Generation Antipsychotics Research Articles

Treatment-resistant obsessive compulsive disorder: New generation antipsychotics as supplemental drugs for assuagement of intractable symptoms

Introduction: About half of patients with obsessive-compulsive disorder don’t respond appropriately to serotonin-Reuptake inhibitors. Hence, the objective of the present study was to examine that whether using olanzapine, as augmentative medication, in addition to current serotonin reuptake inhibitor, is useful for treatment-resistant obsessive-compulsive disorder. Method: Eleven patients with obsessive compulsive disorder who had not responded appropriately to at least two preceding treatments with serotonin reuptake inhibitors had been assigned to receive olanzapine, in addition to serotonin reuptake inhibitor, for eight weeks, in an open-label design evaluation. Response, as well, had been evaluated by Yale-Brown Obsessive-Compulsive Scale (YBOCS), as the primary outcome measure. Results: Around fifty four percent of patients responded to abovementioned maneuver. The mean+/-SD total score of YBOCS reduced significantly from 33.45 +/- 4.47 to 25 +/- 5.98, with a mean reduction of 24.56%. Conclusion: Adding olanzapine to serotonin-reuptake inhibitors can be useful in treatment-refractory obsessive-compulsive disorder.

Erratum: Correction of Acknowledgements Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update.

[This corrects the article on p. 159 in vol. 52, PMID: 27689026.].

Acute hyponatriemia in a patient with schizophrenia: Case report water intoxication induced acute hyponatriemia

Introduction: Hyponatremia is defined as a serum sodium level higher than 135 mmol/L, while serum sodium level lower 125 mmol/L is considered as severe hyponatremia and can lead to coma, death, rhabdomyolysis, and neurologic damage. Case report: We present the case of a 34 year old male with history of schizophrenia with multiple seizures followed by loss of consciousness after intake of 6 liters of water. Diagnostic CT scan revealed cerebral edema. Laboratory tests revealed severe hyponatremia (109 mmol/l), hypokalemia and hypocalcemia. The patient was treated with 10% hypertonic NaCl 120 ml per day, 7.4% KCl and calcium gluconate. He was sedated and mechanically ventilated. Antiedematous therapy with mannitol 20% was started. The biochemical results improved slowly with gradual correction of the sodium level: 112 mmol/l, 119 mmol/l and 127 mmol/l respectively. CT scan showed cerebral edema regression was showed on repeated brain scan. On the 6th day sodium level was 131 mmol/l, and the patient was awake, oriented and extubated. Discussion: Psychogenic polydipsia occurs in 20% of the psychiatric patients which could lead to severe hyponatremia. Second generation antipsychotics intake could also lead to severe hyponatremia. According guidelines hyponatremia treatment consists of hypertonic NaCl 3% 150 ml infusion and frequent sodium levels measurements. The sodium level correction should be gradual and should not exceed more than 10 mmol/l for the first 24 hours neither more than 8 mmol/L for every next 24 hours. Conclusion: In our patient, serum sodium level correction was successfully and safely performed with hypertonic saline (NaCl 10%) in absence of hypertonic NaCl 3%. Strict control of serum sodium levels is a must in order to avoid osmotic demielinisation and rhabdomyolysis.

Clinical and economic efficiency of treatment with cariprazine in schizophrenia

To conduct a comprehensive pharmacoeconomic evaluation of feasibility of treatment with cariprazine (reagila) in patients with schizophrenia. A retrospective study using the pharmacoeconomic cost analysis, budget impact analysis, and cost-effectiveness analysis was performed. Data on cariprazine were compared to those on sertindole. If cariprazine is used instead of sertindole, the cost saved will amount to 30.8% per patient per year. If sertindole is fully replaced with cariprazine, the costs related to treatment of patients with a second generation antipsychotics funded by the state will be reduced by 97.8 million rubles over 3 years (30.9%). Gradual replacement of sertindole with cariprazine will make it possible to reduce budget expenditures by 20.1% or 63.8 million rubles over 3 years. This replacement will make it possible to provide therapy to additional 44.6% of patients, or 561 people. In this case, the number of patients receiving therapy will increase from 1257 to 1818. The results of the pharmacoeconomic analysis show that the registration of cariprazine (reagila) in the Russian Federation as therapeutic drug is economically feasible.

