Comparison of Treatment-Emergent Extrapyramidal Symptoms in Patients With Bipolar Mania or Schizophrenia During Olanzapine Clinical Trials
J Clin Psychiatry 2006;67:107-113
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Previous research on
pharmacotherapy with conventional antipsychotics has
suggested that patients with affective disorders
have higher rates of treatment-emergent
extrapyramidal symptoms (EPS) than patients with
schizophrenia. It is not known whether this
differential vulnerability holds true for treatment with
atypical antipsychotics such as olanzapine. The
present analysis retrospectively examined
olanzapine clinical trial data for incidence of
treatment-emergent EPS in patients with either schizophrenia
or bipolar disorder.
Method: Study participants were 4417
patients meeting DSM-III or DSM-IV criteria for either schizophrenia or bipolar mania
participating in olanzapine clinical trials through July
31, 2001. Data were pooled across haloperidol-controlled trials and separately across
placebo-controlled trials. Measures of EPS included rates
of treatment-emergent EPS adverse event by type (i.e., dystonic, parkinsonian, or
residual), Simpson-Angus Scale score mean change,
rates of treatment-emergent parkinsonism, and rates
of anticholinergic use.
Results: Consistent with prior research,
haloperidol-treated patients with bipolar disorder
appeared to be more vulnerable to the development of EPS than those with schizophrenia.
However, olanzapine-treated patients with bipolar
disorder were no more likely to develop EPS than
those with schizophrenia.
Conclusion: Results support previous
research regarding conventional antipsychotics and
suggest that olanzapine therapy does not increase
the risk of EPS for patients with bipolar disorder.