olanzapine and Obsessive-Compulsive-Disorder

In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines for Obsessive Compulsive Disorder (OCD) recommended anti-psychotics as a class for SSRI treatment resistant OCD. The article aims to systematically review and conduct a meta-analysis on the clinical effectiveness of atypical anti-psychotics augmenting an SSRI.. Studies that were double-blind randomized controlled trials of an atypical antipsychotic against a placebo, for a minimum of 4 weeks, in adults with OCD, were included. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. Inclusion criteria included Y-BOCS score of 16 or more and at least one adequate trial of a SSRI or clomipramine for at least 8 weeks prior to randomization. Data sources included Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews (CDSR), trial registries and pharmaceutical databases and manufacturers up to September 2013. Forest-plots were drawn to display differences between drug and placebo on the Y-BOCS.. Two studies found aripiprazole to be effective in the short-term. There was a small effect-size for risperidone or anti-psychotics in general in the short-term. We found no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo.. Risperidone and aripiprazole can be used cautiously at a low dose as an augmentation agent in non-responders to SSRIs and CBT but should be monitored at 4 weeks to determine efficacy.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clomipramine; Dibenzothiazepines; Double-Blind Method; Drug Resistance; Drug Therapy, Combination; Humans; Obsessive-Compulsive Disorder; Olanzapine; Piperazines; Quetiapine Fumarate; Quinolones; Randomized Controlled Trials as Topic; Risperidone; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Obsessive compulsive disorder (OCD) is a psychiatric disorder which has been shown to affect 2 to 3.5% of people during their lifetimes. Inadequate response occurs in 40% to 60% of people that are prescribed first line pharmaceutical treatments (selective serotonin reuptake inhibitors (SSRIs)). To date not much is known about the efficacy and adverse effects of second-generation antipsychotic drugs (SGAs) in people suffering from OCD.. To evaluate the effects of SGAs (monotherapy or add on) compared with placebo or other forms of pharmaceutical treatment for people with OCD.. The Cochrane Depression, Anxiety and Neurosis Group's controlled trial registers (CCDANCTR-Studies and CCDANCTR-References) were searched up to 21 July 2010. The author team ran complementary searches on ClinicalTrials.gov and contacted key authors and drug companies.. We included double-blind randomised controlled trials (RCTs) comparing oral SGAs (monotherapy or add on) in adults with other forms of pharmaceutical treatment or placebo in people with primary OCD.. We extracted data independently. For dichotomous data we calculated the odds ratio (OR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated mean differences (MD), again based on a random-effects model.. We included 11 RCTs with 396 participants on three SGAs. All trials investigated the effects of adding these SGAs to antidepressants (usually SSRIs). The duration of all trials was less than six months. Only 13% of the participants left the trials early. Most trials were limited in terms of quality aspects.Two trials examined olanzapine and found no difference in the primary outcome (response to treatment) and most other efficacy-related outcomes but it was associated with more weight gain than monotherapy with antidepressants.Quetiapine combined with antidepressants was also not any more efficacious than placebo combined with antidepressants in terms of the primary outcome, but there was a significant superiority in the mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score at endpoint (MD -2.28, 95% CI -4.05 to -0.52). There were also some beneficial effects of quetiapine in terms of anxiety or depressive symptoms.Risperidone was more efficacious than placebo in terms of the primary outcome (number of participants without a significant response) (OR 0.17, 95% CI 0.04 to 0.66) and in the reduction of anxiety and depression (MD -7.60, 95% CI -12.37 to -2.83). . The available data of the effects of olanzapine in OCD are too limited to draw any conclusions. There is some evidence that adding quetiapine or risperidone to antidepressants increases efficacy, but this must be weighed against less tolerability and limited data.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Humans; Obsessive-Compulsive Disorder; Olanzapine; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Risperidone

As many as half of obsessive-compulsive disorder (OCD) patients treated with an adequate trial of serotonin reuptake inhibitors (SRIs) fail to fully respond to treatment and continue to exhibit significant symptoms. Many studies have assessed the effectiveness of antipsychotic augmentation in SRI-refractory OCD. In this systematic review, we evaluate the efficacy of antipsychotic augmentation in treatment-refractory OCD. The electronic databases of PubMed, PsychINFO (1967-2005), Embase (1974-2000) and the Cochrane Central Register of Controlled Trials (CENTRAL, as of 2005, Issue 3) were searched for relevant double-blind trials using keywords 'antipsychotic agents' or 'neuroleptics' and 'obsessive-compulsive disorder'. Search results and analysis were limited to double-blind, randomized control trials involving the adult population. The proportion of subjects designated as treatment responders was defined by a greater than 35% reduction in Yale Brown Obsessive-Compulsive Scale (Y-BOCS) rating during the course of augmentation therapy. Nine studies involving 278 participants were included in the analysis. The meta-analysis of these studies demonstrated a significant absolute risk difference (ARD) in favor of antipsychotic augmentation of 0.22 (95% confidence interval (CI): 0.13, 0.31). The subgroup of OCD patients with comorbid tics have a particularly beneficial response to this intervention, ARD=0.43 (95% CI: 0.19, 0.68). There was also evidence suggesting OCD patients should be treated with at least 3 months of maximal-tolerated therapy of an SRI before initiating antipsychotic augmentation owing to the high rate of treatment response to continued SRI monotherapy (25.6%). Antipsychotic augmentation in SRI-refractory OCD is indicated in patients who have been treated for at least 3 months of maximal-tolerated therapy of an SRI. Unfortunately, only one-third of treatment-refractory OCD patients show a meaningful treatment response to antipsychotic augmentation. There is sufficient evidence in the published literature, demonstrating the efficacy of haloperidol and risperidone, and evidence regarding the efficacy of quetiapine and olanzapine is inconclusive. Patients with comorbid tics are likely to have a differential benefit to antipsychotic augmentation.

Topics: Adult; Aged; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Comorbidity; Depressive Disorder; Dibenzothiazepines; Double-Blind Method; Drug Resistance; Drug Therapy, Combination; Haloperidol; Humans; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Patient Dropouts; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Risperidone; Selective Serotonin Reuptake Inhibitors; Tic Disorders; Treatment Outcome

Antidepressant medications have eased the suffering of millions of people. In addition to treating depression, antidepressant drugs also treat several anxiety disorders. Unfortunately, there are problematic limitations with antidepressant agents, including a delayed therapeutic response and insufficient efficacy. Emerging evidence shows that atypical antipsychotic agents can be used as augmentation therapy in patients with poor responses to antidepressants. Future drugs combining key features of antidepressant and atypical antipsychotic agents could offer new promise for patients suffering from obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, generalized anxiety disorder and depression.

Topics: Animals; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Clinical Trials as Topic; Depressive Disorder, Major; Dibenzothiazepines; Drug Design; Drug Synergism; Drug Therapy, Combination; Humans; Obsessive-Compulsive Disorder; Olanzapine; Quetiapine Fumarate; Receptors, Dopamine; Receptors, Histamine; Receptors, Serotonin; Risperidone; Stress Disorders, Post-Traumatic

Schizophrenia and obsessive-compulsive disorder (OCD) have historical, clinical, and epidemiological links. The clinical use of atypical neuroleptics (ie, dual serotonin-dopamine antagonists) to treat both conditions sheds a new light on them. We report the first two cases of obsessive-compulsive symptoms (OCS) induced by quetiapine in schizophrenia patients. A case of successful augmentation by quetiapine in refractory OCD is also presented. A review of the literature on OCS induced by atypical neuroleptics follows. This paradoxically induced OCD symptomology in schizophrenia patients administered atypical neuroleptics is discussed from new pathophysiological and clinical perspectives. The discussion emphasizes the prognostic implications of OCS in schizophrenia and available therapies for this comorbidity.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Dibenzothiazepines; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Quetiapine Fumarate; Schizophrenia

Nonresponse to treatment in obsessive-compulsive disorder is common, associated with substantial impairment, and understudied. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded well to 2 trials of selective serotonin reuptake inhibitors (SSRIs). Available options include continuation of SSRI treatment, switching to another SSRI or selective serotonin-norepinephrine reuptake inhibitor, augmenting with atypical neuroleptics or cognitive-behavioral therapy, or utilizing novel treatment approaches. The authors synthesize state-of-the-art treatment and give practical advice for clinicians.

