olanzapine and Syndrome

The aim of this paper is to present a case of paliperidone-induced Pisa syndrome and provide treatment experience.. The case report is combined with a review of the literature.. A 37-year-old man had been diagnosed with paranoid-type schizophrenia for about 10 years. He received three-month treatment of paliperidone extended release (ER) at 6 mg per day, but showed a progressively Pisa-like physical position. We initially added an anticholinergic drug, but saw no improvement. The paliperidone ER was replaced by olanzapine at 10 mg per day, and the Pisa-like symptom improved after 1 month of the drug replacement.. We propose olanzapine as a possible replacement choice for patients with paliperidone-related Pisa syndrome.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dyskinesia, Drug-Induced; Dystonia; Humans; Male; Olanzapine; Paliperidone Palmitate; Psychiatric Status Rating Scales; Schizophrenia, Paranoid; Syndrome

An advance in the treatment of schizophrenia is the development of long-acting intramuscular formulations of antipsychotics, such as olanzapine long-acting injection (LAI). During clinical trials, a post-injection syndrome characterized by signs of delirium and/or excessive sedation was identified in a small percentage of patients following injection with olanzapine LAI.. Safety data from all completed and ongoing trials of olanzapine LAI were reviewed for possible cases of this post-injection syndrome. Descriptive analyses were conducted to characterize incidence, clinical presentation, and outcome. Regression analyses were conducted to assess possible risk factors.. Based on approximately 45,000 olanzapine LAI injections given to 2054 patients in clinical trials through 14 October 2008, post-injection delirium/sedation syndrome occurred in approximately 0.07% of injections or 1.4% of patients (30 cases in 29 patients). Symptomatology was consistent with olanzapine overdose (e.g., sedation, confusion, slurred speech, altered gait, or unconsciousness). However, no clinically significant decreases in vital signs were observed. Symptom onset ranged from immediate to 3 to 5 hours post injection, with a median onset time of 25 minutes post injection. All patients recovered within 1.5 to 72 hours, and the majority continued to receive further olanzapine LAI injections following the event. No clear risk factors were identified.. Post-injection delirium/sedation syndrome can be readily identified based on symptom presentation, progression, and temporal relationship to the injection, and is consistent with olanzapine overdose following probable accidental intravascular injection of a portion of the olanzapine LAI dose. Although there is no specific antidote for olanzapine overdose, patients can be treated symptomatically as needed. Special precautions include use of proper injection technique and a post-injection observation period.. ClinicalTrials.gov ID; URL: http://http//www.clinicaltrials.gov/: NCT00094640, NCT00088478, NCT00088491, NCT00088465, and NCT00320489.

Topics: Antipsychotic Agents; Benzodiazepines; Clinical Trials as Topic; Cognition Disorders; Delayed-Action Preparations; Delirium; Drug Administration Schedule; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Humans; Incidence; Injections, Intramuscular; Olanzapine; Risk Factors; Schizophrenia; Sleep; Syndrome; Treatment Outcome

Rowell's syndrome (RS) is a rare type of coexistence of one of the lupus erythematosus (LE) types (systemic, subacute cutaneous or discoid) and erythema multiforme (EM) (including toxic epidermal necrolysis). We present the case of a 51-year-old patient with a diagnosis of RS, most probably caused by drugs given as psychiatric treatment. After cessation of sodium valproate and initiation of treatment with prednisolone, a spectacular clinical remission was achieved. The likely role of psychiatric drugs, namely sodium valproate and sertraline, as triggering factors, is discussed.

Topics: Antipsychotic Agents; Benzodiazepines; Depressive Disorder; Drug Therapy, Combination; Erythema Multiforme; Female; Humans; Lupus Erythematosus, Cutaneous; Middle Aged; Olanzapine; Pericarditis; Sertraline; Syndrome; Treatment Outcome; Valproic Acid

Treatment with olanzapine depot is associated with a rare but potentially adverse reaction, namely post-injection delirium/sedation syndrome (PDSS), characterized by delirium and/or sedation. This is a case report of a 38-year-old male patient who developed symptoms consistent with PDSS shortly after receiving intramuscular injection of olanzapine depot. Clinicians should be aware of PDSS and observe patients for three hours after receiving the injection, measuring vitals and referring to medical care if necessary.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delayed-Action Preparations; Delirium; Humans; Injections, Intramuscular; Male; Olanzapine; Schizophrenia; Syndrome