Second Generation Antipsychotics (SGAs) in Schizophrenic Patients and Bipolar Disorder: Correlation With Metabolic Syndrome (NCEP ATP III(a))

INTRODUCTION: The Metabolic Syndrome is a set of diverse clinical situations such as diabetes mellitus, hypertension and dyslipidemia. Patients with mental illnesses such as schizophrenia or bipolar disorder have a higher mortality than the general population attributable in 60% to somatic diseases and metabolic syndrome, where second generation antipsychotics increase the risk of weight gain and insulin resistance. Objectives. Correlate the treatment with second generation antipsychotics (SGAs) as a possible predictor for Metabolic Syndrome according to the NCEP ATP III (a) classification. 
 
 METHODS: Descriptive, cross-sectional correlational study. The sample was of 92 patients, applying an open and convenience sampling due to the mental state of the patients in order to determine their degree of acceptance to the study (Informed Assent) and consent to the legal guardian as the main inclusion criterion. For the analysis, the following variables were considered: blood pressure, weight, height, abdominal circumference, serum levels of triglycerides, glucose and high density lipoproteins. The SPSS 20.0 ® program was used logistic regression analysis with a p-value <0.05 and a confidence level of 95%. 
 
 RESULTS: SGAs most used was clozapine (54.3%). The correlation analysis showed that sociodemographic aspects such as personal history, habits, physical activity and paraclinical and anthropometric records correlated with the possible diagnosis of metabolic syndrome (p <0.05), but not with SGAs (p> 0.05). ). 
 
 CONCLUSION: No correlation was found between the presence of the metabolic syndrome and the type of antipsychotic treatment.

Aripiprazole is effective in hyperprolactinemia secondary to use of Fluphenazine

Aripiprazole is drug that acts as a partial agonist at D2 and 5-HT1A receptors and antagonist at 5-HT2A receptor. It modulates the neurotransmission over activity on the dopaminergic mesolimbic pathway which is responsible for positive symptoms of Schizophrenia. Dopamine antagonism is the mechanism of action of first generation antipsychotics. In this paper we discuss an interesting case in which Aripiprazole was effective in decreasing Prolactin levels which was elevated secondary to previous Fluphenazine use.South East Asia Journal of Public Health Vol.7(2) 2017: 40-42

The relationship between intake of lithium and neuroradiological alterations in bipolar disorder. Are there predictors of clinical remission?

For avoiding affective episodes, patients with bipolar disorders are treated with mood stabilizers. Under that term, the substances lithium, valproic acid, lamotrigine and carbamazepine are included. In the light of upcoming new psychiatric concepts, the use of second generation antipsychotics is also taken into consideration in pharmacological treatment. In this review, the relation between brain structure and the use of lithium in bipolar disorders is examined. Therefore, results from MRI-, DTI-, SPECT-studies assessing this relation, were included.Most of the studies are cross-sectional and examined the effects of lithium. The latter is associated with increased cortical and sub-cortical gray matter volume and ameliorative white matter microstructure. 7-lithium spectroscopy showed a significant difference in brain-lithium concentrations between remitted and non-remitted patients.There are preclinical studies reporting induction of promitotic and antiapoptotic effects by lithium. This literature underpins the hypothesis of lithium-induced neurogenesis. However, osmotic and physical effects of lithium could also explain the demonstrated volume gain in bipolar human brain.Cross-sectional design and small patient groups are typical limitations of numerous studies included in this review.Notably, with the 7-lithium spectroscopy of the central nervous system, new perspectives in clinical research to clarify pharmacokinetic differences between remitted and non-remitted bipolar patients can be established in future.

