olanzapine and Postoperative-Complications

Olanzapine has become a major drug in the management of chemotherapy-induced nausea and vomiting as a prophylactic agent. In addition, a recent randomized trial has demonstrated its benefits in treating nausea and vomiting associated with advanced cancer. The added benefit to olanzapine is that it also stimulates appetite. As a result, since it treats multiple symptoms associated with advanced cancer, it is likely to become the antiemetic of choice in palliative care at least in the USA. The added benefit of treating insomnia and the avoidance of benzodiazepines should place olanzapine in at the top of the list of drugs to use for patients who do complain of insomnia. There is no good evidence that it potentiates the respiratory depression of opioids unlike benzodiazepines. The evidence is weak that olanzapine in as an adjuvant analgesic. Hopefully, future trials will explore this in greater depth. The benefits of adding olanzapine to potent opioids are that it may reduce craving, drug cues, and opioid misuse. Other symptoms like anxiety and depression may be addressed by the addition of olanzapine to standard antidepressants.

Topics: Antiemetics; Antineoplastic Combined Chemotherapy Protocols; Antipsychotic Agents; Drug Monitoring; Humans; Nausea; Neoplasms; Olanzapine; Palliative Care; Postoperative Complications; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Vomiting

A wide variability in the approach towards delirium prevention and treatment in the critically ill results from the dearth of prospective randomised studies.. We launched a two-stage prospective observational study to assess delirium epidemiology, risk factors and impact on patient outcome, by enrolling all patients admitted to our Intensive Care Unit (ICU) over a year. The first step - from January to June 2008 was the observational phase, whereas the second one from July to December 2008 was interventional. All the patients admitted to our ICU were recruited but those with pre-existing cognitive disorders, dementia, psychosis and disability after stroke were excluded from the data analysis. Delirium assessment was performed according with Confusion Assessment Method for the ICU twice per day after sedation interruption. During phase 2, patients underwent both a re-orientation strategy and environmental, acoustic and visual stimulation.. We admitted a total of respectively 170 (I-ph) and 144 patients (II-ph). The delirium occurrence was significantly lower in (II-ph) 22% vs. 35% in (I-ph) (P=0.020). A Cox's Proportional Hazard model found the applied reorientation strategy as the strongest protective predictors of delirium: (HR 0.504, 95% C.I. 0.313-0.890, P=0.034), whereas age (HR 1.034, 95% CI: 1.013-1.056, P=0.001) and sedation with midazolam plus opiate (HR 2.145, 95% CI: 2.247-4.032, P=0.018) were negative predictors.. A timely reorientation strategy seems to be correlated with significantly lower occurrence of delirium.

Topics: Acoustic Stimulation; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Critical Care; Critical Illness; Delirium; Female; Haloperidol; Humans; Hypnotics and Sedatives; Internal Medicine; Male; Medical Audit; Midazolam; Middle Aged; Narcotics; Olanzapine; Orientation; Photic Stimulation; Postoperative Complications; Propofol; Proportional Hazards Models; Risk Factors; Surveys and Questionnaires; Wounds and Injuries

Topics: Aged; Antipsychotic Agents; Aortic Aneurysm; Benzodiazepines; Delirium; Haloperidol; Humans; Male; Olanzapine; Postoperative Complications; Treatment Outcome

A 79-year-old Japanese woman with schizophrenia was hospitalized because of idiopathic duodenal stenosis. Three days after discontinuing ingestion, including the administration of psychotropic drugs, the patient demonstrated incoherent behaviour and strong general muscle tension, and was unable to engage in conversation. Computed tomography indicated bilateral regions of low density in the frontal lobes, subsequent to which she was diagnosed with post-lobotomy catatonia. Administration of olanzapine (10 mg/day) improved the patient's condition within a short period. Previous studies have demonstrated an association between the dysfunction of frontal circuits and catatonia; therefore, the observed catatonic episode might relate to the disconnection of nerve fibres in the prefrontal lobes induced by her lobotomy. Olanzapine was likely effective in treating catatonia because of its reported efficacy in improving frontal lobe function.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Catatonia; Female; Humans; Olanzapine; Postoperative Complications; Psychosurgery; Schizophrenia; Treatment Outcome

Here we present a case of successful treatment employing a mixed approach including pharmacological and psychosomatic treatments for a 72-year-old woman who experienced severe nausea and vomiting in reaction to postoperative stress from gastric cancer surgery. This case demonstrates that appropriate provision of psychosomatic treatments, including a psychotherapeutic session and autogenic training, enhances the efficacy of pharmacotherapy.

Topics: Aged; Amoxapine; Anti-Anxiety Agents; Antidepressive Agents; Antiemetics; Benzodiazepines; Bromazepam; Clomipramine; Combined Modality Therapy; Female; Humans; Mianserin; Mirtazapine; Nausea; Olanzapine; Physical Therapy Modalities; Postoperative Complications; Psychotherapy; Stomach Neoplasms; Stress, Psychological; Vomiting

Conversion disorder is characterized by several neurological and internistical symptoms that cannot be explained by an organic cause, exacerbating after stress events. The course of this disorder is typically short: it usually lasts about two weeks, and only 20-25% of patients relapse in the following year. This paper aims to show the clinical history of a patient complaining conversion symptoms from 7 consecutive years.

Topics: Adult; Affective Symptoms; Antipsychotic Agents; Benzodiazepines; Cervical Vertebrae; Conversion Disorder; Craniotomy; Female; Ganglioneuroma; Humans; Laminectomy; Nerve Compression Syndromes; Neurologic Examination; Olanzapine; Paralysis; Peripheral Nervous System Neoplasms; Postoperative Complications; Psychological Tests; Self-Injurious Behavior; Spinal Nerve Roots; Time Factors

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

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

We report the case of a patient with temporal lobe epilepsy, nonresponsive to antiepileptic drugs, who became seizure-free, but developed recurrent excessive irritability and psychotic symptoms after successful mesial temporal lobectomy. This patient was refractory to various pharmacological treatments including antipsychotics, mood stabilizers, and benzodiazepines before being successfully treated with olanzapine.

Topics: Adult; Anterior Temporal Lobectomy; Antipsychotic Agents; Benzodiazepines; Epilepsy, Temporal Lobe; Humans; Irritable Mood; Male; Mental Disorders; Olanzapine; Postoperative Complications