Olanzapine in the treatment of adolescent acute mania: a report of seven cases

Soutullo, César; Sorter, Michael T.; Foster, Keith D.; McElroy, Susan L.; Keck, Paul E.

doi:10.1016/s0165-0327(98)00119-0

Cited by 61 publications

(19 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…tolerated with few other side adverse effects. Our results are consistent with the findings of other case and open-label reports of olanzapine in bipolar children and adolescents (Frazier et al, 2001;Chang and Ketter, 2000;Soutullo et al, 1999). However, in order to establish the efficacy of olanzapine in manic youth, double-blind placebo-controlled studies are needed.…”

Section: Discussionsupporting

confidence: 91%

Neurochemical Effects of Olanzapine in First-Hospitalization Manic Adolescents: A Proton Magnetic Resonance Spectroscopy Study

DelBello

Cecil

Adler

et al. 2005

Neuropsychopharmacol

137

View full text Add to dashboard Cite

We used proton magnetic resonance spectroscopy ( 1 H MRS) to compare the in vivo effects of olanzapine on prefrontal N-acetylaspartate (NAA) levels in treatment remitters and nonremitters. Secondary aims of this study were to identify neurochemical predictors of successful olanzapine treatment and other neurochemical effects of olanzapine. In all, 20 adolescents admitted for their first hospitalization for bipolar disorder, type I, manic or mixed and 10 demographically matched healthy subjects were recruited. Manic adolescents were treated with olanzapine monotherapy and scanned at three time points (N ¼ 19). Medial and left and right lateral ventral prefrontal NAA, choline, creatine/phosphocreatine, myo-inositol, and glutamate/glutamine were measured at baseline, prior to receiving medication, and on days 7 and 28 of treatment. Healthy subjects did not receive medication but underwent 1 H MRS scans at the same time points to assess for normal variability in metabolites over time. Although there was no overall increase in NAA in manic adolescents following 28 days of treatment with olanzapine, olanzapine remitters (N ¼ 11, 58%) exhibited a greater increase in medial ventral prefrontal NAA compared with nonremitters (N ¼ 8, 42%, p ¼ 0.006). Specifically, from baseline to end point, NAA levels decreased in nonremitters (p ¼ 0.03) and increased in remitters (p ¼ 0.05). Manic adolescents treated with olanzapine had an increase from baseline to day 7 in medial (p ¼ 0.002) and right lateral (p ¼ 0.02) ventral prefrontal choline. Baseline medial ventral prefrontal choline was greater in olanzapine remitters than in nonremitters (p ¼ 0.001). Successful treatment of mania with olanzapine may lead to increased ventral prefrontal neuronal viability and/or function as compared to unsuccessful treatment with olanzapine. Additionally, olanzapine-induced increases in choline may lead to alteration of abnormalities in cell membrane metabolism or second messenger pathways that are thought to be involved in the pathophysiology of bipolar disorder.

show abstract

Section: Discussionsupporting

confidence: 91%

Neurochemical Effects of Olanzapine in First-Hospitalization Manic Adolescents: A Proton Magnetic Resonance Spectroscopy Study

DelBello

Cecil

Adler

et al. 2005

Neuropsychopharmacol

137

View full text Add to dashboard Cite

show abstract

“…The antimanic efficacy of olanzapine in the treatment of bipolar patients has been suggested in case reports in adults with manic or mixed states (Ravindran et al 1997;Weisler et al 1997;Ketter et al 1998;Zullino and Baumann 1999), and also in juvenile manic patients (Chang and Ketter 2000;Khouzam and El-Gabalawi 2000). Open prospective and retrospective studies reported that olanzapine was effective in the treatment of refractory manic or mixed adult (McElroy et al 1998;Zarate et al 1998;Sharma and Pistor 1999;Ketter et al 2001) or juvenile bipolar patients (Soutullo et al 1999;Frazier et al 2001), as an adjunctive medication or as monotherapy (Table 1). In all open-label uncontrolled studies, on average, 73% of bipolar patients responded to olanzapine (69 of 94 patients) administered at a mean dose of 11.7 mg/day (Table 6).…”

Section: Olanzapinementioning

confidence: 99%

Atypical antipsychotics and mood stabilization in bipolar disorder

2003

View full text Add to dashboard Cite

The available literature on the use of atypical antipsychotics for the treatment of bipolar disorder was reviewed. All uncontrolled and controlled reports were identified through a comprehensive Medline search. Based on the available evidence, olanzapine was found to be the most appropriate atypical antipsychotic agent utilized for the treatment of manic bipolar patients, although there is also preliminary data suggesting the efficacy of risperidone and clozapine. The preliminary data evaluating the efficacy of quetiapine and ziprasidone in bipolar disorder are still very limited. Double-blind controlled studies with atypical antipsychotics in the long-term treatment of bipolar disorder are still largely not available, but will be critical to determine the effectiveness of these agents in the maintenance treatment of bipolar disorder. There are recent uncontrolled suggestions that olanzapine may have beneficial effects in depressed bipolar patients, which deserve further investigation in controlled studies. In conclusion, atypical antipsychotics, due to lower potential for neurotoxicity and preliminary evidence suggesting better efficacy than typical antipsychotics, are increasingly having a more prominent role in the pharmacological management of bipolar patients. Nonetheless, until there is systematic data from long-term controlled follow-up studies on the comparative efficacy of these agents with mood stabilizers, atypical antipsychotics should be cautiously utilized, and preferably in combination with a mood stabilizer for the maintenance phase of treatment.

show abstract

“…These studies reported that olanzapine, in combination with mood stabilizers, led to marked improvement of manic symptomatology. The first study reported on the treatment of seven adolescents (aged 12 to 17 years) with BPD (Soutullo et al 1999), and the second reported on the treatment of three acutely manic bipolar youths whose symptoms dramatically improved within 5 days on this agent (Chang and Ketter 2000). The results of these reports suggest that olanzapine may have important therapeutic benefits in the treatment of pediatric mania, indicating that more systematic work is needed to evaluate this treatment further.…”

Section: Introduction Cmentioning

confidence: 99%