The Effects of Olanzapine in Reducing the Emergence of Psychosis Among Nursing Home Patients With Alzheimer's Disease
J Clin Psychiatry 2001;62:34-40
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Elderly patients with Alzheimer's
disease (AD) commonly exhibit psychotic symptoms, prompting
clinicians to administer antipsychotics. This article compares
the effects of olanzapine and placebo in the emergence of
hallucinations or delusions in AD patients with symptoms of
agitation/aggression but little or no psychotic symptomatology at
Method: A multicenter, double-blind,
placebo-controlled study was conducted in nursing home patients
with AD according to DSM-IV criteria and symptoms of
agitation/aggression and/or psychosis. Patients (N = 206) were
randomly assigned to receive either placebo or fixed-dose
olanzapine (5, 10, or 15 mg/day) for up to 6 weeks. This article
analyzes data from a subgroup of patients (N = 165) with no or
minimal delusions and/or hallucinations at baseline as measured
by the Neuropsychiatric Inventory-Nursing Home Version (NPI/NH).
Three subsets of patients were identified on the basis of their
symptoms at baseline: those with no clinically significant
hallucinations, those with no clinically significant delusions,
and those with no clinically significant delusions or
Results: Of the patients without hallucinations
or delusions at baseline (N = 75), the placebo-treated patients
showed significantly greater development of these symptoms
compared with olanzapine-treated patients overall (NPI/NH
hallucinations + delusions mean change score, +2.73 vs. +0.27, p
= .006). Similarly, of the patients without baseline
hallucinations (N = 153), the placebo-treated patients showed
greater hallucinations score increases than did
olanzapine-treated patients overall (+1.25 vs. +0.33, p = .026),
whereas patients without baseline delusions (N = 87) showed no
significant treatment effects. Olanzapine had a favorable safety
profile in each patient subset.
Conclusion: These results suggest that, overall,
olanzapine effectively attenuated emergence of psychosis in a
short-term trial of patients with Alzheimer's disease.