Topics: Antipsychotic Agents; Benzodiazepines; Cognitive Behavioral Therapy; Combined Modality Therapy; Drug Therapy, Combination; Fluvoxamine; Humans; Morphine; Multicenter Studies as Topic; Neurotransmitter Uptake Inhibitors; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Practice Guidelines as Topic; Retrospective Studies; Review Literature as Topic; Selective Serotonin Reuptake Inhibitors; Sumatriptan; Treatment Outcome

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, dosage and administration, and cost of olanzapine are reviewed. Olanzapine is a serotonin-dopamine-receptor antagonist indicated for use in the treatment of schizophrenia and other psychotic disorders. The affinity of olanzapine for neuroreceptors is similar to that of clozapine. The drug is well absorbed from the GI tract; food has no effect. Olanzapine is more effective than placebo and equal to haloperidol in reducing psychotic symptoms on two rating scales. However, unlike typical dopamine-receptor antagonists used for antipsychotic therapy, olanzapine is more effective in reducing the negative symptoms of schizophrenia. The most frequent adverse drug reactions (ADRs) associated with olanzapine are somnolence, agitation, insomnia, and headache. Constipation and dry mouth occur as dose-dependent ADRs. Unlike clozapine, olanzapine does not cause agranulocytosis. No cases of tardive dyskinesia or neuroleptic malignant syndrome have been reported. Olanzapine has been associated with slight increases in hepatic transaminases. More study is needed to determine whether olanzapine interacts significantly with other drugs. The recommended starting dosage is 5-10 mg orally once daily. Efficacy beyond six weeks has not been evaluated; patients treated for longer than six weeks should be periodically reassessed. Olanzapine costs about 10 times more than typical antipsychotics because a generic version is not available; however, olanzapine costs less than clozapine therapy and may cost less than haloperidol in terms of total health care costs. Olanzapine offers an effective alternative for treating schizophrenia and has a favorable adverse-effect profile.

Topics: Antipsychotic Agents; Benzodiazepines; Clinical Trials as Topic; Dopamine Antagonists; Humans; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia; Serotonin Antagonists

The aim of this study is to examine the effects of memantine as an adjuvant treatment for obsessive compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase.. In this 16-week double-blind placebo-controlled randomized clinical trial, 58 patients in the manic phase of BD who had OC symptoms were randomly allocated to receive memantine or placebo plus their routine medications (lithium + olanzapine + clonazepam). The Yale Brown Obsessive Compulsive Behavior Scale was used to assess the outcomes. Adverse effects were also recorded.. Thirty-eight patients (19 in the memantine group and 19 in the placebo group) completed the trial. Throughout the trial, the mean score decreased from 20.26 ± 5.91 to 9.73 ± 5.44 in the memantine group (P < 0.000) and from 22.89 ± 5.70 to 16.63 ± 4.00 in the placebo group (P < 0.000). At the end of the study, 15 (78.94%) patients in the memantine group and 7 (36.84%) patients in the placebo group demonstrated more than 34% decline in the Yale Brown Obsessive Compulsive Behavior Scale score (P < 0.01). No serious adverse effects were reported.. Our double-blind controlled clinical trial showed that memantine is an effective adjuvant agent for reducing OC symptoms in patients with BD. However, it needs to be noted that our study is preliminary, and larger double-blind controlled studies are needed to confirm the results.

Topics: Adjuvants, Pharmaceutic; Adult; Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Clonazepam; Double-Blind Method; Drug Therapy, Combination; Excitatory Amino Acid Antagonists; Female; GABA Modulators; Humans; Lithium Compounds; Male; Memantine; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Outcome Assessment, Health Care

It has not been examined trialed whether obsessive compulsive symptoms in patients with bipolar disorder respond to topiramate as an adjuvant treatment.. This 4-month double-blind placebo-controlled randomized clinical trial examined the efficacy and safety of augmentation with topiramat for treating the patients with bipolar disorder, manic phase type-I, and obsessive compulsive disorder symptoms. Both groups received lithium+olanzapine+clonazepam. However, one group received topiramate and the other group placebo as adjuvant medications. Yale Brown obsessive compulsive behavior scale was used to assess the outcome. Adverse effects were also recorded.. A total of 32 patients completed this trial. The mean score decreased from 24.2(4.8) to 17.6(8.7) in the topiramate group (P<0.003) and from 20.9(2.9) to 9.6(3.5) in the placebo group during this trial (P<0.0001). Additionally, 9(52.9%) out of 17 patients in the topiramate group and 2(12.5%) out of 16 patients in the placebo group showed more than 34% decline in YBOC score (x2=6.0, df=1, P<0.01). No serious adverse effects were detected.. The limitations of the present study were its small sample size and the fact that it was conducted in a single center.. The combination of lithium+olanzapine+clonazepam decreased the symptoms of obsessive compulsive disorder in the patients with bipolar disorder type I. However, topiramate had a more significant effect than placebo on improvement of the patients with bipolar disorder and obsessive compulsive symptoms. This combination seems to be without serious adverse effects.

Topics: Adult; Antimanic Agents; Benzodiazepines; Bipolar Disorder; Clonazepam; Double-Blind Method; Drug Therapy, Combination; Female; Fructose; Humans; Lithium Compounds; Male; Middle Aged; Neuroprotective Agents; Obsessive-Compulsive Disorder; Olanzapine; Selective Serotonin Reuptake Inhibitors; Topiramate; Treatment Outcome

To compare antimanic response to olanzapine therapy in youth with bipolar disorder (BPD) based on the status of comorbidity with obsessive-compulsive disorder (OCD).. Secondary analysis of identically designed 8-week open-label trials of olanzapine therapy in youth with BPD. Severity of mania assessed with the Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI) scales.. Of the 52 BPD subjects (mean age 8.4 +/- 3.1 years) enrolled in the olanzapine trials (mean dose 8.5 +/- 4.3 mg/day), 39% (n = 20) met criteria for comorbid OCD. Antimanic response in BPD subjects was significantly worse in the presence of comorbid OCD (YMRS mean reduction: -5.9 +/- 13.1 versus -13.7 +/- 18.8, p = 0.04; > or = 30% reduction: 25% versus 63%, p = 0.008; CGI-Improvement score < or = 2: 25% versus 68%, p = 0.003). There was no difference in the rate of dropouts (50% versus 29%, p = 0.2) or adverse effects in BPD subjects with or without comorbid OCD.. Less than expected antimanic response to olanzapine therapy in the presence of comorbidity with OCD suggests that OCD is an important functionally impairing psychiatric comorbidity that may impact the efficacy of antimanic agents in youth with BPD. This study is limited by its design of secondary analysis of data from trials of an uncontrolled nature. Further prospective controlled trials are warranted.

Topics: Adolescent; Antimanic Agents; Benzodiazepines; Bipolar Disorder; Child; Comorbidity; Female; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome

Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short-term trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term.. Subjects (N = 46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued on SSRI monotherapy plus cognitive-behavioral therapy (CBT) for 1 year. Subjects (N = 44) who failed to respond to SSRIs were randomly assigned to 1 of 3 atypical antipsychotics -- olanzapine, quetiapine, or risperidone -- and were consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year. This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital, Japan.. Augmentation with atypical antipsychotics reduced mean +/- SD Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores in SSRI-refractory OCD patients (at initial assessment = 29.3 +/- 9.9, after 1 year = 19.3 +/- 6.8). However, compared to SSRI responders (at initial assessment = 25.8 +/- 11.4, after 1 year = 13.7 +/- 4.6), total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher, and they remained at higher levels than those of SRI responders after 1 year of the treatments.. Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCD patients. Even though this approach seems useful for some types of OCD patients, such as those with symmetry/ordering and hoarding symptoms, these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, and their chronic use raises a number of safety concerns.. (ClinicalTrials.gov) Identifier NCT00854919.