Topics: Antipsychotic Agents; Australia; Betacoronavirus; Conscious Sedation; Coronavirus Infections; COVID-19; Databases, Factual; Delayed-Action Preparations; Delirium; Drug Monitoring; Humans; Incidence; Olanzapine; Pandemics; Pneumonia, Viral; SARS-CoV-2; Syndrome

The aim was to report the occurrence of after application of olanzapine long-acting injection (OLAI) in patients with schizophrenia during one year period.. During one year period, OLAI was applied to 30 patients with schizophrenia (18 men, 12 women) who were non-adherent to previous treatment with oral olanzapine. Patients were 20-58 years of age (39 years old on average), diagnosed with SCID based on DSM-IV-TR criteria. Patients received OLAI in dosage between 210-405 mg (287±62 (mean ± SD)) every 2-4 weeks.. Out of 30 patients that received OLAI, 29 patients improved significantly without side-effects, and one patient developed post-injection delirium/sedation syndrome (PDSS). The patient's somatic condition stabilized and treatment with OLAI was discontinued due to the PDSS.. The occurrence of PDSS is not common and when it occurs, in our experience, it was reversible.

Topics: Adult; Arousal; Benzodiazepines; Consciousness Disorders; Delayed-Action Preparations; Delirium; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Olanzapine; Schizophrenia; Schizophrenic Psychology; Syndrome; Young Adult

Topics: Antipsychotic Agents; Delayed-Action Preparations; Humans; Injections, Intramuscular; Olanzapine; Syndrome

Topics: Adult; Antipsychotic Agents; Culture; Electroconvulsive Therapy; Hallucinations; Hinduism; Humans; Male; Olanzapine; Schizophrenia; Schizophrenic Psychology; Self-Injurious Behavior; Semen; Stress, Psychological; Syndrome; Young Adult

Topics: Antipsychotic Agents; Benzodiazepines; Delayed-Action Preparations; Delirium; Female; Humans; Injections; Middle Aged; Olanzapine; Syndrome

The post-injection olanzapine delirium/sedation syndrome (PDSS) was observed in a 60-year-old Caucasian, schizophrenic, non-smoker and underweight [body mass index (BMI), 18.2 kg/m(2) ] women after the fourth intramuscular injection of 405 mg olanzapine pamoate. Clinical symptoms of PDSS were similar to those of acute oral olanzapine intoxication. The patient received supportive treatment and recovered fully. High olanzapine concentrations in serum, with maximum level of 698 ng/mL, were confirmed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The authors wonder whether a low BMI and advanced age may predispose patients to PDSS occurrence.

Topics: Antipsychotic Agents; Benzodiazepines; Chromatography, Liquid; Delayed-Action Preparations; Delirium; Female; Humans; Injections, Intramuscular; Middle Aged; Olanzapine; Schizophrenia; Syndrome; Tandem Mass Spectrometry; Unconsciousness

Olanzapine long-acting injection (LAI) for the treatment of schizophrenia was associated with a cluster of symptoms termed post-injection delirium/sedation syndrome (PDSS) in a small percentage (~2%) of patients during clinical trials. The objective of this analysis was to evaluate the rate and clinical characteristics of PDSS since olanzapine LAI entered commercial use.. Cases of PDSS were identified from all reported adverse events during worldwide commercial use of olanzapine LAI through to 1 March 2014. Data sources included two ongoing post-marketing safety studies as well as spontaneously reported adverse events from routine clinical practice over a 5-year period (1 March 2009 to 1 March 2014).. A total of 338 PDSS events were identified. Of these, 91% occurred within 1 hour of injection, and 52% of these occurred within 15 minutes. None of the PDSS events in this analysis were fatal, and most resolved within 72 hours. The most common symptoms (occurring in >30% of cases) were sedation (61%), confusion (56%), dysarthria (54%), somnolence (46%), dizziness (45%) and disorientation (35%). Overall, PDSS occurred with approximately 0.07% of injections and in 0.46-1.03% of patients (reporting and incidence rates from spontaneous reports and post-marketing safety studies, respectively).. The PDSS events reported during routine clinical use of olanzapine LAI are generally similar in incidence and presentation to those reported in clinical trials. Caution should be applied when interpreting spontaneously reported rates of adverse events, however, due to potential under-reporting. Implemented risk-minimisation activities may contribute substantially to the identification and appropriate management of patients with PDSS in clinical practice.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delayed-Action Preparations; Delirium; Disorders of Excessive Somnolence; Dizziness; Dysarthria; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Olanzapine; Risk Factors; Schizophrenia; Syndrome; Unconsciousness

Topics: Antipsychotic Agents; Benzodiazepines; Delayed-Action Preparations; Delirium; Dysarthria; Emergency Service, Hospital; Humans; Male; Middle Aged; Olanzapine; Schizophrenia; Syndrome

The PDSS is a potential side-effect of the intramuscular injection of olanzapine pamoate. We saw the typical symptoms develop in a 46-year-old man 4 hours after the injection. The syndrome is caused by a toxic concentration of olanzapine, and is possibly the result of the direct injection of the substance in the bloodstream. The most important measures that can be taken to prevent such an emergency are: a careful injection procedure, a 3-hour observation period following the injection and good counselling of the patient and his family. The treatment is conservative.

