and the clozapine dosage was tapered to 100 mg/day. She gradually became avolitional and displayed poor self-care. Clozapine was titrated up to 150 mg/day on day 23 because of the prominent negative symptoms. There was a recurrence of manic symptoms, with hyperactivity, euphoria, inflated self-esteem, an argumentative attitude and increased talkativeness. Clozapine was tapered down to 125 mg/day, and she became euthymic. Her negative symptoms substantially improved without mania. She has been successfully maintained on clozapine for more than 1 year.Author comment: "We present the case of a schizophrenic patient with a history of meningioma who developed mania while receiving clozapine". Li T-M, et al. Low-dose clozapine exacerbates and then improves mood in a patient with schizophrenia and history of surgical removal of an intraventricular meningioma. Journal of Clinical Psychopharmacology 32: 835-836, No. 6, Dec 2012. Available from: URL: http://dx.