Topics: Adult; Ambulatory Care; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Cognitive Behavioral Therapy; Combined Modality Therapy; Dibenzothiazepines; Drug Resistance; Drug Therapy, Combination; Female; Fluvoxamine; Follow-Up Studies; Humans; Long-Term Care; Male; Obsessive-Compulsive Disorder; Olanzapine; Paroxetine; Quetiapine Fumarate; Risperidone; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Young Adult

To examine whether subjective well-being and craving for cannabis were different in patients with schizophrenia or related disorders treated with either olanzapine or risperidone.. A 6-week, double-blind, randomized trial of olanzapine and risperidone was carried out in 128 young adults with recent onset schizophrenia or related disorders. Primary efficacy measures were the mean baseline-to-endpoint change in total scores on the Subjective Well-Being under Neuroleptics scale, the Obsessive-Compulsive Drug Use Scale, the Drug Desire Questionnaire, and the cannabis use self-report. An analysis of covariance was used to test between-group differences.. Estimated D(2) receptor occupancy did not differ between olanzapine (n = 63) and risperidone (n = 65). Similar improvements in subjective well-being were found in both groups. In the comorbid cannabis-using group (n = 41, 32%), a similar decrease in craving for cannabis was found in both treatment conditions.. Both olanzapine and risperidone were associated with improved subjective well-being. No evidence was found for a differential effect of olanzapine or risperidone on subjective experience or on craving for cannabis in dosages leading to comparable dopamine D(2) occupancy.. ISRCTN46365995.

Topics: Adolescent; Adult; Antipsychotic Agents; Benzodiazepines; Comorbidity; Disruptive, Impulse Control, and Conduct Disorders; Double-Blind Method; Female; Humans; Male; Marijuana Abuse; Obsessive-Compulsive Disorder; Olanzapine; Prevalence; Quality of Life; Risperidone; Schizophrenia; Severity of Illness Index; Surveys and Questionnaires

The aim of the present pilot study was to investigate in a single-blind manner, over a period of 8 weeks, the comparative efficacy and tolerability of risperidone versus olanzapine addition in the treatment of OCD patients who did not show a >or=35% decrease in the YBOCS score after 16-week SRI treatment (defined as resistant). The study consisted of two different phases: a 16-week open-label prospective phase to ascertain resistance to SRI treatment and an 8-week single-blind addition phase for resistant subjects only. Ninety-six subjects with DSM-IV OCD (YBOCS>or=16) entered the open-label prospective phase; at the end of the 16-week period, 50 (52%) were judged to be resistant and were randomized to receive risperidone (1 to 3 mg/d) or olanzapine (2.5 to 10 mg/d) addition for 8 weeks. Overall, patients in both groups responded significantly, without differences between the two treatment groups; although no differences emerged for the proportion of patients reporting at least an adverse event, the profiles of adverse experiences differed significantly, being risperidone associated with amenorrhoea and olanzapine with weight gain.

Topics: Adult; Analysis of Variance; Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; Drug Evaluation; Drug Synergism; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Prospective Studies; Risperidone; Single-Blind Method; Time Factors

The prevalence of obsessive-compulsive symptoms (OCS) in patients with schizophrenia is relatively high. Antipsychotics have been found to influence OCS.. To determine whether induction or severity of OCS differs during treatment with olanzapine or risperidone in young patients with early psychosis.. One hundred twenty-two patients with a Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder were randomized in a double-blind design to groups of 6 weeks' treatment with olanzapine (n = 59) or risperidone (n = 63), with a mean dose of 11.3 mg olanzapine and 3.0 mg risperidone at 6 weeks. Primary outcome measures were the mean baseline-to-endpoint change in total score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).. Treatment with olanzapine was associated with greater decreases in Y-BOCS total score than treatment with risperidone in total group (N = 122: -2.2 vs -0.3, z = -2.651, P < 0.01), in patients with baseline Y-BOCS total score greater than 0 (n = 58: -5.1 vs -0.4, z = -2.717, P < 0.01), and in patients with baseline Y-BOCS total score greater than 10 (n = 29: -7.1 vs -0.6, z = -2.138, P = 0.032).. In this randomized, 6-week, double-blind trial, we found a significant and clinically relevant difference in decrease in Y-BOCS scores favoring olanzapine compared with risperidone.

Topics: Adolescent; Adult; Antipsychotic Agents; Benzodiazepines; Capsules; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Psychiatric Status Rating Scales; Psychotic Disorders; Risperidone; Schizophrenia; Severity of Illness Index; Time Factors; Treatment Outcome

The present study reports the results of an open-label trial on the use of the combination of olanzapine (an atypical antipsychotic) serotonin reuptake inhibitors (SRIs) in 26 resistant outpatients affected by resistant obsessive-compulsive disorder (OCD). All patients had been suffering from OCD, according to DSM IV criteria, for at least 2 years and had different comorbid disorders; they had been treated with an SRI at adequate dosages for at least 6 months, or had tried different augmentation strategies with no or poor response. As a result, olanzapine was added and continued for 1 year. After 12 weeks of this regimen, most of the patients (17) had shown a reduction in OC symptoms, as assessed by a decrease in the Yale-Brown Obsessive Compulsive Scale total score, which continued throughout subsequent months. Only mild side-effects were recorded and no patient halted the treatment. The addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients, especially in those presenting comorbidity with bipolar disorders.

Topics: Adult; Benzodiazepines; Bipolar Disorder; Drug Resistance; Female; Humans; Italy; Long-Term Care; Male; Obsessive-Compulsive Disorder; Olanzapine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors

One of the few combination approaches to the treatment of obsessive-compulsive disorder (OCD) with encouraging support is the addition of an antipsychotic to a serotonin reuptake inhibitor.. The study consisted of a 6-week, placebo-controlled addition of olanzapine 5-10 mg (6.1 +/- 2.1 mg, mean +/- SD) to fluoxetine in OCD subjects who were partial or nonresponders to an 8-week, open-label fluoxetine trial (40 mg in 43 subjects, 20 mg in 1 subject).. Both the fluoxetine-plus-olanzapine (n = 22) and fluoxetine-plus-placebo (n = 22) groups improved significantly over 6 weeks [F(3,113) = 11.64, p <.0001] according to Yale-Brown Obsessive Compulsive Scale scores with repeated-measures analysis of variance; however, the treatment x time interaction was not significant for olanzapine versus placebo addition to fluoxetine.. These findings indicate no additional advantage of adding olanzapine for 6 weeks in OCD patients who have not had a satisfactory response to fluoxetine for 8 weeks, compared with extending the monotherapy trial.

Topics: Adult; Aged; Analysis of Variance; Antipsychotic Agents; Benzodiazepines; Double-Blind Method; Drug Resistance; Drug Therapy, Combination; Female; Fluoxetine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Prospective Studies; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The purpose of this study was to explore the efficacy of adding an atypical antipsychotic, olanzapine, to a serotonin reuptake inhibitor (SRI) in treatment-refractory obsessive-compulsive disorder (OCD).. Twenty-six patients aged between 18 and 65 (mean = 41.2, SD = 11.9) years meeting DSM-IV criteria for OCD, who had not responded to SRIs, were treated for 6 weeks in a double-blind, placebo-controlled augmentation study with either olanzapine (up to 20 mg/day) or placebo. Severity of illness was assessed biweekly by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Analysis of covariance with baseline Y-BOCS score included as a covariate was used to compare improvement in Y-BOCS scores in the 2 groups. Response was defined as a 25% or greater improvement in Y-BOCS score. Data were collected between April 2001 and May 2003.. Outcome was assessed for all patients using the last observation carried forward. Subjects in the olanzapine group had a mean decrease of 4.2 (SD = 7.9) in Y-BOCS score compared with a mean increase in score of 0.54 (SD = 1.31) for subjects in the placebo group (F = 4.85, df = 2,23; p =.04). Six (46%) of 13 subjects in the olanzapine group showed a 25% or greater improvement in Y-BOCS score compared with none in the placebo group. The final mean dose of olanzapine was 11.2 (SD = 6.5) mg/day. Medication was well tolerated. Only 2 (15%) of 13 subjects who received olanzapine discontinued because of side effects: sedation (N = 1) or weight gain (N = 1).. These results provide preliminary evidence that adding olanzapine to SRIs is potentially efficacious and well tolerated in the short-term treatment of patients with refractory OCD. Controlled studies with larger sample sizes are necessary to more definitively address this treatment strategy.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Placebos; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome

