olanzapine and Parkinsonian-Disorders

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

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

Following an earlier study in which elderly patients with schizophrenia had their typical antipsychotic medication changed to olanzapine or risperidone, the 61 patients were followed for up to a further six months to see if either treatment was superior in terms of efficacy or side effects.. To determine whether either olanzapine or risperidone was superior in terms of efficacy or side effects when treating schizophrenia in late life.. Psychiatric symptoms, side effects and quality of life were rated every six weeks for 24 weeks of open label comparative treatment using standard measures. Group differences were examined using analysis of covariance and within-group changes over time were assessed using paired t-tests.. There were 34 olanzapine and 32 risperidone patients who entered the study, but intention to treat data was only available for 61 of the 66 patients. There were no clinical or demographic differences between the groups. Parkinsonism, positive and negative symptoms of schizophrenia improved in both groups both from baseline switch to olanzapine or risperidone and during the six month follow-up after completion of crossover. No significant differences were seen between groups on most measures. However, patients treated with olanzapine showed a significantly greater improvement in quality of life from baseline compared to risperidone patients.. Both drugs were well tolerated and their use was associated with fewer symptoms of schizophrenia and less adverse effects than were seen when the patients were taking a typical antipsychotic at baseline. Olanzapine appears to have particular benefit with regard to quality of life.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Female; Humans; Male; Olanzapine; Parkinsonian Disorders; Patient Dropouts; Quality of Life; Risperidone; Schizophrenia; Treatment Outcome

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

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

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

Although neurological manifestations of typhoid fever was thought to be obsolete from modern world, emergence of multidrug resistant typhoid bacilli and reporting of outbreak of typhoid fever with a range of early neuropsychiatric manifestations from various parts of world has led clinicians and investigators to re-evaluate the clinical spectrum of this endemic sinister disease. An 18-year-old male student was admitted in psychiatry ward with mutism, staring look, posturing and rigidity. There was history of typhoid fever 1 week before for which he was prescribed cefuroxime. Although investigations fail to provide any clue, his catatonic symptoms disappeared 2 weeks later giving way to resting tremor, bradykinesia, cog-wheel rigidity but without gait abnormality. He was successfully treated with lorazepam, amantidine, olanzapine and pramiprexole. The patient was asymptomatic within a month. He had no recurrence of symptoms till last follow-up, 6 months from the illness.

Topics: Adolescent; Amantadine; Antiparkinson Agents; Antipsychotic Agents; Benzodiazepines; Benzothiazoles; Catatonia; Humans; Hypnotics and Sedatives; Lorazepam; Male; Olanzapine; Parkinsonian Disorders; Pramipexole; Typhoid Fever

: The use of antipsychotic medications is associated with an increased risk of death in older adults with dementia. The risk of death in patients with preexisting parkinsonism who receive antipsychotic drugs is not known.. : Using a nested case-control design, we examined the risk of death within 30 days of newly starting antipsychotic medications among people with Parkinsonism aged 70 years and older in Ontario, Canada. Data were obtained from Ontario's healthcare administrative databases.. : Among 5,391 individuals with parkinsonism who died during the study period (2002-2008) and a matched comparison group of 25,937 who were still alive, individuals exposed to atypical antipsychotic drugs had a higher risk of death (unadjusted odds ratio [OR] = 2.8, 95% CI: 2.1-3.8, adjusted OR: 2.0, 95% CI: 1.4-2.7). Results were similar for quetiapine use compared with no antipsychotic use (unadjusted OR: 2.5, 95% CI: 1.6-4.0, adjusted OR = 1.8, 95% CI: 1.1-3.0). Typical antipsychotics were associated with an increased odds of death compared with atypical antipsychotics (unadjusted OR = 2.4, 95% CI 1.1-5.2, adjusted OR = 2.4, 95% CI: 1.1-5.7).. : Individuals with parkinsonism who are newly prescribed antipsychotic medications have a higher risk of death within 30 days than those who do not start these medications. Although it is not possible to establish causality, the results suggest an increased risk. It is important to be vigilant for accompanying serious medical conditions that may increase mortality in individuals requiring treatment with antipsychotics and to consider alternative approaches to treating psychosis, agitation, and aggression in this population.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Case-Control Studies; Cohort Studies; Dibenzothiazepines; Female; Humans; Male; Olanzapine; Ontario; Parkinsonian Disorders; Psychotic Disorders; Quetiapine Fumarate; Retrospective Studies; Risk; Risperidone

