Introduction: The aim of the study was to assess the feasibility of abruptly switching inadequately
treated psychotic outpatients from another oral antipsychotic to olanzapine and to
evaluate subjective well-being under olanzapine. Methods: Previous medication was switched to olanzapine 10 mg/day and continued for 4 weeks
(5-20 mg/day). Successful switch was predefined as no change or any improvement on
the Clinical Global Impression-Improvement (CGI-I) scale after one week. A successful
switch rate of ≥ 70 % was considered a positive study outcome. Well-being was evaluated
using the Subjective Well-being under Neuroleptics (SWN) scale. Results: 198 patients (100 %) were switched to olanzapine. In 177 patients (89 %), CGI-I was
unchanged (29 %) or improved (60 %) after one week of olanzapine treatment, indicating
a positive study outcome (p < 0.001). SWN total score significantly improved from
127.9 (± 32.5) at baseline to 139.2 (± 31.5) at week 1, continuing to 149.3 (± 30.3)
at week 4 (LOCF). Discussion: The findings suggest that an abrupt switch from another antipsychotic to olanzapine
10 mg/day can be performed successfully in psychotic patients, while rapidly improving
subjective well-being.
References
- 1
Amore M, Zazzeri N.
Neuroleptic malignant syndrome after neuroleptic discontinuation.
Prog Neuropsychopharmacol Biol Psychiatry.
1995;
19
1323-1334
- 2
Angermeyer M C, Matschinger H.
Neuroleptics and quality of life. A patient survey.
Psychiatr Prax.
2000;
27
64-68
- 3
Basson B R, Kinon B J, Taylor C C, Szymanski K A, Gilmore J A, Tollefson G D.
Factors influencing acute weight change in patients with schizophrenia treated with
olanzapine, haloperidol, or risperidone.
J Clin Psychiatry.
2001;
62
231-238
- 4
Beasley CM J r, Hamilton S H, Crawford A M, Dellva M A, Tollefson G D, Tran P V, Blin O,
Beuzen J N.
Olanzapine versus haloperidol: acute phase results of the international double-blind
olanzapine trial.
Eur Neuropsychopharmacol.
1997;
7
125-137
- 5 Brunner E, Domhof S, Langer F. Nonparametric analysis of longitudinal data in factorial
experiments. Wiley Interscience 2002
- 6
Carriere P, Bonhomme D, Lemperiere T.
Amisulpride has a superior benefit/risk profile to haloperidol in schizophrenia: results
of a multicentre, double-blind study (the Amisulpride Study Group).
Eur Psychiatry.
2000;
15
321-329
- 7
Claxton A J, Cramer J, Pierce C.
A systematic review of the associations between dose regimens and medication compliance.
Clin Ther.
2001;
23
1296-1310
- 8
de Haan L, Weisfelt M, Dingemans P M, Linszen D H, Wouters L.
Psychometric properties of the Subjective Well-Being Under Neuroleptics scale and
the Subjective Deficit Syndrome Scale.
Psychopharmacology (Berl).
2002;
162
24-28
- 9
Franz M, Lis S, Pluddemann K, Gallhofer B.
Conventional versus atypical neuroleptics: subjective quality of life in schizophrenic
patients.
Br J Psychiatry.
1997;
170
422-425
- 10
Gaertner I, Altendorf K, Batra A, Gaertner H J.
Relevance of liver enzyme elevations with four different neuroleptics: a retrospective
review of 7,263 treatment courses.
J Clin Psychopharmacol.
2001;
21
215-222
- 11
Garcia-Cabeza I, Gomez J C, Sacristan J A, Edgell E, Gonzalez De Chavez M.
Subjective response to antipsychotic treatment and compliance in schizophrenia. A
naturalistic study comparing olanzapine, risperidone and haloperidol (EFESO Study).
BMC Psychiatry.
2001;
1
7
- 12
Hertling I, Philipp M, Dvorak A, Glaser T, Mast O, Beneke M ,. et al .
Flupenthixol versus risperidone: subjective quality of life as an important factor
for compliance in chronic schizophrenic patients.
Neuropsychobiology..
2003;
47
37-46
- 13
Ho B C, Nopoulos P, Flaum M, Arndt S, Andreasen N C.
Two-year outcome in first-episode schizophrenia: predictive value of symptoms for
quality of life.
Am J Psychiatry.
1998;
155
1196-1201
- 14
Ho B C, Miller D, Nopoulos P, Andreasen N C.
A comparative effectiveness study of risperidone and olanzapine in the treatment of
schizophrenia.
J Clin Psychiatry.
1999;
60
658-663
- 15
Karow A, Naber D.
Subjective well-being and quality of life under atypical antipsychotic treatment.
Psychopharmacology (Berl).
2002;
162
3-10
- 16
Kinon B J, Basson B R, Gilmore J A, Malcolm S, Stauffer V L.
