olanzapine and Tremor

Psychogenic tremor is a variant of psychogenic movement disorder. Psychogenic tremor often starts in an abrupt manner and affects voluntary motor function, rapidly reaching maximum impairment for the patient. Patients often present with comorbid psychiatric disorders, including depression, anxiety and personality disorders. Overall prognosis is poor, with 80 to 90 percent of patients symptomatic after one year. The authors present the case of a 33-year-old woman who experienced an acute episode of psychogenic tremor. They review the literature on psychiatric and neurologic manifestations of psychogenic tremor, consider diagnostic and treatment implications and discuss overall prognosis of recovery for patients afflicted with psychogenic tremor.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Cognitive Behavioral Therapy; Depressive Disorder, Major; Drug Therapy, Combination; Duloxetine Hydrochloride; Female; Hospitalization; Humans; Olanzapine; Psychophysiologic Disorders; Thiophenes; Tremor

Atypical antipsychotics are increasingly drugs of first choice in schizophrenia. Amisulpride, a new atypical antipsychotic, is reported to be effective for both positive and negative symptoms of schizophrenia in Western countries but Indian experience is limited. The aim of the present study was therefore to conduct a trial of amisulpride versus olanzapine in Indian schizophrenia patients.. Eighty adult patients of either sex were randomized to receive standard doses of the two drugs orally, in a single blind manner, for 12 weeks, with follow up at 4 and 8 weeks. Effectiveness was assessed by changes in scores on the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), and physician-administered Clinical Global Impression (CGI) scale. Tolerability was assessed by treatment-emergent adverse drug reactions (ADRs).. Evaluable were 39 patients on amisulpride and 38 on olanzapine. The groups were comparable at baseline with respect to demographics, illness duration and rating scores. Final BPRS score was lower for olanzapine (33.2 +/- 9.44) than for amisulpride (37.7 +/- 9.67). SAPS and SANS scores and CGI rating improved individually in both arms but remained comparable between groups throughout the study period, but olanzapine reduced SAPS score to a greater extent. ADRs were encountered in 67.5% and 47.5% of patients (p = 0.113) on amisulpride and olanzapine, respectively. Tremor and insomnia were more frequent with amisulpride, while olanzapine caused more weight gain and sedation. No serious ADRs occurred.. Amisulpride, although comparable to olanzapine on some measures, did not match the improvement seen with the latter drug in BPRS and SAPS scores. Despite differences in ADR profiles, overall tolerability was satisfactory for both drugs. In Indian patients, amisulpride should therefore be an alternative to olanzapine to a limited extent, such as when weight gain and sedation are undesirable.

Topics: Adult; Amisulpride; Antipsychotic Agents; Benzodiazepines; Brief Psychiatric Rating Scale; Drug Administration Schedule; Female; Follow-Up Studies; Humans; India; Male; Olanzapine; Schizophrenia; Schizophrenic Psychology; Selective Serotonin Reuptake Inhibitors; Single-Blind Method; Sleep Initiation and Maintenance Disorders; Sulpiride; Treatment Outcome; Tremor; Weight Gain

This first clinical study of olanzapine in Japanese patients with schizophrenia was conducted to investigate the efficacy and safety of olanzapine. Eighty-one patients were included in the analysis set. Mean modal dose for those patients were 9.4 +/- 3.6 mg/day. For the primary efficacy measure (Final Global Improvement Rating score), 14.8% of patients had remarkable improvement, 59.3% of patients had moderate improvement or better, and 86.4% of patients had slight improvement or better. Results from the Brief Psychiatric Rating Scale showed improvement from baseline in all clusters including positive psychotic symptoms (thought disturbance) but also against negative symptoms (anergia). The most commonly reported treatment-emergent signs and symptoms with > or =10% incidence, were insomnia, weight increase, excitement, sleepiness, and anxiety. There was a low incidence of extrapyramidal treatment-emergent signs and symptoms, and events reported were tremor (6.2%), muscle rigidity (3.7%), and akathisia (2.5%). The most commonly reported treatment-emergent laboratory changes, with > or = 20% of incidence, were prolactin elevations (24.3%) followed by increases in triglycerides (20.4%). However, mean prolactin values tended to be normalized during the study. This study result suggests that olanzapine is an "atypical" antipsychotic.