The aim of this study was to examine the effects of olanzapine on aggressive behaviour and tic severity in children with Tourette's Syndrome (TS).. Ten (10) subjects (aged 7-13 years) with a primary diagnosis of TS and a history of aggressive behaviour were treated in a single-blind, 2-week placebo run-in, 8-week treatment phase trial. The starting dose of olanzapine was 1.25-2.5 mg/day and was titrated at biweekly intervals, as tolerated. The mean dosage at the end of the trial was 14.5 mg/day.. All 10 subjects completed the study. Olanzapine produced clinically and statistically significant reductions of aggression and tic severity from baseline to trial completion, as measured by the Achenbach Child Behavior Checklist (CBCL) and Yale Global Tic Severity Scale (YGTSS). Weight gain during the treatment period was the most common adverse effect (range 2-20 lbs: group mean 12.0 lbs +/- 5.71). No other significant adverse effects were observed during the 10-week trial.. The results of this trial confirm clinical observations that olanzapine may be an effective treatment for aggression and tics in children with Tourette's syndrome. Olanzapine was generally well tolerated, although significant weight gain was observed throughout the trial.

Topics: Adolescent; Affect; Aggression; Antipsychotic Agents; Anxiety; Basal Ganglia Diseases; Benzodiazepines; Child; Family; Female; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pilot Projects; Prospective Studies; Psychiatric Status Rating Scales; Single-Blind Method; Social Behavior; Surveys and Questionnaires; Tics; Tourette Syndrome; Weight Gain

The aim of the present study was to investigate the effect of adjunctive olanzapine in patients with obsessive-compulsive disorder (OCD) refractory to paroxetine. Twenty-one patients unresponsive to treatment with paroxetine, administered for at least 12 weeks at the dose of 60 mg/day, participated to a 12-week open-label, add-on trial with olanzapine (10 mg/day). The psychopathological state was evaluated by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and by Clinical Global Impression (CGI). Three patients did not complete the 12-week adjunctive treatment with olanzapine. In the 18 completers, the mean Y-BOCS score decreased significantly from 27.1+/-4.0 at baseline to 20.1+/-3.9 at final evaluation (P<.001). Seven patients (38.9%) were rated as responders at final evaluation. Steady-state plasma concentrations of paroxetine were not modified during olanzapine coadministration. The drug combination was generally well tolerated and initial sedation and weight gain were the most frequent unwanted effects. Our findings confirm the results of previous studies and indicate that the addition of olanzapine to ongoing treatment with serotonin reuptake inhibitors (SRI) may be beneficial in some patients unresponsive to SRI monotherapy.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Resistance; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Paroxetine; Pirenzepine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Weight Gain

Topics: Adolescent; Adult; Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Recurrence; Risperidone; Surveys and Questionnaires

To determine whether severity of obsessive-compulsive symptoms (OCS) differs during treatment with olanzapine or risperidone and to establish whether duration of antipsychotic treatment is related to severity of OCS.. We conducted a prospective study of consecutively hospitalized young patients (mean age = 22.4 years) with DSM-IV schizophrenia or related disorders (N = 113) who were treated with olanzapine or risperidone. Olanzapine or risperidone was randomly prescribed for patients who were drug-naive or were treated with typical antipsychotics before admission (N = 36). Patients who had started olanzapine (N = 39) or risperidone treatment (N = 23) prior to admission continued with that medication if they showed initial clinical response. Patients who prior to admission started olanzapine (N = 6) or risperidone (N = 9) but showed no response or suffered from adverse effects switched at admission to risperidone or olanzapine, respectively. Medical records, parents, and patients revealed information on duration of treatment and compliance with olanzapine or risperidone prior to admission. The Yale-Brown Obsessive Compulsive Scale (YBOCS) was administered at admission and 6 weeks thereafter.. At baseline and 6-week assessments, OCS were found in about 30% of 106 evaluable cases and 15% met DSM-IV criteria for obsessive-compulsive disorder. No differences in OCS were found in the patients randomly assigned to olanzapine or risperidone. The 35 subjects treated with olanzapine at both assessments had significantly (p = .01) more severe OCS at week 6 than the 20 subjects treated with risperidone at both assessments. Duration of treatment with olanzapine was significantly (p < .01) related to severity of OCS.. There are no differences in the short-term propensity of olanzapine or risperidone to induce or exacerbate OCS. However, severity of OCS was associated with duration of treatment with olanzapine.

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Comorbidity; Female; Humans; Longitudinal Studies; Male; Netherlands; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Prospective Studies; Psychiatric Status Rating Scales; Psychotic Disorders; Risperidone; Schizophrenia; Severity of Illness Index; Treatment Outcome

This study evaluates the clinical response to olanzapine used in association with selective serotonin reuptake inhibitors (SSRIs) or clomipramine in treatment-resistant obsessive-compulsive disorder (OCD).. We describe the cases of 9 patients with serotonin uptake inhibitor-resistant OCD who were given an open-label adjunctive treatment of olanzapine for a minimum of 6 weeks. The response was assessed by using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale (CGI).. Six patients showed improvement of symptoms after the augmentation with olanzapine. One patient (treated with clomipramine) discontinued olanzapine due to side effects, and another 2 did not respond.. Olanzapine augmentation of SSRIs in treating OCD showed a good (two-thirds) response rate, and it could therefore be considered as a treatment option when conventional therapies have failed.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clomipramine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Personality Inventory; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Adding the atypical neuroleptic risperidone to a serotonin reuptake inhibitor (SRI) has benefited patients with treatment-refractory obsessive-compulsive disorder (OCD). Since olanzapine and risperidone have similar serotonergic and dopaminergic receptor binding profiles, we tested the hypothesis that olanzapine augmentation would be beneficial in treatment-unresponsive OCD.. For this 8-week trial, we recruited 10 adult OCD patients (DSM-IV criteria) unresponsive to fluoxetine (> or =60 mg/day) for > or =10 weeks, which was continued throughout the trial. Other psychotropic medications were discontinued. Subjects had OCD for > or =1 year, a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of > or =18, and no organic, psychotic, or other primary Axis I disorder. Two weeks after olanzapine, 2.5 mg/day, was added, and in the absence of responder status (Y-BOCS score decrease > or =25%) and limiting side effects, we increased the dose to 5 mg/day, and after 2 more weeks, to 10 mg/day for 4 weeks.. The subjects had failed a mean of 3.3 SRI trials (range, 1-5) and had a mean +/- SD baseline Y-BOCS score of 29.0 +/- 4.9. Nine patients completed the trial. The subjects' mean +/- SD endpoint Y-BOCS score was 24.4 +/- 8.0 (a 16% decrease). The 3 responders' Y-BOCS scores dropped 68%, 30%, and 29%, but only 1 patient was rated "much improved." He maintained this improvement during a 6-month follow-up period taking olanzapine, 5 mg/day. Improvement in OCD was independent of improvement in mood symptoms. Six patients (60%) experienced significant weight gain.. Olanzapine augmentation may benefit treatment-unresponsive OCD. Double-blind, placebo-controlled trials are warranted along with trials comparing risperidone and olanzapine augmentation.

