olanzapine and Hallucinations

A 54-year-old woman diagnosed with primary Sjögren's syndrome in 2007 presented with a 1-year history of visual hallucinations requiring admission to a psychiatric unit. The hallucinations resolved while on olanzapine and hydroxychloroquine but recurred when they were stopped. Despite restarting olanzapine, her visual hallucinations persisted. When she started a tapering dose of prednisolone, all the hallucinations resolved. This report adds to the small literature on psychiatric manifestations of Sjögren's syndrome and provides evidence that low-dose corticosteroids may be an effective treatment for this manifestation.

Topics: Antipsychotic Agents; Antirheumatic Agents; Benzodiazepines; Female; Glucocorticoids; Hallucinations; Humans; Hydroxychloroquine; Middle Aged; Olanzapine; Prednisolone; Sjogren's Syndrome; Treatment Outcome

Turner syndrome encompasses several chromosomal abnormalities and includes a typical clinical manifestation. While common somatic symptoms are often described, neuropsychiatric alterations are rare and not frequently mentioned in the literature.. In this paper, we report on a subject with Turner syndrome who also showed psychotic symptoms.. The theoretical background and the relevance of this observation are discussed. Furthermore, this article briefly reviews existing reports on Turner syndrome and psychosis and presents neuropsychiatric changes in patients with Turner syndrome.

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Chromosome Aberrations; Citalopram; Combined Modality Therapy; Drug Therapy, Combination; Female; Hallucinations; Humans; Middle Aged; Olanzapine; Patient Education as Topic; Psychotherapy; Psychotic Disorders; Risperidone; Turner Syndrome

Traumatic brain injury (TBI) can result in serious and disabling neuropsychiatric disorders.. The authors report a case of a 51-year old male, admitted to the psychiatric ward for acute psychosis and suicidal ideation, probably associated with TBI. After a temporal head trauma he initiated auditory/verbal hallucinations and subsequently developed paranoid delusions. The electroencephalography showed slow bilateral temporal activity and the neuropsychological testing showed several impairments. The patient improved with olanzapine at a dosage of 20 mg daily.. This case shows the difficulty of differential diagnosis between schizophrenia and psychotic disorder due to traumatic brain injury.. The authors conducted a revision of literature about the diagnosis, epidemiology, clinical aspects, laboratory and structural investigations and the treatment of this condition. Based on this revision work, the authors sketch some recommendations about the work-up that should be done when faced with this diagnostic hypothesis.

Topics: Antipsychotic Agents; Benzodiazepines; Brain Injuries; Diagnosis, Differential; Electroencephalography; Hallucinations; Humans; Male; Middle Aged; Neuropsychological Tests; Olanzapine; Paranoid Disorders; Portugal; Psychotic Disorders; Schizophrenia

Drug-induced iatrogenic hallucinations and psychosis occur in about 30% of Parkinson's disease (PD) patients and are the single most important precipitant for nursing home placement, which carries a grave prognosis. In addition, parkinsonism is a frequent accompaniment to the more common dementing syndromes, Alzheimer's disease (AD), vascular dementia, and dementia with Lewy bodies (DLB). The five most recent antipsychotic drugs approved by the Food and Drug Administration in the United States have been marketed as "atypical" antipsychotics (AA) due to their relative freedom from extrapyramidal symptoms when used in schizophrenia patients. The use of these newer antipsychotic drugs in PD and other parkinson-sensitive populations represents the most stringent test to their freedom from motor side effects. To date, clozapine, risperidone, olanzapine, and quetiapine have been studied in parkinson-vulnerable populations. This article reviews the data and highlights the differences that these four drugs have on motor function. It also emphasizes the challenges in evaluating the available data on the motor effects of AA, especially on the non-PD elderly and cognitively impaired population. Suggestions are made for future research to improve the interpretability of these studies.

Topics: Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Clozapine; Dementia, Vascular; Dibenzothiazepines; Hallucinations; Humans; Iatrogenic Disease; Lewy Body Disease; Olanzapine; Parkinson Disease; Pirenzepine; Psychotic Disorders; Quetiapine Fumarate; Risperidone

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Delusions; Hallucinations; Humans; Olanzapine; Pirenzepine; Psychotic Disorders; Risperidone

Hallucinations are prevalent in schizophrenia and related psychotic disorders and may have severe consequences for the affected patients. Antipsychotic drug trials that specifically address the anti-hallucinatory effectiveness of the respective drugs in representative samples are rare. The aims of the present study were to investigate the rate and severity of hallucinations in acutely admitted psychotic patients at hospital admission and discharge or after 6 weeks at the latest, if not discharged earlier (discharge/6 weeks); and to compare the anti-hallucinatory effectiveness of risperidone, olanzapine, quetiapine, and ziprasidone with up to 2 years' follow-up.. Adult patients acutely admitted to an emergency ward for psychosis were consecutively randomized to risperidone, olanzapine, quetiapine, or ziprasidone and followed for up to 2 years in a pragmatic design. Participants were assessed repeatedly using the hallucinatory behavior item of the Positive and Negative Syndrome Scale (PANSS).. A total of 226 patients, 30.5% of those assessed for eligibility, were randomized and 68% were hallucinating at baseline. This proportion was reduced to 33% at discharge/6 weeks. In the primary analyses based on intention to treat groups of patients experiencing frequent hallucinations, the quetiapine and ziprasidone groups both had faster decreases of the mean hallucination scores than the risperidone group.. Hallucinations are fairly responsive to antipsychotic drug treatment and differential anti-hallucinatory effectiveness may be found among existing antipsychotic drugs. If replicated, this could pave the way for a more targeted pharmacotherapy based on individual symptom profiles, rather than on the diagnostic category.. ClinicalTrials.gov ID; NCT00932529.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Female; Hallucinations; Hospitalization; Humans; Male; Middle Aged; Olanzapine; Piperazines; Psychiatric Status Rating Scales; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Thiazoles; Treatment Outcome