Topics: Antipsychotic Agents; Benzodiazepines; Delayed-Action Preparations; Delirium; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Humans; Injections, Intramuscular; Male; Middle Aged; Olanzapine; Schizophrenia; Syndrome; Treatment Outcome

Olanzapine pamoate injection is an anti-psychotic depot to be administered intramuscularly once every 2-4 weeks. A post-injection syndrome may occur shortly after administration, resulting in an acute intoxication with olanzapine.. A 42-year-old patient with a schizophrenic disorder lost consciousness 30 min after administration of olanzapine pamoate. He was admitted to a nearby hospital with tachycardia, hypotension, pin-point pupils and respiratory distress leading to reduced oxygen saturation. He was ventilated during one night and recovered within 2 days.. A post-injection syndrome may develop after administration of olanzapine pamoate when the entire dose olanzapine is released at once from the muscle. Therefore, the patient should be observed for at least 3 hours after every injection. The risk of a post-injection syndrome and the necessary observation period should to be taken into account when deciding to start treatment with olanzapine pamoate depot.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug-Related Side Effects and Adverse Reactions; Humans; Injections, Intramuscular; Male; Olanzapine; Schizophrenia; Syndrome

Topics: Anticholinergic Syndrome; Antipsychotic Agents; Benzodiazepines; Cholinesterase Inhibitors; Delayed-Action Preparations; Delirium; Humans; Hypnotics and Sedatives; Injections, Intramuscular; Olanzapine; Physostigmine; Syndrome

Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.

Topics: Aged; Benzodiazepines; Cholinesterase Inhibitors; Delusions; Dementia; Donepezil; Humans; Indans; Male; Movement Disorders; Olanzapine; Phenylcarbamates; Piperidines; Posture; Rivastigmine; Syndrome

We report the case of a 69 year-old female patient who was hospitalized for Diogenes syndrome, defined by marked self-neglect, social withdrawal and excessive hoarding, leading to squalor. Somatic causes were eliminated. Her personal history showed an eight-year depressive episode followed by a 20-year hypomanic episode without remission, followed by a persistent manic episode associated with Diogenes syndrome for four years. The Diogenes syndrome was successfully treated with mood stabilizers. Mood disorders - in particular chronic mania (i.e. a manic episode lasting more than two years) - should be considered in cases of Diogenes syndrome and in current classifications.

Topics: Aged; Antimanic Agents; Antipyretics; Benzodiazepines; Bipolar Disorder; Female; Humans; Lithium Compounds; Mood Disorders; Obsessive Behavior; Olanzapine; Social Isolation; Syndrome

The following case report describes an act of genital self mutilation. An employed, unmarried male suffering from schizophrenia paranoid type, autocastrated his genitalia during a period of illness when his psychotic symptoms were absent. Sufficient attention may not have been paid to his depressive symptomatology which may be primary as a core feature or secondary, in what can be called post-psychotic depression. The vulnerability of committing such an act increases when the person appears to be symptom-free and regaining insight. After a review of the available literature, it is considered that this case best fits the description for Klingsor Syndrome.

Topics: Adult; Antipsychotic Agents; Awareness; Benzodiazepines; Depressive Disorder, Major; Humans; Male; Olanzapine; Orchiectomy; Penis; Psychiatric Status Rating Scales; Schizophrenia, Paranoid; Scrotum; Self Mutilation; Syndrome

