Olanzapine is a novel antipsychotic effective in reducing positive and negative symptoms of schizophrenia and with a safe side-effect profile. Premarketing trials, however, included only a few elderly patients. Further data are needed regarding the effects of olanzapine in the elderly and those with comorbid medical illness. In this pilot study, 11 hospitalized patients (age range 60-85 years) who manifested symptoms of psychosis related to schizophrenia and schizoaffective disorders were treated with olanzapine (dose range, 5-20 mg/day). Efficacy and safety were assessed by the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale (CGI), Extrapyramidal Symptom Rating Scale (ESRS), Mini-Mental State Examination (MMSE), Calgary Depression Scale For Schizophrenia (CDSS), EKG, physical examination, and various laboratory tests. Seven patients responded to treatment and all of them showed improvement in both positive and negative symptoms, with greater reduction in positive symptoms. Treatment was discontinued in 2 patients whose symptoms showed no improvement or worsened. The CGI showed significant improvement in 9 patients, remained the same in 1, and worsened in 1 patient. ESRS showed significant reduction from baseline to final visit. Of the 10 patients who cooperated for MMSE, 9 had improved scores. The CDSS showed significant reduction in scores from baseline to final visit. No significant changes were noted in laboratory tests, prolactin levels, EKG, and physical examination. Concomitant administration of lorazepam, carbamazepine, divalproex sodium, and lithium carbonate caused no adverse consequences. The reduction of positive and negative symptoms, lack of significant extrapyramidal symptoms and other side effects, and lack of any significant drug interaction suggest that olanzapine may be a safe and effective antipsychotic medication in the elderly.
SUMMARYSchizophrenia is a psychological disorder, diagnosed by observed behavior and patient reported experiences. Antipsychotic medication mainly works by suppressing dopamine activity. Neuroleptics are also called as antipsychotic drugs. There is a increased risk of extrapyramidal side effects with typical antipsychotics. Atypical antipsychotics refers to newer antipsychotics that confer to less risk of extrapyramidal side effects. Along with these Neuroleptic treatment other adjuvant treatments like Insulin shock, Electroconvulsive, Oestrogen, Glycine, Cox 2 and Antioxidant therapies are also used for Schizophrenia. Insulin is a hormone that maintain blood sugar level. Repeated injections with large doses of insulin causes daily comas over several weeks during which the patient lost psychotic thoughts. In electroconvulsive therapy controlled electric currents pass through the brain, altering brain chemistry and reducing depression and schizophrenic symptoms. Repeated applications of electric current alter the neurotransmitter level in central nervous system. In oestrogen therapy epidemiological, clinical and animal studies exploring the protective effect of oestrogen against schizophrenic symptoms. Psychoprotective action of oestrogen appears to be mediated by central dopaminergic and serotonergic mechanisms. Glycine(amino acid) , antioxidants and vitamins are potential treatments for the negative symptoms of Schizophrenia. There is an imbalance between the type 1 and type 2 immune systems in patients with psychosis, this imbalance can be restored by Cox 2 inhibitors.
Thyroid function abnormalities have been associated with psychiatric illness. Even though it is a common practice to assess thyroid function in geropsychiatric patients, a literature search for the past 10 years did not reveal any published studies of assessments of thyroid function abnormalities in acute geropsychiatric populations. A retrospective chart review of 197 acute geropsychiatric inpatients and 14 comparison group patients showed that 40 geropsychiatric patients and 2 comparison group patients had abnormal thyroid function tests (TFfs). The most common abnormality was elevated triiodothyronine uptake (T3U), which was noted in 19 female and 13 male geropsychiatric patients. The difference in the prevalence of TFT abnormalities between the geropsychiatric patients and the comparison group subjects was not statistically significant. Both T3U and free thyroxine index (FTI) were significantly higher in the female geropsychiatric patients than in the female comparison group patients. The abnormalities in T3U and FTI in this study group may be related to an increased prevalence of unidentified systemic illness or to the presence of chronically poor nutrition.
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