Strategies of treatment with olanzapine in schizophrenic patients during stable phase: Results of a pilot study

Rouillon, Frédéric; Chartier, F.; Gasquet, Isabelle

doi:10.1016/j.euroneuro.2008.04.012

Cited by 19 publications

(7 citation statements)

References 20 publications

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“…However, as long as we regard the patients as having decision capacity ( 95 ) and therefore able to provide informed consent, it is our obligation to inform them about potential adverse effects, including what we currently do not know, if this could affect the decision making. In four RCTs determining the effect of dose reduction, a paradoxical weight increase was seen in the reduced group ( 47 , 56 , 73 , 96 ), suggesting that metabolic adverse effects may not be dose dependent, which is also found in other studies ( 97 ). This underlines the importance of reconsidering the current off-label prescribing trend, as also small doses may lead to metabolic disturbances.…”

Section: Discussionsupporting

confidence: 63%

Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis

et al. 2021

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Background and AimsWeight gain is a major adverse effect of antipsychotic medication, negatively affecting physical and mental well-being. The objective of this study was to explore if dose reduction, discontinuation, switch to a partial agonist, or switch from polypharmacy to monotherapy will lead to weight loss.MethodsControlled and uncontrolled studies reporting the effects of discontinuation, dose reduction, switch to a partial agonist, or switch from polypharmacy to monotherapy on weight were included. Primary outcome was difference in weight compared to maintenance groups based on controlled studies. Secondary outcome was change in weight from initiation of one of the included interventions until follow-up in a pre-post analysis.ResultsWe identified 40 randomized controlled trials and 15 uncontrolled studies including 12,279 individuals. The effect of the interventions, i.e. dose reduction, drug discontinuation, or switch to a partial agonis, reduced the weight with 1.5 kg (95% CI −2.03 to −0.98; P < 0.001) compared to maintenance treatment. The weight change from pre to post was a reduction of 1.13 kg (95% CI −1.36 to −0.90; P < 0.001).ConclusionWe found a significant but small reduction in weight, suggesting that antipsychotic-induced weight gain can be reversed to some degree. Only a few studies were designed to address the question as primary outcome, which limits the generalizability of our findings.

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Section: Discussionsupporting

confidence: 63%

Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis

et al. 2021

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“…Hospitalization [11,15-59]; Positive and Negative Syndrome Scale (PANSS) [7,15,17,18,60-72]; Clinical Global Impression (CGI) scale [17,18,26,30,52,57,60-62,65],[66,68,71,73,74]; exacerbation/re-emergence of symptoms [7,27,29,34,38,43,63,67],[75-81]; deliberate self-harm or violent behaviour, suicidal or homicidal ideation, arrest [18,23,27,43,49,50,57,65],[66,71,74,82-84]; Brief Psychiatric Rating Scale (BPRS) [28,43,71,76,84-91]; change of medication or patient management [18,27,38,41,56,66,75,92]; exacerbation/re-emergence of symptoms leading to hospitalization [20,66,92-96]; clinical assessment of patient notes [38,57,88]; International Classification of Diseases (ICD) criteria [70,89,97]; Global Assessment of Functioning (GAF) [64,72]; physician interview and/or assessment [86,98]; Present State Examination (PSE) [84]; Global Assessment Scale (GAS) [84]; Target Symptoms Ratings Scale (TSRS) [76]; Psychiatric Assessment Scale (PAS) [99]; scale for the assessment of positive symptoms [86]; social functioning [75]; Social and Occupational Functioning Assessment Scale (SOFAS) [60…”

Section: Resultsmentioning

confidence: 99%

Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review

et al. 2013

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Relapse in patients with schizophrenia has devastating repercussions, including worsening symptoms, impaired functioning, cognitive deterioration and reduced quality of life. This progressive decline exacerbates the burden of illness on patients and their families. Relapse prevention is identified as a key therapeutic aim; however, the absence of widely accepted relapse definition criteria considerably hampers achieving this goal. We conducted a literature review in order to investigate the reporting of relapses and the validity of hospitalization as a proxy for relapse in patients with schizophrenia. The primary aim was to assess the range and validity of methods used to define relapse in observational or naturalistic settings. The secondary aim was to capture information on factors that predicted or influenced the risk of relapse. A structured search of the PubMed database identified articles that discussed relapse, and hospitalization as a proxy of relapse, in patients with schizophrenia. National and international guidelines were also reviewed. Of the 150 publications and guidelines identified, 87 defined relapse and 62% of these discussed hospitalization. Where hospitalization was discussed, this was as a proxy for, or a component of, relapse in the majority of cases. However, hospitalization duration and type varied and were not always well defined. Scales were used to define relapse in 53 instances; 10 different scales were used and multiple scales often appeared within the same definition. There were 95 references to factors that may drive relapse, including non-adherence to antipsychotic medication (21/95), stress/depression (11/95) and substance abuse (9/95). Twenty-five publications discussed the potential of antipsychotic therapy to reduce relapse rates—continuous antipsychotic therapy was associated with reduced frequency and duration of hospitalization. Non-pharmacological interventions, such as psychoeducation and cognitive behavioural therapy, were also commonly reported as factors that may reduce relapse. In conclusion, this review identified numerous factors used to define relapse. Hospitalization was the factor most frequently used and represents a useful proxy for relapse when reporting in a naturalistic setting. Several factors were reported to increase the risk of relapse, and observation of these may aid the identification of at-risk patients.

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“…Rouillon et al studied 97 stable patients undergoing treatment with olanzapine and compared a reduced‐dose group (average of 17.6 to 13.3 mg/d) and a continuation group (average of 18.1 mg/d). The results over six months showed no significant differences in relapse rate (8% vs 6%), treatment continuation rate, psychiatric symptoms, and side effects (EPS and weight gain) 7 . Wang et al compared the results among a group of individuals whose dose reductions started four weeks after becoming stable with risperidone treatment to half of the initial dose level (average of 4.4 to 2.2 mg/d), a group whose dose reductions started 26 weeks to half of the initial dose level (average of 4.2‐2.1 mg/d), and a continuation group (average of 4.3 mg/d).…”

Section: Cq3‐4 Is Reducing the Dose Of Antipsychotics Useful In The Maintenance Phase?mentioning

confidence: 81%

Japanese Society of Neuropsychopharmacology: “Guideline for Pharmacological Therapy of Schizophrenia”

2021

Neuropsychopharm Rep

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Strategies of treatment with olanzapine in schizophrenic patients during stable phase: Results of a pilot study

Cited by 19 publications

References 20 publications

Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis

Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis

Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review

Japanese Society of Neuropsychopharmacology: “Guideline for Pharmacological Therapy of Schizophrenia”

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