The case of a patient taking high-dosage olanzapine who experienced parkinsonism after smoking cessation is reported.. A 73-year-old Caucasian woman with a recent diagnosis of Parkinson disease and a history of chronic obstructive pulmonary disease, hyperlipidemia, chronic osteoarthritis, and hypothyroidism was hospitalized for altered mental status, weakness, and ambulatory dysfunction. The diagnosis of Parkinson disease was made approximately four months prior. Despite initiation of carbidopa-levodopa, the patient's symptoms did not improve, and her mental and physical status declined. The patient was taking olanzapine 30 mg daily for bipolar disorder and had a 40-pack-year history of smoking, but she quit smoking approximately four months before this hospitalization. The results of a neurologic evaluation suggested that the patient did not have Parkinson disease but was possibly experiencing olanzapine toxicity secondary to smoking cessation. Carbidopa-levodopa was discontinued. Psychiatry was consulted, and a monthlong cross-taper to discontinue olanzapine and initiate aripiprazole with a target dosage of 20 mg daily was recommended. During the course of therapy, the patient's level of alertness and bradykinesia improved. Overall, it was noted that her extrapyramidal symptoms were gradually improving; two days before hospital discharge, she was noted to have no definite remaining evidence of parkinsonism. In this case, use of the Naranjo et al. adverse-drug-reaction probability scale and the drug interaction probability scale indicated that the adverse effects were probably related to the interaction between smoking and olanzapine.. A 73-year-old woman receiving high-dosage olanzapine for bipolar disorder developed parkinsonism after smoking cessation.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Drug Interactions; Female; Humans; Olanzapine; Parkinsonian Disorders; Smoking; Smoking Cessation

We explored the subjective effects associated with olanzapine, risperidone and older antipsychotics.. We conducted a content analysis of an Internet database of comments about prescribed medications.. We analysed 223 comments on risperidone, 170 on olanzapine and 46 relating to three older antipsychotics. The predominant subjective effects produced by all drugs consisted of sedation, cognitive impairment and emotional flattening or indifference. Connections appeared between these effects and Parkinsonian-like symptoms with the older drugs, sexual impairment with risperidone and metabolic effects with olanzapine. The experience of akathisia was frequently linked to suicidal thoughts. Some respondents described how the drugs' subjective effects helped to reduce symptoms of mania, psychosis and anxiety.. The generalisability of Internet data is uncertain. However, the data suggest that adverse subjective effects play a central role in the experience of taking antipsychotic drugs and may be related to the drugs' desired benefits.

Topics: Adult; Affect; Akathisia, Drug-Induced; Antipsychotic Agents; Anxiety Disorders; Attitude to Health; Benzodiazepines; Bipolar Disorder; Cognition Disorders; Female; Health Behavior; Humans; Internet; Male; Middle Aged; Olanzapine; Parkinsonian Disorders; Psychotic Disorders; Risperidone; Sexual Dysfunction, Physiological

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

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

The present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care.. Sixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated.. Most psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care.. Our results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.

Topics: Adult; Age Factors; Antipsychotic Agents; Anxiety Disorders; Benzodiazepines; Clozapine; Cognition; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Educational Status; Female; Humans; Male; Olanzapine; Parkinsonian Disorders; Quality of Life; Schizophrenia; Schizophrenic Psychology; Sex Factors; Socioeconomic Factors; Treatment Outcome; Weight Gain

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delirium; Female; Humans; Olanzapine; Parkinsonian Disorders

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dyskinesia, Drug-Induced; Hepatolenticular Degeneration; Humans; Male; Muscle Rigidity; Olanzapine; Parkinsonian Disorders; Pirenzepine; Psychotic Disorders; Risperidone