olanzapine and Dystonia

The aim of this paper is to present a case of paliperidone-induced Pisa syndrome and provide treatment experience.. The case report is combined with a review of the literature.. A 37-year-old man had been diagnosed with paranoid-type schizophrenia for about 10 years. He received three-month treatment of paliperidone extended release (ER) at 6 mg per day, but showed a progressively Pisa-like physical position. We initially added an anticholinergic drug, but saw no improvement. The paliperidone ER was replaced by olanzapine at 10 mg per day, and the Pisa-like symptom improved after 1 month of the drug replacement.. We propose olanzapine as a possible replacement choice for patients with paliperidone-related Pisa syndrome.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dyskinesia, Drug-Induced; Dystonia; Humans; Male; Olanzapine; Paliperidone Palmitate; Psychiatric Status Rating Scales; Schizophrenia, Paranoid; Syndrome

The enthusiasm produced by the introduction of antipsychotic medication in the 1950s gave way to a certain frustration in the 1970s and 1980s. Despite the development of a large number of new drugs, little progress was made in treatment because these new agents were, in essence, therapeutically equivalent. This lack of progress was perhaps also related to an emphasis on tardive dyskinesia in the 1970s, i.e., the preoccupation with a negative effect of treatment. The reverse is taking place today. Clozapine and the other atypical antipsychotics are associated in people's minds with fewer or absent extrapyramidal symptoms and less tardive dyskinesia than the older typical agents. As a result, a certain amount of complacency exists. Tardive dyskinesia not only may be painful and disfiguring, but it also predicts poor outcome in patients with schizophrenia. Although many treatments have been tried, none have proven completely efficacious. The best treatment for tardive dyskinesia and dystonia is prevention, which is a function of medication choice. Pharmacologic interventions for tardive dyskinesia include clozapine and the other atypical antipsychotics. If typical antipsychotics must be used, they should be started at the lowest possible levels. Studies of risperidone suggest that it, too, should be used at very low doses to minimize the risk of tardive dyskinesia. It is also possible that schizophrenic patients taking atypical antipsychotics may experience fewer spontaneous dyskinesias, although further study is warranted.

Topics: Adult; Akathisia, Drug-Induced; Algorithms; Antipsychotic Agents; Benzodiazepines; Clozapine; Decision Trees; Drug Administration Schedule; Dyskinesia, Drug-Induced; Dystonia; Female; Humans; Male; Olanzapine; Pirenzepine; Probability; Reserpine; Risperidone; Schizophrenia; Substance Withdrawal Syndrome; Tetrabenazine; Treatment Outcome; Vitamin E

The incidence of acute extrapyramidal symptoms (EPS)--akathisia, dystonia, and parkinsonism--associated with traditional antipsychotics varies, but most researchers agree that neuroleptic-induced EPS occur in 50% to 75% of patients who take conventional antipsychotics. Atypical antipsychotics were developed to widen the therapeutic index and to reduce EPS. Although the mechanisms are unclear, the risk of EPS is less with the novel antipsychotics than with conventional drugs, and agents that produce low levels of acute EPS are likely to produce less tardive dyskinesia. Nevertheless, clinicians should exercise caution when comparing data from investigations of the novel antipsychotics and, until long-term data become available, should administer the new drugs at doses below the EPS-producing level.

Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Clinical Trials as Topic; Clozapine; Dibenzothiazepines; Drug Administration Schedule; Dyskinesia, Drug-Induced; Dystonia; Humans; Olanzapine; Parkinson Disease, Secondary; Pirenzepine; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Substance Withdrawal Syndrome

Clinical safety data for treatment of acute schizophrenia with olanzapine, a new atypical antipsychotic agent, are summarized. The primary clinical trial safety database included 2500 patients treated with olanzapine, 810 with haloperidol, and 236 with placebo. The overall discontinuation rate from olanzapine treatment was low. Significant adverse events included somnolence, weight gain, and asymptomatic treatment-emergent transaminase elevation. Minimal parkinsonism and akathisia with rare dystonia were noted. No hematotoxicity was noted. The incidence of seizures and sexual dysfunction was rare.

