Olanzapine for the Treatment of Somatic Symptom Disorder: Biobehavioral Processes and Clinical Implications

Crapanzano, Calogero; Amendola, Chiara; Politano, Andrea; Laurenzi, Pier Francesco; Casolaro, Ilaria

doi:10.1097/psy.0000000000001052

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…2) [36,37]. The D1/H1/5HT2A/5HT2C/ α1 antagonist activity, underling its sedative and anxiolytic properties, may contribute to i) ameliorate nightmares/sleep disturbances and hyperarousal [37][38][39][40][41][42][43] although its anti-arousal effects appears to be direct and unrelated to psychosedation [24] ii) help re-socialization (decreasing levels of anxiety) and improve therapeutic alliance like oxytocin promotes socially-oriented behaviors (normalizing amygdalar and insular activity) (Fig. 2) [24,44,45].…”

Section: Discussionmentioning

confidence: 99%

Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature

Crapanzano¹,

Damiani

Casolaro

et al. 2023

Clin Psychopharmacol Neurosci

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Paroxetine and Sertraline are the only medications approved in posttraumatic stress disorder (PTSD). However, about 60% of traumatized patients fail to show an adequate clinical response. Second generation antipsychotics are recommended as second-line monotherapy or third-line augmentation strategies and quetiapine appears as one of the most used and promising agents. Up to date, no reviews assessed the efficacy of quetiapine in the treatment of PTSD. We aimed to assess the effectiveness and general safety of quetiapine on PTSD. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting studies that evaluated the efficacy of quetiapine on global or specific PTSD symptomatology. Ten studies (n = 894) were considered eligible for qualitative synthesis: one case report, one case series, one prospective cohort study, 3 open-label trials, 3 retrospective studies, one randomized controlled trial. Quetiapine was effective on global PTSD symptomatology assessed in 6 studies as well as on re-experiencing (4/4 studies), avoidance (4/3 studies) and hyperarousal (4/4 studies), flashbacks (2/2 studies), depressive (4/4 studies), anxiety (1/1 studies), psychotic (3/3 studies), insomnia (4/5 studies), nightmares (3/3 studies) specific symptoms and PTSD domains. Sedation was among the most frequently observed adverse effects and the main cause of drug discontinuation. Preliminary findings support the efficacy of quetiapine in ameliorating symptoms relative to PTSD and its overall safety. However, quetiapine use in PTSD cannot be recommended yet as studies mainly rely on open-label, retrospective studies or case series.

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Section: Discussionmentioning

confidence: 99%

Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature

Crapanzano¹,

Damiani

Casolaro

et al. 2023

Clin Psychopharmacol Neurosci

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“…It has been well established that SSD can be detrimental to a patient's well-being and causes a significant negative impact on functionality. Extensive data has demonstrated that in routine clinical settings, the prevalence of somatic symptoms and disorders is progressively escalating, contributing to significant disability and distress among individuals [6]. Patients suffering from SSD usually seek psychiatric care only after having undergone many different ineffective medical assessments and diagnostic examinations.…”

Section: Discussionmentioning

confidence: 99%

“…This prolonged use poses problems due to side effects, potential dependence, and abuse risks. Some potential side effects associated with their extended use include sedation, cognitive impairment, and impaired psychomotor performance [6]. For instance, a Cochrane review that examined nine randomized controlled trials involving 679 subjects (n = 697) demonstrated that the combination of antidepressants and benzodiazepines was more effective than antidepressant monotherapy in terms of efficacy outcomes after one and four weeks of treatment [8].…”

Section: Discussionmentioning

confidence: 99%

The Role of Low-Dose Quetiapine in the Treatment of Somatic Symptom Disorder: A Case Report