Gender differences exist in psychiatric disorders; however, gender has not been well studied in psychotic depression. This analysis of the largest clinical trial in psychotic depression examined the effects of age and gender on clinical characteristics and predictors of treatment outcome and treatment-associated changes in body mass index (BMI) and metabolic measures.. Secondary analyses were performed on data from 259 subjects with major depressive disorder with psychotic features (DSM-IV-TR) aged 18-93 years in the double-blind randomized controlled trial of olanzapine plus sertraline versus olanzapine plus placebo for psychotic depression (Study of Pharmacotherapy of Psychotic Depression). Sociodemographic factors, clinical characteristics, treatment outcome, and treatment-associated changes in BMI and metabolic measures were analyzed by gender and age. Subjects were enrolled from December 2002 to June 2007.. Female gender was associated with divorced (χ(2)(1) = 5.3, P = .03) or widowed (χ(2)(1) = 8.1, P ≤ .01) marital status. Comorbid anxiety disorders were more common in women than in men (χ(2)(1) = 4.9, P = .03). Hallucinations (χ(2)(1) = 7.8, P = .005) and delusions with disorganization (t(257) = -2.10, P = .04) were significantly associated with female gender, as were higher cholesterol measures (χ(2)(1) = 7.15, P = .008). There were no significant interactions between treatment and gender in terms of change in BMI. Gender was not associated with treatment response.. This study is the first analysis of gender and age as predictors of treatment outcome and treatment-associated changes in BMI and metabolic adverse effects in psychotic depression. Gender differences exist in patients with psychotic depression, most notably with regard to the presence of hallucinations. Female gender was associated with metabolic measures. Future studies with larger sample sizes may detect small gender differences in treatment outcome and treatment-associated changes in BMI and metabolic measures in psychotic depression.. ClinicalTrials.gov identifier: NCT00056472.

Topics: Adult; Age Factors; Aged; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Body Weight; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Drug Monitoring; Drug Therapy, Combination; Female; Hallucinations; Humans; Male; Metabolism; Middle Aged; Olanzapine; Outcome Assessment, Health Care; Psychiatric Status Rating Scales; Sertraline; Sex Factors; Socioeconomic Factors; Treatment Outcome

Psychotic symptoms and behavioral disturbances are a concern in the care of elderly patients with Alzheimer's dementia (AD). This study was conducted to compare the efficacy of olanzapine versus placebo in patients with psychotic symptoms associated with AD in long-term or continuing-care settings.. Patients (n = 652) with AD and delusions or hallucinations were randomly assigned to 10 weeks of double-blind treatment with placebo or fixed-dose olanzapine (1.0, 2.5, 5.0, 7.5 mg/day).. Mean age was 76.6+/-10.4 years. Repeated-measures analysis showed significant improvement from baseline in NPI/NH Psychosis Total scores (sum of Delusions, Hallucinations items-primary efficacy measure) in all five treatment groups (p<0.001), but no pairwise treatment differences were seen at the 10-week endpoint. However, under LOCF analysis, improvement in the 7.5 mg olanzapine group (-6.2 +/- 4.9) was significantly greater than with placebo (-5.0 +/- 6.1, p = 0.008), while endpoint CGI-C scores showed the greatest improvement in the Olz 2.5 olanzapine group (2.8 +/- 1.4, p = 0.030) relative to placebo (3.2 +/- 1.4). There were significant overall treatment-group differences in increased weight, anorexia, and urinary incontinence, with olanzapine showing numerically higher incidences. However, neither the incidence of any other individual events, including extrapyramidal symptoms, nor of total adverse events occurred with significantly higher frequency in any olanzapine group relative to placebo. No clinically relevant significant changes were seen across groups in cognition or any other vital sign or laboratory measure, including glucose, triglyceride, and cholesterol.. While 1.0 mg olanzapine did not show significant differences from placebo, the 2.5 mg dose was a reasonable starting dose. Olanzapine at 7.5 mg/day significantly decreased psychosis and overall behavioral disturbances (NPI/NH, BPRS) and was well tolerated.

Topics: Adult; Aged; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Cognition Disorders; Delusions; Double-Blind Method; Female; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Patient Compliance; Psychiatric Status Rating Scales; Psychotic Disorders; Time Factors; Treatment Outcome

Attentional deficits have been implicated in the pathophysiology of auditory hallucinations in schizophrenia. Since the latency of the P300 component of event-related potentials (ERPs) is considered to be a sensitive measure of stimulus classification speed, while its amplitude-a measure of attentional resource allocation when memory updating is engaged, the present study focuses on the comparison of P300 between healthy subjects and schizophrenic patients experiencing auditory hallucinations and treated with clozapine and olanzapine.. The auditory P300 was assessed during the anticipatory period of a short memory test, in 16 male hallucinated schizophrenic patients and 13 male normal subjects matched for age and educational level. The patients were reexamined under identical conditions when their hallucinations had resolved following treatment with clozapine (8 patients) and olanzapine (8 patients).. The patients with hallucinations exhibited significantly reduced P300 amplitude at leads Fp1, F3, (C3-T5)/2, F4, Cz and Fz, when compared to the normal controls and at leads Fp1, F3, F4, (C4-T6)/2, C4, P4, Cz and Fz when compared to themselves during the remission phase. However logistic regression models revealed that the most important leads, differentiating the patient group before treatment either with the healthy controls, or with itself after treatment, were that at the left temporoparietal and at the left prefrontal area. Memory performance of the patient group, even after treatment and in spite of its significant improvement, remained significantly less than that of healthy controls. both antipsychotic agents had similar effects on the p300 amplitude and memory performance.. These findings indicate that auditory hallucinations in schizophrenia manifest abnormal aspects of attention, mediated by a distributed network involving or affecting the left temporoparietal and left prefrontal area. Additionally, the present study points to an improvement of attentional function in schizophrenic patients experiencing auditory hallucinations, both in the clozapine group but also in the olanzapine group.

Topics: Adult; Antipsychotic Agents; Attention; Benzodiazepines; Case-Control Studies; Clozapine; Event-Related Potentials, P300; Hallucinations; Humans; Male; Memory, Short-Term; Neuropsychological Tests; Olanzapine; Psychiatric Status Rating Scales; Reaction Time; Schizophrenia

Older individuals with dementia are highly sensitive to the effects of muscarinic receptor blockade.. This was a 6-week multisite, randomized clinical trial.. Eighty-six patients with probable Alzheimer's disease, vascular dementia, or mixed-etiology dementia (DSM-IV criteria) were randomly assigned to treatment with olanzapine or risperidone.. Anticholinergic activity was measured with a radioreceptor assay, and plasma levels of antipsychotic medications were determined. Primary outcomes were assessed with the Udvalg for Kliniske Undersogelser (UKU) scale and somnolence adverse events; secondary outcome measures included scores on the Neuropsychiatric Inventory (NPI) and other scales.. There were no between-treatment differences in the UKU scale or in somnolence adverse events. Statistically significant improvements (p < .001) from baseline were found for the NPI measures, with no between-treatment group differences. Olanzapine was associated with significant increases from baseline in anticholinergic activity, while risperidone was not; the between-treatment group differences were not statistically significant. Increase in anticholinergic activity was associated with an increase in anticholinergic side effects and slower performance on the Trail Making Test Part A. Higher endpoint anticholinergic activity was associated with higher endpoint scores on several items from the NPI, including delusions, anxiety, and aberrant motor behavior.. Efficacious doses of olanzapine increased anticholinergic activity in older patients with dementia, while similarly efficacious doses of risperidone did not. Patients whose anticholinergic activity increased were more likely to experience anticholinergic side effects and to have worsening in certain cognitive domains. These data suggest that certain patients may be vulnerable to the anticholinergic activity associated with antipsychotic treatment.

