From the January issue of Webtrack in Schizophrenia (Note, Feb. and March issues are also available now) http://www.imagic.be/webtrack/

An article discussing the possible impact of the novel antipsychotics on long-term outcome in schizophrenia includes an account of three years' clinical experience with olanzapine as part of a Phase III multicentre, double-blind clinical trial.

In the trial, which compared olanzapine with haloperidol, flexible olanzapine doses of 5 to 20 mg/day were permitted. There was a 6-week acute phase followed by a long-term maintenance phase. The patients were all chronically ill and unresponsive to medication. The 15 patients receiving an olanzapine trial of at least 6 weeks were scored (1 to 3) for improvements in EPS, positive and negative symptoms. The scores were based on the authors' impressions.

Of the 15 patients, 12 (all of whom received either 20 or 15 mg/day) experienced a dramatic improvement in at least one of the three outcome areas with olanzapine. Eight of the 15 patients had problems with antipsychotic-induced parkinsonism before the start of the trial and all eight had a marked (score 2 or 3) improvement in their EPS after treatment with olanzapine. Marked improvements (score 2 or 3) in positive symptoms were noted in nine patients and in 10 patients for negative symptoms. In most cases, the clinical response seemed to level off within one year. No cases of complete remission of active symptoms were observed.

Despite the highly structured environment in which these patients lived, non-compliance was a problem, with patients often trying to stop olanzapine after about a year of successful treatment. The most problematic side effect noted was weight gain, with this being a potential clinical problem for three of the 15 patients and mildly distressing for another two patients. Most of the patients gained weight.

The authors say that they were not prepared for the extent and frequency of improvements observed in the first few successfully treated cases. They discuss the potential problems caused by "awakenings" - they discuss an increased awareness of complications that occur following improvement. In this group, they seemed to cause increased substance abuse, high-risk sexual behavior and non-compliance or drop-out. The authors stress that as the use of these drugs increases, better ways of helping patients cope with the emotional upheavals and feelings of loss that accompany symptom improvement will be needed.

Weiden P et al. J Clin Psychiatry 1996; 57(suppl 11):53x60.

Other articles of interest on WebTrack in Schizophrenia:

March Issue of WebTrack in Schizophrenia (Table of Contents):

Volume 2, Issue 3 - March 1997

Edited by Professor Stuart Montgomery, St. Mary's Hospital Medical School, UK Dr William Glazer, Yale University School of Medicine, USA

Contents Prenatal and perinatal risk factors Effects of clozapine on specific symptons Insight amoung outpatients Prescribing tends Smooth pursuit performance Speech problems in geriatric patients

Volume 2, Issue 2 - February 1997

Contents

Childhood-onset schizophrenia Novel antipsychotic usage in elderly patients Receptor-occupancy profile of a new antipsychotic Genetic linkage of auditory deficit Prescribing patterns in France and the UK Motor abnormalities in schizophrenia