olanzapine and Anorexia-Nervosa

Second-generation antipsychotics (SGAs) are frequently prescribed for the treatment of resistant anorexia nervosa. However, few clinical trials have been conducted so far and no pharmacological treatment has yet been approved by the Food and Drug Administration. The aim of this paper is to conduct a systematic scoping review exploring the effectiveness and safety of atypical antipsychotics in anorexia nervosa (AN).. We conducted a systematic scoping review of the effectiveness and tolerability of SGAs in the management of AN. We included articles published from January 1, 2000, through September 12, 2022 from the PubMed and PsycInfo databases and a complementary manual search. We selected articles about adolescents and adults treated for AN by four SGAs (risperidone, quetiapine, aripiprazole or olanzapine). This work complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRIMA-ScR) and was registered in the Open Science Framework (OSF) repository.. This review included 55 articles: 48 assessing the effectiveness of SGAs in AN and 7 focusing only on their tolerability and safety. Olanzapine is the treatment most frequently prescribed and studied with 7 randomized double-blind controlled trials. Other atypical antipsychotics have been evaluated much less often, such as aripiprazole (no randomized trials), quetiapine (two randomized controlled trials), and risperidone (one randomized controlled trial). These treatments are well tolerated with mild and transient adverse effects in this population at particular somatic risk.. Limitations prevent the studies both from reaching conclusive, reliable, robust, and reproducible results and from concluding whether or not SGAs are effective in anorexia nervosa. Nonetheless, they continue to be regularly prescribed in clinical practice. International guidelines suggest that olanzapine and aripiprazole can be interesting in severe or first-line resistant clinical situations.

Topics: Adolescent; Adult; Anorexia Nervosa; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Humans; Olanzapine; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Risperidone

Identifying medications that may be used as therapeutic agents for eating disorders is a longstanding focus of research, with varying degrees of success. The present review consolidates the most recent findings on pharmacological treatment of three eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).. Recent research suggests that olanzapine demonstrates positive effects on weight gain among outpatients with AN. There are fewer recent advances in psychopharmacological treatment for BN and BED, likely due to the relative success of prior medication trials. Olanzapine is the first medication to safely promote weight gain among individuals with AN. Fluoxetine is FDA-approved for BN treatment, and lisdexamfetamine is FDA-approved for BED treatment. BN and BED also generally respond well to SSRIs prescribed off-label. Research on psychopharmacological treatments for other eating disorders, such as avoidant-restrictive food intake disorder and other specified feeding and eating disorders, are sorely needed.

Topics: Anorexia Nervosa; Binge-Eating Disorder; Bulimia Nervosa; Feeding and Eating Disorders; Humans; Olanzapine; Weight Gain

Psychotropic medications are commonly used in the treatment of eating disorders in children and adolescents. This article reviews the evidence base on psychotropic medications, including all randomized trials, uncontrolled trials, and case reports for the treatment of anorexia nervosa, bulimia nervosa, other specified feeding and eating disorders, binge-eating disorder, and avoidant/restrictive food intake disorder. Despite advances in the number of medication-based studies completed in young patients with eating disorders over the last 2 decades, significantly more work needs to be done in terms of identifying what role, if any, psychotropic medications can have on treatment outcomes.

Topics: Adolescent; Anorexia Nervosa; Avoidant Restrictive Food Intake Disorder; Binge-Eating Disorder; Bulimia Nervosa; Child; Feeding and Eating Disorders; Humans; Olanzapine; Psychotropic Drugs; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Treatment Outcome

This article, which was triggered by a case study of a 15-year-old female patient, gives an overview of the literature on the use of olanzapine as an adjunctive treatment for anorexia nervosa in adolescents. On the basis of studies performed so far (two small double-blind placebo-controlled studies, two open-label trials, one retrospective study, a number of case studies that included adolescents, and four series of case studies on adolescents alone), the short-term results of using olanzapine were promising. However, careful monitoring is needed.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Female; Humans; Olanzapine; Treatment Outcome

To review the literature on the use of atypical antipsychotics in anorexia nervosa of children and adolescents and to present three case reports on quetiapine treatment of this subgroup.. Review of the literature and case report.. Several case reports and two small open-label trials, mainly in adults, observed beneficial effects of olanzapine on anorexic psychopathology. Only 16 case reports have been published on children and adolescents. Because of its lower propensity to induce weight gain quetiapine might be favourable with regard to patients' compliance. Our case reports revealed positive psychopathological effects and good tolerability of quetiapine in minors with severe anorexia nervosa. Careful titration and intense drug monitoring are recommended.. In a small subset of patients with severe, treatment- resistant anorexia nervosa, extreme weight phobia, delusional body image disturbances or severe hyperactivity might be considered as indications for atypical antipsychotics. However, controlled studies are needed.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Child; Dibenzothiazepines; Female; Humans; Olanzapine; Quetiapine Fumarate; Risperidone

To evaluate the role of olanzapine in the treatment of anorexia nervosa.. Literature was obtained through searches of MEDLINE (1966-December 2006), EMBASE (1980-4th Quarter 2006), and PsycINFO (1985-December 2006) and a bibliographic review of published articles. Key terms used in the searches included anorexia nervosa, antipsychotics, eating disorders, olanzapine, and Zyprexa.. All English language articles that were identified from the search were evaluated. All primary literature was included in the review.. In several case reports and most clinical trials, patients with anorexia nervosa successfully gained weight while being treated with olanzapine. Moreover, many patients treated with olanzapine achieved a healthy body weight. Case reports and trials identified additional benefits of olanzapine, including reduction in delusional thinking; improvement in body image, sleep, depressive symptoms, adherence to treatment, and eating-disorder symptoms; and decreased agitation and premeal anxiety.. Preliminary evidence supports the use of olanzapine for treatment of anorexia nervosa by demonstrating that olanzapine 2.5-15 mg daily promotes weight gain and has positive effects on associated psychological symptoms. Limitations of the reported data include small sample size, low completion rate in clinical trials, and open-label trial design. Although olanzapine appears to have a potential role in the treatment of anorexia nervosa that has been unresponsive to other therapy, randomized, placebo-controlled studies with larger sample sizes are necessary to establish its role in therapy.