Olanzapine long-acting injection (LAI) is a salt-based depot antipsychotic combining olanzapine and pamoic acid. The slow intramuscular dissolution of this practically insoluble salt produces an extended release of olanzapine lasting up to 4 weeks. However, in a small number of injections (< 0.1%), patients experienced symptoms suggestive of olanzapine overdose, a phenomenon that has been termed "post-injection delirium/sedation syndrome" (PDSS). The authors conducted a series of parallel investigations into the possible reasons PDSS events occur.. Healthcare providers involved in the PDSS cases were queried for clinical information around the events. Plasma samples from patients experiencing PDSS were collected when possible (12/30 cases) and olanzapine concentrations compared with the known pharmacokinetic profile for olanzapine LAI. Product batches and used vials from the PDSS cases were evaluated for compliance with established manufacturing standards and/or possible user error. Because this depot formulation depends upon slow dissolution at the intramuscular injection site, in-vitro experiments were conducted to assess solubility of olanzapine pamoate in various media.. Injection administrators reported no unusual occurrences during the injection. No anomalies were found with the product batches or the remaining suspension in the used vials. Olanzapine concentrations during PDSS events were higher than the expected 5-73 ng/mL range, with concentrations exceeding 100 ng/mL and in some cases reaching >600 ng/mL during the first hours after injection but then returning to the expected therapeutic range within 24 to 72 hours. Solubility and dissolution rate of olanzapine pamoate were also found to be substantially greater in plasma than in other media such as those approximating the environment in muscle tissue.. Manufacturing irregularities, improper drug reconstitution, and inappropriate dosing were ruled out as possible causes of PDSS. In-vitro solubility and in-vivo pharmacokinetic investigations suggest that PDSS is related to exposure of the injected product to a substantial volume of blood. This exposure is most likely the result of unintended partial intravascular injection or blood vessel injury during the injection (occurring even with proper injection technique) with subsequent seepage of the medication into the vasculature, which would produce higher than intended olanzapine concentrations and symptoms consistent with PDSS.. ClinicalTrials.gov ID; URL: http://http//www.clinicaltrials.gov/: NCT00094640, NCT00088478, NCT00088491, NCT00088465, and NCT00320489.

Topics: Antipsychotic Agents; Benzodiazepines; Clinical Trials as Topic; Delayed-Action Preparations; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Humans; Injections, Intramuscular; Olanzapine; Schizophrenia; Syndrome; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Facial Muscles; Humans; Male; Olanzapine; Psychotic Disorders; Syndrome; Tremor

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Diagnostic and Statistical Manual of Mental Disorders; Humans; Male; Olanzapine; Posture; Risperidone; Schizophrenia; Self-Injurious Behavior; Syndrome

Topics: Abnormalities, Multiple; Adolescent; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Eye Abnormalities; Hallucinations; Humans; Lorazepam; Male; Olanzapine; Syndrome; Trabeculectomy; Tropanes

To report a case of olanzapine-induced Pisa syndrome that improved after treatment with clozapine.. A 22-year-old male with paranoid schizophrenia presented with insidious onset tonic truncal flexion with axial rotation and difficulty in walking after exposure to olanzapine in doses up to 15 mg/day for 9 months. An objective causality assessment suggested that Pisa syndrome was probably related to olanzapine. There was improvement in his symptoms after 6 weeks of treatment with clozapine in doses gradually titrated to 350 mg/day.. Pisa syndrome is a type of dystonia that has been associated with both typical and atypical antipsychotics. Both acute and insidious onset cases have been described in the literature, which have different course and treatment response. Clozapine was found to be effective in reducing the severity of olanzapine-induced Pisa syndrome.. Clozapine may be a useful treatment option for Pisa syndrome that has been caused by olanzapine.

Topics: Adult; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Dystonia; Humans; Male; Olanzapine; Schizophrenia, Paranoid; Syndrome

Rabbit syndrome (RS) is a rare extrapyramidal side effect of antipsychotic treatment. It is characterized by involuntary, rhythmic dyskinesias of mouth and lips excluding the tongue, and is most common under typical neuroleptics. There are also several reports of the syndrome in patients with the atypical antipsychotics risperidone and aripiprazole. We report a 74 year-old patient suffering from a bipolar affective disorder, who developed a rabbit syndrome following the intake of 20 mg/d olanzapine. To our knowledge this is the first case report of a RS due to olanzapine.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Dose-Response Relationship, Drug; Dyskinesia, Drug-Induced; Female; Humans; Neurologic Examination; Olanzapine; Syndrome