Strategies for switching from conventional antipsychotic drugs or risperidone to olanzapine.
J Clin Psychiatry.
2000;
61
833-840
- 17
Lacro J P, Dunn L B, Dolder C R, Leckband S G, Jeste D V.
Prevalence of and risk factors for medication nonadherence in patients with schizophrenia:
a comprehensive review of recent literature.
J Clin Psychiatry.
2002;
63
892-909
- 18
Lambert M, Schimmelmann B G, Karow A, Naber D.
Subjective well-being and initial dysphoric reaction under antipsychotic drugs - concepts,
measurement and clinical relevance.
Pharmacopsychiatry.
2003;
36(Suppl 3)
181-190
- 19
Lee C T, Conde B J, Mazlan M, Visanuyothin T, Wang A, Wong M M,. et al .
Switching to olanzapine from previous antipsychotics: a regional collaborative multicenter
trial assessing 2 switching techniques in Asia Pacific.
J Clin Psychiatry.
2002;
63
569-576
- 20
Löffler W, Kilian R, Toumi M, Angermeyer M C.
Schizophrenic patients' subjective reasons for compliance and noncompliance with neuroleptic
treatment.
Pharmacopsychiatry.
2003;
36
105-112
- 21
Naber D.
A self-rating to measure subjective effects of neuroleptic drugs, relationships to
objective psychopathology, quality of life, compliance and other clinical variables.
Int Clin Psychopharmacol..
1995;
10(Suppl 3)
133-138
- 22
Naber D, Moritz S, Lambert M, Pajonk F G, Holzbach R, Mass R ,. et al .
Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic
drugs.
Schizophr Res.
2001;
50
79-88
- 23
Osser D N, Sigadel R.
Short-term inpatient pharmacotherapy of schizophrenia.
Harv Rev Psychiatry.
2001;
9
89-104
- 24
Revicki D A, Genduso L A, Hamilton S H, Ganoczy D, Beasley CM J r.
Olanzapine versus haloperidol in the treatment of schizophrenia and other psychotic
disorders: quality of life and clinical outcomes of a randomized clinical trial.
Qual Life Res.
1999;
8
417-426
- 25
Ritchie C W, Chiu E, Harrigan S, Hall K, Hassett A, Macfarlane S ,. et al .
The impact upon extrapyramidal side effects, clinical symptoms and quality of life
of a switch from conventional to atypical antipsychotics (risperidone or olanzapine)
in elderly patients with schizophrenia.
Int J Geriatr Psychiatry.
2003;
18
432-440
- 26
Ritsner M, Ponizovsky A, Endicott J, Nechamkin Y, Rauchverger B, Silver H ,. et al
.
The impact of side effects of antipsychotic agents on life satisfaction of schizophrenia
patients: a naturalistic study.
Eur Neuropsychopharmacol.
2002;
12
31-38
- 27
Rosenheck R, Cramer J, Xu W, Thomas J, Henderson W, Frisman L, Fye C, Charney D.
A comparison of clozapine and haloperidol in hospitalized patients with refractory
schizophrenia. Department of Veterans Affairs Cooperative Study Group on Clozapine
in Refractory Schizophrenia.
N Engl J Med.
1997;
337
809-815
- 28
Tempier R, Pawliuk N.
Influence of novel and conventional antipsychotic medication on subjective quality
of life.
J Psychiatry Neurosci.
2001;
26
131-136
- 29
Tran P V, Hamilton S H, Kuntz A J, Potvin J H, Andersen S W, Beasley C J r, Tollefson G D.
Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia
and other psychotic disorders.
J Clin Psychopharmacol.
1997;
17
407-418
- 30
Tranter R, Healy D.
Neuroleptic discontinuation syndromes.
J Psychopharmacol.
1998;
12
401-406
- 31
Tsuji S, Kikkawa S, Horiguchi J, Yamashita H, Kagaya A, Morinobu S, Yamawaki S.
Meige syndrome with apraxia of lid opening after the discontinuation of sulpiride
treatment.
Pharmacopsychiatry.
2002;
35
155-156
- 32
Viguera A C, Baldessarini R J, Hegarty J D, van Kammen D P, Tohen M.
Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment.
Arch Gen Psychiatry.
1997;
54
49-55
- 33
Voruganti L, Cortese L, Oyewumi L, Cernovsky Z, Zirul S, Awad A.
Comparative evaluation of conventional and novel antipsychotic drugs with reference
to their subjective tolerability, side-effect profile and impact on quality of life.
Schizophr Res.
2000;
43
135-145
- 34
Wyatt R J.
Research in schizophrenia and the discontinuation of antipsychotic medications.
Schizophr Bull.
1997;
23
3-9
Dr. Michael Kluge
Max-Planck-Institute of Psychiatry
Kraepelinstr. 10
80804 Munich
Germany
Phone: ++49-89-30622-396
Fax: ++49-89-30622-548
Email: kluge@mpipsykl.mpg.de