Tardive dyskinesia: Who gets it and why

Tardive dyskinesia (TD) is a potentially permanent movement disorder resulting from chronic use of dopamine receptor blocking agents (DRBA). Identified risk factors include the type of antipsychotic agent, being greater for those of first generation antipsychotics (FGA), the duration of illness and cumulative dose of DRBA and advanced age. Female sex and African and Caucasian ethnicity are additional potential risk factors. Because only a subset of people taking DRBA's develops TD, genetics may play a role. Susceptibility gene candidates include those involved in DRBA metabolism and the targets or receptors of DRBA's. Although met with conflicting data, the following genes may be involved with TD development: the cytochrome P450 gene CYP2D6, involved with metabolism of most antipsychotics, Dopamine D2 and D3 receptor genes, serotonin 2A and 2C receptor genes, vesicular monoamine transporter 2 (VMAT 2) gene, involved with intracellular neurotransmitter packaging, and the manganese superoxide dismutase (MnSOD) gene, an antioxidant enzyme. Heparan sulfate proteoglycan 2 (HSPG 2) gene is another potential gene involved with development of TD. The pathogenesis of TD is unknown, however there are three main theories proposed: dopamine receptor supersensitivity resulting from chronic dopamine receptor blockade, oxidative stress and maladaptive synaptic plasticity each of which is discussed further in this article.Tardive dyskinesia (TD) is a potentially permanent and disabling adverse effect from certain medications. By definition TD is the insidious onset of rhythmic, repetitive, stereotypic movements of the face, mouth and tongue, often with involvement of the trunk and extremities that occur as a result of dopamine receptor blocking agents (DRBA) [1]. The term tardive refers to the delayed onset of the disorder. The mean prevalence of TD is estimated to be 25.3% in psychiatric patients taking antipsychotics [2]. Compared to the number of people taking these drugs, TD represents a minority. TD is a potentially permanent condition; stopping the offending agent does not always alleviate the condition. Therefore, prevention of TD by avoiding DRBA's if at all possible is ideal. However, there is no apparent way to predict who will develop TD and there are some cases in which DRBA's are necessary for treatment of chronic conditions. As TD has been present since the development of DRBA's, possible risk factors for its development have been studied. Solmi et al. (2018) [3] have written a comprehensive review on this subject.

Direct and indirect effects of psychopharmacological treatment on the cardiovascular system.

Background Severe mental disorders, i.e. psychotic disorders, unipolar and bipolar disorders are associated with increased morbidity and mortality from cardiovascular and metabolic disorders. The underlying cause of this association is complex and comprises disorder specific alterations such as dysfunctions of immunological and hormonal systems, body-composition changes and health associated behaviors (smoking, sedentary lifestyle, alcohol intake and treatment compliance). Furthermore, some psychopharmacological drugs may exert unwanted side effects that impact the cardiovascular system. Methods This paper reviews studies concerning commonly used antidepressant and antipsychotics drugs with a particular focus on direct and indirect cardiovascular side effects. Results Newer antidepressant drugs have a favorable cardiovascular safety profile compared to tricyclic antidepressants. However, QTc prolongation, increased blood pressure and potentially higher risks of bleeding have been observed in some newer antidepressants. Some second generation (atypical) antipsychotics have raised concern because of indirect cardiovascular, metabolic side effects such as weight gain and disturbances in lipid and glucose metabolism. Conclusions Psychiatrists need to be aware of potential direct and indirect cardiovascular side effects and to include them in the risk/benefit assessment when choosing a specific individualized treatment.

Antipsychotic polypharmacy in the treatment of schizophrenia in China and Japan.

Although antipsychotic monotherapy is recommended as the main treatment for schizophrenia, antipsychotic polypharmacy is not rare in practice. However, longitudinal data on antipsychotic polypharmacy in schizophrenia treatment are limited. This longitudinal database study described antipsychotic polypharmacy in the treatment of schizophrenia in real-world settings in China and Japan. We retrieved information about antipsychotic treatment for schizophrenia from January 2010 to December 2014 from two hospital Electronic Medical Records databases in China and one claims database, Japan Medical Data Centre in Japan. Eligible patients had a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision F20.x) and at least one prescription for first or second generation antipsychotics. Antipsychotic polypharmacy was defined as having more than one antipsychotic medication overlapping for ⩾60 days. The Japan Medical Data Centre study cohort was further stratified by employees (insurance beneficiaries) and their dependents. The study cohorts comprised 11,961 patients from China and 25,034 (10,661 employee sub-cohort and 14,373 dependent sub-cohort) from 14 days Japan Medical Data Centre in Japan. Most patients were prescribed monotherapy (87.3% in China and 80.1% in Japan), of which oral second-generation antipsychotics were the majority (78.9% in China and 65.8% in Japan). The prevalence rate of antipsychotic polypharmacy was 12.7% in China and 19.9% in Japan (13.7% in employees vs 24.5% in dependents). The most common combinations were two oral antipsychotics. Combinations of more than two drugs were uncommon in China (0.3%) but were prescribed for 5.3% of patients in Japan. Among patients treated with monotherapy, 12.6/100 person-years (11.8%) in China and 9.6/100 person-years (11.0%) in Japan switched to antipsychotic polypharmacy during follow-up. Younger patients were more likely to switch to antipsychotic polypharmacy than older patents in all study cohorts. The observed rates of antipsychotic polypharmacy ranged from 12.7% in China to 19.9% in Japan. Switching from monotherapy to antipsychotic polypharmacy was most likely to occur in younger patients with schizophrenia.