Topics: Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Cognition Disorders; Delusions; Dementia; Double-Blind Method; Female; Hallucinations; Humans; Male; Middle Aged; Muscarinic Antagonists; Olanzapine; Psychiatric Status Rating Scales; Psychotic Disorders; Radioligand Assay; Receptors, Muscarinic; Risperidone; Sleep Wake Disorders; Trail Making Test; Treatment Outcome

The aim of the study was to investigate patterns of the P600 component of event-related potentials (ERPs) elicited during a working memory test in 16 male schizophrenic patients experiencing auditory hallucinations before and after treatment with clozapine and olanzapine, and 13 male normal subjects matched for age and educational level. Before treatment, patients showed significantly reduced P600 amplitudes on the right parietal region compared with controls, and when in remission also showed significantly reduced P600 amplitudes located on the right parietal and temporofrontal areas, compared both to themselves before treatment and to normal controls. The patient's memory performance before and after treatment remained significantly lower than that of healthy controls. These findings may indicate that auditory hallucinations in schizophrenia are associated with impaired synchronization of the processes related to target detection, as reflected by the P600. The present study also casts doubts regarding the cognitive sparing effect of atypical antipsychotics, despite the fact that they mediate symptom improvement.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Brain; Clozapine; Cognition; Double-Blind Method; Evoked Potentials, Auditory; Hallucinations; Humans; Male; Memory; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Reference Values; Schizophrenia; Schizophrenic Psychology

Atypical antipsychotic medications with lower affinities for D2 receptors are considered useful alternatives to treat drug-induced hallucinations in Parkinson's disease (PD). We conducted a double-blind, placebo-controlled, unforced titration, parallel design study (2:1 drug to placebo randomization ratio) using olanzapine (2.5-10 mg/day to effect) in 30 PD patients with drug-induced hallucinations. We performed an extensive battery of neuropsychological tests, the Unified Parkinson's Disease Rating Scale (UPDRS), assessments of on and off time at baseline and at 9 weeks after starting the medication. Sixteen patients on olanzapine (mean dose, 4.6 mg/night) and 11 on placebo completed the study. Compared with placebo, performance on the UPDRS item 2 (thought disorder), and a structured interview for hallucinations, both tended to improve on drug but neither reached statistical significance. A neuropsychological test battery did not show any significant differences. Total on UPDRS motor scores (P < 0.05) and timed tapping (P < 0.01) worsened while on drug compared to placebo. Bradykinesia (P < 0.01) and gait (P < 0.001) items on the UPDRS largely accounted for this deterioration. After completion of the study, 8 of 16 patients randomly assigned to drug continued olanzapine at a mean dose of 2.4 mg/day. However, at the last recorded visit only 5 of 24 (20.8%) of all patients exposed to drug (including those originally randomly assigned to placebo) remained on olanzapine. In patients with PD, low-dose olanzapine did not significantly improve hallucinations but did worsen motor function.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Cognition Disorders; Dopamine Agonists; Double-Blind Method; Female; Hallucinations; Humans; Interview, Psychological; Male; Neuropsychological Tests; Olanzapine; Parkinson Disease; Pirenzepine

This study sought to determine whether patients with dementia with Lewy bodies (DLB) and psychosis responded to treatment with olanzapine.. This was a post hoc analysis of a subgroup of patients with DLB included in a larger double-blind, placebo-controlled, randomized parallel group trial of olanzapine for the treatment of psychosis in patients with Alzheimer's disease. Patients meeting the consensus criteria for DLB and exhibiting parkinsonism and visual hallucinations were selected from the initial study. Psychosis was assessed with the Neuropsychiatric Inventory/Nursing Home (NPI-NH) version and the Brief Psychiatric Rating Scale (BPRS). Extrapyramidal symptoms were evaluated with the Simpson-Angus scale.. Twenty-nine patients met the criteria for DLB; 10 were randomized to placebo, 5 received 5 mg of olanzapine, 7 received 10 mg of olanzapine and 7 received 15 mg of olanzapine. Patients with DLB treated with 5 mg of olanzapine showed significant reductions in delusions and hallucinations. Patients treated with 10 mg showed a significant reduction in the NPI-NH delusion subscale score. No significant differences were found between the 15-mg group and the placebo group. Confirmatory findings emerged from an analysis of the BPRS. Caregivers reported decreased disruptions in their occupational routines for the group receiving 5 or 10 mg of olanzapine. There was no significant exacerbation of parkinsonian symptoms in any study group, no decrement in Mini-Mental State Examination scores in any of the treatment groups, and symptoms suggestive of anticholinergic toxicity did not differ among treatment groups.. This preliminary analysis suggests that olanzapine (5 or 10 mg) reduces psychosis in patients with DLB without worsening parkinsonism.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Behavior; Benzodiazepines; Cognition; Delusions; Dose-Response Relationship, Drug; Double-Blind Method; Female; Hallucinations; Humans; Lewy Body Disease; Male; Olanzapine; Parkinsonian Disorders; Personality Inventory; Pirenzepine; Psychiatric Status Rating Scales; Psychotic Disorders

Elderly patients with Alzheimer's disease (AD) commonly exhibit psychotic symptoms, prompting clinicians to administer antipsychotics. This article compares the effects of olanzapine and placebo in the emergence of hallucinations or delusions in AD patients with symptoms of agitation/aggression but little or no psychotic symptomatology at baseline.. A multicenter, double-blind, placebo-controlled study was conducted in nursing home patients with AD according to DSM-IV criteria and symptoms of agitation/aggression and/or psychosis. Patients (N = 206) were randomly assigned to receive either placebo or fixed-dose olanzapine (5, 10, or 15 mg/day) for up to 6 weeks. This article analyzes data from a subgroup of patients (N = 165) with no or minimal delusions and/or hallucinations at baseline as measured by the Neuropsychiatric Inventory-Nursing Home Version (NPI/NH). Three subsets of patients were identified on the basis of their symptoms at baseline: those with no clinically significant hallucinations, those with no clinically significant delusions, and those with no clinically significant delusions or hallucinations.. Of the patients without hallucinations or delusions at baseline (N = 75), the placebo-treated patients showed significantly greater development of these symptoms compared with olanzapine-treated patients overall (NPI/NH hallucinations + delusions mean change score, +2.73 vs. +0.27, p = .006). Similarly, of the patients without baseline hallucinations (N = 153), the placebo-treated patients showed greater hallucinations score increases than did olanzapine-treated patients overall (+1.25 vs. +0.33, p = .026), whereas patients without baseline delusions (N = 87) showed no significant treatment effects. Olanzapine had a favorable safety profile in each patient subset.. These results suggest that, overall, olanzapine effectively attenuated emergence of psychosis in a short-term trial of patients with Alzheimer's disease.