Topics: Acute Disease; Akathisia, Drug-Induced; Antipsychotic Agents; Benzodiazepines; Blood Pressure; Clinical Trials as Topic; Cross-Over Studies; Dizziness; Double-Blind Method; Dystonia; Haloperidol; Heart Rate; Humans; Liver; Olanzapine; Parkinson Disease, Secondary; Pirenzepine; Placebos; Psychiatric Status Rating Scales; Randomized Controlled Trials as Topic; Schizophrenia; Schizophrenic Psychology; Sleep; Transaminases; Treatment Outcome; Weight Gain

The objective of this study was to compare the effects of risperidone and olanzapine in schizophrenic patients with intolerant extrapyramidal side effects (EPS) on first generation antipsychotics. We conducted an 8-week, rater-blinded, flexible dose study. Seventy patients with schizophrenia, who met the DSM-IV research criteria of having neuroleptic-induced acute dystonia or parkinsonism, were randomly assigned to risperidone or olanzapine group. The primary outcome was a comparison of the incidence of concomitant anticholinergic drugs usage between the groups to manage their acute dystonia and parkinsonism. The average doses of risperidone and olanzapine from baseline to study end point were 1.8-3.5 mg/day and 7.7-11.7 mg/day, respectively. There were no significant differences in demographic data, severity of EPS or psychotic symptoms between the groups at baseline assessment. Patients taking risperidone had significantly higher incidence of using anticholinergic drugs to manage acute dystonia or parkinsonism overall during the study (OR = 5.17, 95%CI = 1.49-17.88, P = 0.013). There was no significant between-group difference in the changing of rating scales of EPS and psychotic symptoms. The results of our study favour olanzapine as a better choice in schizophrenic patients with intolerant EPS. Double-blinded, fixed dose and different ethnical study for EPS-intolerant schizophrenic patients is needed to confirm the results of our study.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; Dystonia; Female; Humans; Male; Middle Aged; Olanzapine; Parkinsonian Disorders; Risperidone; Schizophrenia; Severity of Illness Index; Single-Blind Method

Adaptive trial design applied to randomized clinical trials of psychiatric medicines offers the potential to make clinical trials more efficient. In the current analysis, we retrospectively applied Bayesian adaptive allocation methods to a case study in agitated patients with schizophrenia and related diseases. The original study used a randomized, double-blind, parallel design. The objective of this analysis was to demonstrate the potential benefits of Bayesian adaptive designs by shortening the study duration and therefore limiting patient exposure to ineffective placebo or an active comparator with a known side effect. Bayesian methods allowed us to fully leverage historical data along with data observed as the study was ongoing to calculate predictive probabilities of patient response to treatment without experiencing a specified side effect. Using the Bayesian adaptive approach would have required less than half the number of patients as the original study to draw the same conclusion. Sample size was reduced from 311 to 156 patients, thereby decreasing the number of patients exposed to placebo from 54 to 30 and the number exposed to the active control with a known side effect from 126 to 60.

Topics: Antipsychotic Agents; Bayes Theorem; Benzodiazepines; Double-Blind Method; Drug-Related Side Effects and Adverse Reactions; Dystonia; Haloperidol; Humans; Monte Carlo Method; Olanzapine; Psychiatric Status Rating Scales; Psychotic Disorders; Research Design; Retrospective Studies; Sample Size; Schizophrenia; Schizophrenic Psychology; Severity of Illness Index; Treatment Outcome

To compare the efficacy and frequency of akathisia and dystonia between the dopamine antagonist headache medications olanzapine, metoclopramide and prochlorperazine.. This was a retrospective observational cohort study of patients presenting to a large urban level one trauma center between 2010 and 2018. Inclusion criteria was age ≥ 18 who presented to the emergency department with a chief complaint of headache who received either olanzapine, metoclopramide or prochlorperazine. The primary outcome was need for rescue medication. Secondary outcomes were receiving medication for either akathisia or dystonia. Logistic regression was used to identify differences between the three cohorts up to 72 h from initial presentation.. There were 5643 patients who met inclusion criteria. Olanzapine was the most commonly used drug (n = 2994, 53%) followed by prochlorperazine (n = 2100, 37%) and metoclopramide (n = 549, 10%). After adjusting for age and gender, there were no differences in risk for receiving rescue therapy or developing akathisia or dystonia.. During initial ED visit and up to 72 h after receiving olanzapine, metoclopramide or prochlorperazine, we found no difference in risk for requiring rescue medication or developing akathisia or dystonia.