Topics: Adult; Benzodiazepines; Drug Administration Schedule; Drug Therapy, Combination; Fluoxetine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Risperidone; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Weight Gain; Xerostomia

Despite the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive-compulsive disorder, a significant number of patients show no or only partial remission of symptoms. Some evidence exists to suggest that risperidone augmentation can be helpful in treating this refractory group. The efficacy of other atypical antipsychotic agents, such as olanzapine, in augmenting SSRIs in refractory obsessive-compulsive patients has yet to be systematically investigated.. A series of 10 patients with DSM-IV obsessive-compulsive disorder showing significant residual symptoms following an adequate SSRI trial (12 weeks) were given open-label olanzapine augmentation for a minimum of an additional 8 weeks. Treatment response was assessed using the Yale-Brown Obsessive Compulsive Scale and the Clinical Global Impressions scale.. Nine of the 10 patients in this series treated with olanzapine and an SSRI completed the 8-week augmentation trial. Of these, 4 demonstrated a complete remission or major improvement in obsessive-compulsive symptoms, 3 had partial remission, and 2 experienced no benefit. Nine patients experienced minimal adverse effects, primarily sedation, which did not interfere with continuing treatment. One patient discontinued olanzapine owing to excessive sedation.. The results of this preliminary, open-label trial suggest that olanzapine may be effective in augmenting ongoing SSRI treatment for a portion of patients with obsessive-compulsive disorder refractory to SSRI treatment. Larger, placebo-controlled trials appear warranted to investigate the clinical efficacy and tolerability of olanzapine augmentation of SSRI treatment in SSRI-refractory obsessive-compulsive disorder.

Topics: Adult; Ambulatory Care; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Olanzapine is a recently introduced atypical neuroleptic agent for which little information is available on its use in children. Open clinical trials of olanzapine treatment were conducted on five hospitalized children (ages 6 to 11 years) with varying diagnoses including bipolar disorder, psychosis not otherwise specified, schizophrenia, and attention-deficit/ hyperactivity disorder. Each patient had failed previous psychotropic medication trials, with a mean of four prior trials. The mean length of olanzapine treatment was 32 days (range, 2 to 7 weeks), and mean daily dose was 7.5 mg/day (range, 2.5 to 1.0 mg/day) or 0.22 mg/kg/day (range, 0.12 to 0.29 mg/kg/day). All children experienced adverse effects, including sedation (N = 3), weight gain of up to 16 pounds (N = 3), and akathisia (N = 2). Three patients showed some clinical improvement, but olanzapine treatment was discontinued in all five children within the first 6 weeks of treatment because of adverse effects or lack of clinically significant therapeutic response, although higher (or lower) doses, slower titration of dosage, or a longer duration of treatment might have produced more favorable results. Psychotic symptoms did not respond in the two patients with evidence of overt hallucinations and paranoid ideation. Improvement was observed in sleep in all five patients and in control of aggression in three. Before controlled trials of olanzapine in children are undertaken, further exploration of dose range and increased duration of treatment on an open basis are warranted. Until more encouraging data are available, clinicians should be cautious and conservative in their predictions about the potential value of olanzapine in treating preadolescent psychiatric disorders.

Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Benzodiazepines; Child; Female; Humans; Impulsive Behavior; Male; Mental Disorders; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Psychotic Disorders; Self-Injurious Behavior; Tourette Syndrome

The antipsychotic drug olanzapine is similar to clozapine and risperidone in potent serotonergic antagonism. We assessed obsessive-compulsive symptoms during olanzapine treatment because these symptoms have been reported during risperidone and clozapine treatment. Obsessions and compulsions were measured in 25 subjects with schizophrenia before and after a 6-week double-blind trial comparing two olanzapine doses to placebo. At baseline, 8 subjects had mild or moderate obsessions, and 6 had mild compulsions. There was no significant difference in the course of obsessive-compulsive symptoms among the three treatment groups. We found that olanzapine did not appear to cause obsessive-compulsive symptoms in patients with schizophrenia. Our sample size, the dose and duration of olanzapine treatment, and assessment methods limit the extent to which this finding can be generalized. Though emerging obsessive-compulsive symptoms have been reported for 13 clozapine-treated and 2 risperidone-treated patients with schizophrenia, this phenomenon has not yet been demonstrated in a controlled study.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

About half of the patients with Obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) or have a partial improvement in their symptoms. This study aimed to compare the efficiency and safety of aripiprazole, olanzapine, and L-methyl folate in patients with resistant OCD. The study consisted of an open-label prospective phase of 12-weeks to ascertain resistance to SRIs and a second 6-week open-label addition phase for non or, partial responders of the first phase. One-hundred-fifteen patients entered the 16-week open-label phase. Fifty patients (43.47%) responded to the SRIs monotherapy, two patients developed adverse effects and another three were lost to the follow up. Sixty patients (52.2%) were considered treatment-resistant and entered the 6-week open-label aripiprazole, olanzapine, or L-methyl folate addition phase; Patients showed a significant improvement over 6-week study period in olanzapine and aripiprazole group as measured by YBOCS total score (p < 0.001) while there was no change in the L-methyl folate group at the end as compared with baseline (p = 0.150). Clinical Global Impression-Severity decreased from 4.90 to 2.90 in olanzapine and aripiprazole group at the end of 6 weeks while there was no change in the L-methyl folate group. The CGI-I was significant in the olanzapine and aripiprazole group (p < 0.001) while it was insignificant in the L-methyl folate group (p = 0.088). Augmentation of SRIs with olanzapine or aripiprazole could be a promising option for resistant OCD. L-methyl folate though shown to be effective in resistant depression was not effective in treatment resistant OCD.

Topics: Antipsychotic Agents; Aripiprazole; Drug Therapy, Combination; Humans; Obsessive-Compulsive Disorder; Olanzapine; Prospective Studies; Selective Serotonin Reuptake Inhibitors; Tetrahydrofolates; Treatment Outcome

Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and have significant impacts on clinical course. This study was intended to investigate the relationships of OCS with pharmacological parameters of olanzapine, psychopathology, and quality of life. Totally 151 schizophrenia patients were recruited, and rated using Yale-Brown Obsessive-Compulsive scale (YBOCS), Positive and Negative Syndrome Scale (PANSS), Montgomery-Åsberg Depression Rating Scale (MADRS), and World Health Organization Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). The concentrations of olanzapine and N-desmethylolanzapine were determined by HPLC. Twenty-five patients (16.6%) revealed the presence of OCS. OCS group had significantly higher olanzapine dose, more numbers of past hospitalizations, higher PANSS total, positive, negative, and general psychopathology scores, and higher MADRS score than those in non-OCS group. The WHOQOL-BREF physical subscale score in schizophrenia patients with OCS was significantly lower. Olanzapine dose, PANSS score, and MADRS score were significantly correlated with YBOCS score. Our findings highlight that OCS is highly prevalent in schizophrenia patients under olanzapine treatment, especially those at high doses. Schizophrenia patients with OCS had higher severity of psychotic and depressive symptoms and poorer quality of life. Clinicians should monitor OCS in patients with schizophrenia receiving olanzapine treatment.

Topics: Adult; Antipsychotic Agents; Comorbidity; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Psychiatric Status Rating Scales; Psychopathology; Quality of Life; Schizophrenia; Schizophrenic Psychology; Surveys and Questionnaires

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Citalopram; Comorbidity; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Valproic Acid

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Fluoxetine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Schizophrenia; Selective Serotonin Reuptake Inhibitors

The goal of this study is to report on the treatment of obsessive-compulsive disorder (OCD), a chronic disabling condition that often presents during childhood and adolescence. Reports on adults using clonazepam for the treatment of OCD are more numerous than on children. Clonazepam as an augmentative treatment in OCD is still controversial. Our aim is to illustrate in a case report the efficacy of clonazepam as an augmentative treatment for severe childhood onset OCD. We report on the case of a young teenage girl with an extremely severe form of obsessive-compulsive disorder (score of 32 on the Children's Yale-Brown Obsessive Compulsive Scale), who, after a mild improvement with a combination of serotonin recapture inhibitors and second generation antipsychotics at high doses, has responded to clonazepam (3mg/day) augmentation of sertraline (200mg/day) and olanzapine (15mg/day). Clonazepam was effective not only in reducing anxiety symptoms, but also in lowering compulsions and obsessions frequency within 6 weeks with a drop in the Children's Yale-Brown Obsessive Compulsive Scale of 16 points. It may be asserted that clonazepam could be useful in the initial stage for severe OCD in young patients.