Topics: Aged; Aged, 80 and over; Aggression; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Delusions; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hallucinations; Humans; Male; Nursing Homes; Olanzapine; Pirenzepine; Psychomotor Agitation; Psychotic Disorders; Treatment Outcome

To compare olanzapine and clozapine for safety and efficacy measures of psychosis and motor function in patients with PD and chronic hallucinations.. Hallucinations occur in approximately one third of patients with PD treated chronically with dopaminergic drugs. Although clozapine is known to be an effective antipsychotic agent that does not significantly exacerbate parkinsonism, its use requires frequent blood count assessment. Olanzapine is another novel antipsychotic that is not associated with blood dyscrasia, and if equally effective could become the preferred drug for treating hallucinations in subjects with PD.. A randomized, double-blind, parallel comparison of olanzapine and clozapine in patients with PD with chronic hallucinations was conducted. The primary outcome measure was the Scale for the Assessment of Positive Symptoms (SAPS) for psychotic symptoms. The Unified Parkinson's Disease Rating Scale (UPDRS) motor subscale was used as a secondary outcome measure and as a safety monitoring tool.. After 15 patients had completed the study, safety stopping rules were invoked because of exacerbated parkinsonism in olanzapine-treated subjects. UPDRS motor impairment scores from baseline to study end significantly increased with olanzapine treatment, and change scores between the olanzapine and clozapine groups significantly differed. The primary clinical domains responsible for the motor decline were gait and bradykinesia. Even with a smaller patient number than originally anticipated, clozapine significantly improved hallucinations and overall behavioral assessment, whereas olanzapine had no effect.. At the doses studied, olanzapine aggravates parkinsonism in comparison with clozapine and should not be regularly used in the management of hallucinations in patients with PD.

Topics: Aged; Behavior; Benzodiazepines; Clozapine; Double-Blind Method; Female; Hallucinations; Humans; Male; Middle Aged; Movement; Olanzapine; Parkinson Disease; Pirenzepine

Hallucinosis is a dopaminergic dose limiting complication of the treatment of idiopathic Parkinson's disease. Typical neuroleptic medications cannot be used for suppressing hallucinosis because the extrapyramidal side effects worsen parkinsonian motor control. Olanzapine is a novel atypical antipsychotic drug with few reported extrapyramidal side effects which may be more suitable for controlling hallucinosis in these patients.. Olanzapine was given to five patients with idiopathic Parkinson's disease and the dosage was titrated until a clinically meaningful reduction in hallucinosis was achieved. The commercially available 5 mg, 7.5 mg and 10 mg tablets were used.. After an initial 9 days of treatment, hallucinosis frequency was significantly reduced, an effect which was maintained with continued treatment. However, during this early phase of treatment, parkinsonian motor disability increased, which resulted in two of the patients discontinuing medication.. Olanzapine is effective in the suppression of hallucinosis in patients with idiopathic Parkinson's disease but the currently available dose increments may result in an unacceptable exacerbation of motor disability.

Topics: Aged; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Dose-Response Relationship, Drug; Female; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Parkinson Disease; Pirenzepine; Severity of Illness Index

Topics: Antipsychotic Agents; Benzodiazepines; Delirium; Hallucinations; Humans; Olanzapine

We report a case of refractory psychosis after carbon monoxide poisoning in a 65-year-old woman who attempted suicide by charcoal burning in 2018. On discharge from hospital, she was bedbound, tube-fed, and had limited verbal output. In early 2019, she was able to resume oral feeding and her physical condition improved. However, she started to have paranoid ideas and auditory hallucinations. She was diagnosed as having organic brain syndrome and was prescribed with quetiapine 300 mg every night. Because of the poor clinical response, quetiapine was switched to olanzapine 20 mg every night and augmented with amisulpride and valproate sodium. However, she remained distressed, psychotic, and suicidal. She was then prescribed with clozapine 300 mg every night. Her symptoms improved despite residual auditory hallucinations remained, but she was less distressed about them.

Topics: Aged; Carbon Monoxide Poisoning; Female; Hallucinations; Humans; Olanzapine; Psychotic Disorders; Quetiapine Fumarate

Topics: Antipsychotic Agents; Asymptomatic Infections; COVID-19; Delusions; Female; Hallucinations; Haloperidol; Humans; India; Olanzapine; Psychotic Disorders; Puerperal Disorders; Restraint, Physical; Self-Injurious Behavior; Trihexyphenidyl; Young Adult

Topics: Adult; Antipsychotic Agents; Delusions; Hallucinations; Humans; Male; Olanzapine; Psychotic Disorders

A man in his 40s was brought to the accident and emergency department in an acute psychotic state, 3 weeks after the European Union referendum results in the UK were declared. His mental health had deteriorated rapidly following the announcement of the results, with significant concerns about Brexit. He presented as agitated, confused and thought disordered. He had auditory hallucinations, and paranoid, referential, misidentification and bizarre delusions. He recovered completely within 2 weeks after a brief admission and treatment with olanzapine. He had experienced a similar episode of much less severity 13 years previously after major work related stress which resolved completely within a few days. He was experiencing stress related to work and family prior to the current episode which could potentially have been a contributory factor. Political events can act as major psychological stressors and have a significant impact on the mental health of people, especially those with a predisposition to develop mental illness.