Topics: Cohort Studies; Double-Blind Method; Dystonia; Emergency Service, Hospital; Headache; Humans; Metoclopramide; Migraine Disorders; Olanzapine; Prochlorperazine; Psychomotor Agitation

Drug-induced dystonias are rare but can occur with second-generation antipsychotics. They are usually dose-related and occur soon after dose initiation. This case describes the development of dystonia after two years of olanzapine 5 mg daily in an older person with Alzheimer's dementia. The dystonia resolved after diphenhydramine treatment on day two of hospitalization, but then the patient became delirious, which was treated with lorazepam on day three. Six days after admission, she developed tremors and rigidity that self-resolved. Her dystonia resolved after 11 days. The recurrence of symptoms during the hospitalization may have been a result of the progression of her dementia. This is the first known case of a patient developing dystonia after chronic use of low-dose olanzapine. This was not characterized as tardive dystonia because the dystonia was resolved with anticholinergic medication. This case illustrates the difficulty of using anticholinergics to treat dystonias in older people, which can precipitate delirium. Choosing an alternative antipsychotic with less extrapyramidal symptom risk is challenging as she had previous trials with quetiapine and risperidone. Clozapine was deemed an unfavorable alternative, as laboratory monitoring would be burdensome. Olanzapine-induced dystonias can develop anytime during therapy. Families must balance the desire for mood stabilization with antipsychotics side effects.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Dystonia; Female; Humans; Olanzapine; Risperidone

A 46 year-old man with schizophrenia had taken several anti-psychotic drugs since 25 years of age. From ~35 years of age, he noticed occasional neck torsion to the left, and later an ataxic gait; both symptoms gradually worsened. On admission, the patient was taking olanzapine (5 mg/day) and biperiden hydrochloride (1 mg/day) because his schizophrenia was well controlled. His parents were not consanguineous, and there was no family history of neuropsychiatric diseases. On neurological examination, he showed mild cognitive impairment, saccadic eye pursuit with horizontal gaze nystagmus, mild dysarthria, dystonic posture and movement of the neck, incoordination of both hands, and an ataxic gait. Deep tendon reflexes were normal except for the patellar tendon reflex, which was exaggerated bilaterally. Pathological reflexes were negative and there was no sign of rigidity, sensory disturbance or autonomic dysfunction. Ophthalmological examinations detected thinning of the outer macula lutea in both eyes, indicative of macular dystrophy. After admission, all anti-psychotic drugs were ceased, but his dystonia was unchanged. Levodopa and trihexyphenidyl hydrochloride were not effective. General blood, urine and cerebrospinal fluid examinations showed no abnormalities. Brain MRI showed cerebellar atrophy and bilateral symmetrical thalamic lesions without brainstem atrophy or abnormal signals in the basal ganglia. I

Topics: Antipsychotic Agents; Atrophy; Biperiden; Cerebellar Ataxia; Cerebellum; Dystonia; Dystonia Musculorum Deformans; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neck; Olanzapine; Schizophrenia

Topics: Adolescent; Akathisia, Drug-Induced; Antipsychotic Agents; Aripiprazole; Autism Spectrum Disorder; Delusions; Dystonia; Female; Hallucinations; Humans; Hypnotics and Sedatives; Intellectual Disability; Lorazepam; Loxapine; Olanzapine; Paranoid Disorders; Psychotic Disorders; Quetiapine Fumarate; Tourette Syndrome

Olanzapine-related seizures have rarely been reported despite associated proconvulsant risk factors described in the literature: myoclonic status, increased frequency of seizures, tonic-clonic seizures, as well as fatal status epilepticus. We present a psychiatric patient who developed repetitive focal motor seizures and lingual dystonia when olanzapine was added for psychomotor agitation and aggressiveness. Olanzapine was immediately suspended and the seizures progressively disappeared. A control EEG showed no paroxysmal discharges. Olanzapine shares some pharmacological similarities with clozapine, a neuroleptic with a high risk of dose-dependent seizures. This adverse effect should be taken into account, and olanzapine should be used with caution if concomitant circumstances decrease the seizure threshold. [Published with video sequence online].

