An open trial of olanzapine in patients with treatment-refractory psychoses

Olanzapine's structural similarities to clozapine and the results of premar keting clinical trials suggested potential usefulness in treating patients with treatment-refractory psychoses. Sixteen inpatients from the state hosp ital with severe, refractory schizophrenic or schizoaffective psychoses rec eived olanzapine in a prospective, 12-week, open-label trial. The olanzapin e dose was 10 mg/day for at least the first 6 weeks and never exceeded 20 m g/day. Mood stabilizers and other antipsychotic agents were discontinued be fore olanzapine was started. Patients frequently became more agitated withi n the first several weeks of initiating treatment, requiring the increased use of benzodiazepines and often leading to the discontinuation of olanzapi ne. Two patients improved significantly. Overall, significant clinical impr ovement was noted only for motor side effects. This study concluded that ol anzapine was not effective in this heterogeneous group with chronic, severe , treatment-resistant psychosis when used in this manner. Further research is needed to explain the tendency toward agitation upon transition to olanz apine, which is reminiscent of reported risperidone complications. Clinicia ns should be alert for this complication and should minimize concomitant me dication changes that might add to the risk of emergent agitation.