Topics: Adjustment Disorders; Adult; Antipsychotic Agents; Delusions; Diagnosis, Differential; European Union; Hallucinations; Humans; Male; Olanzapine; Psychotic Disorders; Treatment Outcome; United Kingdom

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

A dopamine excess is thought to be involved in positive psychotic symptoms in schizophrenia. All current antipsychotics show a degree of dopamine receptor antagonism. Little is known about the differential effectiveness of different antipsychotics in treating specific sets of symptoms. We report the case of a 35-year-old man with schizophrenia who presented with prominent hallucinatory symptoms (Positive and Negative Syndrome Scale [PANSS] P1=5, P3=5, P6=5) resistant to high doses of a dopamine, serotonin receptor antagonist, olanzapine. Switching from olanzapine to zuclopenthixol, a dopamine D2 receptor antagonist, led to a complete shift of his symptomatology: his hallucinations abated, however, he presented as very highly paranoid (PANSS P1=6, P3=2, P6=7). On a combination of both antipsychotics, his symptoms subsided (PANSS P1=3, P3=2, P6=2). We discuss the potential for differential effectiveness of different antipsychotic medications in treating hallucinations and paranoia. We argue that future studies could address this question by stratifying patients based on symptoms.

Topics: Adult; Antipsychotic Agents; Clopenthixol; Dopamine Antagonists; Drug Therapy, Combination; Hallucinations; Humans; Male; Olanzapine; Paranoid Disorders; Receptors, Dopamine; Schizophrenia; Treatment Outcome

A 94 year old woman with a late-onset paraphrenia was referred to our clinic from a community care center. The patient showed symptoms of paranoia and auditory hallucination. The patient was in conflict with her neighbors regarding noise-related problems and was experiencing loss of appetite. Because the patient had a strong aversion to outpatient treatment due to difficulty in commuting, home visits were commenced. Improvements were observed after administration of 2.5 mg per day of olanzapine.In home medical care, precise definitive diagnosis and determination of treatment approach is necessary under limited time and resources. The fact that elderly people often exhibit psychological symptoms such as hallucinations is well known among clinical professions. However, this is not well known among home care patients, families and other professionals, and, therefore, is often overlooked. As the population ages further, it can be predicted that cases of elderly patients requiring treatment for psychological symptoms will increase in home medical care situations. In Japan, with a super-aging society, understanding and continuously supporting late-onset paraphrenia among elderly people is a pressing issue for all communities in advancing home medical care and nursing.

Topics: Age of Onset; Aged, 80 and over; Female; Hallucinations; Home Care Services; Humans; Mood Disorders; Olanzapine

Topics: Aged, 80 and over; Female; Hallucinations; Hearing Loss; Humans; Music; Olanzapine; Selective Serotonin Reuptake Inhibitors

A 50-year-old man with known multidrug resistant coexistent focal and generalised epilepsy was commenced on ethosuximide, with normalisation of his electroencephalogram and cessation of absence seizures. Within 3 weeks, he developed a rapidly worsening paranoid psychosis with visual and olfactory hallucinations. A month after the cessation of ethosuximide and concurrent treatment with olanzapine, his psychosis resolved and permitted reinitiation of ethosuximide at a lower dose without recurrence of psychotic symptoms.

Topics: Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Electroencephalography; Epilepsy; Ethosuximide; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Psychotic Disorders

Topics: Antipsychotic Agents; Benzodiazepines; Delusions; Female; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Parasitic Diseases; Psychotic Disorders; Referral and Consultation; Shared Paranoid Disorder

A 19-year-old male came to the Emergency Room of our hospital due to an episode of dystonic movements and disorientation 4 days after consuming methamphetamine, which evolved to a catatonic frank syndrome and eventually to status epilepticus. Definitive diagnosis was anti-NMDA receptor encephalitis, an acute inflammation of the limbic area of autoimmune origin in which early diagnosis and treatment are key elements for the final outcome. In this case, initial normal tests and previous methamphetamine poisoning delayed diagnosis, because inhaled-methamphetamine poisoning causes similar clinical symptoms to anti-NMDA receptor encephalitis. Methamphetamine poisoning may have caused an immune response in the patient, bringing on the progress of the pathology.

Topics: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Autoantibodies; Benzodiazepines; Catatonia; Delayed Diagnosis; Diagnosis, Differential; Diagnostic Errors; Diazepam; Electroconvulsive Therapy; Emergencies; Epilepsies, Partial; Hallucinations; Humans; Infectious Encephalitis; Male; Methamphetamine; Olanzapine; Poisoning; Receptors, N-Methyl-D-Aspartate; Status Epilepticus; Young Adult

Topics: Adult; Antipsychotic Agents; Culture; Electroconvulsive Therapy; Hallucinations; Hinduism; Humans; Male; Olanzapine; Schizophrenia; Schizophrenic Psychology; Self-Injurious Behavior; Semen; Stress, Psychological; Syndrome; Young Adult

Topics: Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Cerebral Peduncle; Chronic Disease; Female; Hallucinations; Humans; Olanzapine; Treatment Outcome

Anecdotal evidence tends to favour olanzapine in the treatment of hallucinations in patients with schizophrenia spectrum disorders; however, no conclusive evidence is available on this topic. We report here a clinical case in which a 46-year-old man, suffering from a schizoaffective disorder (depressed type), underwent olanzapine treatment (20 mg/day). After inducing an initial amelioration, the patient had a re-exacerbation of auditory hallucinations and a clinical and psychosocial worsening, which subsided after olanzapine discontinuation. Olanzapine may induce a worsening of hallucinations in a psychotic disorder with substantial affective component and therefore its use should be carefully evaluated in such cases.

Topics: Antipsychotic Agents; Benzodiazepines; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Psychotic Disorders; Recurrence

Topics: Alcoholism; Benzodiazepines; Clonazepam; Depressive Disorder; Dibenzothiazepines; Disulfiram; Female; Fluoxetine; Foreign Bodies; Hallucinations; Humans; Middle Aged; Movement Disorders; Olanzapine; Pharynx; Quetiapine Fumarate; Tetrabenazine; Tongue Habits

Many patients with Lewy body dementia develop visual hallucinations and other psychiatric symptoms. These patients are hypersensitive to antipsychotic drugs. Although patients tolerate atypical better than typical antipsychotics, both types can cause major extrapyramidal side effects. The anticonvulsant mood stabilizer topiramate, which does not cause parkinsonism, has been used as adjuvant therapy for both the positive and negative symptoms of schizophrenia; these symptoms can resemble those of Lewy body dementia. This report documents a 65-year-old woman with a 3-year history of progressive dementia that over the past 2 years had become complicated by severe extrapyramidal symptoms and agitated hallucinations. Her hallucinations became daily and were disrupting to her family. She was given a clinical diagnosis of Lewy body dementia after imaging and laboratory studies ruled out other etiologies. Treatment with olanzapine relieved her psychotic symptoms but caused severe dystonias, daily myoclonic jerks, and tremors. Stopping the olanzapine and starting topiramate 25 mg daily eliminated the hallucinations and agitation without worsening her extrapyramidal side effects. However, the topiramate was stopped because the patient reportedly developed anorexia and significant weight loss. Her hallucinations returned. When topiramate was reinstated at 12.5 mg a day, her agitation resolved, although her hallucinations continued. After 6 months on this dose, her agitation was still fairly well controlled without serious side effects or worsening of her parkinsonian symptoms.

