olanzapine and Attention-Deficit-and-Disruptive-Behavior-Disorders

Topics: Adolescent; Antipsychotic Agents; Aripiprazole; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Child; Clozapine; Dibenzothiazepines; Drug Interactions; Drug Monitoring; Humans; Olanzapine; Pediatrics; Piperazines; Quetiapine Fumarate; Quinolones; Risperidone

This review of published studies compares scores on individual items of mania rating scales that systematically recorded symptom severity in persons diagnosed with bipolar disorder to identify age-grouped differences.. An extensive literature search identified item scores from mania rating scales, with a particular emphasis on baseline Young Mania Rating Scale (YMRS) item scores in published double-blind, placebo-controlled studies of bipolar I manic disorder. These baseline YMRS item scores were assessed as a proportion of the total YMRS score and compared by age group. Additional YMRS item/total scores in subjects with bipolar spectrum disorders were added to expand the analysis.. Preadolescents with bipolar disorder had significantly higher YMRS item scores than adolescents on aggression, irritability, and motor activity. Young Mania Rating Scale baseline item scores relative to the YMRS total score revealed that adolescents diagnosed with bipolar I mania scored comparatively higher than did adults on YMRS aggression and irritability items, whereas adults with bipolar I manic disorder scored comparatively higher on the grandiosity and sexual interest items. Age-grouped findings from subjects diagnosed with bipolar I, II, and Not Otherwise Specified (NOS) disorders yielded similar age-grouped results.. In age-grouped YMRS item assessments of bipolar mania, anger dyscontrol was most prominent for youth, whereas disordered thought content was paramount for adults.

Topics: Adolescent; Adult; Age Factors; Aggression; Anger; Antipsychotic Agents; Aripiprazole; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Bipolar Disorder; Child; Clinical Trials as Topic; Comorbidity; Defense Mechanisms; Female; Humans; Irritable Mood; Male; Middle Aged; Motor Activity; Olanzapine; Piperazines; Psychiatric Status Rating Scales; Psychometrics; Quinolones; Sexual Behavior; Thinking; Young Adult

Use of atypical antipsychotic medications (AAMs) in the treatment of disruptive behavior (DB) in children and adolescents has increased dramatically worldwide. However, with exception of using risperidone (i.e., for the management of irritability associated with autism, manic and mixed episodes associated with bipolar I disorder, and schizophrenia) and aripiprazole (i.e., for manic and mixed episodes associated with bipolar I disorder and schizophrenia), the Food and Drug Administration (FDA) has not approved the use of AAMs in children and adolescents. Although research on use of these medications in children and adolescents has increased, mechanisms of action and long-term outcomes remain poorly understood or unknown. Particularly concerning is that use of these medications in children and adolescents may impact cognitive, social, and physical development, as side effects may interfere with activities in their educational setting, peer networks, and recreational settings. Overall, AAMs frequently are prescribed off label, control DB through sedation rather than targeting actual causes of DB, and lead to many negative side effects with unknown long-term effects. Reconsidering the use of AAMs in managing DB is encouraged strongly.

Topics: Adolescent; Antipsychotic Agents; Aripiprazole; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Child; Humans; Olanzapine; Piperazines; Practice Guidelines as Topic; Quinolones; Risperidone; Treatment Outcome

Disruptive behavior disorders, including conduct disorder, oppositional defiant disorder, and disruptive behavior disorder not otherwise specified, are serious conditions in children and adolescents that include a behavior pattern of violating the basic rights of others and age-appropriate rules or standards and may include aggressive behavior. Although no pharmacotherapy is currently approved for use in this population, evidence suggests that atypical antipsychotic treatment may be useful in patients with these conditions who present with problematic aggression. Currently, research on risperidone shows it to be effective in treating aggressive behavior in this patient population. Limited research is also available on olanzapine, quetiapine, and aripiprazole, but more research is needed on these and other agents. As with any pharmacotherapy, adverse events (including weight gain, headache, and somnolence) should be carefully considered with these medications, especially in children and adolescents, and it is important to properly dose and monitor patients during medication therapy.