Topics: Anorexia Nervosa; Benzodiazepines; Humans; Olanzapine; Treatment Outcome

This study evaluated the benefits of olanzapine compared with placebo for adult outpatients with anorexia nervosa.. This randomized double-blind placebo-controlled trial of adult outpatients with anorexia nervosa (N=152, 96% of whom were women; the sample's mean body mass index [BMI] was 16.7) was conducted at five sites in North America. Participants were randomly assigned in a 1:1 ratio to receive olanzapine or placebo and were seen weekly for 16 weeks. The primary outcome measures were rate of change in body weight and rate of change in obsessionality, assessed with the Yale-Brown Obsessive Compulsive Scale (YBOCS).. Seventy-five participants were assigned to receive olanzapine and 77 to receive placebo. A statistically significant treatment-by-time interaction was observed, indicating that the increase in BMI over time was greater in the olanzapine group (0.259 [SD=0.051] compared with 0.095 [SD=0.053] per month). There was no significant difference between treatment groups in change in the YBOCS obsessions subscale score over time (-0.325 compared with -0.017 points per month) and there were no significant differences between groups in the frequency of abnormalities on blood tests assessing potential metabolic disturbances.. This study documented a modest therapeutic effect of olanzapine compared with placebo on weight in adult outpatients with anorexia nervosa, but no significant benefit for psychological symptoms. Nevertheless, the finding on weight is notable, as achieving change in weight is notoriously challenging in this disorder.

Topics: Adolescent; Adult; Ambulatory Care; Anorexia Nervosa; Body Mass Index; Double-Blind Method; Female; Humans; Male; Middle Aged; Obsessive Behavior; Olanzapine; Selective Serotonin Reuptake Inhibitors; Time Factors; Weight Gain; Young Adult

The salience network (SN), a set of brain regions composed of the anterior fronto-insular cortex (aFI) and the anterior cingulate cortex (ACC), is usually involved in interoception, self-regulating, and action selection. Accumulating evidence indicates that dysfunctions in this network are associated with various pathophysiological deficits in both schizophrenia and eating disorders, stemming mainly from dysfunctional information processing of internal or external stimuli. In addition, the metabolic side effects of some antipsychotics (APs), as well as their pharmacological mechanisms of action, also suggest a link between the functional and neurophysiological changes in the brain in both schizophrenia and in eating disorders. Nevertheless, there is still a knowledge gap in explicitly and directly linking the metabolic side effects associated with AP treatment with the dysfunction in SN associated with processing of food-related information in schizophrenia. Here we provide neuroimaging evidence for such a link, by presenting data on a group of schizophrenia patients who followed 16 weeks of olanzapine treatment and undertook a passive viewing task while their brain activity was recorded. In response to food-related dynamic stimuli (video clips), we observed a decreased activity in SN (aFI and ACC) after the treatment, which also correlated with ghrelin plasma concentration and a measure of dietary restraint. Taken together with past findings regarding the role of SN in both schizophrenia and eating disorders, our results suggest that enhancing the reactivity in the SN has the potential to be a treatment strategy in people with anorexia nervosa.. NCT 00290121.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Appetite; Benzodiazepines; Brain Mapping; Cerebral Cortex; Female; Ghrelin; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Olanzapine; Schizophrenia

Treatments of eating disorders result too often in partial psychological and physical remission, chronicization, dropout, relapse and death, with no fully known explanations for this failure. In order to clarify this problem, we conducted three studies to identify the biochemical background of cognitive-behavioural psychotherapy (CBT), individual psychology brief psychotherapy (IBPP), and psychotherapy-pharmacotherapy with CBT + olanzapine in anorexics (AN) and bulimics (BN) by measuring the levels of plasma homovanillic acid (HVA) for dopamine secretion, plasma 3-methoxy-4-hydroxy-phenylglycol (MHPG) for noradrenalin secretion, and platelet [3H]-Paroxetin-binding Bmax and Kd for serotonin transporter function. The data were then compared with psychopathological and physical alterations.. Study 1 investigated the effects of 4 months of CBT on plasma HVA, MHPG and [3H]-Par-binding in 14 AN-restricted, 14 AN-bingeing/purging, and 22 BN inpatients. Study 2 investigated the effects of 4 months of IBPP on plasma HVA in 15 AN and 17 BN outpatients. Study 3 investigated the effect of 3 months of CBT + olanzapine (5 mg/day) in 30 AN outpatients. The data were analyzed using one-way ANOVA for repeated measures for the changes between basal and post-treatment biological and psychological parameters, two-way ANOVA for repeated measures for the differences in the psychobiological data in the 3 groups, Spearman's test for the correlations between basal and final changes in the psychological and biological scores.. Study 1 revealed significant amelioration of the psychopathology in the AN and BN patients, no effects on HVA, MHPG or Paroxetin binding Kd, and a significant increase in Par-binding Bmax only in the BN patients. Study 2 revealed a significant effect of IBPP on psychopathology in the AN and BN patients, and a significant increase in HVA only in the BN patients. Study 3 revealed a significant positive effect of CBT + olanzapine therapy on the psychopathology and increased HVA values. No correlations were observed in the 3 groups between biological and psychological effects of the three treatments.. Our data advance suggestions on the mechanism of action of the three therapies; however, the lack of correlations between biochemical and psychological effects casts doubt on their significance. Clinical Trials.gov. Identifier NCT01990755 .

Topics: Administration, Oral; Adult; Analysis of Variance; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Bulimia Nervosa; Cognitive Behavioral Therapy; Combined Modality Therapy; Double-Blind Method; Female; Homovanillic Acid; Humans; Male; Methoxyhydroxyphenylglycol; Olanzapine; Paroxetine; Psychotherapy, Brief; Serotonin Plasma Membrane Transport Proteins; Treatment Failure

Anorexia nervosa (AN) is a serious psychiatric illness associated with significant morbidity and mortality. There is little empirical support for specific treatments and new approaches are sorely needed. This two-site study aimed to determine whether olanzapine is superior to placebo in increasing body mass index (BMI) and improving psychological symptoms in out-patients with AN.. A total of 23 individuals with AN were randomly assigned in double-blind fashion to receive olanzapine or placebo for 8 weeks together with medication management sessions that emphasized compliance. Weight, other physical assessments and measures of psychopathology were collected.. End-of-treatment BMI, with initial BMI as a covariate, was significantly greater in the group receiving olanzapine [F(1, 20)=6.64, p=0.018]. Psychological symptoms improved in both groups, but there were no statistically significant group differences. Of the 23 participants, 17 (74%) completed the 8-week trial. Participants tolerated the medication well with sedation being the only frequent side effect and no adverse metabolic effects were noted.. This small study suggests that olanzapine is generally well tolerated by, and may provide more benefit than placebo for out-patients with AN. Further study is indicated to determine whether olanzapine may affect psychological symptoms in addition to BMI.