Topics: Adolescent; Benzodiazepines; Clonazepam; Drug Therapy, Combination; Female; GABA Modulators; Humans; Obsessive-Compulsive Disorder; Olanzapine; Sertraline; Severity of Illness Index; Turkey

The aim of the study was to investigate the prevalence rates of obsessive-compulsive disorder (OCD) and hypochondriasis in schizophrenic patients treated with atypical antipsychotics (AAPs) and to investigate the different comorbidity rates of OCD and hypochondriasis between clozapine-treated patients and patients treated with other AAPs.. We therefore recruited 60 schizophrenic patients treated with clozapine or other AAPs. We assessed the prevalence rates of OCD or OC symptoms and hypochondriasis or hypochondriac symptoms in the whole group of patients and in clozapine-treated patients versus patients treated with other AAPs.. Schizophrenic patients had a higher comorbidity rate of OCD (26.6% vs 1-3%) and hypochondriasis (20% vs 1%) than the general population. These comorbidities were more frequent in schizophrenic patients treated with clozapine versus patients treated with other AAPs (36.7% vs 16.7% and 33.3% vs 6.7%). Clozapine-treated patients showed a higher mean Y-BOCS and HY-BOCS score when compared to patients treated with other AAPs (10.90 vs 5.90, p = .099; 15.40 vs 8.93, p = .166). A statistical significant correlation was found between the Y-BOCS and HY-BOCS scores of the whole group (r = .378, p = 0.03). Furthermore, we found an inverse correlation between the global level of functioning and the diagnosis of hypochondriasis (p = .048) and the severity of hypochondriac symptoms (p = .047).. Hypochondriasis could represent an important clinical feature of schizophrenic patients treated with atypical antipsychotics, and further research is needed in this field.

Topics: Adult; Amisulpride; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Comorbidity; Female; Humans; Hypochondriasis; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Paliperidone Palmitate; Prevalence; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Sulpiride

To compare the prevalence of obsessive-compulsive symptoms (OCS) in a population of patients with schizophrenia taking clozapine, olanzapine, or risperidone or taking no antipsychotic medication.. Baseline data of the Genetic Risk and Outcome of Psychosis study were collected between April 2005 and October 2008. We conducted a naturalistic cross-sectional study of 543 patients with schizophrenia and related disorders, who were recruited from multiple mental health centers, including inpatient and outpatient clinics, across The Netherlands. The patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and were taking no antipsychotic medication or taking clozapine, olanzapine, or risperidone. OCS severity was measured with the Yale-Brown Obsessive Compulsive Scale. We compared patients to a sample of 575 healthy controls.. Prevalence of OCS in patients was significantly higher than in the control sample, 23.4% versus 4.9% (χ(2) = 73.8, P < .001). Patients taking clozapine reported OCS significantly more often during the last week (38.9%), when compared to patients taking olanzapine (20.1%, χ(2) = 10.02, P = .002) or risperidone (23.2%, χ(2) = 5.96, P = .015) and patients taking no antipsychotics (19.6%, χ(2) = 8.20, P = .004). Patients taking clozapine for 6 months or longer reported OCS significantly more often than patients taking clozapine for less than 6 months, 47.3% versus 11.8% (χ(2) = 6.89, P = .009).. Treatment with clozapine in patients with schizophrenia is associated with a higher prevalence of OCS, especially when patients have been taking clozapine for 6 months or longer. We cannot rule out the possibility that this association is related to illness characteristics. Patients treated with risperidone or olanzapine or without treatment with antipsychotic medication had comparable prevalence of OCS, all significantly higher than the control sample.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Case-Control Studies; Causality; Clozapine; Cross-Sectional Studies; Female; Humans; Male; Netherlands; Obsessive-Compulsive Disorder; Olanzapine; Psychiatric Status Rating Scales; Risperidone; Schizophrenia; Young Adult

Epidemiological investigations show that up to 30% of schizophrenic patients suffer from obsessive-compulsive symptoms (OCS) associated with negative impact on the general prognosis. It has been proposed that antiserotonergic second-generation antipsychotics (SGAs) might induce OCS, but investigations of large samples integrating psychopathology, neuropsychology and psychopharmacology are missing.. We stratified 70 patients with schizophrenia according to their mode of antipsychotic treatment: clozapine and olanzapine (group I) compared with aripiprazole and amisulpride (group II). The groups were matched according to age, sex, educational levels and severity of the psychotic disorder (Positive and Negative Syndrome Scale). As the primary endpoint, we evaluated OCS severity (Yale-Brown Obsessive-Compulsive Scale).. OCS were significantly more prevalent and severe in group I, in which OCS severity correlated with dosage of clozapine and duration of treatment. Pronounced cognitive deficits in group I were found in visuospatial perception and visual memory (Wechsler Adult Intelligence Scale-Revised block design, Rey-Osterrieth Complex Figure Test), impulse inhibition (go/no-go test), higher perseveration scores (Wisconsin Card Sorting Test) and reduced set-shift abilities (Trail Making Test Part B, Set-shift Task). These cognitive domains correlated with OCS severity.. OCS in schizophrenia are associated with antiserotonergic SGA treatment, but longitudinal studies have to prove causality. Before starting treatment with antiserotonergic SGAs, specific neurocognitive domains should be evaluated, as visuospatial learning and impulse inhibition performance might allow early detection of OCS secondary to antipsychotic treatment in schizophrenia.

Topics: Adult; Amisulpride; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Comorbidity; Female; Germany; Humans; Male; Matched-Pair Analysis; Obsessive-Compulsive Disorder; Olanzapine; Piperazines; Prevalence; Quinolones; Schizophrenia; Serotonin Antagonists; Severity of Illness Index; Sulpiride

Topics: Amlodipine; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Clonazepam; Drug Therapy, Combination; Fluoxetine; GABA Modulators; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Raynaud Disease; Schizophrenia; Vasodilator Agents

Little is known about the neuronal mechanism underpinning the pathophysiology of compulsive hoarding. We report the cerebral blood flow changes in an obsessive-convulsive patient with severe hoarding. The patient showed hyperperfusion of the fronto-temporal region and hypoperfusion of the striatal, the middle cingulate and the medial temporal regions during the stage with severe symptoms. Following improvement from the hoarding behaviors, the extent of hypoperfusion was expanded in the bilateral striatum, the anterior and middle cingulate gyrus. The result may substantiate evidence of the fronto-limbic abnormality involved in the pathophysiology of compulsive hoarding.

Topics: Antipsychotic Agents; Benzodiazepines; Cerebrovascular Circulation; Compulsive Behavior; Cysteine; Diagnostic and Statistical Manual of Mental Disorders; Female; Frontal Lobe; Humans; Image Processing, Computer-Assisted; Limbic System; Obsessive-Compulsive Disorder; Olanzapine; Organotechnetium Compounds; Radiopharmaceuticals; Recovery of Function; Risperidone; Tomography, Emission-Computed, Single-Photon; Young Adult

We report the case of two young subjects who developed an obsessive-compulsive disorder (OCD) during a heavy use of ecstasy. After several months of discontinuation of the drug, major depression with psychotic features developed in one subject and a psychotic disorder in the other individual. No mental disorder preceded the use of ecstasy in any subject.. A familial and personality vulnerability for mental disorder was revealed in one subject, but not in the other, and all physical, laboratory and cerebral NMR evaluations showed normal results in both patients. Remission of OCD and depressive episode or psychotic disorder was achieved after treatment with a serotoninergic medication associated with an antipsychotic.. The heavy long-term use of ecstasy may induce an alteration in the brain balance between serotonin and dopamine, which might constitute a pathophysiological mechanism underlying the onset of obsessive-compulsive, depressive and psychotic symptoms. The heavy use of ecstasy probably interacted with a vulnerability to psychiatric disorder in one subject, whereas we cannot exclude that an "ecstasy disorder" ex novo affected the other individual.

