olanzapine and Panic-Disorder

The purpose of our study was to evaluate the efficacy and tolerability of low-dose olanzapine augmentation in selective serotonin reuptake inhibitor (SSRI)-resistant panic disorder (PD) with or without agoraphobia. In this 12-week, open-label study, 31 adult outpatients with treatment-resistant PD who had previously failed to respond to SSRI treatment were treated with fixed dose of olanzapine (5 mg/d) in addition to SSRI. Efficacy was assessed using the Panic Attack and Anticipatory Anxiety Scale (PAAAS), the Agoraphobic Cognitions Questionnaire (ACQ), the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), the Global Assessment of Functioning Scale (GAF), and the Clinical Global Impression of Improvement (CGI-I). Twenty-six patients completed the trial period with a dropout rate of 16.1%. At week 12, 21 patients were responders (81.8%), and an overall improvement on all rating scales was observed in all patients both with or without agoraphobia. Fifteen patients (57.7%) achieved remission. Olanzapine was well tolerated and the most frequent adverse effects were mild-to-moderate weight gain and drowsiness. No extrapyramidal symptoms were reported. Olanzapine appears to be effective as augmentation strategy in the treatment of SSRI-resistant PD, but study limitations must be considered and placebo-controlled studies are needed.

Topics: Adult; Agoraphobia; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Humans; Male; Olanzapine; Panic Disorder; Paroxetine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Failure

Panic disorder is a common and disabling psychiatric disorder. Despite treatment advances, refractory panic disorder requires novel interventions. One such pharmacologic intervention with theoretical and case study support includes olanzapine, a thienobenzodiazepine medication currently approved for schizophrenia in the United States. Ten people with refractory DSM-IV diagnosed panic disorder completed an 8-week, open-label, flexible-dose clinical trial. Baseline, in-treatment, and end-of-treatment data for panic attacks, anticipatory anxiety, phobic avoidance, and impairment were collected. Data were analyzed using SPSS software. Refractory panic disorder patients required a wide dose range averaging 12.3 mg/day of olanzapine to significantly improve or ablate panic attacks. On the average, number of attacks decreased from 6.1/week at baseline to 1.1/week at the end of treatment, and anticipatory anxiety from 32% of the day to 8% of the day. At treatment end, 5 of 10 participants (50%) were panic free, 4 (40%) had one attack in the previous week, 1 (10%) had seven attacks in the previous week, and 6 of 10 participants (60%) were anticipatory anxiety free. There were also statistically and clinically significant improvements in impairment over the course of the trial. There were no significant changes in vital signs, emergent side effects, or average weight, although 6 of 10 people did gain weight. Olanzapine is potentially effective and safe in panic disorder. Due to study limitations, further clinical trials are needed to demonstrate effectiveness.

Topics: Adult; Benzodiazepines; Diagnostic and Statistical Manual of Mental Disorders; Drug Administration Schedule; Female; Humans; Male; Olanzapine; Panic Disorder; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index

This paper describes a case of co-morbid panic disorder and psychosis with a focus on the successful treatment of the panic disorder via a CBT approach. The patient has had only one episode of psychosis. The cognitive model of panic disorder is used as a template to consider this young man's psychotic experiences, in the context of some types of delusional beliefs, especially those involving the catastrophic and atypical misinterpretation of the physiological sensations associated with anxiety. This case emphasises the therapeutic value for certain patients of focussing therapy on the non-psychotic symptoms once the acute psychotic state has been managed.

Topics: Adult; Agoraphobia; Antipsychotic Agents; Atenolol; Benzodiazepines; Cognitive Behavioral Therapy; Combined Modality Therapy; Desensitization, Psychologic; Diazepam; Hospitalization; Humans; Male; Olanzapine; Panic Disorder; Paroxetine; Psychotic Disorders; Reality Testing; Socialization

Chronic and treatment refractory cases of panic disorder are not uncommon. We report on a man completely remitted from panic disorder after olanzapine and paroxetine combined treatment, and the possible modulating anti-anxiety effect of olanzapine is discussed. Olanzapine augmentation in panic and other anxiety disorders is deserving of more clinical attention.

Topics: Agoraphobia; Benzodiazepines; Drug Synergism; Drug Therapy, Combination; Humans; Male; Middle Aged; Olanzapine; Panic Disorder; Paroxetine; Selective Serotonin Reuptake Inhibitors

Topics: Antipsychotic Agents; Benzodiazepines; Depressive Disorder, Major; Drug Resistance; Female; Humans; Middle Aged; Olanzapine; Panic Disorder; Pirenzepine; Psychiatric Status Rating Scales

Topics: Adult; Agoraphobia; Antipsychotic Agents; Benzodiazepines; Comorbidity; Female; Humans; Male; Olanzapine; Panic Disorder; Pirenzepine; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Female; Humans; Olanzapine; Panic Disorder; Pirenzepine; Schizophrenia, Paranoid

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Olanzapine; Panic Disorder; Pirenzepine; Schizophrenia; Time Factors