Topics: Adolescent; Adult; Analysis of Variance; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Double-Blind Method; Female; Humans; Male; Middle Aged; New York; Olanzapine; Ontario; Outpatients; Placebos; Psychiatric Status Rating Scales; Treatment Outcome; Weight Gain; Young Adult

The objective of this study was to explore whether the addition of olanzapine versus placebo increases weight gain and improves psychological symptoms in adolescents with anorexia nervosa-restricting type who are participating in a comprehensive eating disorders treatment program.. Twenty underweight females participated in this 10-week, double-blind, placebo-controlled pilot study of olanzapine. The primary efficacy measure was change in percentage of median body weight measured at baseline and weeks 5 and 10. Secondary efficacy measures included clinician-rated and self-reported measures of psychological functioning measured at 2-week intervals and eating disorder symptoms measured at baseline and weeks 5 and 10 as well as laboratory assessments (including indirect calorimetry), which were also performed at baseline and weeks 5 and 10. A mixed models approach to repeated measures analysis of variance was utilized to detect any treatment-by-time interaction.. Fifteen of 20 enrolled females (median age, 17.1 years; range, 12.3-21.8 years; mean body mass index, 16.3) completed this 10-week pilot study. Change in % median body weight did not differ between the treatment groups at midpoint or end of study. Both groups gained weight at a similar rate and had similar improvements in eating attitudes and behaviors, psychological functioning, and resting energy expenditure. A trend of increasing fasting glucose and insulin levels was found only in the olanzapine group at week 10.. These preliminary findings do not support a role for adjunctive olanzapine for underweight adolescent females with anorexia nervosa-restricting type who are receiving standard care in an eating disorder treatment program (clinical trials.gov; no. NCT00592930).

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Blood Glucose; Body Weight; Child; Double-Blind Method; Feeding Behavior; Female; Humans; Insulin; Models, Statistical; Olanzapine; Pilot Projects; Treatment Outcome; Young Adult

The aim of this study was to evaluate the efficacy of olanzapine in girls with anorexia nervosa, restricting subtype (ANr).. Thirteen patients (mean age 13.7 +/- 2.3 years, age range 9.6-16.3 years) enrolled in a multimodal treatment for ANr were evaluated with standardized measures at baseline and after 1 and 6 months after starting low-dose olanzapine monotherapy (mean dose 4.13 mg/day).. A significant improvement was evident on weight (body mass index, BMI), global functioning (Children's Global Assessment Scale, CGAS), eating attitudes (Eating Attitudes Test-26, EAT-26), anxious-depressive symptoms (Child Behavior Checklist, CBCL) and hyperactivity (Structured Inventory for Anorexic and Bulimic Syndromes, SIAB). At the end of the 6-month follow up, 7 patients were responders according to an improvement of at least 50% in the EAT-26 results. The only measure that improved significantly in responders, but not in nonresponders, was hyperactivity (SIAB). Clinical improvement, in terms of both body mass index (BMI) recovery and global functioning, paralleled the improvement of hyperactivity, was evident at the end of the first month of treatment, and further increased in the following 5 months, with minimal side effects.. Low-dose olanzapine monotherapy may be useful as adjunctive treatment of youths with ANr. It is suggested that efficacy may be mediated by a decrease of hyperactivity.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Body Weight; Child; Dose-Response Relationship, Drug; Female; Humans; Hyperkinesis; Olanzapine

Anorexia nervosa is associated with high mortality, morbidity, and treatment costs. Olanzapine, an atypical antipsychotic, is known to result in weight gain in other patient populations. The objective of this trial was to assess the efficacy of olanzapine in promoting weight gain and in reducing obsessive symptoms among adult women with anorexia nervosa.. The study was a double-blind, placebo-controlled, 10-week flexible dose trial in which patients with anorexia nervosa (N=34) were randomly assigned to either olanzapine plus day hospital treatment or placebo plus day hospital treatment.. Compared with placebo, olanzapine resulted in a greater rate of increase in weight, earlier achievement of target body mass index, and a greater rate of decrease in obsessive symptoms. No differences in adverse effects were observed between the two treatment conditions.. These preliminary results suggest that olanzapine may be safely used in achieving more rapid weight gain and improvement in obsessive symptoms among women with anorexia nervosa. Replication, in the form of a large multicenter trial, is recommended.

Topics: Adolescent; Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Body Weight; Combined Modality Therapy; Compulsive Behavior; Day Care, Medical; Double-Blind Method; Female; Humans; Length of Stay; Obsessive Behavior; Olanzapine; Thinking; Thinness

Anorexia Nervosa (AN) is a serious, debilitating condition that causes significant physical, emotional, and functional impairment. The condition is characterized by destructive weight loss behaviours and a refusal to maintain body weight at or above a minimally normal weight for age and height. AN often develops in adolescence and is a predominantly female disorder. Treatment for AN typically involves medical, nutritional and psychological interventions. Pharmacotherapy is also often used; however, the literature on the effectiveness of these drugs in a pediatric population is very limited. Olanzapine, which is an 'atypical' antipsychotic, is becoming more widespread in the treatment of AN. Olanzapine is hypothesized to facilitate weight gain, while decreasing levels of agitation and decreasing resistance to treatment in young women with AN. This randomized, double-blind placebo-controlled trial seeks to examine the effectiveness and safety of olanzapine in female youth with AN.. Adolescent females between the ages of 12 and 17 diagnosed with AN (either restricting or binge/purge type) or Eating Disorder Not Otherwise Specified with a Body Mass Index of less than or equal to 17.5, will be offered inclusion in the study. Patients will be randomly assigned to receive either olanzapine or placebo. Patients assigned to receive olanzapine will start at a low dose of 1.25 mg/day for three days, followed by 2.5 mg/day for four days, 5 mg/day for one week, then 7.5 mg/day (the target dose chosen) for 10 weeks. After 10 weeks at 7.5 mg the medication will be tapered and discontinued over a period of two weeks. The effectiveness of olanzapine versus placebo will be determined by investigating the change from baseline on measures of eating attitudes and behaviors, depression and anxiety, and change in Body Mass Index at week 12, and after a follow-up period at week 40. It is anticipated that 67 participants will be recruited over two years to complete enrollment.. Randomized controlled trials designed to measure the safety and effectiveness of olanzapine in comparison to placebo are desperately needed, particularly in the adolescent population.. Current Controlled Trials ISRCTN23032339.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Clinical Protocols; Double-Blind Method; Female; Humans; Olanzapine; Research Design; Severity of Illness Index; Therapeutics; Treatment Outcome

Olanzapine (OLA) administration has been reported to induce weight gain in experimental animals and humans, through not yet fully defined mechanisms of action. Aim of this study was to determine whether in patients with Anorexia Nervosa (AN) OLA induces weight gain through the modulation of the hunger-satiety regulatory peptides leptin and ghrelin.. Twenty anorexic probands received a 3 months course of cognitive-behavioral psychotherapy and programmed nutritional rehabilitation, combined with OLA PO (2.5 mg for 1 month and 5 mg for 2 months) in ten patients and with placebo PO (PL) in the other 10. Weight, measured as body mass index (BMI), leptin and ghrelin plasma values were monitored before starting the therapy and then monthly for 3 months. Plasma leptin was measured by ELISA, and plasma ghrelin by radioimmunoassay.. BMI increased significantly but not differently in both treatment groups. Leptin and ghrelin secretion did not change during the course of the treatments. No correlations were observed between BMI values and leptin and ghrelin levels.. Our data suggest that the weight gain observed in our OLA-treated patients was not linked to drug administration. Moreover, leptin and ghrelin secretions were not responsible for BMI changes.