Topics: Aged; Anticonvulsants; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Female; Fructose; Hallucinations; Humans; Lewy Body Disease; Neuroprotective Agents; Olanzapine; Psychomotor Agitation; Schizophrenia; Topiramate; Treatment Outcome

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Child; Dominance, Cerebral; Follow-Up Studies; Hallucinations; Humans; Olanzapine; Parietal Lobe; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Temporal Lobe; Transcranial Magnetic Stimulation; Treatment Outcome

Topics: Antipsychotic Agents; Benzodiazepines; Female; Follow-Up Studies; Hallucinations; Humans; Middle Aged; Olanzapine; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delusions; Epilepsy, Temporal Lobe; Female; Hallucinations; Humans; Olanzapine; Psychotic Disorders

Visual hallucinations have a differential diagnosis, both psychiatric and nonpsychiatric in nature. Described first by Lhermitte, peduncular hallucinosis is an uncommon etiology of visual hallucinations (VH). Typically, the offending lesion is vascular in origin and occurs at the level of the midbrain, thalamus, or rostral brainstem. Interestingly, the origin of the VH in our patient's case could have been either/both from an ischemic insult at the midbrain or compression of the brainstem due to aneurism. While evidence for treatment is scarce, we present a posited case of peduncular hallucinosis treated successfully with olanzapine.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Cerebral Infarction; Female; Follow-Up Studies; Hallucinations; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Mental Status Schedule; Neurocognitive Disorders; Neurologic Examination; Olanzapine; Postoperative Complications; Schizophrenia; Schizophrenic Psychology; Tegmentum Mesencephali

Topics: Antipsychotic Agents; Benzodiazepines; Brain Diseases; Hallucinations; Humans; Olanzapine; Tegmentum Mesencephali

Marijuana (cannabis) is the most commonly abused drug by adolescents and young adults and also by people with schizophrenia or other psychotic disorders. An increasing number of studies suggest that regular cannabis users can show psychotic episodes similar to schizophrenic disorders but it still unclear if cannabis induced psychotic disorder is a distinct entity requiring special therapy or regular cannabis use consequently leads to schizophrenia. Therefore, we retrospectively compared psychotic patients with and without cannabis use by clinical profile. Clinical data of 85 patients with schizophrenia spectrum disorder were analyzed retrospectively. Cannabis use was not reported by 43 persons (Cnbs0 subgroup) and 42 patients used regularly cannabis during at least 1 year (Cnbs1 subgroup). Clinical data were collected from electronic medical documentation of patients concerning anamnesis, family history, socio-demographic condition, symptoms and psychiatric state, acute and long-term therapies. Men were over-represented in the cannabis abuser group while mean age was lower among them compared to the Cnbs0 subgroup. Prevalence of suicidal attempts was increased in men without cannabis use. Patients without cannabis use spent more time in hospital and smoking was more frequent among them. Positive and negative symptoms and family history did not differ significantly between the two subgroups. Dosage, intensity and length of pharmacotherapy was different between the two subgroups. These results revealed that certain clinical aspects were different in case of cannabis-related schizophrenia spectrum disorder compared to schizophrenia.

Topics: Adolescent; Adult; Aggression; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Dibenzothiazepines; Hallucinations; Haloperidol; Humans; Hungary; Male; Marijuana Abuse; Olanzapine; Paranoid Disorders; Piperazines; Psychomotor Performance; Quetiapine Fumarate; Quinolones; Retrospective Studies; Risperidone; Schizophrenia; Schizophrenic Psychology

Topics: Antipsychotic Agents; Benzodiazepines; Cognition; Drug Resistance; Electric Stimulation Therapy; Hallucinations; Humans; Male; Middle Aged; Neurons; Olanzapine; Schizophrenic Psychology; Theta Rhythm

We present a 72-year-oldpatient with probable diffuse Lewy body disease and visual hallucinations, who developed subacute reversible "dropped head syndrome" and parkinsonian signs after the introduction of olanzapine at a total daily dose of 10 mg. One week after olanzapine was withdrawn, the patient's posture started to improve. Further improvement was achieved after dopaminergic substitution. Clinical and electrophysiological observations might indicate neck extensor myopathy due to axial rigidity or focal neck dystonia, induced by dopamine receptor blockade.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Dopamine Antagonists; Female; Hallucinations; Head Movements; Humans; Kyphosis; Lewy Body Disease; Muscular Diseases; Olanzapine

To report the case of an 11-year-old girl who presented with acute onset of psychotic symptoms with catatonic features treated with electroconvulsive therapy (ECT).. Described herein is the case of an 11-year-old, prepubertal girl who represented with catatonic symptoms unresponsive to conventional medical treatment. After thorough clinical investigation and obtaining a second opinion we gained consent from her parents to perform ECT as a life saving procedure.. Six ECT treatments were administered with clinical improvement, the patient did develop hypomanic symptoms as a side-affect of ECT.. The patient exhibited potentially life-threatening self-harming behaviour secondary to catatonic and psychotic symptoms. Her behaviour and symptoms responded to ECT. The patient developed hypomania that responded to mood stabilization. ECT was a safe and effective treatment for catatonia in this prepubescent girl.

Topics: Acute Disease; Antipsychotic Agents; Benzodiazepines; Catatonia; Child; Electroconvulsive Therapy; Female; Hallucinations; Humans; Olanzapine

Topics: Aged; Alzheimer Disease; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Delirium; Depressive Disorder; Diagnosis, Differential; Dibenzothiazepines; Hallucinations; Humans; Male; Olanzapine; Oxazepam; Psychotic Disorders; Quetiapine Fumarate; Tachycardia