Topics: Antipsychotic Agents; Benzodiazepines; Dystonia; Electroencephalography; Epilepsy, Partial, Motor; Humans; Male; Middle Aged; Olanzapine; Seizures

We report the patient of a 53-year-old woman who developed subacute-onset marked tonge protrusion and bite. She was diagnosed as dementia with Lewy bodies (DLB) from the clinical features including progressive cognitive decline, visual hallucinations, parkinsonism, and severe insomnia and depression, and the radiological finding of low dopamine transported uptake in basal ganglia by Dat SCAN and low blood circulation in occipital lobe of cerebrum. The patient received 600 mg doses of levodopa for over a year, followed by rotigotine and ropinirole with a rapid increase of dosage. It is believed that these treatments stimulated and sensitized dopamine D1 receptors, thereby inducing lingual dystonia. Furthermore, the patient demonstrated dyspnea and attacks of apnea caused by the closure of bilateral vocal cords due to laryngeal dyskinesia. After initiation of the neuroleptic, olanzapine, for a short duration, the high dose of levodopa overlapped with neuroleptic sensitivity, suggesting DOPA-induced dystonia and dyskinesia. This interaction can sometimes lead to lethal adverse events, and must be considered very important when treating patients with DLB.

Topics: Acute Disease; Antipsychotic Agents; Benzodiazepines; Bites and Stings; Drug Interactions; Drug Therapy, Combination; Dyskinesia, Drug-Induced; Dystonia; Female; Humans; Indoles; Laryngeal Diseases; Levodopa; Lewy Body Disease; Middle Aged; Olanzapine; Receptors, Dopamine D1; Tetrahydronaphthalenes; Thiophenes; Tongue Diseases

The incidence of extrapyramidal symptoms (EPS) has been shown to be generally low among patients with schizophrenia receiving oral olanzapine. A long-acting injection (LAI) of olanzapine has recently been approved for the treatment of schizophrenia in a number of countries. Accordingly, the objective of the current analyses was to compare the incidences of EPS during treatment with olanzapine LAI versus oral olanzapine.. The incidences of treatment-emergent EPS were examined in adults with schizophrenia receiving olanzapine LAI or oral olanzapine for up to 3 years. Short-term data were obtained from two double-blind studies of olanzapine LAI: one included a placebo comparator, and the other included oral olanzapine as an active comparator. Long-term data were obtained from an open-label extension study for olanzapine LAI and from an integrated database for oral olanzapine.. The short-term incidence of EPS was 5.6% during treatment with olanzapine LAI (45-405 mg every 2-4 weeks) and 5.0% with oral olanzapine (5-20 mg/day). Akathisia (2.6% LAI, 1.2% oral), and Parkinson-like symptoms (1.8% LAI, 3.7% oral) were similar between treatment groups. The incidence of EPS for long-term treatment was 9.2% for olanzapine LAI. Incidences of EPS events were not significantly different between patients receiving olanzapine LAI or oral olanzapine for up to 3 years.. These findings suggest that EPS profiles are similar for olanzapine LAI and oral olanzapine.

Topics: Administration, Oral; Adolescent; Adult; Aged; Akathisia, Drug-Induced; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Delayed-Action Preparations; Dyskinesia, Drug-Induced; Dystonia; Humans; Incidence; Middle Aged; Olanzapine; Parkinsonian Disorders; Schizophrenia; Young Adult

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dystonia; Female; Humans; Olanzapine; Piperazines; Piperidines; Risperidone; Schizophrenia; Young Adult

Topics: Adult; Airway Obstruction; Anesthetics, Intravenous; Antipsychotic Agents; Benzodiazepines; Drug Interactions; Dystonia; Fracture Fixation; Humans; Laryngeal Muscles; Male; Olanzapine; Propofol; Psychotic Disorders; Spinal Fractures

Topics: Adult; Antiparkinson Agents; Antipsychotic Agents; Benzodiazepines; Chlorpromazine; Drug Therapy, Combination; Dystonia; Fatal Outcome; Haloperidol; Humans; Larynx; Male; Olanzapine; Respiratory Distress Syndrome; Respiratory Insufficiency; Risperidone; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dystonia; Humans; Male; Olanzapine; Piperazines; Schizophrenia, Paranoid; Thiazoles

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dystonia; Humans; Male; Ocular Motility Disorders; Olanzapine; Schizophrenia

Frontotemporal dementia (FTD) often presents with behavioural changes warranting treatment with antipsychotic medications. It is known that patients with Lewy body dementia are sensitive to developing extrapyramidal symptoms (EPS) from these medications. This has not been emphasized in FTD. We report three patients with FTD that developed parkinsonism and prominent antecollis after treatment with newer antipsychotics, including olanzapine, risperidone and quetiapine. Patients with FTD might have increased sensitivity to antipsychotic medications as with Lewy body dementia. Although newer antipsychotics have favourable side effect profiles, there is increasing evidence that EPS develop more frequently than previously thought.