Topics: Adult; Anorexia Nervosa; Benzodiazepines; Body Mass Index; Double-Blind Method; Female; Ghrelin; Humans; Leptin; Olanzapine; Peptide Hormones; Placebos; Selective Serotonin Reuptake Inhibitors; Weight Gain

Dopamine impairments occur in anorexia nervosa. The aim of this study was to see whether treatment with the atypical dopamine antagonist antipsychotic olanzapine improves the disorder. Thirty anorexics, 18 restricted and 12 bingeing-purging, underwent a 3-month course of cognitive behavioral therapy, plus at random and double-blinded oral olanzapine (2.5 mg for 1 month, 5 mg for 2 months) in half and oral placebo in the other half of them. BMI, psychopathological aspects (eating disorder inventory, Hamilton Rating Scale, Buss-Durkee Rating Scale, Yale Brown Cornell for Eating Disorders Rating Scale, temperament-character inventory), and homovanillic acid blood concentrations for dopamine secretion, were monitored at baseline and then monthly during the trial. At the end of the trial BMI, total eating disorder inventory, total Yale Brown Cornell for Eating Disorders Rating Scale, Buss-Durkee Rating Scale, Hamilton Rating Scale scores and in olanzapine-treated patients the subitems of eating disorder inventory ineffectiveness and maturity fear, of Buss-Durkee Rating Scale direct aggressiveness, of temperament-characteristic inventory persistence had improved significantly. When stratified for anorexia nervosa subtype, BMI changes were significant among anorexia nervosa bingeing-purging patient, 'depression' (Hamilton Rating Scale) and 'direct aggressiveness' (Buss-Durkee Rating Scale) among anorexia nervosa bingeing-purging patients, 'persistence' (temprerament-characteristic inventory), among anorexics restricted patients, with a trend toward significance for obsessivity-compulsivity (Yale Brown Cornell for Eating Disorders Rating Scale). homovanilic acid blood levels increased significantly in the cognitive behavioral therapy+olanzapine group. No correlations were observed between homovanilic acid concentrations and psychopathological parameters. The pharmacological treatment can significantly improve specific aspects of anorexia nervosa.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Cognitive Behavioral Therapy; Combined Modality Therapy; Dopamine Antagonists; Double-Blind Method; Female; Homovanillic Acid; Humans; Olanzapine

Recovery from anorexia nervosa is confounded by intrusive anorectic cognitions and rituals. It has been observed that olanzapine, an atypical antipsychotic, can reduce this anorexic rumination. A pilot study was designed to test the effectiveness of olanzapine in this role.. A randomized trial of olanzapine versus chlorpromazine, with anorexic rumination as the primary outcome, was conducted. Of the 26 patients who presented, 15 were randomized in a balanced block design, eight to olanzapine and seven to chlorpromazine.. Only the olanzapine group had a significant reduction in the degree of rumination.. Olanzapine may be of benefit in anorexia nervosa by causing a reduction in anorexic rumination.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Chlorpromazine; Cognition Disorders; Drug Administration Schedule; Female; Humans; Male; Olanzapine

Recent reports raise the possibility that olanzapine can assist weight gain and improve behavioral symptoms during refeeding in anorexia nervosa.. Seventeen DSM-IV anorexia nervosa subjects hospitalized between May 1999 and October 2000 were enrolled in open-label treatment with olanzapine for up to 6 weeks. Baseline weight and symptoms were compared to patients' status at the end of treatment.. Olanzapine administration was associated with a significant reduction in depression, anxiety, and core eating disorder symptoms, and a significant increase in weight. A comparison with our historical data suggests that subjects in this study had a significantly greater decrease in depression.. These data lend support to the possibility that olanzapine may be useful in treating anorexia nervosa. However, a controlled trial is necessary to demonstrate that olanzapine is efficacious.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Behavioral Symptoms; Benzodiazepines; Female; Humans; Olanzapine; Treatment Outcome; Weight Gain

Recent reports raise the possibility that olanzapine, which commonly causes weight gain in non-eating-disordered subjects, assisted weight gain and mood during refeeding in anorexia nervosa (AN) patients.. Eighteen AN subjects who engaged in open treatment with olanzapine were retrospectively questioned about their response.. Subjects reported a significant reduction in anxiety, difficulty eating, and core eating disorder symptoms after taking olanzapine.. These data lend support to the possibility that olanzapine may be useful in AN patients.. A controlled trial is necessary to prove that olanzapine is efficacious.

Topics: Adolescent; Adult; Anorexia Nervosa; Benzodiazepines; Humans; Olanzapine; Pirenzepine; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Surveys and Questionnaires

The primary goal of the study was to determine if olanzapine is effective in producing weight gain in patients with anorexia nervosa.. Twenty patients with anorexia nervosa (restricting or binge/purge subtype) without schizophrenia, schizoaffective disorder, or bipolar disorder enrolled in an open label study of olanzapine 10 mg. Patients attended weekly drug monitoring sessions and weekly group medication adherence sessions that provided psychoeducation.. Eighteen patients received the drug and 14 patients completed the 10-week study. The four drop-outs had gained a mean of 3.25 lb at their last visit. Of the 14 patients who completed the study, 10 gained an average of 8.75 lb and 3 of these patients attained their ideal body weight. The remaining four patients who completed the study lost a mean of 2.25 lb.. These findings are promising with clinically significant weight gain in an outpatient setting during a brief 10-week period.

Topics: Adolescent; Adult; Anorexia Nervosa; Benzodiazepines; Female; Humans; Male; Middle Aged; Olanzapine; Patient Compliance; Patient Education as Topic; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Weight Gain

The atypical antipsychotic drug olanzapine is prescribed despite clinical studies on olanzapine treatment showing mixed results on treatment efficacy in anorexia nervosa. We investigated the effect of systemic and intranasal administration of olanzapine in the activity-based anorexia (ABA) model. Rats were habituated to a running wheel and exposed to the ABA model while treated with olanzapine. During ABA rats had 1.5 h of daily access to food and ad libitum access to a running wheel for seven consecutive days. Olanzapine was administered via an osmotic minipump (1, 2.75, and 7.5 mg/kg) or intranasally 2 h before dark onset (1 and 2.75 mg/kg). We monitored body weight, food intake, wheel revolutions, body temperature, and adipose tissue. We found 2.75 and 7.5 mg/kg systemic olanzapine decreased wheel revolutions during ABA. Relative adipose tissue mass was increased in the 7.5 mg/kg olanzapine-treated group while body weight, food intake, and body temperature were unaltered by the systemic olanzapine. 1 and 2.75 mg/kg intranasal olanzapine diminished wheel revolutions and body temperature during the first 2 h after administration. The intranasal olanzapine-treated rats had a higher body weight at the end of ABA. We find that olanzapine has beneficial outcomes in the ABA via two administration routes by acting mainly on running wheel activity. Intranasal olanzapine showed a rapid effect in the first hours after administration in reducing locomotor activity. We recommend further exploring intranasal administration of olanzapine in anorectic patients to assist them in coping with restlessness.