Topics: Adolescent; Antipsychotic Agents; Aripiprazole; Attention Deficit and Disruptive Behavior Disorders; Attention Deficit Disorder with Hyperactivity; Benzodiazepines; Child; Dibenzothiazepines; Disorders of Excessive Somnolence; Headache; Humans; Methylphenidate; Obesity; Olanzapine; Piperazines; Quetiapine Fumarate; Quinolones; Risperidone

Atypical antipsychotics offer superior safety and similar efficacy compared with conventional agents in adults with psychotic disorders. Consequently, atypical antipsychotics have been increasingly used in children and adolescents. Because most information now available on pediatric use comes from case reports and small open-label studies rather than large controlled trials, treatment in pediatric patients is often guided by experience with adults or based on limited evidence in youths. Although the literature contains reports on the use of each agent in this class in children, risperidone has been the focus of the greatest number of reports. However, the atypical antipsychotics are not interchangeable; each has a unique pharmacologic profile and may differ considerably in terms of adverse effects. Evidence on the use of atypical antipsychotics in children and adolescents is summarized in this review.

Topics: Adolescent; Age Factors; Antipsychotic Agents; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Bipolar Disorder; Child; Child Development Disorders, Pervasive; Clozapine; Dibenzothiazepines; Humans; Mental Disorders; Olanzapine; Piperazines; Quetiapine Fumarate; Risperidone; Schizophrenia; Thiazoles; Tic Disorders

The aim of this study was to assess the use of atomoxetine and olanzapine in combination to treat attention-deficit/hyperactivity disorder (ADHD) and comorbid disruptive behaviors in children and adolescents 10-18 years of age.. Eleven subjects ages 10-18 received open-label atomoxetine and olanzapine for a 10 week treatment period. Patients were assessed at baseline, 2 weeks, 4 weeks, 6 weeks, and 10 weeks (posttreatment). ADHD improvement was measured through the ADHD Rating Scale (ADHD-RS) (Investigator and Parent ratings). Aggression was measured through the Modified Overt Aggression Scale (MOAS).. The combined use of atomoxetine and olanzapine resulted in statistically significant improvement in ADHD symptoms and overt aggression from baseline to posttreatment. As evidenced by a 33% reduction in symptoms on the ADHD-RS-I and the MOAS, 73% of patients were considered responders to ADHD treatment, whereas 55% responded to treatment for aggression. Both medications were generally well tolerated. Olanzapine treatment was associated with significant weight gain. Patients gained, on average, 3.9 kg. throughout the treatment period.. These data provide initial evidence that combination use of atomoxetine and olanzapine for the treatment of ADHD and comorbid disruptive behaviors was effective in reducing ADHD symptoms and aggressive behavior in a 10 week treatment period.

Topics: Adolescent; Adrenergic Uptake Inhibitors; Aggression; Antipsychotic Agents; Atomoxetine Hydrochloride; Attention Deficit and Disruptive Behavior Disorders; Attention Deficit Disorder with Hyperactivity; Benzodiazepines; Child; Drug Therapy, Combination; Female; Humans; Male; Olanzapine; Propylamines; Time Factors; Treatment Outcome; Weight Gain

Olanzapine, an atypical antipsychotic, has been shown to be efficacious for treatment of psychotic and mood disorders in adults. This prospective, open-label study was conducted to examine the safety and usefulness of olanzapine in treating disruptive behavior disorders in adolescents with subaverage intelligence.. Sixteen adolescents (ages 13-17 years) with borderline to moderate mental retardation and disruptive behavior were enrolled in an 8-week olanzapine trial (5-20 mg/day). Dependent measures included the Aberrant Behavior Checklist, Conners Parent Rating Scale, Clinical Global Impressions, and two side effects scales.. Statistically significant improvement (p <.002) was found on the Irritability and Hyperactivity subscales of the Aberrant Behavior Checklist and the Conners Parent Rating Scale Hyperactivity Index. No subjects developed extrapyramidal side effects. However, four were terminated prematurely from the trial because of either worsening of symptoms (requiring psychiatric inpatient hospitalization in two subjects) or side effects. The most common side effect for the sample was weight gain (averaging 12.7 lb), with 67% of subjects gaining > or =10 lb. Although there was also a statistically significant increase in prolactin levels, no subjects reported prolactin-related side effects (e.g., gynecomastia, galactorhea, amenorrhea).. Olanzapine may be useful in treating disruptive behavior in adolescents with subaverage intelligence. However, side effects, especially weight gain, are a significant issue. Future double-blind, placebo-controlled studies need to confirm these findings and assess long-term safety and outcome of olanzapine treatment.