Topics: Adult; Akathisia, Drug-Induced; Antipsychotic Agents; Anxiety; Benzodiazepines; Female; Humans; Japan; Male; Muscle Rigidity; Olanzapine; Pirenzepine; Prolactin; Psychiatric Status Rating Scales; Psychomotor Agitation; Schizophrenia; Sleep Wake Disorders; Treatment Outcome; Tremor; Triglycerides; Weight Gain

Clinical relevance of dental caries is often underestimated in patients with schizophrenia. The objective of this study was to examine dental caries and to identify clinical and demographic variables associated with poor dental condition in patients with schizophrenia.. Inpatients with schizophrenia received a visual oral examination of their dental caries, using the decayed-missing-filled teeth (DMFT) index. This study was conducted in multiple sites in Japan, between October and December, 2010. A univariate general linear model was used to examine the effects of the following variables on the DMFT score: age, sex, smoking status, daily intake of sweets, dry mouth, frequency of daily tooth brushing, tremor, the Clinical Global Impression-Schizophrenia Overall severity score, and the Cumulative Illness Rating Scale for Geriatrics score.. 523 patients were included in this study (mean ± SD age = 55.6 ± 13.4 years; 297 men). A univariate general linear model showed significant effects of age group, smoking, frequency of daily tooth brushing, and tremor (all p's < 0.001) on the DMFT score (Corrected Model: F(23, 483) = 3.55, p < 0.001, R2 = 0.42) . In other words, older age, smoking, tremor burden, and less frequent tooth brushing were associated with a greater DMFT score.. Given that poor dental condition has been related with an increased risk of physical co-morbidities, physicians should be aware of patients' dental status, especially for aged smoking patients with schizophrenia. Furthermore, for schizophrenia patients who do not regularly brush their teeth or who exhibit tremor, it may be advisable for caregivers to encourage and help them to perform tooth brushing more frequently.

Topics: Adult; Age Factors; Antipsychotic Agents; Benzodiazepines; Cross-Sectional Studies; Dental Caries; Dietary Sucrose; DMF Index; Drug Therapy, Combination; Female; Humans; Japan; Male; Middle Aged; Olanzapine; Risperidone; Schizophrenia; Sex Factors; Smoking; Tokyo; Toothbrushing; Tremor; Xerostomia

Toluene toxicity primarily affects central nervous system white matter, causing a characteristic brain MRI pattern.. A toluene addicted man, after an abstinence period and a treatment with neuroleptics, presented with severe worsening of preexisting generalized tremor, opsoclonus, dysarthria, gait inability, jerky tendon reflexes and behaviour disorders. Magnetic resonance imaging showed mild leukoencephalopathy and hypointensities in deep gray matter nuclei. The DaT-scan revealed a decrease in presynaptic dopamine reuptake.. Clinical and neuroradiological findings and the possible sensitivity to neuroleptics indicate dopaminergic impairment. Our case suggests that chronic toluene abuse causes presynaptic dopaminergic depletion.