Topics: Administration, Intranasal; Animals; Anorexia; Anorexia Nervosa; Body Weight; Disease Models, Animal; Eating; Olanzapine; Rats

The use of valproate in the treatment of Anorexia Nervosa (AN) in children and adolescents is currently not recommended by clinical guidelines, due to lack of evidence. Nonetheless, valproate is used to treat a series of psychiatric and neurologic conditions. To date, only six cases of patients with Feeding and Eating Disorders (three with AN) have been described.. Case series of 14 children and adolescent patients hospitalized for AN and treated with valproate as an adjunctive treatment. Reasons for introduction, dosages, plasma levels, adverse drug reactions (ADR) and modifications of liver enzymes, platelets levels, abdominal and pelvic ultrasounds, and concurrent drugs plasma levels were assessed.. Reasons for the introduction of valproate included unstable mood (57.1%), lack of compliance (50%) and aggressive behaviour (21.4%). In 71.4% of patients an improvement on target symptoms was observed. Valproate was started at 241.7 (± 73.3) mg, up to 521.4 (± 204.5) mg; the most frequent scheme was twice-daily. The mean plasmatic concentration was 66.3 (± 25.0) mg/L. One patient (7.1%) experienced side effects (somnolence). No major modifications of liver enzymes, platelet levels, abdominal and pelvic ultrasounds emerged after the introduction of valproate. Low concurrent olanzapine and quetiapine levels were documented.. This is the largest sample of patients with AN treated with valproate. Valproate was administered to improve psychiatric symptoms impairing compliance with inpatient treatment programs. The majority of patients experienced an improvement on target symptoms after being administered valproate, with minor ADR. These data should be investigated in wider populations and controlled studies.. Level IV, case series.

Topics: Adolescent; Anorexia Nervosa; Child; Hospitalization; Humans; Inpatients; Olanzapine; Valproic Acid

Electroconvulsive therapy (ECT) is rarely, if ever, considered for the treatment of severe anorexia nervosa (AN) or other eating disorders comorbid with an affective illness. Mood disorders are common in these patients, and psychotropic medications, although frequently used, have limited evidence of benefit in AN or copresenting depressive symptoms. Even when the illness is life threatening, ECT as a treatment may be overlooked. We present a case of an adolescent girl with severe AN and comorbid major depressive disorder with suicidality. This patient failed multiple medication trials but went on to experience complete remission from both the symptoms of her AN and major depressive disorder after undergoing a course of bilateral ECT. Electroconvulsive therapy may prove to be a fast and effective treatment strategy for mood disorders and suicidality in the setting of comorbid AN in adolescents.

Topics: Adolescent; Anorexia Nervosa; Benzodiazepines; Citalopram; Depressive Disorder, Major; Electroconvulsive Therapy; Female; Humans; Male; Olanzapine; Selective Serotonin Reuptake Inhibitors; Suicide; Treatment Outcome

Topics: Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Humans; Olanzapine

There is little information about the pharmacological treatment of avoidant and restrictive food intake disorder (ARFID), a challenging feeding disorder associated with marked impairment and developmental arrest. This brief clinical report seeks to fill this gap.. A retrospective chart review of nine patients with ARFID treated in an eating disorder (ED) program (residential, partial hospital, and intensive outpatient levels of care) with adjunctive olanzapine was undertaken.. The mean initial and final olanzapine doses were 0.9 + 0.63 mg/day and 2.8 + 1.47 mg/day, respectively. There was a statistically significant difference in weight gain pre- versus post-olanzapine treatment (3.3 ± 7.3 lbs vs. 13.1 ± 7.9 lbs [2.99 ± 6.62 lb SI vs. 11.88 ± 7.17 lb SI], paired t-test (p < 0.04, t = -2.48). Clinically, adjunctive olanzapine was helpful for not only weight gain but also reduction of associated anxious, depressive, and cognitive symptoms. Clinical Global Impressions scale scores indicated marked improvement in patients receiving adjunctive olanzapine.. These cases illustrate that judicious use of low-dose olanzapine, when used as an adjunct to other treatment modalities, may facilitate eating, weight gain, and the reduction of anxious, depressive, and cognitive symptoms in ARFID patients. Future randomized, placebo-controlled studies in ARFID are warranted.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Appetite Regulation; Benzodiazepines; Child; Combined Modality Therapy; Feeding and Eating Disorders; Female; Humans; Male; Olanzapine; Retrospective Studies; Weight Gain

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine

Anorexia nervosa (AN) is a life-threatening and difficult to treat mental illness with the highest mortality rates of any psychiatric disorder. We aimed to garner preliminary data on the real-world use of olanzapine and aripiprazole as augmentation agents of Selective Serotonin Reuptake Inhibitors (SSRIs) in adult inpatients affected by AN. We retrospectively evaluated the clinical charts of patients who were hospitalized between 2012 and 2014. Patients were evaluated upon admission and discharge. We investigated eating symptomatology, and both general and eating psychopathology using: Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Yale-Brown-Cornell Eating Disorders Scale. The charts of 75 patients were included in this study. The sample resulted equally distributed among those receiving SSRIs and either aripiprazole or olanzapine in addition to SSRIs. Notwithstanding a few baseline clinical differences, upon discharge all groups were significantly improved on all measures. Interestingly, aripiprazole showed the greatest effectiveness in reducing eating-related preoccupations and rituals with a large effect size. The body of evidence on medication management in AN is in dismal condition. Augmentation therapy is a well-established approach to a variety of mental disorders and it is often used in every-day clinical practice with patients affected by AN as well. Nevertheless, to date very little data is available on this topic. Results from our sample yielded promising results on the effectiveness of aripiprazole augmentation in reducing eating-related obsessions and compulsions. Randomized controlled trials are warranted to confirm these encouraging findings.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Depression; Drug Synergism; Drug Therapy, Combination; Female; Humans; Male; Olanzapine; Selective Serotonin Reuptake Inhibitors; Serotonin

Anorexia nervosa (AN) is an eating disorder characterized by severe hypophagia and weight loss, and an intense fear of weight gain. Activity-based anorexia (ABA) refers to the weight loss, hypophagia and paradoxical hyperactivity that develops in rodents exposed to running wheels and restricted food access, and provides a model for aspects of AN. The atypical antipsychotic olanzapine was recently shown to reduce both AN symptoms and ABA. We examined which component of the complex pharmacological profile of olanzapine reduces ABA. Mice received 5-HT(2A/2C), 5-HT3, dopamine D1-like, D2, D3 or D2/3 antagonist treatment, and were assessed for food intake, body weight, wheel running and survival in ABA. D2/3 receptor antagonists eticlopride and amisulpride reduced weight loss and hypophagia, and increased survival during ABA. Furthermore, amisulpride produced larger reductions in weight loss and hypophagia than olanzapine. Treatment with either D3 receptor antagonist SB277011A or D2 receptor antagonist L-741,626 also increased survival. All the other treatments either had no effect or worsened ABA. Overall, selective antagonism of D2 and/or D3 receptors robustly reduces ABA. Studies investigating the mechanisms by which D2 and/or D3 receptors regulate ABA, and the efficacy for D2/3 and/or D3 antagonists to treat AN, are warranted.

