A 12-Week, Double-blind Comparison of Olanzapine vs Haloperidol in the Treatment of Acute Mania

Tohen, Mauricio; Goldberg, Joseph F.; Arrillaga, Ana María González-Pinto; Azorin, J.-M.; Vieta, Eduard; Hardy-Bayle, Marie Christine; Lawson, William B.; Emsley, Robin; Zhang, Fan; Baker, Robert W.; Risser, Richard C.; Namjoshi, M.; Evans, Angela R.; Breier, Alan

doi:10.1001/archpsyc.60.12.1218

Cited by 197 publications

(124 citation statements)

References 35 publications

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“…From this review, haloperidol had the highest risk for movement disorders. These results are consistent with head-to-head comparison studies of haloperidol versus atypical agents in BPD 45,46 and schizophrenia. 47,48 However, it is also possible that the unnecessarily high doses of haloperidol being used in these studies might play a role.…”

Section: Discussionsupporting

confidence: 87%

Antipsychotic-Induced Extrapyramidal Side Effects in Bipolar Disorder and Schizophrenia

Gao¹,

Kemp²,

Ganocy³

et al. 2008

Journal of Clinical Psychopharmacology

194

110

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Objectives-Newer atypical antipsychotics have been reported to cause a lower incidence of extrapyramidal side effects (EPS) than conventional agents. This review is to compare antipsychotic-induced EPS relative to placebo in bipolar disorder (BPD) and schizophrenia.Methods-English-language literature cited in Medline was searched with terms antipsychotics, placebo-controlled trial, and bipolar disorder or schizophrenia and then with antipsychotic (generic/brand name), safety, akathisia, EPS, or anticholinergic use, bipolar mania/depression, BPD, or schizophrenia, and randomized clinical trial. Randomized, double-blind, placebocontrolled, monotherapy studies with comparable doses in both BPD and schizophrenia were included. Absolute risk increase and number needed to treat to harm (NNTH) for akathisia, overall EPS, and anticholinergic use relative to placebo were estimated.Results-Eleven trials in mania, 4 in bipolar depression, and 8 in schizophrenia were included. Haloperidol significantly increased the risk for akathisia, overall EPS, and anticholinergic use in both mania and schizophrenia, with a larger magnitude in mania, an NNTH for akathisia of 4 versus 7, EPS of 3 versus 5, and anticholinergic use of 2 versus 4, respectively Among atypical antipsychotics, only ziprasidone significantly increased the risk for overall EPS and anticholinergic use in both mania and schizophrenia, again with larger differences in mania, an NNTH for overall EPS of 11 versus 19, and anticholinergic use of 5 versus 9. In addition, risks were significantly increased for overall EPS (NNTH = 5) and anticholinergic use (NNTH = 5) in risperidone-treated mania, akathisia in aripiprazole-treated mania (NNTH = 9) and bipolar depression (NNTH = 5), and overall EPS (NNTH = 19) in quetiapine-treated bipolar depression.Conclusions-Bipolar patients, especially in depression, were more vulnerable to having acute antipsychotic-induced movement disorders than those with schizophrenia.The matter of bipolar disorder (BPD) as a risk factor for antipsychotic-induced movement disorders is still inconclusive. Some early studies showed that patients with BPD were more vulnerable to developing tardive dyskinesia (TD) as well as acute extrapyramidal side effects (EPS) than those with schizophrenia, 1-3 but others found that they had a similar risk. 4,5 More recently, in a pooled data analysis, Canvazoni et al 6 reported that haloperidoltreated patients with BPD seemed to be more vulnerable to the development of EPS than those with schizophrenia, but not olanzapine-treated patients with BPD. METHODSEnglish-language literature published and cited in Medline through October 31, 2007 was searched using the terms antipsychotics, placebo-controlled trial, and BPD, or mania, or schizophrenia, and then with terms typical antipsychotics, atypical antipsychotics, fluphenazine, haloperidol, perphenazine, pimozide, thiothixene, trifluoperazine, loxapine, molindone, chlorpromazine, mesoridazine, thioridazine, fluspirilene, penfuridol, pipothiazine, flupenthi...

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Section: Discussionsupporting

confidence: 87%

Antipsychotic-Induced Extrapyramidal Side Effects in Bipolar Disorder and Schizophrenia

Gao¹,

Kemp²,

Ganocy³

et al. 2008

Journal of Clinical Psychopharmacology

194

110

View full text Add to dashboard Cite

show abstract

“…94,95,[100][101][102]105,106 Data from studies longer than 12 weeks are limited. A total of 4 studies have reported on monotherapy with atypical antipsychotics for a period greater than 12 weeks, 3 with olanzapine and 1 with aripiprazole, with 26-week and 100-week results being reported separately.…”

Section: Overview Of Efficacy Evidence From Key Clinical Trialsmentioning

confidence: 99%

“…The AE profiles of quetiapine and olanzapine in the bipolar depression studies reflect those already established in the bipolar mania studies, with the exception that quetiapine is associated with EPS significantly more often than placebo in depression trials. In terms of effects on metabolic parameters, all of the atypical antipsychotics have been associated with weight gain [92][93][94][95][96][97][98][99][100][101][102]104,106 ; however, levels varied according to the different atypical antipsychotics. 66,[93][94][95]97,106 Compared with haloperidol, atypical antipsychotics (olanzapine and quetiapine) were associated with lower rates of akathisia in monotherapy trials of 12 weeks.…”

Section: Overview Of Safety Evidence From Clinical Trialsmentioning

confidence: 99%

“…In terms of effects on metabolic parameters, all of the atypical antipsychotics have been associated with weight gain [92][93][94][95][96][97][98][99][100][101][102]104,106 ; however, levels varied according to the different atypical antipsychotics. 66,[93][94][95]97,106 Compared with haloperidol, atypical antipsychotics (olanzapine and quetiapine) were associated with lower rates of akathisia in monotherapy trials of 12 weeks. 101,106 Atypical antipsychotics (olanzapine, risperidone, and aripiprazole) were also associated with greater improvements in EPS rating scales (Simpson-Angus Scale and Barnes Akathisia Scale SAS and BAS for olanzapine 106 and aripiprazole 95 and EPS rating scale for risperidone 100 ) than haloperidol in 12-week trials.…”

Section: Overview Of Safety Evidence From Clinical Trialsmentioning

confidence: 99%

“…66,[93][94][95]97,106 Compared with haloperidol, atypical antipsychotics (olanzapine and quetiapine) were associated with lower rates of akathisia in monotherapy trials of 12 weeks. 101,106 Atypical antipsychotics (olanzapine, risperidone, and aripiprazole) were also associated with greater improvements in EPS rating scales (Simpson-Angus Scale and Barnes Akathisia Scale SAS and BAS for olanzapine 106 and aripiprazole 95 and EPS rating scale for risperidone 100 ) than haloperidol in 12-week trials. The remainder of this review focuses on the safety and tolerability data for aripiprazole, with a final section on practical considerations when administering this treatment for bipolar disorder.…”

Section: Overview Of Safety Evidence From Clinical Trialsmentioning

confidence: 99%

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