Topics: Adolescent; Amphetamine-Related Disorders; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Borderline Personality Disorder; Brain; Clomipramine; Comorbidity; Depressive Disorder, Major; Dopamine; Female; Genetic Predisposition to Disease; Hallucinogens; Humans; Male; N-Methyl-3,4-methylenedioxyamphetamine; Obsessive-Compulsive Disorder; Olanzapine; Psychoses, Substance-Induced; Risk Factors; Risperidone; Serotonin; Substance Withdrawal Syndrome; Young Adult

Topics: Adult; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Body Image; Delusions; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Obsessive-Compulsive Disorder; Olanzapine; Paroxetine

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

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

Numerous neuroimaging studies have suggested that obsessive-compulsive disorder (OCD) patients had a neurobiological abnormality in the frontal-subcortical circuits. On the other hand, there are distinct differences in the responses to pharmacological treatment among OCD patients. In the present study, we measured the concentration of N-acetyl aspartate (NAA), a putative marker of neuronal viability, with proton magnetic resonance spectroscopy (MRS) in OCD patients with different pharmacological responses. Participants comprised 20 patients and 26 healthy control subjects. OCD patients were divided into three groups according to the pharmacological response; responders to a selective serotonin reuptake inhibitor (SSRI) (group A: n=7), responders to SSRI with an atypical antipsychotic (group B: n=8) and non-responders to either SSRI or SSRI with an atypical antipsychotic (group C: n=5). Short echo proton MRS was used to measure NAA concentrations in the anterior cingulate, the left basal ganglia and the left prefrontal lobe of subjects. A significantly lower NAA concentration was observed only in group B compared with control subjects in the anterior cingulate. Our results suggest that a subgroup of OCD patients who respond to an SSRI with an atypical antipsychotic have distinct biological abnormalities in the anterior cingulate.

Topics: Adult; Antipsychotic Agents; Aspartic Acid; Basal Ganglia; Benzodiazepines; Dominance, Cerebral; Dose-Response Relationship, Drug; Drug Therapy, Combination; Energy Metabolism; Female; Fluvoxamine; Frontal Lobe; Gyrus Cinguli; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Nerve Net; Obsessive-Compulsive Disorder; Olanzapine; Paroxetine; Prefrontal Cortex; Risperidone; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Topics: Adult; Antidepressive Agents; Benzodiazepines; Cyclopropanes; Depression; Drug Therapy, Combination; Female; Humans; Milnacipran; Nausea; Obsessive-Compulsive Disorder; Olanzapine; Selective Serotonin Reuptake Inhibitors

Although selective serotonin reuptake inhibitors (SSRIs) are the mainstay of pharmacological treatment for obsessive-compulsive disorder (OCD), some OCD patients do not show improvement. Sometimes, the addition of a low-dose atypical antipsychotic, such as risperidone, or olanzapine, to ongoing SSRI treatment has been shown to be effective. However, there are patients who still show no response after trials with this augmentation therapy. In the present study, we examined the clinical features of OCD patients who showed different responses to pharmacological treatment.. Fifty OCD patients were divided into three groups according to their pharmacological responses: responders to SSRI (group A: n= 25), responders to SSRI with an atypical antipsychotic (group B: n= 15), and non-responders to both SSRI and SSRI with an atypical antipsychotic (group C: n= 10). We examined the clinical features such as age, sex, age of onset, duration of illness, types of obsessive-compulsive symptoms, severity, improvement after treatment, insight into disease, depression, comorbidity, involving family members in compulsive or ritualistic behavior, and the level of social adaptation of each OCD group.. Twenty five patients showed a good response to SSRI monotherapy, 15 showed a response to antipsychotic augmentation, and 10 were non-responders to both SSRI and SSRI with an atypical antipsychotic. Significantly lower insight levels were observed only in group B and higher depressive levels in group C. OCD patients who were refractory to SSRI monotherapy showed comorbidity at a significantly higher frequency. OCD patients in group A showed significantly greater improvement, and group B showed inferior social adaptation after treatment. There were no significant differences in age, sex, age of onset, duration of illness, severity, involving family members in compulsive or ritualistic behavior, and social adaptation before treatment in the three OCD groups.. There were differences in the clinical features of OCD patients who showed different responses to pharmacological treatment. Our results suggest that OCD is clinically and biologically heterogeneous. It may be important to divide OCD patients into subgroups for future studies.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Retrospective Studies; Risperidone; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome

Obsessive-compulsive symptoms (OCSs) frequently occur in schizophrenia and seem to worsen prognosis. Many case studies suggest that OCSs appear or worsen with an atypical antipsychotic agent treatment (that is, with risperidone, olanzapine, and clozapine). Therefore, family or personal history of OCS should be investigated before initiating such treatment, and OCS onset should be monitored during treatment. Clozapine is involved in most such cases. When OCSs appear with clozapine, dosage can be reduced and a serotonin reuptake inhibitor treatment added. Current studies suggest that patients with schizophrenia and OCSs should benefit from treatment with an antipsychotic and an antiobsessive medication. Two controlled trials deal with OCS treatment in schizophrenia: the first, with clomipramine; and the second, with fluvoxamine. Both have proven their efficacy, but these trials include a small number of patients with heterogeneous characteristics.

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Humans; Obsessive-Compulsive Disorder; Olanzapine; Risperidone; Schizophrenia; Severity of Illness Index

Although there only have been a limited number of double-blind, placebo controlled trials, antipsychotics are considered to be effective drugs for the treatment of tics in Gilles de la Tourette syndrome (GTS). Evidence concerning the efficacy of olanzapine and other atypical antipsychotics in the treatment of tics in GTS is growing, but still limited. Little is known about the use of olanzapine in adult GTS patients and about its effect on comorbid behavioural problems. We report on the use of olanzapine in a 25-year old male GTS patient with comorbid obsessive-compulsive behaviours, who was treated with olanzapine. Tic severity was rated using the Yale Global Tic Severity Scale (Y-GTSS). Comorbid obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Both scales were performed at admission and after 4 weeks of treatment with olanzapine. Treatment with olanzapine (20 mg) resulted not only in a fast reduction of tic severity and frequency, but also in a reduction of obsessive-compulsive behaviours.. This case report further supports the available literature on the use of olanzapine as a therapeutic strategy for tics in GTS and draws attention to its possible use for comorbid behavioural disorders. Further research of antipsychotics in GTS should include measurements of comorbid behavioural symptom clusters.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Comorbidity; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Tics; Tourette Syndrome

The emergence or exacerbation of obsessive-compulsive (OC) symptoms during treatment with atypical antipsychotics, mostly clozapine, has been documented by numerous case reports (reviewed by Lykouras et al., 2003). In six recent reports involving nine cases, (Jonkers and de Haan, 2002; Lykouras et al., 2003) olanzapine was found either to cause de novo emergence or to exacerbate OC symptoms. In six of these cases olanzapine caused exacerbation and in three cases caused de novo emergence of OC symptoms.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Depressive Disorder, Major; Double-Blind Method; Female; Humans; Obsessive-Compulsive Disorder; Olanzapine; Schizophrenia

Topics: Adult; Benzodiazepines; Bipolar Disorder; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Antipsychotic medications are increasingly used in adolescents for a variety of psychiatric difficulties, including psychosis, bipolar disorder, and aggression. Weight gain is a significant side effect of neuroleptics, which may limit adolescents' compliance with these medications. This report presents a case of significant weight loss while on olanzapine, with a body mass index (BMI) falling from 25 to 19.5 during 8 months of treatment. Possible mechanisms for this effect are discussed.