Topics: Amisulpride; Animals; Anorexia Nervosa; Benzodiazepines; Disease Models, Animal; Dopamine D2 Receptor Antagonists; Eating; Female; Indoles; Mice; Mice, Inbred BALB C; Motor Activity; Nitriles; Olanzapine; Piperidines; Receptors, Dopamine D3; Salicylamides; Sulpiride; Tetrahydroisoquinolines; Weight Loss

Topics: Adult; Anorexia Nervosa; Benzodiazepines; Female; Humans; Hypoglycemia; Olanzapine

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Child; Follow-Up Studies; Humans; Olanzapine; Retrospective Studies; Treatment Outcome

With this paper we aimed to describe a case of a woman affected by Anorexia Nervosa Restricting subtype (AN-R) with delusional symptoms, visual hallucinations and severe body image distortion. We discussed the main AN diagnosis and whether delusional symptoms could be related to severity of AN describing also the use of olanzapine in such a severe clinical condition. The use of olanzapine was found to be effective to reduce both delusions and body distortions, and to improve compliance to treatments. We found a severe delusional symptomatology with mystic, omnipotence and persecution features. The psychotic structure seemed preceding the eating disorder and was also found to be worsened by emaciation. The use of antipsychotic helped reducing delusional symptoms and improving compliance to treatments. Finally, the dynamically oriented therapeutic relationship helped the patient to gain weight and to achieve a full recovery from psychotic symptoms.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Body Image; Female; Humans; Olanzapine; Patient Compliance; Psychotic Disorders; Treatment Outcome

No studies have compared the response to selective serotonin reuptake inhibitors and atypical antipsychotics in anorexia nervosa. This case study examines such a comparison.. This report describes a case of 12-year-old identical twins with anorexia nervosa, one of whom was treated with olanzapine and the other with fluoxetine, while undergoing family therapy.. Twin A treated with fluoxetine went from 75 to 84.4% ideal body weight, while Twin B treated with olanzapine went from 72 to 99.9% ideal body weight over the course of 9 months.. This case supports the need for adequately powered, controlled clinical trials to test the efficacy of olanzapine in adolescents presenting with anorexia nervosa.

Topics: Anorexia Nervosa; Benzodiazepines; Child; Diseases in Twins; Family Therapy; Female; Fluoxetine; Humans; Olanzapine; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Twins, Monozygotic; Weight Gain

Like any other patient, a schizophrenic patient can get a physical illness, too. As such patients tend to ignore reality and neglect themselves and are stigmatized by society, due to which their physical symptomatology is often ignored, physical illness can remain undetected. If the schizophrenic patient is observed and adequate care is provided by the family, family doctor and a psychiatrist, it is possible to recognize the physical illness and intervene promptly. We are presenting a case of a female patient who has been treated for schizophrenia for a number of years. The treatment was mostly ambulatory (i.e. the patient was hospitalized twice) and consisted of first-generation antipsychotics. During the past two years, for reasons unknown, the patient stopped taking regular meals and as a result lost significant body weight, became apathetic and withdrawn, started avoiding social contacts and neglected personal hygiene. She reportedly took the psychopharmaca regularly, but rarely attended psychiatric follow-up consultations. Due to substantial weight loss and hypotonia, correction of antipsychotic was made and internist treatment administered. The choice of olanzapine was not an accidental one. We decided to take advantage of its side effect for the treatment of an anorectic syndrome. Interdisciplinary cooperation proved to be a justified decision.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Apathy; Benzodiazepines; Comorbidity; Cooperative Behavior; Disease Progression; Dose-Response Relationship, Drug; Drug Substitution; Drug Therapy, Combination; Female; Humans; Interdisciplinary Communication; Mobility Limitation; Olanzapine; Paroxetine; Schizophrenia; Schizophrenic Psychology; Social Isolation; Vitamin B 12; Weight Loss

To examine assessment and treatment profiles of adolescent patients with anorexia nervosa and eating disorder not otherwise specified who received olanzapine as compared with an untreated matched sample.. A retrospective, matched-groups comparison study was completed. Medical files of 86 female patients treated in the eating disorder program at the Children's Hospital of Eastern Ontario were examined. Patients treated with olanzapine were initially identified through chart review and then matched to a diagnosis, age, and, when possible, treatment group that served as the active comparator. Weight gain was examined in a sample of 22 inpatients.. Patients treated with olanzapine displayed greater evidence of psychopathology and medical compromise at the time of first assessment compared with those not treated. Rate of weight gain was not statistically different between groups when olanzapine was started during inpatient admissions. Medication effect on eating disorder cognitions could not be assessed given the presence of multiple confounders relating to treatment. Notable side effects included sedation and dyslipidemia in 56% of patients.. Despite our best attempts at matching olanzapine-treated subjects with a control sample, analysis revealed significant differences between groups, suggesting greater illness severity in those augmented with olanzapine. Given these inherent differences, we were unable to draw any firm conclusions regarding the potential efficacy of olanzapine. Factors associated with the prescription of adjunctive pharmacotherapy in this cohort appear to be linked to illness severity, acuity, and associated comorbidity. The observed side-effect profile indicates the need for more consistent predrug screening and for closer monitoring during treatment.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Body Weight; Child; Cohort Studies; Female; Humans; Olanzapine; Research Design; Retrospective Studies; Severity of Illness Index; Treatment Outcome

Eating disorders in early childhood are the same frequency in boys and girls. During adolescence eating disorders are ten (10) times more frequent in girls than in boys. Worrying is the fact that eating disorders are the third chronic illness among adolescents after obesity and asthma. Depicting this adolescent we tried to show difficulty of treatment of this disorder, where in the beginning is important to stabilize body weight and prevent somatic damages such as: heart damage, amenorrhoea, changes in EKG (electrocardiogram) and electrolyte dysbalance that could endanger the life of patient. Simultaneously it is important to recognize and treat comorbid psychological disturbances such as in this case: depression, delusions with occasional psychotic reactions combined with unrealistic thinking about the layout of her own body. There is still no cure for the treatment of eating disorders which are in growing number of reports among male adolescents.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Female; Humans; Olanzapine; Psychotic Disorders

