Olanzapine Treatment of Psychotic and Behavioral Symptoms in Patients With Alzheimer Disease in Nursing Care Facilities

Abstract

Low-dose olanzapine (5 and 10 mg/d) was significantly superior to placebo and well tolerated in treating agitation/aggression and psychosis in this population of patients with AD.

Apolipoprotein E ɛ4 Allele Increases Risk for Psychotic Symptoms in Alzheimer's Disease

“…Virtually all studies to date have considered only presence or absence of psychosis. However, when we alternatively considered two more restrictive thresholds of clinically significant psychosis from the NPIFthat have been used as criteria for entry into clinical trials of antipsychotic drugs (Street et al, 2000;Deberdt et al, 2005) F we found essentially the same results. These analyses suggest that our findings did not depend heavily on the criterion employed to classify AD subjects as psychotic.…”

“…To ascertain whether our results were dependent on a particular definition of psychosis, we repeated the multiple logistic regression analysis using two progressively more restrictive criteria that have been utilized for entry into trials of antipsychotic drug for patients with dementia: (1) score X3 on either the Delusions or Hallucinations item of the NPI, corresponding with moderate severity or frequency (Street et al, 2000); (2) NPI-Psychosis X6 (Deberdt et al, 2005). We also examined the effect of four concomitant medication classes on psychotic symptoms by simultaneously adding them as independent variables to the primary logistic regression analysis.…”

“…Post hoc analyses were conducted to examine more restrictive definitions of psychosis, using the same independent variables in the logistic regression model (Table 2). When psychosis was alternatively defined by a score X3 on either the Delusions or Hallucinations item of the NPI (Street et al, 2000), the presence of e4 was still associated with psychosis (OR ¼ 2.10, 95% CI ¼ 1.11-3.99, P ¼ 0.020). When psychosis was instead defined by NPI-Psychosis score X6 (Deberdt et al, 2005), the presence of e4 was significantly associated with psychosis (OR ¼ 2.45, 95% CI ¼ 1.21-4.98, P ¼ 0.013).…”

Comparison of Rapidly Acting Intramuscular Olanzapine, Lorazepam, and Placebo A Double-blind, Randomized Study in Acutely Agitated Patients with Dementia

“…The availability of an IM formulation of olanzapine may offer safety advantages in the parenteral treatment of agitation. Oral administration of olanzapine has been shown previously to control psychotic symptoms and behavioral disturbances in elderly patients with Alzheimer's disease (Clark et al 2001;Street et al 2000), and this drug has been especially recommended for patients with dementia who exhibit "sundowning" behavior (Expert Consensus Guideline Series 1998). Intramuscular delivery of olanzapine provides a rapidly acting treatment for agitation in aggressive or hyperactive patients or those refusing oral medication, and may confer the advantages that have been reported for other parenteral formulations over their corresponding oral preparations, such as rapid onset (Dubin et al 1985;Schaffer et al 1982) and higher steady-state plasma concentrations (Kahn et al 1990;Simpson et al 1978).…”

“…Lorazepam is commonly used for treatment of acute agitation, and the benzodiazepines are currently among the few agents available in a parenteral formulation for treatment of agitation. Use of orally administered atypical antipsychotics such as olanzapine and risperidone has met with some success in treating behavioral disturbances in patients with dementia (Clark et al 2001;De Deyn et al 1999;Katz et al 1999;Street et al 2000). A parenteral formulation of a second-generation antipsychotic might offer some advantage over their corresponding oral formulations due to faster onset of effect and utility where the patient cannot, or will not, accept oral treatment (Bianchetti et al 1980;Schaffer et al 1982).…”