olanzapine and Schizotypal-Personality-Disorder

Approximately 60% of patients with a first episode of psychosis will significantly reduce the severity of their positive symptomatology with antipsychotic drugs. The aim of this study was to investigate predictors of response to antipsychotic treatment during the first episode of non-affective psychosis. 172 patients (107 male) with a diagnosis of schizophreniform, schizophrenia, schizoaffective, brief reactive psychosis, schizotypal personality disorder or psychosis non-otherwise specified entered the study. Sociodemographic, premorbid and clinical data at baseline were evaluated. Unpaired t-test for continuous and chi2 for categorical data, respectively, were used to compare responders and non-responders selected variables. Multivariate logistic regression was used to establish a prediction model. 57.6% of study subjects (99 of 172) responded to antipsychotic treatment. The following variables were significantly associated with less likelihood of response: 1.--lower severity of general psychopathology, positive symptoms and disorganized symptoms at baseline; 2.--earlier age of onset; 3.--diagnosis of schizophrenia; 4.--longer DUP; 5.--poorer premorbid adjustment during adolescence, and 6.--hospitalization. Multivariate logistic regression demonstrated that differences between responders and non-responders were largely accounted for by BPRS total score, age of onset, premorbid adjustment at early adolescence, and diagnosis. Patients with an early age of onset of schizophrenia, a poor premorbid adolescent functioning, and with a lower severity of psychopathology at intake seem to have a decrease likelihood of responding to antipsychotic treatment. Helping clinicians to identify non-responders is meant as a first step to optimise therapeutic effort to benefit individuals in this vulnerable group.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Antipsychotic Agents; Benzodiazepines; Comorbidity; Female; Haloperidol; Humans; Longitudinal Studies; Male; Middle Aged; Olanzapine; Prognosis; Psychotic Disorders; Risperidone; Schizophrenia; Schizophrenic Psychology; Schizotypal Personality Disorder; Socioeconomic Factors; Spain; Treatment Outcome

Few treatment studies of schizotypal personality disorder (SPD) have investigated the new, atypical antipsychotic drugs. This study examined the efficacy and tolerability of olanzapine, an atypical antipsychotic drug, in a series of patients with DSM-IV diagnosed schizotypal personality disorder.. This was a 26-week, open-label study with flexible dose design in 11 subjects with a diagnosis of schizotypal personality disorder based on Structured Clinical Interview for DSM-IV (SCID) and Personality Disorder Examination (PDE Journal of Psychiatric Disorders 1 (1987) 1). Subjects were treated with a low dose (average 9.32 mg/day) of olanzapine. Psychopathology was assessed at baseline and at the end of the study and analyzed with last observation carried forward analysis.. Patients showed significant improvements in psychosis and depression ratings, as well as in overall functioning. Olanzapine was well tolerated, though significant weight gain was observed.. This study provides preliminary data regarding olanzapine efficacy and tolerability in schizotypal personality disorder subjects. These data need to be confirmed in larger controlled clinical trials.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Brief Psychiatric Rating Scale; Diagnostic and Statistical Manual of Mental Disorders; Drug Administration Schedule; Drug Tolerance; Electrocardiography; Follow-Up Studies; Health Care Costs; Humans; Olanzapine; Schizotypal Personality Disorder; Severity of Illness Index

Schizophrenia is a neurodevelopmental disorder associated with persistent symptomatology, severe functional disability, and residual morbidity characteristic of neurodegenerative brain diseases. The illness begins with genetic susceptibility and generally expresses itself after puberty through subtle changes that begin during the prodromal stage. Symptoms get progressively worse and tend to become more resistant to treatment with each relapse. Evidence for a neuroprotective effect of some forms of early treatment is beginning to emerge. While the underlying mechanisms remain uncertain, atypical antipsychotics may counteract some of the progressive deteriorative effects by enhancing synaptic plasticity and cellular resilience. However, identifying and treating patients in the earliest disease states presents methodological challenges as there is no consensus on the best methods of intervention and differences in at-risk children are not readily detectable or substantial enough to predict which ones will develop schizophrenia. In this expert roundtable supplement, Jeffrey A. Lieberman, MD, reviews the historical context of progressive deterioration in schizophrenia. Next, Diana O. Perkins, MD, MPH, reviews some of the challenges to early identification of illness as well as the impact of early versus delayed treatment. Finally, L. Fredrik Jarskog, MD, focuses on the neurobiology of functional progression in schizophrenia as well as pharmacology and the potential for neuroprotection.

Topics: Adolescent; Adult; Antipsychotic Agents; Atrophy; Benzodiazepines; Cerebral Cortex; Child; Cognition Disorders; Disease Progression; Haloperidol; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Neurodegenerative Diseases; Neuroprotective Agents; Neuropsychological Tests; Olanzapine; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology; Schizotypal Personality Disorder

Schizotypal personality disorder (SPD) has rarely been reported as an eating disorder-related personality trait. A 23-year-old woman was diagnosed as having anorexia nervosa binge eating/purging type. At the age of 53 years, she was admitted to Jikei University Hospital because of excessive bodyweight loss. She was diagnosed as having SPD based on bizarre behavior, ideation and a tendency to seek isolation. She was treated with low-dose antipsychotics, and her impulsive behavior improved. The patient's SPD was considered to have had a psychopathological contribution to her chronic episodes of anorexia nervosa.

Topics: Anorexia Nervosa; Antidepressive Agents, Second-Generation; Benzodiazepines; Body Weight; Bulimia; Chronic Disease; Female; Hospitalization; Humans; Mianserin; Middle Aged; Olanzapine; Paroxetine; Schizotypal Personality Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Depressive Disorder, Major; Drug Interactions; Drug Therapy, Combination; Humans; Male; Mianserin; Middle Aged; Mirtazapine; Olanzapine; Pirenzepine; Schizophrenia; Schizotypal Personality Disorder; Serotonin Syndrome; Tramadol

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