Olanzapine-induced leucopaenia and thrombocytopaenia in an elderly patient: a case report and review of the evidence

Haematological adverse effects of antipsychotics are rare but life threatening. Existing literature is limited to case reports, which are mostly reported on second generation antipsychotics (clozapine, olanzapine, risperidone, quetiapine). Elderly...

Quality of randomized controlled trials of new generation antidepressants and antipsychotics identified in the China National Knowledge Infrastructure (CNKI): a literature and telephone interview study

BackgroundWe are witnessing an exponential increase in the number of randomized controlled trials (RCTs) reported from mainland China. The increase is particularly notable in the field of new generation antidepressants and antipsychotics. Several previous studies have raised doubts regarding their quality. However, the quality of most recent RCTs published in China may have improved.MethodsWe searched RCTs that examined new generation antidepressants and antipsychotics published between 2013 and 2016 in the China National Knowledge Infrastructure (CNKI), the largest database of scientific publications in China. We interviewed the authors of a random subset of the identified references. We assessed the methodological rigor of each study based on the published reports and telephone interviews with the authors using six methodological domains adapted from the Cochrane’s risk of bias tool.ResultsThe final sample consisted of 138 studies, for which we interviewed 58 authors; the authors of 51 studies declined the interview, and the authors of 29 studies could not be contacted. The 51 studies with refused interviews were significantly less likely to be reported from university-affiliated hospitals and were less likely to be published in Chinese core journals. Based on the published reports, most of the 58 studies were assessed to be at unclear risk of bias in most methodological domains. After the interview, only 10 studies were assessed to be at low risk of bias for sequence generation and allocation concealment. Assuming that the studies for which the authors declined interviews had an unclear risk, the proportion of RCTs at low risk of bias in both sequence generation and allocation concealment was 9.2% (10/109, 95% confidence interval [CI]: 5.0 to 16.2). The interviews indicated that the studies were at high risk of bias for most of the other domains.ConclusionIn general, RCTs that evaluate new generation antidepressants or antipsychotics and are indexed in the CNKI continue to be of low quality. When conducting systematic reviews and meta-analyses in this field, it would be wise to include a specialist from China as a coresearcher to help assess the risk of bias in the identified studies.

Safety of the second generation antipsychotics during pregnancy

Safety of the second generation antipsychotics during pregnancy

Concomitant Clozapine and Opium Usage Induced Constipation Leads to Fecal Impaction: A Case Report

Introduction: Fecal impaction (FI) is a disorder characterized by the inability to evacuate large mass of compacted faces at any level of lower GI tract. The population with highest risk for FI includes elderly patients with neuropsychiatric disorders such as Alzheimer disease, schizophrenia, Parkinson disease, dementia, and severe stroke. Clozapine is an antipsychotic drug that can cause constipation and in some cases, progress to bowel obstruction and finally FI. Opium is a well-known etiology for constipation and its’ concomitant use with clozapine can have an additive effect on this complication. Case Presentation: We present a 63-year-old man who had been treated for schizophrenia with clozapine (100 mg/TDS for 30 years) and who was using opium for about 20 years. This patient was presented with a history of constipation for 4 weeks, characterized by lack of urge to defecate as well as hard stool. We used a combination of normal saline and glycerin in our patient. In this case, successful therapy was focused on keeping the mechanical balance of colon, to clear out FI. Conclusions: We concluded that in patients who take opioids or with a history of psychotic disorders who had been treated with antipsychotic drugs, especially low-potency, first generation antipsychotics and clozapine presenting with abdominal pain and constipation should raise immediate concern. Keywords: Clozapine; Constipation; Fecal impaction; Opium; Schizophrenia

Cognitive functioning following discontinuation of antipsychotic medication. A naturalistic sub-group analysis from the OPUS II trial.

