Abstract
Treatment-resistant schizophrenia has an extremely negative impact on mental health and social life. If clozapine, the gold standard treatment, fails, there are very few options left. The literature suggests that high-dose olanzapine (20 - 60 mg/day) is a possible alternative. We report two cases in which very high doses of olanzapine were administered, with significant clinical improvements above 60 mg/day. Clinical, metabolic and cardiac tolerance was good. This report highlights the usefulness of very-high-dose olanzapine in treatment-resistant schizophrenia. The main hypotheses concerning the psychopharmacological mechanisms of very-high-dose olanzapine are discussed.
Highlights
According to Kane’s criteria (1988), treatment-resistant schizophrenia is defined as clinical resistance (PANSS decrease of less than 20%) after the administration of three antipsychotic drugs from at least two different chemical classes at optimum doses and over sufficiently long periods.Clozapine is currently the gold standard treatment for refractory schizophrenia [1,2]
We report two cases illustrating the usefulness of very high doses (≥60 mg/day) of olanzapine in the management of treatment-resistant schizophrenia
There have been no controlled studies of such high doses of olanzapine in treatment-resistant schizophrenia, and only a handful of case reports have been published on doses of olanzapine between 20 and 60 mg
Summary
According to Kane’s criteria (1988), treatment-resistant schizophrenia is defined as clinical resistance (PANSS decrease of less than 20%) after the administration of three antipsychotic drugs from at least two different chemical classes at optimum doses and over sufficiently long periods. Clozapine is currently the gold standard treatment for refractory schizophrenia [1,2]. There are few treatment options left, treatment-resistant delusions appear to be alleviated by electroconvulsive therapy, and refractory auditory hallucinations by transcranial magnetic stimulation of the temporoparietal junction [2]. Over the past few years, several studies and case reports have identified high-dose. Olanzapine (>20 mg/day) as a pharmacological alternative to clozapine. We report two cases illustrating the usefulness of very high doses (≥60 mg/day) of olanzapine in the management of treatment-resistant schizophrenia
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