Statistical models based on item response theory were used to examine (a) the performance of individual Positive and Negative Syndrome Scale (PANSS) items and their options, (b) the effectiveness of various subscales to discriminate among individual differences in symptom severity, and (c) the appropriateness of cutoff scores recently recommended by Andreasen and her colleagues (2005) to establish symptom remission.. Option characteristic curves were estimated using a nonparametric item response model to examine the probability of endorsing each of 7 options within each of 30 PANSS items as a function of standardized, overall symptom severity. Our data were baseline PANSS scores from 9205 patients with schizophrenia or schizoaffective disorder who were enrolled between 1995 and 2003 in either a large, naturalistic, observational study or else in 1 of 12 randomized, double-blind, clinical trials comparing olanzapine to other antipsychotic drugs.. Our analyses show that the majority of items forming the Positive and Negative subscales of the PANSS perform very well. We also identified key areas for improvement or revision in items and options within the General Psychopathology subscale. The Positive and Negative subscale scores are not only more discriminating of individual differences in symptom severity than the General Psychopathology subscale score, but are also more efficient on average than the 30-item total score. Of the 8 items recently recommended to establish symptom remission, 1 performed markedly different from the 7 others and should either be deleted or rescored requiring that patients achieve a lower score of 2 (rather than 3) to signal remission.. This first item response analysis of the PANSS supports its sound psychometric properties; most PANSS items were either very good or good at assessing overall severity of illness. These analyses did identify some items which might be further improved for measuring individual severity differences or for defining remission thresholds. Findings also suggest that the Positive and Negative subscales are more sensitive to change than the PANSS total score and, thus, may constitute a "mini PANSS" that may be more reliable, require shorter administration and training time, and possibly reduce sample sizes needed for future research.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Defense Mechanisms; Delusions; Depression; Double-Blind Method; Dyskinesias; Female; Hallucinations; Humans; Individuality; Male; Middle Aged; Models, Statistical; Olanzapine; Personality Inventory; Psychiatric Status Rating Scales; Psychometrics; Psychotic Disorders; Randomized Controlled Trials as Topic; Reproducibility of Results; Schizophrenia; Schizophrenic Psychology; Statistics, Nonparametric; Treatment Outcome

Reported herein is a case of methamphetamine psychosis in which tardive dystonia was treated successfully with clonazepam. The patient was a 69-year-old man who had taken methamphetamine habitually for approximately 40 years. Auditory hallucinations had developed 25 years previously, for which haloperidol had been prescribed. Tardive dystonia had developed in December 2005. Haloperidol was withdrawn and risperidone or olanzapine alone had been administered, but neither had improved the dystonic posture. However, when clonazepam was added, a gradual improvement in the dystonic posture became evident. Tardive dystonia is currently treated on a trial-and-error basis. Accumulation of further cases similar to the present one is very important for establishing an effective treatment.

Topics: Aged; Anti-Dyskinesia Agents; Antipsychotic Agents; Benzodiazepines; Biperiden; Central Nervous System Stimulants; Clonazepam; Dyskinesia, Drug-Induced; Hallucinations; Haloperidol; Humans; Male; Methamphetamine; Olanzapine; Posture; Psychoses, Substance-Induced; Risperidone

We report a case of recurrent psychosis, spanning decades, with full inter-episode recovery and minimal functional impairment. While it is difficult to classify this disorder using DSM IV-TR criteria, Leonhard and others have described a 'cycloid psychosis' that correlates well with the phenomenology and course of this case. We believe this may represent a subset within the ICD-10 category of 'acute and transient psychotic disorders'. While this disorder, of unknown incidence, is not well reported in the U.S., it is worthy of further investigation and clinical attention given its generally favorable prognosis and potentially distinct pathophysiology and treatment.

Topics: Acute Disease; Aged; Benzodiazepines; Cognition Disorders; Delusions; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Drug Therapy, Combination; Hallucinations; Hospitalization; Humans; Lorazepam; Male; Olanzapine; Psychomotor Agitation; Psychotic Disorders; Recurrence

There is retrospective evidence of a correlation between psychosis in multiple sclerosis (MS) patients and temporal lobe pathology. A 35-year-old woman with MS presented with psychosis. There was no concurrent history of medication/substance use or family history. Comparison with previous MRI scans showed significant progression of lesions within the periventricular white matter of the left temporal lobe. This case highlights the association of psychosis and MS progression with worsening of left temporal lobe lesions. Prospective studies are required to ascertain the extent to which left temporal lobe lesions are predictive of future psychosis.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delusions; Excitatory Amino Acid Antagonists; Female; Hallucinations; Humans; Lamotrigine; Magnetic Resonance Imaging; Multiple Sclerosis; Olanzapine; Pain; Psychotic Disorders; Risperidone; Temporal Lobe; Triazines; Weight Gain

Topics: Abnormalities, Multiple; Adolescent; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Eye Abnormalities; Hallucinations; Humans; Lorazepam; Male; Olanzapine; Syndrome; Trabeculectomy; Tropanes

Topics: Adult; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Drug Therapy, Combination; Gynecomastia; Hallucinations; Humans; Imipramine; Male; Olanzapine; Suicide, Attempted

Topics: Antipsychotic Agents; Benzodiazepines; Evidence-Based Medicine; Hallucinations; Humans; Olanzapine

Charles Bonnet syndrome (CBS) is characterised by the triad of complex visual hallucinations, ocular pathology causing visual deterioration and preserved cognitive status. We report a case of a 62-year-old man with a brief history of visual hallucinations. The patient complained of amaurosis with optic nerve atrophy in his left eye and a severe impairment of visual acuity in the right and suddenly experienced complex, vivid, elaborate and coloured visual hallucinations persisting long after eye closure and stopping during sleep. The patient maintained his insight, criticising these visions as unreal and felt distressed by them. Hallucination onset was 3 days before hospital admission. No cognitive impairment and no diseases apart from prostatic adenoma treated with alpha-lythic therapy were reported. Neurological examination and neuroimaging data were normal. Therapy with olanzapine (OLZ) 5 mg/day led to a progressive clearance of visual hallucinations in seven days and was gradually reduced and withdrawn. Three months later the visions reappeared and OLZ 5 mg/day yielded a persisting remission so that at the follow-up examination after 1 year on therapy the patient is still asymptomatic. To date, no established treatment for CBS is stated and in some patients the hallucinations fade spontaneously; in our case an antipsychotic therapy with OLZ was effective while generally anticonvulsant drugs with different mechanism of action such as carbamazepine, valproate and gabapentin are proposed.

