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Pharmacopsychiatry 2005; 38(1): 6-12
DOI: 10.1055/s-2005-837764
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

A Simple Switching Strategy for Inadequately Treated Patients with Schizophrenia to Olanzapine: Changes in Psychopathology and Subjective Well-being

M. Kluge1 , P. M. Wehmeier1 , R. W. Dittmann1 , 2 , F. Langer1 , J. Czekalla1 , M. Lehmann1 , F. H. Keßler1 , S. Beyenburg3 , D. Naber4
  • 1Lilly Deutschland GmbH, Medical Department, Bad Homburg, Germany
  • 2University of Hamburg, Children’s Hospital, Psychosomatic Department, Hamburg, Germany
  • 3Centre Hospitalier de Luxembourg, Department of Neurosciences, Luxembourg
  • 4University of Hamburg, Psychiatric Department, Hamburg, Germany
The study was funded by Lilly Deutschland GmbH
Further Information

Publication History

Received: 24.9.2003 Revised: 9.12.2003

Accepted: 31.3.2004

Publication Date:
11 February 2005 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 2 Angermeyer M C, Matschinger H. Neuroleptics and quality of life. A patient survey.  Psychiatr Prax. 2000;  27 64-68
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Brunner E, Domhof S, Langer F. Nonparametric analysis of longitudinal data in factorial experiments. Wiley Interscience 2002
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Karow A, Naber D. Subjective well-being and quality of life under atypical antipsychotic treatment.  Psychopharmacology (Berl). 2002;  162 3-10
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 23 Osser D N, Sigadel R. Short-term inpatient pharmacotherapy of schizophrenia.  Harv Rev Psychiatry. 2001;  9 89-104
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 28 Tempier R, Pawliuk N. Influence of novel and conventional antipsychotic medication on subjective quality of life.  J Psychiatry Neurosci. 2001;  26 131-136
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 30 Tranter R, Healy D. Neuroleptic discontinuation syndromes.  J Psychopharmacol. 1998;  12 401-406
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 34 Wyatt R J. Research in schizophrenia and the discontinuation of antipsychotic medications.  Schizophr Bull. 1997;  23 3-9
    PubMedGoogle Scholar

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

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