Metabolic side effects of clozapine represent an important treatment limitation. Ziprasidone is a new atypical antipsychotic with low affinity to hystaminergic H1 and adrenergic alpha 1 receptors and few effects on body weight, metabolic parameters and cardiovascular system.

To confirm the efficacy and tollerability of ziprasidone as adjunctive therapy in Schizoaffective or bipolar patients partially responder to clozapine or with persisting negative symptoms, metabolic syndrome or overweight.

8 patients with psychotic Bipolar Disorder or schizoaffective 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, concomitant treatments, BMI, cholesterol and tryglicerides (in patients at cardiovascular risk) were tested at T0 and T1.

Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. Concomitant antipsychotics and mood stabilizers were reduced. Patients at cardiovascular risk showed a reduction of total cholesterol, Cholesterol LDL and triglycerides. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course.

The adding of ziprasidone consented a better control of metabolic parameters in patients with cardiovascular risk and a reduction of the severity of the disorder. Ziprasidone showed an efficacy on negative and depressive symptoms.