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Child; Child Abuse, Sexual; Depressive Disorder, Major; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Weight Loss

Topics: Adult; Benzodiazepines; Clomipramine; Fluoxetine; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Comorbidity; Drug Therapy, Combination; Humans; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia, Paranoid; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chronic Disease; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia

Topics: Adrenergic alpha-Agonists; Adult; Antipsychotic Agents; Benzodiazepines; Drug Overdose; Humans; Male; Norepinephrine; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine

Topics: Adult; Benzodiazepines; Bipolar Disorder; Female; Humans; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine

The aim was to describe the short-term (6 months) effects of olanzapine on behavioral and motor clinical manifestations in a group of 11 patients with Huntington disease.. An open-pilot study of olanzapine (5 mg) in patients with clinical and genetic diagnosis of Huntington disease was used. The Unified Huntington Disease Rating Scale for clinical assessment and the Total Functional Capacity score for the disease-stage evaluation were used. A statistical analysis was performed to compare the effects of olanzapine on the Unified Huntington Disease Rating Scale scores at time 0 (baseline) and at time 1 (6 months). Comparisons of motor scores, of single behavioral items, and of TFC scores were performed within the group.. The behavioral assessment score of items regarding depression, anxiety, irritability, and obsessions showed a significant improvement (range of p, 0.0134-0.048). Given the total behavioral scores (sum of all the items investigated), five patients significantly improved their behavioral score after a 6-month treatment (range of p, 0.013-0.047). Choreic movements improved, although not significantly (0.05 < or = p < or = 1).. Olanzapine is a potentially useful antipsychotic drug, with significant short-term effects on behavioral changes, mainly in patients with severe psychiatric symptoms at the onset. It might be considered as a possible therapeutic choice for treatment of Huntington disease.

Topics: Administration, Oral; Adult; Aged; Antipsychotic Agents; Anxiety; Benzodiazepines; Depression; Female; Humans; Huntington Disease; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Severity of Illness Index; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Polypharmacy; Priapism; Risperidone; Schizophrenia; Treatment Outcome

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

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

Topics: Age of Onset; Antipsychotic Agents; Benzodiazepines; Drug Administration Schedule; Female; Humans; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Somatoform Disorders; Treatment Outcome

Whereas the Fiji government provides all aspects of mental health care services free of charge to its citizens, many schizophrenics have failed to respond to classical antipsychotic drugs.. To assess the efficacy and safety of olanzapine among various patients with severe psychiatric disorders.. Naturalistic setting.. Descriptive study.. Outcome was based on reduction of symptoms on the PANSS (> or = 40%) and CGI shift to 1-3.. The were 64 patients (30 males) aged 17-77 years. Thirty six (56.3%) had schizophrenia, eight mania, ten severe depression, four obsessive compulsive disorder (OCD), one each had schizo-affective and delusional disorders, while the remaining had chronic brain diseases.. At weeks 3, 8, 12, the proportion of subjects with 40% improvement was 60.6%, 79.9%, and 76.8%, respectively. Positive and negative symptoms improved. Thirteen (48.1%) of the 27 long-stay treatment--resistant schizophrenics achieved clinical recovery at eight weeks. All with primary diagnosis of severe depression and mania achieved full clinical recovery (mostly within two weeks). Two OCD cases achieved clinical recovery at week eight.. Olanzapine was safe for all categories of patients. There was not a single case of extrapyramidal reaction among subjects who did not have it pre-treatment; and the drug was safe in a suicidal overdose of 205 mg. Most patients experienced weight gain; two adolescent girls had temporary amenorrhoea and one subject had transient rise in liver transaminases which normalised without discontinuing the drug.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Depressive Disorder; Female; Fiji; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Schizophrenia; Severity of Illness Index; Treatment Outcome; Weight Gain

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine

Some studies suggest that obsessive-compulsive symptoms may be common (7.8-46%) in schizophrenic patients and seem to be poorly responsive to drug therapy. Conventional neuroleptics are of limited value, but adjunctive anti-obsessive agents (clomipramine, fluvoxamine) may be an option. Although novel atypical antipsychotics (clozapine, risperidone) reportedly aggravate the obsessive-compulsive symptoms, a recent trial has shown that olanzapine did not induce new-onset obsessive-compulsive symptoms in schizophrenic patients. We report our experience with three schizophrenic patients with obsessive-compulsive symptoms who were unsuccessfully treated with various conventional neuroleptics in combination with anti-obsessive agents and subsequently showed resistance or intolerance to clozapine. All of them were switched to olanzapine (10-20 mg/ day). All patients demonstrated a significant improvement in both schizophrenic and obsessive-compulsive symptoms as measured by the Brief Psychiatric Rating Scale (BPRS) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Within 5-8 weeks of initiation of olanzapine, the BPRS scores of the three patient decreased by 53%, 51% and 48%, and the Y-BOCS scores by 68%, 73% and 85%. Olanzapine was well tolerated. These preliminary results suggest that olanzapine may be a therapeutic option in schizophrenic patients with obsessive-compulsive symptoms.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia; Severity of Illness Index; Treatment Outcome

Clozapine and risperidone have been implicated in the development of obsessive-compulsive symptoms. We present three cases in which olanzapine caused a significant exacerbation of obsessive-compulsive symptoms in schizophrenia (two cases) and obsessive-compulsive disorder (one case).

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia

A few studies have tried antipsychotic augmentation in obsessive-compulsive disorder (OCD) patients who are non-responders to selective serotonin reuptake inhibitors. The aim of this study was to investigate the efficacy and tolerability of olanzapine addition to fluvoxamine-refractory OCD patients and to assess if a comorbid chronic tic disorder or a concomitant schizotypal personality disorder was associated with response. Twenty-three OCD non-responders to a 6-month, open-label trial with fluvoxamine (300 mg/day) entered a 3-month open-label trial of augmentation with olanzapine (5 mg/day). OC symptom change was measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale. Differences between responders and non-responders were assessed with regard to age, sex, duration of illness, baseline Y-BOCS score, and comorbidity with chronic tic disorders or schizotypal personality disorder. A significant decrease of mean Y-BOCS score between pre- and post-treatment (26. 8+/-3.0 vs. 18.9+/-5.9) was found at endpoint. Ten patients (43.5%) were rated as responders. The most common side effects were mild to moderate weight gain and sedation. In our sample, three patients (13. 04%) had a chronic motor tic disorder, and four (17.39%) had a codiagnosis of schizotypal personality disorder. Concomitant schizotypal personality disorder was the only factor significantly associated with response. It appears that augmentation of olanzapine in fluvoxamine-refractory OCD may be effective in a large number of patients, including those with comorbid schizotypal personality disorder.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Benzodiazepines; Comorbidity; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Schizotypal Personality Disorder; Tic Disorders; Treatment Outcome

Previous reports suggest that some atypical antipsychotics may have obsessogenic as well as antiobsessional effects. Given their higher affinity for serotonin 5HT2 receptors than dopamine D2 receptors, it has been speculated that atypical antipsychotics may induce obsessive-compulsive (OC) symptoms, even at low doses, due to high 5HT2 antagonism, whereas improvement in OC symptoms is thought to occur only at high doses due to high D2 antagonism.. In this open case series, the dose-response relationship of atypical antipsychotic augmentation in the treatment of obsessive compulsive disorder (OCD), and the dose-severity relationship in atypical anti psychotic-induced OC symptoms were examined. Three patients were identified who had either refractory OCD or OC symptoms following administration of atypical antipsychotics such as olanzapine and risperidone.. Case 1: A linear dose-response relationship between increasing doses of olanzapine and improvement in OC symptoms was observed in an OCD patient resistant to 5-HT reuptake inhibitors. 2: OC symptoms induced by low doses of risperidone (1 mg) were reversed by increasing the doses of risperidone (3 mg) in a bipolar disorder patient suggesting an inverse dose-severity relationship. 3: No inverse dose-severity relationship was noted between olanzapine induced OC symptoms and its dosage in an asymptomatic OCD patient. Tretment-emergence OC symptoms responded to increasing the doses of maintanance clomipramine treatment.. Controlled studies are needed to investigate the dose-response or dose-severity relationships between OCD and atypical antipsychotics.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clomipramine; Dopamine Antagonists; Female; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists

Topics: Antipsychotic Agents; Benzodiazepines; Drug Interactions; Fluoxetine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clomipramine; Fluoxetine; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Comorbidity; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Tremor

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Fluoxetine; Humans; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Retreatment; Selective Serotonin Reuptake Inhibitors; Treatment Failure