Olanzapine Therapy in Treatment-Resistant Psychotic Mood Disorders: A Long-Term Follow-Up Study
J Clin Psychiatry 2001;62(7):509-516
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Recent studies suggest a role for
the atypical antipsychotic olanzapine in the acute treatment of
psychotic mood disorders, but long-term data are unavailable. The
purpose of this naturalistic study was to determine the long-term
effectiveness and tolerability of olanzapine as add-on therapy in
psychotic mood disorders.
Method: Hospital records were reviewed for 125
inpatients at the state psychiatric hospital in Buffalo, N.Y.,
who received at least 6 weeks of add-on olanzapine treatment for
psychotic mood disorders (schizoaffective disorders [bipolar and
depressive type], bipolar disorders [I, II, and NOS], and major
depressive disorder). A group of schizophrenic patients served as
a control group (N = 50). Baseline measures, including age,
gender, number of hospitalizations in the 2 years prior to
olanzapine treatment, concomitant medications, the Clinical
Global Impressions scale (CGI), and the Global Assessment of
Functioning-Equivalent (GAF-EQ) and Kennedy Axis V psychological
impairment, violence, social skills, and activities of daily
living subscale scores, were obtained. Follow-up information was
obtained from the patients at least 6 months after initiation of
olanzapine or by chart review and discussion with the treating
psychiatrist. Patients with a diagnosis of psychotic mood
disorders were compared with patients with the nonaffective
psychotic disorder (schizophrenia) on a variety of outcome
Results: Follow-up information was available on
102 patients (82%). Mean follow-up was 15 months; 50 (49%) of the
102 patients remained on olanzapine treatment at follow-up (32
psychotic mood disorder, 18 schizophrenic). The primary reason
for discontinuation in both groups was lack of response. Both the
psychotic mood disorder and schizophrenic groups had comparable
outcomes on the CGI and GAF-EQ. Improvement on the Kennedy Axis V
psychological impairment and social skills subscales was seen
only in the psychotic mood disorders group (p < .01); both
groups showed significant (p < .02) improvement in the
violence subscale. Sustained mood-stabilizing effect was evident
in only 7/27 (26%) of the psychotic mood disorders patients
continuing on add-on olanzapine treatment at follow-up.
Conclusion: Lack of response was the primary
reason for discontinuation of add-on olanzapine in both groups.
Mood symptoms predicted a better response to add-on olanzapine in
patients with psychotic mood disorders on selective outcome
measures. However, only 26% of the patients with psychotic mood
disorders sustained a clinically meaningful mood-stabilizing
effect with add-on olanzapine treatment at follow-up.