Topics: Antipsychotic Agents; Benzodiazepines; Dementia; Dibenzothiazepines; Dystonia; Humans; Male; Middle Aged; Neck Muscles; Olanzapine; Parkinsonian Disorders; Quetiapine Fumarate; Risperidone

The patient with acute extrapyramidal signs and symptoms presents a significant clinical challenge. We present the case of a young man who developed an acute akathisia and dystonia after inadvertent overdose of olanzapine (Zyprexa) in the setting of a recent discontinuation of fluoxetine. The receptor chemistry and mechanisms pertinent to his presentation are reviewed. An analysis of the literature indicates that a broad incidence range is cited for the extrapyramidal effects of these medications. We suggest a diagnostic and therapeutic approach to the undifferentiated patient presenting with extrapyramidal signs and symptoms. The possibility of neuroleptic malignant syndrome (NMS), serotonin syndrome (SS), tricyclic overdose, and cocaine abuse should be considered in a patient with extrapyramidal signs and symptoms, given the potential for complications. An emphasis is placed on the need for carefully verbalized discharge instructions to avoid a potential untoward outcome.

Topics: Accidents; Acute Disease; Adult; Akathisia, Drug-Induced; Benzodiazepines; Drug Overdose; Dystonia; Emergency Service, Hospital; Fluoxetine; Humans; Male; Olanzapine; Selective Serotonin Reuptake Inhibitors

To report a case of olanzapine-induced Pisa syndrome that improved after treatment with clozapine.. A 22-year-old male with paranoid schizophrenia presented with insidious onset tonic truncal flexion with axial rotation and difficulty in walking after exposure to olanzapine in doses up to 15 mg/day for 9 months. An objective causality assessment suggested that Pisa syndrome was probably related to olanzapine. There was improvement in his symptoms after 6 weeks of treatment with clozapine in doses gradually titrated to 350 mg/day.. Pisa syndrome is a type of dystonia that has been associated with both typical and atypical antipsychotics. Both acute and insidious onset cases have been described in the literature, which have different course and treatment response. Clozapine was found to be effective in reducing the severity of olanzapine-induced Pisa syndrome.. Clozapine may be a useful treatment option for Pisa syndrome that has been caused by olanzapine.

Topics: Adult; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Dystonia; Humans; Male; Olanzapine; Schizophrenia, Paranoid; Syndrome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Drug Administration Schedule; Dystonia; Female; Humans; Olanzapine; Recurrence; Schizophrenia, Paranoid

This is the first report on generalised dystonia beneficially treated by olanzapine. A 63-year-old Taiwanese man with intractable general dystonia was treated with olanzapine starting at a dose of 2.5 mg/day to the maximal dose of 15 mg/day. Clinically, there was slow, but steady, improvement in his dystonia and disability after olanzapine treatment. Evaluation of his dystonia 3 months later revealed 70% improvement on dystonic movement and 60% on disability on the Burke-Fahn-Marsden Dystonia Scale. The result suggests that treatment with olanzapine can be an alternative therapy for patients with generalised dystonia.

Topics: Antipsychotic Agents; Benzodiazepines; Disability Evaluation; Dystonia; Humans; Male; Middle Aged; Olanzapine; Severity of Illness Index

Topics: Antipsychotic Agents; Benzodiazepines; Dystonia; Humans; Larynx; Male; Middle Aged; Olanzapine; Pharynx; Schizophrenia

Topics: Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; Dystonia; Female; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Schizophrenia

Topics: Adult; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Dystonia; Female; Humans; Olanzapine; Pirenzepine; Tongue Diseases

Topics: Antipsychotic Agents; Benzodiazepines; Dystonia; Facial Muscles; Humans; Male; Middle Aged; Neck Muscles; Olanzapine; Pirenzepine; Psychotic Disorders; Recurrence; Risperidone

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Dyskinesia, Drug-Induced; Dystonia; Female; Humans; Olanzapine; Pirenzepine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dyskinesia, Drug-Induced; Dystonia; Humans; Male; Olanzapine; Pirenzepine; Schizophrenia, Paranoid

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Dystonia; Female; Humans; Olanzapine; Pirenzepine

Topics: Acute Disease; Antipsychotic Agents; Benzodiazepines; Dystonia; Female; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Psychotic Disorders; Schizophrenia, Paranoid