Olanzapine therapy in treatment-resistant psychotic mood disorders: A long-term follow-up study

Background: Recent studies suggest a role for the atypical antipsychotic ol anzapine in the acute treatment of psychotic mood disorders, but longterm d ata are unavailable. The purpose of this naturalistic study was to determin e the long-term effectiveness and tolerability of olanzapine as add-on ther apy in psychotic mood disorders. Method. Hospital records were reviewed for 125 inpatients at the state psyc hiatric hospital in Buffalo, N.Y., who received at least 6 weeks of add-on olanzapine treatment for psychotic mood disorders (schizoaffective disorder s [bipolar and depressive type], bipolar disorders [I, II, and NOS], and ma jor depressive disorder). A group of schizophrenic patients served as a con trol group (N = 50). Baseline measures, including age, gender, number of ho spitalizations in the 2 years prior to olanzapine treatment, concomitant me dications, the Clinical Global Impressions scale (CGI), and the Global Asse ssment of Functioning-Equivalent (GAF-EQ) and Kennedy Axis V psychological impairment, violence, social skills, and activities of daily living subscal e scores, were obtained. Follow-up information was obtained from the patien ts at least 6 months after initiation of olanzapine or by chart review and discussion with the treating psychiatrist. Patients with a diagnosis of psy chotic mood disorders were compared with patients with the nonaffective psy chotic disorder (schizophrenia) on a variety of outcome measures. Results: Follow-up information was available on 102 patients (82%). Mean fo llow-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. Bot h the psychotic mood disorder and schizophrenic groups had comparable outco mes 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) improve ment in the violence subscale. Sustained mood-stabilizing effect was eviden t 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 selectiv e outcome measures. However, only 26% of the patients with psychotic mood d isorders sustained a clinically meaningful mood-stabilizing effect with add -on olanzapine treatment at follow-up.