A 15 year old patient suffering from psychiatric disturbances looked for psychiatric help but refused hospital admission. Following an ambulatory treatment, the patient was diagnosed with Anorexia nervosa. The patient, a girl, was 175 centimeters tall, weighting only 39 kilos. Within the clinical picture, there were few dominant disorders present; anxiety, depression, low self-esteem, fear of feminization, with recurrent psychotic episodes. By the implementation of an intensive psychotherapeutic treatment, without the use of psychopharmacs, the weight was kept stable. In accordance with the girl's mother, a psychopharmacotherapy was commenced, a combination of olanzapine and paroxetine (the choice of psychopharmacs was lead by the side effects known). At the end of a 24-month period of a psychological treatment which was combined with psychopharmacotherapy, the patient exhibited no symptomatology and a stable clinical remission of the illness was achieved.

Topics: Adolescent; Ambulatory Care; Anorexia Nervosa; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Body Weight; Combined Modality Therapy; Defense Mechanisms; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; MMPI; Olanzapine; Paroxetine; Psychotherapy

This case report describes the history and hospital course of a 42-year-old devout evangelical Christian woman with a long standing history of anorexia nervosa, binge/purge type, who developed religious delusions, including the conviction that God was prohibiting her from eating. The discussion emphasizes the difficulties of diagnosing and treating psychosis in devout individuals, and the interplay between anorexia, psychosis, and religion.

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Behavior Therapy; Benzodiazepines; Female; Hospitalization; Humans; Olanzapine; Religion and Psychology; Risperidone; Schizophrenia, Paranoid

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Bias; Cognitive Behavioral Therapy; Day Care, Medical; Double-Blind Method; Female; Humans; Motivation; Multicenter Studies as Topic; Obsessive Behavior; Olanzapine; Patient Compliance; Patient Dropouts; Randomized Controlled Trials as Topic; Treatment Refusal; Weight Gain

This report describes the case of a young man with a large calcification in the right thalamus that was first diagnosed at 9 years of age. Case history reveals specific eating rituals and other obsessive-compulsive personality traits during the patient's childhood and adolescence, fulfilling diagnostic criteria of obsessive-compulsive personality disorder. After a critical life event the patient develops anorexia nervosa. We suggest that our case and further literature provide evidence for an involvement of specific thalamic structures, such as the dorsomedial nucleus, in the development of anorexia nervosa. Furthermore, the treatment of the patient by a combined psychotherapeutic and pharmacotherapeutic approach is described. We focus on the beneficial effect of the atypical antipsychotic olanzapine, which can induce weight gain by an increase of leptin levels.

Topics: Adult; Anorexia Nervosa; Benzodiazepines; Calcinosis; Combined Modality Therapy; Dominance, Cerebral; Humans; Life Change Events; Male; Mediodorsal Thalamic Nucleus; Mianserin; Mirtazapine; Obsessive-Compulsive Disorder; Olanzapine; Paroxetine; Psychotherapy; Thalamic Diseases; Tomography, X-Ray Computed

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Child; Child Development Disorders, Pervasive; Feeding Behavior; Female; Humans; Olanzapine; Weight Gain

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Female; Humans; Hyperglycemia; Olanzapine

Schizotypal personality disorder (SPD) has rarely been reported as an eating disorder-related personality trait. A 23-year-old woman was diagnosed as having anorexia nervosa binge eating/purging type. At the age of 53 years, she was admitted to Jikei University Hospital because of excessive bodyweight loss. She was diagnosed as having SPD based on bizarre behavior, ideation and a tendency to seek isolation. She was treated with low-dose antipsychotics, and her impulsive behavior improved. The patient's SPD was considered to have had a psychopathological contribution to her chronic episodes of anorexia nervosa.

Topics: Anorexia Nervosa; Antidepressive Agents, Second-Generation; Benzodiazepines; Body Weight; Bulimia; Chronic Disease; Female; Hospitalization; Humans; Mianserin; Middle Aged; Olanzapine; Paroxetine; Schizotypal Personality Disorder; Selective Serotonin Reuptake Inhibitors

Several studies have shown that olanzapine is effective in weight restoration and maintenance for patients with anorexia nervosa (AN). However, major depression is a very common comorbid psychiatric disorder associated with AN. Additional antidepressant therapy may be required for treating anorexic patients with major depression. The authors present a case of AN associated with major depression, who responded well to the combination treatment of olanzapine and mirtazapine. A 27-year-old Taiwanese woman was admitted because of severe weight loss, poor nutrition, amenorrhea, major depression, and starvation complications including hematological dyscrasis, electrolytes and endocrine imbalance, and sinus bradycardia. In additional to nutritional and medical treatments, the patient was given olanzapine 10 mg/day and mirtazapine 30 mg/day. She took the combined medications for six months. Meanwhile she received cognitive behavior therapy and family therapy. With these treatments, the patient's depression was in remission, her body weight was increased from 24 to 38 kg, and her body mass index was increased from 9.8 to 15.5. Our case suggests that the combined treatment of olanzapine and mirtazapine can be used in the treatment of AN associated with major depression.

Topics: Adult; Anorexia Nervosa; Antidepressive Agents, Tricyclic; Antiemetics; Benzodiazepines; Depressive Disorder, Major; Drug Therapy, Combination; Female; Humans; Mianserin; Mirtazapine; Olanzapine

Several case reports and open label trials describe olanzapine in the treatment of anorexia nervosa (AN). We report 5 adolescents with AN who received olanzapine in addition to psychotherapy for their eating disorder. Body mass index (BMI) of each case increased while on olanzapine. At doses of 5 mg per day and above, patients reported decreased anxiety around eating, improved sleep, and decreased rumination about food and body concerns. Morning sedation was the most commonly reported adverse effect. Olanzapine appeared to be useful in addition to psychotherapy for these adolescents. This report augments a limited literature on the treatment of this disorder, and an almost nonexistent literature specific to pharmacotherapy for adolescents with AN.

