Review of recent clinical studies with olanzapine

Tollefson, Gary D.; Kuntz, Amy J.

doi:10.1192/s0007125000293641

Cited by 57 publications

(29 citation statements)

References 17 publications

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“…However, clozapine, an atypical antipsychotic drug, retains its capacity to suppress both forms of locomotor activity in KA-lesioned animals . Consistent with these observations, the ability of haloperidol to elevate dopamine turnover is reduced in the nucleus accumbens of KA-lesioned animals, while the ability of clozapine to increase dopamine turnover in the same brain region is normal (Bardgett et al 1997b).Risperidone and olanzapine are presently the most widely used antipsychotic drugs, and their atypical properties in patients have been asserted (Marder 1999;Tollefson and Kuntz 1999). The purpose of this study was to determine if KA lesions alter the locomotor suppressive effects of risperidone and olanzapine on spontaneous and amphetamine-elevated locomotor activity.…”

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confidence: 56%

“…Risperidone and olanzapine are presently the most widely used antipsychotic drugs, and their atypical properties in patients have been asserted (Marder 1999;Tollefson and Kuntz 1999). The purpose of this study was to determine if KA lesions alter the locomotor suppressive effects of risperidone and olanzapine on spontaneous and amphetamine-elevated locomotor activity.…”

Section: Previous Studies Have Shown That Excitotoxic Hippocampal Lesmentioning

confidence: 99%

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The Effects of Excitotoxic Hippocampal Lesions in Rats on Risperidone- and Olanzapine-Induced Locomotor Suppression

Bardgett

Humphrey

Csernansky

2002

Neuropsychopharmacology

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Previous studies have shown that excitotoxic hippocampal lesions in rats attenuate the ability of different doses of haloperidol, but not of clozapine, to suppress locomotor activity. The purpose of the present study was to determine if kainic acid-induced hippocampal damage reduces the degree of locomotor suppression produced by two relatively newer antipsychotic drugs, risperidone and olanzapine. Young adult male rats received bilateral intracerebroventricular infusions of the excitotoxin McCarley et al. 1999) and Alzheimer's disease (e.g., Csernansky et al. 2000). Neurons within the hippocampus and other limbic-cortical structures project to the nucleus accumbens shell, a primary locus of antipsychotic drug action (Deutch 1996). Since brain regions involved in antipsychotic drug action receive input from limbic-cortical structures, it is plausible that limbic-cortical neurons modulate antipsychotic drug action. One way to determine if limbiccortical neurons contribute to antipsychotic drug action is to assess the effects of limbic-cortical lesions in animals on locomotor responses to antipsychotic drugs. The ability of drug compounds to reduce spontaneous locomotor activity and amphetamine-induced elevations in locomotor activity has served as a principal preclinical NO . 6 Kainic Acid Lesions, Antipsychotics, and Locomotion 931 assay of antipsychotic drug action (Arnt 1995;Ogren 1996). However, despite the evidence for hippocampal deficits in disorders treated with antipsychotics, very few studies have considered the possibility that hippocampal lesions can alter the ability of antipsychotic drugs to suppress both forms of locomotor activity (Bardgett and Csernansky 1996). Our research has characterized the impact of limbiccortical deficits on antipsychotic drug action by studying animals with limbic-cortical neuropathology induced by the intracerebroventricular (ICV) administration of kainic acid (KA). Animals treated with KA exhibit neuronal loss predominantly in the dorsal CA3 pyramidal cell field of the hippocampus. A minority of the animals also display cell loss and/or gliosis in the CA1 pyramidal cell field of the hippocampus, in the laterodorsal thalamus, the amygdala, and/or the posterior piriform cortex. We have previously demonstrated that KA lesions can alter behavioral and biochemical responses to some antipsychotic drugs. For instance, haloperidol, a typical antipsychotic drug, has a reduced capacity to decrease spontaneous and amphetamine-elevated locomotor activity in KA-lesioned rats. However, clozapine, an atypical antipsychotic drug, retains its capacity to suppress both forms of locomotor activity in KA-lesioned animals . Consistent with these observations, the ability of haloperidol to elevate dopamine turnover is reduced in the nucleus accumbens of KA-lesioned animals, while the ability of clozapine to increase dopamine turnover in the same brain region is normal (Bardgett et al. 1997b).Risperidone and olanzapine are presently the most widely used antipsychotic drugs, and their atyp...

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supporting

confidence: 56%

Section: Previous Studies Have Shown That Excitotoxic Hippocampal Lesmentioning

confidence: 99%

The Effects of Excitotoxic Hippocampal Lesions in Rats on Risperidone- and Olanzapine-Induced Locomotor Suppression

Bardgett

Humphrey

Csernansky

2002

Neuropsychopharmacology

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“…Although this risk is lower than with typical antipsychotics, the risk remains and has to be taken into consideration in using these drugs. Hyperprolactinemia also is a potential problem, particularly for risperidone (49), although elevations are seen at higher doses with olanzapine (50) and at least transiently with ziprasidone (51). Hence, although AAPs may be effective augmenters, their place remains obscure.…”

Section: Discussionmentioning

confidence: 99%

Augmentation of antidepressants with atypical antipsychotics for treatment‐resistant major depressive disorder

Shelton

Papakostas

2008

Acta Psychiatr Scand

103

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Objective: Atypical antipsychotics (AAPs) have been hypothesized to be beneficial in treatment‐resistant depression (TRD). This paper will review a biochemical rationale and will summarize the data regarding the effectiveness of AAPs in TRD.Method: Studies were identified using searches of Pubmed/Medline, EMBase and the Cochrane databases by cross‐referencing the term ‘depression’ with each of the six AAPs.Results: After initial positive, short case reports and clinical trials, larger studies failed to show the effectiveness of AAPs combined with antidepressants for TRD. More recently, larger scale clinical trials have supported the effectiveness of at least some of these medications. While AAPs have gained in popularity for TRD, there are nagging concerns regarding risks such as metabolic syndrome and tardive dyskinesia.Conclusion: The existing research provides some support for the beneficial effects of AAPs when combined with SSRI’s in TRD. These medications pose significant risks that must be considered in their use.

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“…Although women on risperidone, amisulpride and paliperidone had the highest prolactin levels, elevated prolactin levels were observed in all antipsychotic groups. Atypical antipsychotics have various effects on prolactin levels, with clozapine, quetiapine and olanzapine showing little or no elevation (Tollefson and Kuntz, 1999) compared to risperidone and amisulpride, which have shown marked and sustained elevation (Wieck and Haddad, 2003). The increase in prolactin levels associated with antipsychotics is believed to be due to the antipsychotic drugs themselves, as patients with acute or chronic psychiatric disorders who have not yet been placed on antipsychotic medication having normal prolactin levels (Rao et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

Menstrual cycle characteristics in women with persistent schizophrenia

Gleeson

Worsley

Gavrilidis

et al. 2015

Aust N Z J Psychiatry

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Objective: Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms. Method:Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery-Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays. Results:Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery-Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%). Conclusion:Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia.

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Review of recent clinical studies with olanzapine

Cited by 57 publications

References 17 publications

The Effects of Excitotoxic Hippocampal Lesions in Rats on Risperidone- and Olanzapine-Induced Locomotor Suppression

The Effects of Excitotoxic Hippocampal Lesions in Rats on Risperidone- and Olanzapine-Induced Locomotor Suppression

Augmentation of antidepressants with atypical antipsychotics for treatment‐resistant major depressive disorder

Menstrual cycle characteristics in women with persistent schizophrenia

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