Olanzapine treatment-resistant

Conley RR, Tamminga CA, Bartko JJ, et al (1998). Olanzapine compared with chlorpromazine in treatment resistant schizophrenia. Am J... 

Alternatively, the current antidepressant may be augmented (potentiated) by the addition of another agent (e.g., lithium, T3), or an atypical antipsychotic (e.g., risperidone). Risperidone has been shown to be effective in combination with fluvoxamine, paroxetine, or citalopram in treatment-resistant depression. Olanzapine and fluoxetine have been found to be safe and effective in treatment-resistant depression. 

Clozapine was the first atypical antipsychotic released in the United States. However, clozapine is associated with the risk of leukopenia and, potentially, lethal agranulocytosis. Because of these concerns, hematological monitoring during clozapine pharmacotherapy is required (Alphs and Anand, 1999). Due to these hematological risks, clozapine is indicated only for patients with treatment-resistant schizophrenia. The other atypical antipsychotics, risperidone, olanzapine, quetiapine, and ziprasidone, that are marketed in the United States can be used as first-line treatments for adults with schizophrenia. 

Several reports also suggest that adjunctive risperidone (Giakas, 1995 Jacobsen, 1995 Lombroso et al., 1995 McDougle et al., 1995 Ravizza et al., 1996 Stein et al., 1997)or olanzapine (Peris and Szerman, 2000) may be helpful in treatment-resistant OCD. Systematic data in pediatric samples are needed, however, before such an approach can be recommended, and there are anecdotal reports of increased obsessions and anxiety with the atypical neuroleptics (Alzaid and Jones, 1997 Andrade, 1998 Mottard and de la Sa-blonniere, 1999). 

Studies of the use of the specific serotonin-uptake inhibitors (SSRIs) to treat OCD suggest that, compared to non-tic-related OCD, tic-related OCD is less responsive to SSRI monotherapy (McDougle et al., 1993, 1994). Addition of a neuroleptic, such as haloperidol (McDougle et ah, 1994), risperidone (McDougle et al., 2000), or olanzapine (Bogetto et al., 2000), appears to be useful in improving treatment-resistant individuals response to a SSRI. It is unclear whether this pattern of treatment response is specifically associated with a comorbid tic disorder the pattern of obsessive compulsive symptoms characteristic of TS or yet some other predictors. 

There has been a report of two patients with treatment-resistant PD who responded to treatment with olanzapine added to ongoing treatment with clonazepam (2 mg per day), ketazolam (30 mg per day), and venlafaxine (150 mg per day). The first patient was started on 7.5 mg at bedtime, and 2 weeks later he was much calmer and sleeping well. Olanzapine was increased to 12.5 mg per day, and venlafaxine was replaced with nefazodone up to 60 mg per day. Over the next few weeks, he improved progressively and clonazepam and ketazolam were discontinued. After 4 months, he was free from panic attacks and left his home alone. The second patient had 10 mg olanzapine daily added to ongoing treatment with 75 mg per day amitriptyline and 10 mg per day diazepam. After 2.5 months, she was being given olanzapine and had started going out on her own (126). 

Barbee JG, Comad EJ, Jamhour NJ. The effectiveness of olanzapine, risperidone, quetiapine, and ziprasidone as augmentation agents in treatment-resistant major depressive disorder. J Clin Psychiatry 2004 65(7) 975-981. 

The concept of treatment-resistant schizophrenia, which was developed to delineate a market for the relaunch of clozapine, has lead to public acknowledgment of the extent of non-response to treatment with other neuroleptic drugs. It is now widely admitted that at least 25% of patients do not show any significant clinical improvement with drug treatment. A recent comparison of two of the newer neuroleptic drugs, risperidone and olanzapine, found that 46% and 56% of patients, respectively, did not respond after four months of treatment (Robinson et al. 2006). In addition, the majority of inpatients with psychosis are treated with other sedative drugs in addition to... 

Clozapine has well-documented efficacy in the treatment of mania, including treatment-resistant mania [74], although it has not been approved for this indication. Olanzapine and quetiapine both have been approved for the treatment of mania, though not for the treatment of bipolar depression. Olanzapine also has approval for maintenance treatment of bipolar disorder. 

Olanzapine versus chlorpromazine In 103 previously treatment-resistant patients with schizophrenia were given a prospective 6-week trial of 10-40 mg/day of haloperidol 84 failed to respond and were randomly assigned to a double-blind, 8-week, fixed-dose trial of either olanzapine 25 mg/day alone (n = 42) or chlorpromazine 1200 mg/day plus benzatropine mesylate 4 mg/day (n = 39) (51). There was no significant... 

Olanzapine has been compared with haloperidol in cannabis-induced psychosis (54), schizoaffective disorder (55), first-episode psychosis (56), and treatment-resistant schizophrenia (57) the two last studies were reanalyses of data from large clinical trials promoted by the manufacturers, Eli Lilly. In all cases olanzapine was better than haloperidol at reducing BPRS scores, but in patients with cannabis-induced psychotic disorders they were similar. Increased appetite was consistently reported more often in olanzapine-treated patients and extrapyramidal signs more often in those treated with haloperidol. 

Breier A, Hamilton SH. Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia. Biol Psychiatry 1999 45(4) 403-11. 

A thorough and extensive review has summarized five pivotal clinical trials comprising 3252 patients (7). In some studies olanzapine has failed to show efficacy in treatment-resistant schizophrenia (8,9). 

In 16 patients with treatment-resistant schizophrenia (defined as non-responsiveness to at least three antipsychotic drugs from at least two different chemical classes), olanzapine was effective treatment in a significant proportion no serious adverse events were associated with maintenance doses of 10-40 mg/day, and no subjects dropped out (26). 

Two patients, one with treatment-resistant rapid cycling bipolar disorder (36) and the other with severe mood changes during corticosteroid therapy (37), improved with olanzapine. 

McElroy SL, Frye M, Denicoff K, Altshuler L, Nolen W, Kupka R, Suppes T, Keck PE Jr, Leverich GS, Kmetz GF, Post RM. Olanzapine in treatment-resistant bipolar disorder. J Affect Disord 1998 49(2) 119-22. 

Dursun SM, Gardner DM, Bird DC, Flinn J. Olanzapine for patients with treatment-resistant schizophrenia a naturalistic case-series outcome study. Can J Psychiatry 1999 44(7) 701 1. 

Jakovljevic, Sagud M, Mihaljevic-Peles A. Olanzapine in the treatment-resistant, combat-related PTSD-a series of case reports. Acta Psychiatr Scand 2003 107 394-6. 

Bitter I, Dossenbach MR, Brook S, Feldman PD, Metcalfe S, Gagiano CA, Furedi J, Bartko G, Janka Z, Banki CM, Kovacs G, Breier A Olanzapine HGCK Study Group. Olanzapine versus clozapine in treatment-resistant or treatment-intolerant schizophrenia. Prog Neuro-psycho-pharmacol Biol Psychiatry 2004 28 173-80. 

Actions at 5FIT2C receptors may explain in part fluoxetine s efficacy in combination with olanzapine for bipolar depression and treatment-resistant depression, since both agents have this property... 

Olanzapine has been compared with haloperidol in cannabis-induced psychosis (40), schizoaffective disorder (41), first-episode psychosis (42), and treatment-resistant... 

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