No abstract

Pharmacological risk factors for neuroleptic malignant syndrome (NMS) are better defined than clinical risk factors. We examined the psychopathological status preceding the onset of NMS in 20 patients. We evaluated four key psychiatric symptoms (psychomotor agitation, catatonia, disorganization and confusion) and grouped them into definite clinical syndromes. Six patients presented with an acute and severe catatonic syndrome, with all the four key psychiatric symptoms. Twelve patients presented with an acute and severe disorganized psychotic episode, with two or three key psychiatric symptoms, but not catatonia. Our study suggests that a clinical syndrome of acute disorganization, in addition to acute catatonia, is a potential clinical risk factor for NMS. The two syndromes, which can occur in the context of different mental disorders, are related to each other as both implicate alteration in behavioural monitoring, and were, in our experience, unresponsive to neuroleptics. In conclusion, we hypothesize that the recognition of these two syndromes should reduce NMS occurrence. We recommend a judicious use of neuroleptics not only in patients with acute catatonia, but also in patients with acute disorganization.

INTRODUZIONEI nuovi antipsicotici hanno consentito un significativo progresso nel trattamento farmacologico della schizofrenia. In particolare, la olanzapina è più efficace dell'aloperidolo sia in termini di miglioramento clinico globale che nel trattamento dei sintomi negativi, depressivi e cognitivi (1, 2, 3). Inoltre, la olanzapina comporta un rischio significativamente ridotto di sintomi extrapiramidali e sintomi da iperprolattinemia (1, 2, 4, 5), ma causa altri effetti collaterali, tra cui aumento di peso (1, 2). I nuovi antipsicotici possono essere particolarmente vantaggiosi nelle fasi iniziali della schizofrenia. Sanger et al (6) hanno infatti mostrato che mentre tra i casi con schizofrenia cronica olanzapina è solo moderatamente più efficace dell'aloperidolo sui sintomi positivi, la differenza di efficacia diviene invece più ampia e statisticamente significativa nei pazienti con schizofrenia in fase di esordio. Studi recenti, inoltre, hanno dimostrato che gli antipsicotici di nuova generazione possono migliorare sostanzialmente la prognosi se utilizzati precocemente (7,8,9,10).A fronte di tali vantaggi, i nuovi antipsicotici presentano un costo di acquisizione marcatamente più elevato dei neurolettici tradizionali, determinando un aumento della spesa farmaceutica.Numerosi studi di farmacoeconomia hanno però concordemente mostrato che la maggiore efficacia dei nuovi antipsicotici, inclusa la olanzapina, comporta una riduzione dei ricoveri e di altre voci di spesa che bilancia e supera i più alti costi di ICERCA ORIGINALE ABSTRACTObjective: In Italy, use of olanzapine in the public sector was limited by law to patients that had failed treatment with conventional antipsychotics, due to the higher purchase price of the drug. This restriction prevented first-episode patients and patients early in the course of their illness from being treated with olanzapine. The present study investigates economic consequences of this policy. Design: The present study retrospectively outlines treatment costs of patients switched to olanzapine during the early stages of schizophrenia as compared to the costs of patients switched during a later stage of the illness. Setting: The study was conducted within Italian Community Mental Health Services. Patients: The cost of pharmacological and non-pharmacological treatment was retrospectively calculated in 25 out-patients with schizophrenia and related disorders over a one-year span. Thirteen patients were switched to olanzapine in the early stage of their illness, prior to drug approval under a compassionate use regimen. Twelve patients started olanzapine under the restriction in a later stage of illness following failed treatment with a conventional antipsychotic. Results: While total treatment costs between the two groups was similar, cost distribution was different. Early Switch patients had higher drug costs and higher rehabilitation costs, while Late Switch patients had higher hospitalisation costs. Conclusions: Small patient numbers and design limitations prevent conclusion...

ResumenSe administró clozapina a 28 esquizofrénicos resistentes al tratamiento en los servicios psiquiátricos en Bolonia. A las 26 semanas, el 62% de los pacientes mostraba respuesta. Los síntomas positivos y negativos mejoraron, pero la disminución de los síntomas negativos dependía en parte de la mejoría de los positivos y los extrapiramidales. No se vieron casos de agranulocitosis. Algunos abandonos estaban relacionados con dificultades con la mejoría psicopatológica.

No abstract