The effect of antipsychotics medication on cognitive functioning in patients diagnosed with schizophrenia is poorly understood. Some studies of second generation antipsychotics indicated that they improved cognitive functioning while other studies have found that they decrease the level of cognitive functioning. We included patients with schizophrenia who were in treatment with antipsychotics 1.5 years (baseline) after initiation of treatment and followed them up 3.5 years later (n = 189). At follow-up 60 (32%) had discontinued their antipsychotic treatment and 129 (68%) were still taking antipsychotics. Using the Brief Assessment of Cognition in Schizophrenia (BACS) we assessed cognition at baseline and follow-up. The patients who discontinued their medication had a higher level of cognitive functioning in all domains at baseline, as well as Global cognitive function [mean z-score -1.50 (s.d. 1.24) v. -2.27 (s.d. 1.30), p = 0.00015]. After controlling for relevant confounders those who discontinued antipsychotic medication improved significantly more than those who remained on antipsychotic medication during the course of the follow-up on the Token Motor task [estimated mean change difference -0.46 (95% CI -0.89 to -0.04)], the Speed of Processing Domain [estimated mean change difference -0.38 (95% CI -0.68 to -0.08)] and global cognition [estimated mean change difference -0.36 (95% CI -0.66 to -0.07)]. Due to the naturalistic design, we cannot conclude on the direction of the relationship between antipsychotics and cognition. There is no evidence that discontinuation of medication had a negative effect on cognitive functioning. Rather, we found that that discontinuation of medication was associated with better cognitive functioning.

Atypical Antipsychotics and Metabolic Complications

Introduction: Second generation antipsychotics (SGA) such as olanzapine are often used for psychotic disorders due to their efficacy and fewer neurological side effects. However, they have been associated with weight gain, prediabetes, diabetes ketoacidosis (DKA), myopathy and rarely rhabdomyolysis. These side effects were reported in individual cases. Our case had both DKA and rhabdomyolysis with chronic olanzapine use of 9 years. Case: A 36 year-old AAM with schizophrenia on olanzapine and risperidone, diet-controlled hyperlipidemia, obesity and prediabetes (HbA1c 6%,) admitted with fatigue, polyuria, polydipsia and confusion. He was diagnosed with DKA with HbA1c 13.7%, rhabdomyolysis (CK 13000 units/L) and acute kidney injury (peak creatinine 12, eGFR<10), requiring insulin infusion, dialysis and mechanical ventilation. Olanzapine was discontinued; his creatinine and glucose improved. His C-peptide was 4.28 ng/ml. Anti-GAD and islet cell antibodies were negative. He was discharged on glargine and risperidone. Two months after discharge, HbA1c was 5.8%, creatinine 1 (eGFR>60) and insulin was stopped. Discussion: This case highlights the importance of monitoring patients on SGA for metabolic complications. Olanzapine’s association with DKA is rare and with rhabdomyolysis is very rare. Several mechanisms for SGA-induced glucose intolerance exist, the most common being the antagonistic effect of olanzapine on serotonin 5HT2C and histamine (H1) receptors in the hypothalamus which leads to increased appetite and weight gain (our patient gained 40 lbs). Additionally, few reports on the association between olanzapine and rhabdomyolysis have been published. The mechanism remains unclear but may be due to drug-related myopathy secondary to high affinity for H1, 5-HT2A and D2 receptors. It is possible that the development of DKA predisposed our patient to developing rhabdomyolysis. Disclosure M. Akunjee: None. S.M. Gandhi: None. E. Nylen: None.

Adjuvant role of testosterone in treatment of schizophrenia and its interaction with combination of first and second generation anti-psychotics, chlorpromazine and risperidone

Background: There is great controversy about role of male sex steroid, testosterone, in mental disorders like schizophrenia. This study assessed the effectiveness of testosterone in schizophrenic patients and probes how it modulates the action of combination of first and second generation anti-psychotic medications (Chlorpromazine + Risperidone) both of which are very commonly used anti-psychotic agents in clinical psychiatric practice.Methods: It Is randomized, double-blind, Clinical study performed in Indian schizophrenic patients (new cases) in the Department of psychiatry from Feb 2003 to March 2004. Patients twelve (12) patients aged 20 to 60 years diagnosed schizophrenics according to ICD-10 Criteria who visited in outpatient department of psychiatry during study period. 12 Patient was treated with combination of oral Chlorpromazine 200mg BD + oral Risperidone 2mg BD, half of the 12 patients also received single dose of testosterone 100mg intramuscularly with above-mentioned treatment. Measure How symptomatology in schizophrenic patients affected is measured by applying various validated psychiatric scales like Brief psychiatric Rating Score (BPRS), Scale for assessment of positive symptom(SAPS), and Scale for Assessment of Negative Symptoms (SANS).Results: Single dose of Testosterone 100mg administered initially by I.M. route potentiated the reduction level in negative symptoms of schizophrenia by 119% in patients receiving oral Chlorpromazine 200mg along with oral Risperidone 4mg/day.Conclusions: In this study, Testosterone potentiated the effects of combination of oral Chlorpromazine 100mg BD + Risperidone 2mg BD, on general psychotic manifestations, positive symptoms and negative symptoms of schizophrenia, assessed on BPRS, SAPS and SANS scoring scales, however the effect is most pronounced in negative symptomology of schizophrenia.

