At the time of this review , seven AAPs were available in Canada : aripiprazole clozapine olanzapine paliperidone quetiapine risperidone ziprasidone
Schizophrenia is a mental illness that requires lifelong treatment and is associated with symptoms that include hallucinations , delusions , cognitive impairment , disorganized thoughts , social withdrawal , and low motivation .
Antipsychotic medications are effective at relieving the symptoms of schizophrenia , and they form the foundation of treatment .
A randomized, double-blind comparison of clozapine and high-dose olanzapine in treatment-resistant patients with schizophrenia.
BACKGROUND Clozapine , despite its side-effect burden , has been considered to be the drug of choice for patients with schizophrenia whose psychotic symptoms fail to respond adequately to other anti-psychotic drugs . There are conflicting data concerning the potential utility of olanzapine in treatment-resistant schizophrenia at doses beyond the 10- to 20-mg/day range that has proven to be effective for most nonrefractory patients with schizophrenia . OBJECTIVE The main objective of this study was to compare the efficacy and tolerability of high-dose olanzapine ( target dose , 25 - 45 mg/day ) and clozapine ( 300 - 900 mg/day ) in patients with schizophrenia or schizoaffective disorder who had failed to respond adequately to prior treatment with other antipsychotic drugs . STUDY DESIGN / METHOD This 6-month , r and omized , double-blind , parallel-group study compared the efficacy and tolerability of olanzapine ( mean dose , 34 mg/day ; N = 19 ) or clozapine ( mean dose , 564 mg/day ; N = 21 ) in patients with treatment-resistant schizophrenia or schizoaffective disorder , diagnosed according to DSM-IV criteria . Outcome measures included psychopathology , cognitive performance ( as assessed with a comprehensive neuropsychological test battery ) , and tolerability . The study was conducted between May 2000 and December 2003 . RESULTS Robust and significant ( mostly p < .001 ) improvement in multiple measures of psychopathology , mainly between 6 weeks and 6 months of treatment , was found in both treatment groups , with no significant difference between the 2 treatments except for the Global Assessment of Functioning score , which favored clozapine ( p = .01 ) . Improvement in some domains of cognition was significant- and equivalent for both drugs , as well . Nonsignificantly different improvement in Verbal List Learning-Immediate Recall ( p < .05 ) , Controlled Word Association Test ( p < .05 ) , and Digit Symbol Substitution Test ( p < .001 ) was found . There were no significant differences in extrapyramidal symptoms . Weight gain was significantly ( p = .01 ) greater with olanzapine . CONCLUSIONS Olanzapine , at higher than customary doses , demonstrated similar efficacy to clozapine in treatment-resistant schizophrenia and schizoaffective disorder in this study . However , the small sample size precludes definitively concluding that the 2 treatments are equivalent , at these doses , in treatment-resistant schizophrenia . The metabolic side effects of olanzapine are a limitation in its use . CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT00179231
At the time of this review , seven AAPs were available in Canada : aripiprazole clozapine olanzapine paliperidone quetiapine risperidone ziprasidone
Schizophrenia is a mental illness that requires lifelong treatment and is associated with symptoms that include hallucinations , delusions , cognitive impairment , disorganized thoughts , social withdrawal , and low motivation .
Antipsychotic medications are effective at relieving the symptoms of schizophrenia , and they form the foundation of treatment .