Pagan Cruz,

Guiribitey,

Shupe

2023

Cureus

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Somatic symptom disorder (SSD) involves physical symptoms like palpitations, pain, weakness, dizziness, and pseudo-neurological symptoms. These symptoms are accompanied by excessive thoughts, emotions, and behaviors related to the symptom, causing significant distress and impairment lasting at least six months. They may not be explained by any underlying medical conditions. SSD can be resistant to standard treatment modalities like Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Antipsychotics, in particular second generations, have also been used to treat SSD but not as frequently. This case report shows the improvement in symptomatology of SSD after low-dose quetiapine was used for its management. This case is a 41-year-old Hispanic male with a diagnosis of SSD who presented to the outpatient clinic for severe somatic symptoms. The use of low-dose second-generation antipsychotic (SGA), in particular quetiapine, to successfully improve symptoms and patient functionality after just four weeks on quetiapine as the patient and wife both reported significant normalization of intrusive thoughts and health-related behaviors. To the best of our knowledge, this is the first case demonstrating symptom improvement in SSD following the addition of low-dose quetiapine to SNRI treatment.

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“…Olanzapine is characterized by antagonism for D2 receptors as well as for H1, 5HT-2a, 5HT2c and alpha1 receptors. The antagonism of H1, 5HT-2a, 5HT2c, alpha1 and M1 receptors could be the pharmacodynamic mechanism underlying the anti-anxiety properties of olanzapine [ 45 , 47 - 50 ] as shown in several preclinical models: i) 5HT-2a antagonist activity decreases anxiety potentially through 5-HT2A downregulation in the frontal cortex and in the hippocampus [ 51 ]; ii) Dorsal Raphe 5-HT2C antagonist activity prevents anxiety-like behavior through attenuation of increased GABAergic activity [ 52 ]; iii) H1 antagonistic activity reduces anxiety by potentially decreasing adrenergic neuron activation and modulation acetylcholine release [ 53 ]; iv) the alpha1 adrenoceptor antagonism attenuates anxiety-like behavior potentially due to reduction of excessive norepinephrine activity, in line with the noradrenergic theory of anxiety [ 54 , 55 ]; v) the M1 antagonism may ameliorate anxiety by blocking postsynaptic M1 receptors in the ventromedial prefrontal cortex, in line with the cholinergic theory of anxiety [ 56 ]. Another possible hypothesis is linked to the ability to regulate the glutamatergic system.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Olanzapine in Anxiety Dimension of Schizophrenia: A Systematic Review of Randomized Controlled Trials

Crapanzano¹,

Casolaro

Damiani

et al. 2022

Clin Psychopharmacol Neurosci

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Anxiety symptoms and anxiety disorders are frequent in patients with schizophrenia and are associated with greater severity of both positive and negative symptoms, cognitive impairment, poorer functioning and quality of life. Accumulating evidence suggests that atypical antipsychotics may have a role in treating comorbid anxiety symptoms. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting randomized control trials (RCTs) that evaluated efficacy of olanzapine on anxiety symptoms in patients diagnosed with schizophrenia and included anxiety evaluation scales. We searched PubMed and Web of Science databases for articles in English language available until September 2021. We selected 7 studies (3 with primary data analysis, 4 with secondary data analysis) regarding the use of olanzapine in patients with schizophrenia. In fours studies olanzapine was superior to haloperidol in improving anxiety symptoms. Four studies compared olanzapine versus risperidone: in two of them risperidone was superior to olanzapine, although one study was limited by a relatively small sample size. In the other two there were no significant differences between olanzapine and risperidone-treated patients. One study found that olanzapine and clozapine were comparable in terms of efficacy. Although olanzapine was superior to haloperidol in treating anxiety, this symptom was a secondary outcome measure in most of the considered studies. Future RCTs comparing different antipsychotics and larger sample sizes may allow to develop more solid treatment strategies.

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Olanzapine for the Treatment of Somatic Symptom Disorder: Biobehavioral Processes and Clinical Implications

Cited by 3 publications

References 29 publications

Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature

Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature

The Role of Low-Dose Quetiapine in the Treatment of Somatic Symptom Disorder: A Case Report

Efficacy of Olanzapine in Anxiety Dimension of Schizophrenia: A Systematic Review of Randomized Controlled Trials

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