Topics: Adolescent; Anorexia Nervosa; Benzodiazepines; Body Mass Index; Child; Female; Humans; Male; Olanzapine; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Sleep Wake Disorders; Treatment Outcome

The aim of this study was to assess dose-related steady-state serum concentrations of olanzapine (OLZ) and its metabolites N-desmethyl OLZ (DMO) and 2-hydroxymethyl OLZ (2-OH-OLZ) (assessed by high-performance liquid chromatography) in 122 child and adolescent psychiatric patients (age 16.9 +/- 2.2, range, 10-21 years; 74 males, 48 females) with a variety of diagnoses: schizophrenia group (n = 80); nonschizophrenia group (n = 29); anorexia nervosa (AN) group (n = 13). Median OLZ serum concentrations were 32.7 (range, 1-118; all patients), 37.7 (2-115; schizophrenia group), and 18.7 (1-63, AN group) ng/mL. The median OLZ concentration-to-dose (C/D) ratio (n = 122) was 2.6, with 90% of the distribution between 0.8 and 5.5 (ng/mL)/(mg/d). OLZ concentration was significantly correlated with DMO (r = 0.567; P < 0.0005) but not with 2-OH-OLZ (r = 0.122; P = 0.188). Daily OLZ dose was correlated with OLZ concentration in all (r = 0.684; P < 0.0005), schizophrenic (r = 0.542; P < 0.0005), and AN (r = 0.805; P = 0.001) patients, respectively. Patients aged less than 16 years displayed similar C/D for OLZ (P = 0.58) but higher C/D for DMO (P = 0.003) than those 16 years or older. AN patients received lower median OLZ doses (7.5; 5-15 mg) than schizophrenic patients (12.5; 2.5-40 mg), even after correcting for body mass index (P = 0.02). OLZ dose did not differ (P = 0.088) between smokers and nonsmokers, but smokers showed lower C/D for OLZ than nonsmokers (P = 0.008). C/D for OLZ was 38% higher (P = 0.041) under comedication with selective serotonin reuptake inhibitors when compared with OLZ monotherapy. Multiple linear regression analysis revealed that 46% of the variation of OLZ concentration can be explained by dose, diagnosis, age, sex, smoking, and comedication. The data are compared with the literature, and the relevance of therapeutic antipsychotic drug monitoring in previously sparsely investigated subgroups, such as children and adolescents or patients with AN, is emphasized.

Topics: Adolescent; Adult; Age Factors; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Child; Drug Combinations; Female; Humans; Male; Olanzapine; Pirenzepine; Schizophrenia; Sex Factors; Smoking

Topics: Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Clinical Trials as Topic; Fluoxetine; Humans; Olanzapine; Personality Inventory; Research Design; Sample Size; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Weight Gain

A recent case report suggested that olanzapine resulted in improved weight gain and maintenance, as well as decreased anxiety and agitation, for two hospitalized inpatients with anorexia nervosa (AN). However, a subsequent larger case study did not show a relationship between the use of olanzapine and rate of weight gain among a primarily adult population. The aim of this case report was to clinically examine the therapeutic benefit and tolerability of olanzapine as an adjunctive treatment for four children with AN in a pediatric inpatient setting.. Olanzapine use was associated with considerable weight gain and maintenance, with an average rate of weight gain during hospitalization of 0.99 kg per week. In addition to weight gain, olanzapine was associated with a clinically notable decrease in levels of agitation and premeal anxiety and almost immediate improvement in sleep, general functioning, and overall compliance with treatment. Olanzapine was also well tolerated in these young patients.. These case report findings warrant more controlled research, including randomized controlled studies, to better determine the therapeutic benefits and safety of olanzapine use in children with AN.

Topics: Anorexia Nervosa; Benzodiazepines; Body Mass Index; Child; Female; Hospitalization; Humans; Male; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors

This case report presents a severe case of anorexia nervosa in a 15-year-old female adolescent. The patient suffered from extreme weight loss and agitation that required hospitalization in the Intensive Care Unit. The initial treatment consisted of fluoxetine management. Marked improvements, both in weight and psychological adjustment, were observed with the later addition of olanzapine. The findings reported here support previous findings that suggest the beneficial use of olanzapine in the treatment of anorexia nervosa.

Topics: Adolescent; Anorexia Nervosa; Benzodiazepines; Critical Care; Female; Humans; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Weight Loss

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Female; Humans; Middle Aged; Olanzapine

Topics: Adult; Affect; Anorexia Nervosa; Appetite; Benzodiazepines; Dose-Response Relationship, Drug; Dreams; Euphoria; Humans; Male; Olanzapine; Pirenzepine; Psychoanalytic Interpretation

To examine whether antiputamen antibodies are present in adolescents with anorexia nervosa (AN).. Using enzyme-linked immunosorbent assay (ELISA) with an extract of human putamen as an antigen, sera samples obtained from 22 adolescents with active AN and from 22 healthy adolescents (control group) were assayed for antibodies to neuronal components. Mean optical density (OD) readings for serum antibodies against human putamen in adolescents with AN was significantly greater than the mean OD readings in the control group (0.492 +/- 0.086 vs. 0.275 +/- 0.028, p =.02). When serum positivity was defined as an OD level greater than 2 SD above the mean control group value (0.541), antiputamen antibodies were detected in the blood of 6 AN patients (27%) whereas they were detected in the blood of 1 patient (5%) in the control group (p <.05; Fisher's exact test).. The detection of antiputamen antibodies in adolescents with AN suggests an underlying immune process at the putamen level in some patients with this eating disorder.

Topics: Adolescent; Anorexia Nervosa; Antibodies; Benzodiazepines; Body Mass Index; Caudate Nucleus; Enzyme-Linked Immunosorbent Assay; Female; Fluoxetine; Humans; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Putamen; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Surveys and Questionnaires

Psychopathology in severely anorexic patients often seems to be of compulsive and delusional quality rendering therapeutic approaches extremely difficult. With conventional therapeutic regimes failing, administration of the novel antipsychotic olanzapine induced remarkable improvement in five cases reported here. Paranoid ideation concerning body image or weight gain decreased and sedative effects helped to reduce inner tensions and phobia with respect to food intake. Olanzapine, therefore, might represent an important therapeutic tool in anorexic patients who present the following characteristics: long-term history of anorexia nervosa mostly with several hospitalisations, missing perception of their severe state of illness, refusal of therapy, delusional quality of anorexic thinking, risk of discontinuation of therapy with life-threatening consequences.

Topics: Adolescent; Anorexia Nervosa; Benzodiazepines; Body Image; Child; Delusions; Female; Humans; Olanzapine; Patient Compliance; Perceptual Distortion; Pirenzepine; Treatment Outcome

Two females with severe anorexia nervosa were treated with olanzapine in open trials. Olanzapine was tried because it has caused weight gain in other patient groups. Both anorexic patients had a chronic illness and had failed multiple other treatments. Olanzapine administration was associated with weight gain and maintenance as well as reduced agitation and resistance to treatment. These case histories support further exploration of this class of drugs in anorexia nervosa.

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Female; Humans; Olanzapine; Pirenzepine; Treatment Outcome

Topics: Adult; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Female; Humans; Middle Aged; Olanzapine; Pirenzepine; Self Concept; Treatment Outcome

Topics: Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Female; Humans; Middle Aged; Olanzapine; Pirenzepine; Self Concept