Topics: Antipsychotic Agents; Benzodiazepines; Brain; Chronic Disease; Dopamine; Gait Disorders, Neurologic; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Neural Pathways; Neuropsychological Tests; Neurotoxicity Syndromes; Olanzapine; Solvents; Substance-Related Disorders; Toluene; Tomography, Emission-Computed, Single-Photon; Tremor; Young Adult

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

In several previous studies, tremulous jaw movements in rats have been used to assess the effects of antiparkinsonian drugs and atypical antipsychotics. Because antihistamines such as diphenhydramine are used as antiparkinsonian agents, and atypical antipsychotic drugs such as clozapine and olanzapine have high affinity for histamine H1 receptors, the present study investigated the effects of H1 antagonists on cholinomimetic-induced jaw movements. Diphenhydramine, doxepin, and mepyramine (all injected IP 2.5-20.0 mg/kg) were assessed for their ability to block the jaw movements induced by 5.0 mg/kg of the anticholinesterase tacrine. Within this dose range, only diphenhydramine produced a robust and significant reduction in jaw movement activity. Thus, diphenhydramine was subjected to further testing, which employed procedures previously used to assess the effects of other antitremorogenic drugs, such as clozapine. Diphenhydramine did not induce jaw movement activity. In addition to suppressing jaw movement activity after acute injections, diphenhydramine also suppressed tacrine-induced jaw movements after repeated (14-day) administration. In summary, the present results show that diphenhydramine suppresses cholinomimetic-induced jaw movements, an effect that is similar to other antiparkinsonian or antitremor drugs such as anticholinergics, L-DOPA, DA antagonists, and clozapine. Nevertheless, doxepin produced only mild effects, and mepyramine, which has a higher affinity and selectivity than diphenhydramine for H1 receptors, failed to suppress cholinomimetic-induced jaw movements. These results suggest that diphenhydramine suppresses tremulous movements through a mechanism that does not depend upon antagonism of histamine H1 receptors.

Topics: Animals; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Cholinergic Agents; Clozapine; Diphenhydramine; Dose-Response Relationship, Drug; Doxepin; Histamine H1 Antagonists; Jaw; Male; Movement; Olanzapine; Pirenzepine; Pyrilamine; Rats; Rats, Sprague-Dawley; Receptors, Histamine H1; Receptors, Muscarinic; Tacrine; Tremor

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Fluphenazine; Haloperidol; Humans; Male; Mental Disorders; Olanzapine; Pirenzepine; Tremor

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Tremor

The purpose of this study was to compare the subchronic, low-dose effects of clozapine with those of olanzapine in a learned behavioral task previously shown to distinguish between clozapine and haloperidol with acute and subchronic treatment regimes. Rats were trained to use a single forelimb to press a force-recording operandum and simultaneously to lick water from a dipper that remained available while forelimb force exceeded a modest lower limit. Analysis of the resulting forcetime recordings provided measures of task engagement (time on task-analogous to response rate), lick rhythm, tremor, ballistic (maximum force) and tonic (hold force) forelimb force measures, as well as the durations of the individual responses. In a between-groups dosing design, five separate groups of rats received vehicle, clozapine 1.0 or 5.0 mg/kg, olanzapine 0.5 or 1.0 mg/kg daily for 27 days. A 7-day withdrawal period followed. On days 22 and 26 of antipsychotic drug treatment, all rats additionally received 0.3 mg/kg trihexyphenidyl or 1.0 mg/kg quipazine, respectively. The effects of olanzapine and clozapine were similar in that both drugs reduced time on task, increased response duration, and slowed lick rhythm. The two drugs differed in that clozapine reduced the force and tremor measures but olanzapine did not. Both tolerance and withdrawal effects, as reflected by the tremor measure, were observed for clozapine but not for olanzapine. Trihexyphenidyl further increased the duration of responses already lengthened by clozapine; in contrast, trihexyphenidyl decreased the duration lengthening effect of olanzapine. Taken together, the results indicated that olanzapine did not have the antitremor and hypotonic effects displayed by clozapine, and olanzapine did not induce tolerance and withdrawal phenomena as clozapine did.

Topics: Animals; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Clozapine; Drug Tolerance; Forelimb; Male; Muscarinic Antagonists; Olanzapine; Pirenzepine; Quipazine; Rats; Rats, Sprague-Dawley; Serotonin Receptor Agonists; Substance Withdrawal Syndrome; Tremor; Trihexyphenidyl