Abstract
BackgroundClinical trials assessing efficacy and safety of Intramuscular (IM) Olanzapine in acute schizophrenia and acute mania have previously been undertaken in studies required for drug registration in patients who were required to give informed consent. These patients may have less severe forms of psychosis than patients treated in routine practice. Data derived from naturalistic practice following the launch of IM olanzapine may be helpful for clinicians in assessing efficacy and safety of IM olanzapine. The PANSS-EC scale used in the clinical studies may represent a tool that could be used in routine clinical practice.Case presentationWe report on an early unselected case series of 7 patients who received IM olanzapine in routine clinical practice settings in the UK. In this case series, olanzapine IM was generally effective, and no adverse events were reported. Adjunctive benzodiazepines were given concomitantly in 1 of the 7 subjects. This is relevant as concomitant benzodiazepines are not recommended for a minimum of 1 hour post IM olanzapine administration. PANSS-EC data was collected in 2 of the 7 subjects.ConclusionAlthough patients had greater severity of psychosis than clinical trial patients there were no unexpected findings. In addition the PANSS-EC scale is a scale that may be useful in assessing the efficacy of IM antipsychotics in routine clinical practice.
Highlights
Clinical trials assessing efficacy and safety of Intramuscular (IM) Olanzapine in acute schizophrenia and acute mania have previously been undertaken in studies required for drug registration in patients who were required to give informed consent
In addition the PANSS-EC scale is a scale that may be useful in assessing the efficacy of IM antipsychotics in routine clinical practice
There were no differences found between placebo and IM olanzapine in terms of QTc prolongation from a pooled analysis of the IM olanzapine clinical trials
Summary
During recent years more attention has been shown to rapid tranquilisation for the treatment of acute agitation in schizophrenia and bipolar disorder and the potential problems associated with it [1,2]. Case 4 An 18-year old male with a diagnosis of schizophrenia was admitted in an acutely psychotic state under the MHA He refused oral medication and presented in an extremely agitated state expressing paranoid delusions such as "people have put fish bones in my food". Case 6 A 40-year old female with a diagnosis of bipolar disorder was admitted in an acutely manic state Her normal medications included olanzapine 20 mg and sodium valproate. For the 2 weeks prior to admission he had received additional oral risperidone and sodium valproate He had showed features of paranoid and grandiose delusions together with elevated mood and had been asked to leave work, as "colleagues could not understand his talk" On admission, he was given a single injection of IM olanzapine 10 mg at around 18.00.
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