Topics: Adolescent; Antipsychotic Agents; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Female; Humans; Intelligence; Male; Olanzapine; Prospective Studies

The effectiveness of olanzapine in treating challenging behaviors in the intellectually disabled and its ability to substitute for conventional antipsychotic drugs were evaluated.. A total of 20 institutionalized adults with a mean age of 42.7 years (range, 18-55 years) with intellectual disability and aggression, self-injurious behavior, destructive/disruptive behavior, or combinations of these behaviors were studied. These individuals were receiving multiple psychotropic medications at baseline and were given additional treatment with the atypical antipsychotic agent olanzapine. The mean dose of olanzapine was 9.1 mg/day (range, 2.5-22.5 mg/day). Effectiveness was determined by retrospective review of the summaries of quarterly neuropsychiatric behavioral reviews and retrospective review of longitudinal behavioral graphs of target symptoms. Data were collected from 1995 to 2000.. A significant decrease in global challenging behaviors and specific target behaviors (i.e., aggression, self-injurious behaviors, destructive/disruptive behaviors) occurred (p <.05). A numerical decrease in the dosage of concurrent conventional antipsychotic medications occurred over the course of the first 6 months of olanzapine therapy, and a statistically significant (p <.005) decrease from the start of olanzapine therapy occurred in those subjects who received olanzapine for longer than 6 months (mean = 20.3 months). A significant increase in weight occurred in the subject group during the first 6 months of olanzapine treatment (p <.006), and sedation and constipation were the other common side effects noted.. Olanzapine was found to be effective in the treatment of challenging behaviors in the intellectually disabled and in part could be substituted for administration of conventional antipsychotic drugs.

Topics: Adolescent; Adult; Aggression; Antipsychotic Agents; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Comorbidity; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Intellectual Disability; Longitudinal Studies; Male; Mental Disorders; Middle Aged; Olanzapine; Pirenzepine; Psychotropic Drugs; Retrospective Studies; Self-Injurious Behavior; Treatment Outcome

Topics: Adolescent; Analysis of Variance; Antipsychotic Agents; Aripiprazole; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Bipolar Disorder; Body Mass Index; Body Weight; Child; Dibenzothiazepines; Female; Follow-Up Studies; Humans; Male; Mental Disorders; Olanzapine; Piperazines; Quetiapine Fumarate; Quinolones; Risperidone; Schizophrenia; Spain; Time Factors

Considerable number of intellectual disabled people experience some form of disruptive behavior. Antipsychotics are the most common treatment for these behaviors. Numerous patients were efficiently treated with thioridazine, recently withdrawn. The authors describe a case series of "thioridazine responders" treated with olanzapine. Thirty three patients with severe intellectual disability were recruited. All patients were assessed for seven types of disruptive behavior on five point scale. Patients with severe behavior disturbances were included in treatment. The time points of assessment were at day 0, 30, 60 and 180. Twenty one patient accomplished inclusion criteria. A significant decrease occurred at day 30 for all types of behavior. Total score, self injurious behavior, compulsive and destructive behavior showed further decrease at day 60 and became stable until the end of study. Olanzapine appears to be efficacious in the treatment of disruptive behavior in the intellectually disabled and could be substitute for thioridazine treatment.

Topics: Adolescent; Adult; Antipsychotic Agents; Attention Deficit and Disruptive Behavior Disorders; Benzodiazepines; Child; Female; Humans; Institutionalization; Intellectual Disability; Male; Olanzapine