Postinjection Delirium/Sedation Syndrome (Pdss) Following Olanzapine Long-Acting Injection: A Case Report

A systematic review and meta-analysis of the evidence on inflammation in depressive illness and symptoms in chronic and end-stage kidney disease

“…Amongst studies which used self-report tools as diagnostic for DS, 44 analyses of (from 40 studies; 7757 patients) found significantly higher levels of CRP in the group with DS compared to no DS group [SMD = 0.49 (95% CI 0.25–0.73); p < 0.001] (Armaly et al, 2012; Atalay et al, 2010; Barros, Costa, Mottin, & D'Avila, 2016; Bornivelli, Aperis, Giannikouris, Paliouras, & Alivanis, 2012; Bossola, Di Stasio, Giungi, Rosa, & Tazza, 2015; Bossola et al, 2010; Boulware et al, 2006; Chilcot et al, 2017; Choi et al, 2013; Cilan et al, 2013; Dogan, Erkoc, Eryonucu, Sayarlioglu, & Agargun, 2005; Dong et al, 2016; Fan et al, 2014; Guenzani et al, 2019; Güney et al, 2008; Gyamlani et al, 2011; Haverkamp et al, 2018, 2019; Hsu et al, 2009a, 2009b; Hung et al, 2011; Jong et al, 2017; Kalender et al, 2007, 2006; Kim, Kim, Kim, & Song, 2012; Ko et al, 2010; Kusztal et al, 2018; Li et al, 2011; Malhotra et al, 2017; Micozkadioglu et al, 2006; Mok et al, 2019; Nie et al, 2019; Nowak, Adamczak, & Więcek, 2013; Oguz et al, 2016; Park et al, 2012, 2010; Schricker et al, 2019; Simic Ogrizovic et al, 2009; Su et al, 2012; Taraz et al, 2012; Tufan, Yıldız, Dogan, Yıldız, & Sevinir, 2015; Uglešić et al, 2015; Wang et al, 2016; Yavuz et al, 2015; Zhang et al, 2014). Significant heterogeneity was detected ( I 2 = 96%; χ 2 = 1032.71, df = 43; p < 0.0001; τ 2 = 0.79).…”

“…Sample sizes of patients with depression were very small in all (9-11 people with MD) (Cilan et al, 2012(Cilan et al, , 2013Kalender et al, 2007). Amongst studies which used self-report DS, 25 analyses (from 22 studies; 4823 patients) found significant differences in IL-6 levels in individuals with increased DS compared to no DS (SMD = 0.74, 95% CI −0.39 to 1.08, p < 0.001) (Alshogran et al, 2018;Bossola et al, 2010Bossola et al, , 2015Boulware et al, 2006;Brys et al, 2020;Damayanti et al, 2018;Dervisoglu et al, 2008;Guenzani et al, 2019;Haverkamp et al, 2018Haverkamp et al, , 2019Hung et al, 2011;Jong et al, 2017;Knuth et al, 2014;Kusztal et al, 2018;Nie et al, 2019;Nowak et al, 2013;Schricker et al, 2019;Simic Ogrizovic et al, 2009;Sonikian et al, 2010;Taraz et al, 2013;Uglešić et al, 2015;Zhao et al, 2017). All 25 analyses showed significant considerable heterogeneity (I 2 = 97%; χ 2 = 692.92, df = 24; p < 0.001; τ 2 = 0.75) (online Supplementary Table S3).…”

Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy

“…The potential for onset of PDSS is greatest within the first hour after injection, and most patients fully recover within 72 hours. 5 , 9 , 10 Although symptoms are generally consistent with olanzapine overdose with supratherapeutic systemic concentrations, the exact mechanism of PDSS is unknown. 9 There is insufficient data to suggest specific risk factors.…”

“… 5 , 9 , 10 Although symptoms are generally consistent with olanzapine overdose with supratherapeutic systemic concentrations, the exact mechanism of PDSS is unknown. 9 There is insufficient data to suggest specific risk factors. The most hypothesized theory involves accidental entry of the medication into the bloodstream following blood vessel injury during the injection process.…”

“…8 The exact mechanism of PDSS is unknown but is likely the result of unintended partial intravascular injection, resulting in supratherapeutic blood concentrations of olanzapine with blood concentrations reported as high as 670 ng/mL (reference 20 to 80 ng/mL). 4,5,[9][10][11] Additionally, it is hypothesized that the elevated olanzapine concentrations observed during PDSS are secondary to the enhanced rate of dissolution of OLAI in blood rather than the slow medication release from the OLAI depot with repeated dosing. 5 No clear risk factors for PDSS are identified from clinical trials.…”