Topics: Antipsychotic Agents; Benzodiazepines; Eye Diseases; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Sensory Deprivation; Syndrome; Treatment Outcome; Vision Disorders

Topics: Adult; Benzodiazepines; Hallucinations; Humans; Male; Olanzapine; Schizophrenia; Selective Serotonin Reuptake Inhibitors

Topics: Aged; Aged, 80 and over; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Carbamazepine; Cognition Disorders; Hallucinations; Humans; Male; Music; Olanzapine; Syndrome; Visual Fields

Topics: Antipsychotic Agents; Appetite; Appetite Depressants; Benzodiazepines; Central Nervous System Stimulants; Delusions; Depressive Disorder; Dose-Response Relationship, Drug; Drug Therapy, Combination; Ephedrine; Euphoria; Female; Hallucinations; Haloperidol; Humans; Long-Term Care; Mazindol; Middle Aged; Olanzapine; Psychoses, Substance-Induced; Recurrence; Substance Withdrawal Syndrome; Substance-Related Disorders; Thioridazine

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening adverse effect of antipsychotic agents. It generally is characterized by fever, altered mental status, rigidity, and autonomic dysfunction. A 53-year-old man developed NMS without rigidity while taking olanzapine. Such atypical cases may support either a spectrum concept of NMS or the theory that NMS secondary to atypical antipsychotics differs from that caused by conventional neuroleptics. More flexible diagnostic criteria than currently mandated by the the Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision, may be warranted.

Topics: Antipsychotic Agents; Benzodiazepines; Blood Cell Count; Hallucinations; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia, Paranoid; Schizophrenic Psychology

Olanzapine (Zyprexa) is an atypical neuroleptic used in adult and pediatric patients for the management of schizophrenia. Common side effects include increased appetite and weight gain. An uncommon but severe adverse effect is the development of diabetic ketoacidosis, reported until now only in adults. We report a case of acute onset diabetic ketoacidosis presenting in a 16-year-old girl during olanzapine therapy.

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Diabetic Ketoacidosis; Female; Hallucinations; Humans; Olanzapine; Pirenzepine

Topics: Benzodiazepines; Hallucinations; Humans; Olanzapine; Parkinson Disease; Pirenzepine

Behavioral/psychological symptoms of dementia (BPSD) affect caregiver burden and transition from home to hospital or long-term care. The authors examined change in BPSD for dementia patients (from hospital admission to discharge) who were prescribed haloperidol (n= 289), olanzapine (n=209), or risperidone (n=500). Olanzapine was associated with significantly greater overall improvement in BPSD (based on the Psychogeriatric Dependency Rating Scale total score) than risperidone or haloperidol. Olanzapine was significantly superior on measures of active-, verbal-, and passive-aggression and delusions/hallucinations to risperidone or haloperidol, and, on manipulative behavior and noisiness, to risperidone. Results support the effectiveness of olanzapine in improving several BPSD in hospitalized dementia patients.

Topics: Aged; Aged, 80 and over; Aggression; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Depressive Disorder, Major; Female; Hallucinations; Hospitalization; Humans; Male; Mental Disorders; Middle Aged; Olanzapine; Pirenzepine; Severity of Illness Index; Treatment Outcome

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Hallucinations; Humans; Male; Olanzapine; Parkinson Disease; Pirenzepine

Topics: Antipsychotic Agents; Benzodiazepines; Bias; Clozapine; Hallucinations; Humans; Olanzapine; Parkinson Disease; Pirenzepine

Topics: Adolescent; Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Diagnosis, Dual (Psychiatry); Drug Therapy, Combination; Female; Hallucinations; Humans; Olanzapine; Pirenzepine; Risperidone; Substance-Related Disorders; Treatment Outcome; Valproic Acid

Four patients affected by severe Parkinson's disease developed leucopenia (900-1200 WBC) during treatment of psychosis (3) or untreatable insomnia (1) with clozapine (37.5-75 mg/day). Clozapine withdrawal was followed by recovery of leucopenia (4000-6000 WBC) in two weeks with no need for the administration of leucokines. After 1-6 months olanzapine was administered (increasing the dose from 2.5 to 10 mg/day) to treat persisting disturbances, but the drug induced severe worsening of parkinsonism and also this drug had to be withdrawn.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Clozapine; Dose-Response Relationship, Drug; Female; Hallucinations; Humans; Leukopenia; Male; Olanzapine; Parkinson Disease; Pirenzepine; Psychotic Disorders; Sexual Dysfunctions, Psychological; Sleep Initiation and Maintenance Disorders

Dementia with Lewy bodies (DLB) is now a well-recognized form of dementia in which psychosis and behavioural disturbance are common. Treatment with conventional neuroleptics is often very poorly tolerated. Olanzapine, a newly introduced atypical neuroleptic which binds to multiple receptor types with relatively low affinity for D2 receptors, may be a useful treatment option in DLB.. The Behavioural Pathology in Alzheimer's Disease Rating Scale, The Neuropsychiatric Inventory, Unified Parkinson's Disease Rating Scale and The Webster Disability Scale.. We present the results of eight DLB patients with associated psychotic and behavioural difficulties. All patients were given olanzapine 2.5-7.5 mg. Their psychotic phenomena and behavioural and extrapyramidal symptoms were monitored at 2-weekly intervals.. Three out of the eight patients could not tolerate olanzapine even at the lowest available dose. Two patients had clear improvement in psychotic and behavioural symptoms. Three patients were able to tolerate olanzapine but gained only minimal benefit.. Olanzapine at the doses used conferred little advantage over conventional neuroleptics and should only be given with great caution to patients with DLB. The utility of smaller doses deserves further evaluation.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Cognition Disorders; Contraindications; Delusions; Dementia; Depression; Dose-Response Relationship, Drug; Female; Hallucinations; Humans; Lewy Bodies; Male; Olanzapine; Parkinson Disease; Pirenzepine; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Overdose; Female; Hallucinations; Humans; Olanzapine; Pirenzepine; Schizophrenia; Schizophrenic Psychology

The atypical antipsychotic drug olanzapine has been proposed for treatment of dopaminergic psychosis in Parkinson's disease (PD). We report on a 68-year-old patient who developed a severe akinetic-rigid extrapyramidal syndrome, accompanied by additional paranoid symptoms, following olanzapine treatment of optic hallucinosis in PD. Olanzapine may also induce clinically relevant extrapyramidal side effects in PD patients.

Topics: Aged; Antiparkinson Agents; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Clozapine; Drug Therapy, Combination; Hallucinations; Humans; Levodopa; Male; Olanzapine; Paranoid Disorders; Parkinson Disease; Piperidines; Pirenzepine; Selegiline; Severity of Illness Index

Topics: Alcoholism; Antipsychotic Agents; Benzodiazepines; Diabetes Mellitus, Type 1; Dyskinesia, Drug-Induced; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Risperidone

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Extrapyramidal Tracts; Female; Hallucinations; Humans; Male; Olanzapine; Parkinson Disease; Pirenzepine

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Dyskinesia, Drug-Induced; Hallucinations; Humans; Male; Olanzapine; Pirenzepine; Schizophrenia