Disrupted sphingolipid metabolism following acute clozapine and olanzapine administration

BackgroundSecond generation antipsychotics (SGAs) induce glucometabolic side-effects, such as hyperglycemia and insulin resistance, which pose a therapeutic challenge for mental illness. Sphingolipids play a role in glycaemic balance and insulin resistance. Endoplasmic reticulum (ER) stress contributes to impaired insulin signalling and whole-body glucose intolerance. Diabetogenic SGA effects on ER stress and sphingolipids, such as ceramide and sphingomyelin, in peripheral metabolic tissues are unknown. This study aimed to investigate the acute effects of clozapine and olanzapine on ceramide and sphingomyelin levels, and protein expression of key enzymes involved in lipid and glucose metabolism, in the liver and skeletal muscle.MethodsFemale rats were administered olanzapine (1 mg/kg), clozapine (12 mg/kg), or vehicle (control) and euthanized 1-h later. Ceramide and sphingomyelin levels were examined using electrospray ionization (ESI) mass spectrometry. Expression of lipid enzymes (ceramide synthase 2 (CerS2), elongation of very long-chain fatty acid 1 (ELOVL1), fatty acid synthase (FAS) and acetyl CoA carboxylase 1 (ACC1)), ER stress markers (inositol-requiring enzyme 1 (IRE1) and eukaryotic initiation factor (eIF2α) were also examined.ResultsClozapine caused robust reductions in hepatic ceramide and sphingolipid levels (p < 0.0001), upregulated CerS2 (p < 0.05) and ELOVL1 (+ 37%) and induced significant hyperglycemia (vs controls). In contrast, olanzapine increased hepatic sphingomyelin levels (p < 0.05 vs controls). SGAs did not alter sphingolipid levels in the muscle. Clozapine increased (+ 52.5%) hepatic eIF2α phosphorylation, demonstrating evidence of activation of the PERK/eIF2α ER stress axis. Hepatic IRE1, FAS and ACC1 were unaltered.ConclusionsThis study provides the first evidence that diabetogenic SGAs disrupt hepatic sphingolipid homeostasis within 1-h of administration. Sphingolipids may be key candidates in the mechanisms underlying the diabetes side-effects of SGAs; however, further research is required.

PMH69 - Health Technology and Regulatory Assessment of Adherence and Improved Outcomes for Second Generation Antipsychotics in Schizophrenia

PMH69 - Health Technology and Regulatory Assessment of Adherence and Improved Outcomes for Second Generation Antipsychotics in Schizophrenia

Olanzapine-induced Cataract in a Teenage Girl

Cataract, defined as cloudiness of the lens, is a common adverse effect of first-generation antipsychotic medications. Newer generation antipsychotics, also known as atypical antipsychotics, are less commonly associated with cataract. A 19-year-old girl with underlying schizophrenia on olanzapine for the past two years complained of gradual blurring of vision in both eyes for four months prior to presentation. On examination, the best corrected visual acuity was counting finger in both eyes. The anterior segment examination showed bilateral diffuse cortical cataract precluding fundus examination. Systemic examination was unremarkable. Blood investigations revealed a high random blood sugar, which normalised after she was initiated on oral hypoglycemic medication. After bilateral lens aspiration, her visual acuity was 6/6 bilaterally. Olanzapine may be cataractogenic via its action as a serotonin antagonist, which results in reduced glucose responsiveness of the pancreatic beta-cells. Patients on anti-psychotic medication are at risk of developing diabetes mellitus and cataract compared to the general population. Screening for diabetes mellitus should be part of the follow-up of these patients. Ophthalmological evaluation is warranted in the presence of visual complaints.