Charles Bonnet syndrome (CBS) is characterised by the triad of complex visual hallucinations, ocular pathology causing visual deterioration and preserved cognitive status. We report a case of a 62-year-old man with a brief history of visual hallucinations. The patient complained of amaurosis with optic nerve atrophy in his left eye and a severe impairment of visual acuity in the right and suddenly experienced complex, vivid, elaborate and coloured visual hallucinations persisting long after eye closure and stopping during sleep. The patient maintained his insight, criticising these visions as unreal and felt distressed by them. Hallucination onset was 3 days before hospital admission. No cognitive impairment and no diseases apart from prostatic adenoma treated with alpha-lythic therapy were reported. Neurological examination and neuroimaging data were normal. Therapy with olanzapine (OLZ) 5 mg/day led to a progressive clearance of visual hallucinations in seven days and was gradually reduced and withdrawn. Three months later the visions reappeared and OLZ 5 mg/day yielded a persisting remission so that at the follow-up examination after 1 year on therapy the patient is still asymptomatic. To date, no established treatment for CBS is stated and in some patients the hallucinations fade spontaneously; in our case an antipsychotic therapy with OLZ was effective while generally anticonvulsant drugs with different mechanism of action such as carbamazepine, valproate and gabapentin are proposed.

Topics: Antipsychotic Agents; Benzodiazepines; Eye Diseases; Hallucinations; Humans; Male; Middle Aged; Olanzapine; Sensory Deprivation; Syndrome; Treatment Outcome; Vision Disorders

Topics: Affective Disorders, Psychotic; Aged; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Citalopram; Delusions; Depersonalization; Depressive Disorder, Major; Drug Therapy, Combination; Duloxetine Hydrochloride; Female; Humans; Long-Term Care; Olanzapine; Risperidone; Syndrome; Thiophenes

Topics: Benzodiazepines; Citalopram; Combined Modality Therapy; Delusions; Depressive Disorder, Major; Electroconvulsive Therapy; Female; Humans; Middle Aged; Olanzapine; Syndrome

Topics: Aged; Aged, 80 and over; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Carbamazepine; Cognition Disorders; Hallucinations; Humans; Male; Music; Olanzapine; Syndrome; Visual Fields

Topics: Adult; Benzodiazepines; Brain; Capgras Syndrome; Cognition Disorders; Depersonalization; Female; Humans; Magnetic Resonance Imaging; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Self Concept; Severity of Illness Index; Single Parent; Syndrome; Wechsler Scales

Hypersensitivity syndrome is defined as a drug-induced complex of symptoms consisting of fever, rash, and internal organ involvement. The hypersensitivity syndrome is well recognized as being caused by anticonvulsants. Olanzapine is an atypical antipsychotic agent whose side effects include sedation, weight gain, and increased creatinine kinase and transaminase levels. To date, there have been no reports of hypersensitivity syndrome related to this drug. A 34-year-old man developed a severe generalized pruritic skin eruption, fever, eosinophilia, and toxic hepatitis 60 days after ingestion of olanzapine. After termination of olanzapine treatment, the fever resolved, the skin rash was reduced, eosinophil count was reduced to normal, and the transaminase levels were markedly reduced. Clinical features and the results of skin and liver biopsies indicated that the patient developed hypersensitivity syndrome caused by olanzapine.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chemical and Drug Induced Liver Injury; Diagnostic Errors; Drug Eruptions; Drug Hypersensitivity; Dyspnea; Eosinophilia; Fever; Humans; Male; Olanzapine; Pirenzepine; Pruritus; Respiratory Hypersensitivity; Respiratory Insufficiency; Schizophrenia, Paranoid; Syndrome

The aim of this paper is to document regular nocturnal intensification of delusional nihilistic and persecutory ideas (Cotard delusion) linked with extreme depersonalisation and hypervivid dreaming.. A 17-year-old man presented with Cotard and Capgras delusions after sustaining multiple cognitive impairments secondary to traumatic brain injury.. Delusional ideation fully resolved within 14 days of commencement of olanzapine 5 mg daily.. This patient's experience of perceptual abnormalities and impairments in meta-abilities related to self-monitoring and critical inferencing lends support to multicomponent sensory processing accounts of brain injury related, content-specific delusional syndromes.

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Brain Injuries; Capgras Syndrome; Circadian Rhythm; Delusions; Humans; Male; Olanzapine; Perceptual Disorders; Pirenzepine; Syndrome

Topics: Adult; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Female; Haloperidol; Humans; Mouth Diseases; Olanzapine; Pirenzepine; Schizophrenia; Stereotypic Movement Disorder; Syndrome; Treatment Outcome

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Female; Humans; Middle Aged; Olanzapine; Pirenzepine; Psychotic Disorders; Syndrome

Topics: Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Female; Humans; Middle Aged; Olanzapine; Pirenzepine; Schizophrenia; Syndrome

Topics: Adult; Antidepressive Agents; Benzodiazepines; Clomipramine; Dehydration; Depressive Disorder; Diabetes Mellitus, Type 2; Female; Humans; Hyperglycemia; Olanzapine; Pirenzepine; Syndrome