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Olanzapine compared to placebo or other medicine as treatment for mania

High withdrawal rates from the trials limit the confidence that can be placed on the results. Olanzapine was superior to placebo in reduction of manic symptoms both as monotherapy and combined with mood stabilizers, though caused weight gain. Olanzapine was more efficacious than divalproex and caused less nausea but more weight gain, somnolence and movement disorders. Olanzapine was comparable to haloperidol in efficacy, caused less movement disorders but greater weight gain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Olanzapine in long‐term treatment for bipolar disorder

Bipolar affective disorder is a severe and common mental illness, characterised by periods of mania, depression and "mixed episodes" (or "dysphoric mania": a mixture of manic and depressed symptoms). Antipsychotic drugs are often used to treat acute manic episodes and one commonly used antipsychotic drug that has recently been approved for use in mania in USA and Europe is olanzapine. This review considered the efficacy, acceptability and adverse effects of olanzapine in long‐term treatment of bipolar disorder in comparison with placebo or other active drug comparisons. Five trials (1165 participants) met the inclusion criteria and are included in the review. Based on a limited amount of information, olanzapine may prevent further mood episodes (especially manic relapse) in patients who responded to olanzapine during an index manic or mixed episode and who have not previously had a satisfactory response to lithium or valproate. The olanzapine group had significantly fewer patients suffering from insomnia than the placebo group, but a significantly larger number of people suffering from weight gain. When compared with lithium, olanzapine caused more weight gain and depressive symptoms but fewer insomnia and nausea symptoms and a lower rate of manic worsening. However, considering the lack of clear findings of this review, conclusions on efficacy and acceptability of olanzapine compared to placebo, lithium or valproate cannot be made with any degree of confidence

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Risperidone versus olanzapine for schizophrenia

Schizophrenia is a debilitating mental illness that affects about one percent of the population worldwide.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Olanzapine for schizophrenia

Since the early 1950s the mainstay of treatment for schizophrenia has been the typical antipsychotics such as chlorpromazine and haloperidol. Although they are effective in controlling voices and delusions for many people with schizophrenia, they have a smaller effect on symptoms such as apathy and social withdrawal. They also have disabling adverse effects such as tremor, stiffness and slowing of movement. The newer drugs, such as olanzapine, are reputed to have fewer adverse motor effects and are as effective, if not more so, than the older drugs. This review examines the randomised controlled trials of olanzapine compared with placebo, typical and atypical antipsychotic drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Olanzapine versus other atypical antipsychotics for schizophrenia

This review examined the effects of olanzapine compared to other second generation antipsychotic drugs for schizophrenia. We identified 50 relevant studies with 9476 participants, comparing olanzapine with amisulpride, aripiprazole, clozapine, quetiapine, risperidone and ziprasidone. Comparisons of olanzapine with the second generation antipsychotic drugs sertindole or zotepine are currently not available. Olanzapine was somewhat more efficacious than aripiprazole, quetiapine, risperidone and ziprasidone, whereas there was no efficacy difference compared to amisulpride and clozapine. The main disadvantage of olanzapine was its higher weight gain and associated metabolic problems compared to all other second generation antipsychotic drugs, except for clozapine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Olanzapine IM or velotab for acutely disturbed/agitated people with suspected serious mental illnesses

Sometimes it is necessary to use medication to help stop aggressive or agitated behaviour that is thought to be caused by serious mental illness. Two ways of doing this are to give olanzapine as an injection into the muscle (IM ) or as a swiftly dissolved oral preparation (orodispersable or velotab). In this review, we attempted to summarise the effects of these approaches as seen from within evaluative randomised studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Medicines for Treating Mental Health Conditions: A Review of the Research for Adults and Caregivers

This summary will tell you about research on how well some antipsychotic medicines work for conditions other than psychosis and bipolar disorder. It will also tell you about research on the risks of side effects for these medicines.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 1, 2012

Lurasidone (Latuda) for schizophrenia: Overview

Lurasidone (trade name: Latuda) has been approved since March 2014 for the treatment of schizophrenia in adults.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 2, 2015

Antipsychotic Medicines for Children and Teens: A Review of the Research for Parents and Caregivers

This summary discusses using antipsychotic medicines to treat psychiatric conditions in children. It explains what medical research says about the benefits and possible side effects of these medicines when taken by children. This summary does not discuss other medicines to treat psychiatric conditions or non-medicine treatment options. It can help you talk with your child’s doctor to decide if an antipsychotic medicine is right for your child.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 4, 2012

Antipsychotic Medicines for Treating Schizophrenia and Bipolar Disorder: A Review of the Research for Adults and Caregivers

This summary talks about one type of medicine—antipsychotics— used to treat schizophrenia and bipolar disorder. It will tell you what research says about how older and newer antipsychotics compare for treating schizophrenia and bipolar disorder in adults. Please note that the research on antipsychotics as treatment for bipolar disorder is limited, and more research is needed. This summary will also tell you about the possible side effects of antipsychotics. It can help you talk with your doctor about whether or not one of these antipsychotic medicines might be right for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: April 10, 2013

There is some evidence from RCTs that antipsychotics are effective, in varying doses, for different presentations of delirium

Haloperidol (<3.5 mg/d), risperidone, and olanzapine were equally effective in treating delirium, with few adverse effects. Parkinsonian adverse effects were common with higher dose haloperidol (>4.5 mg/d) compared with olanzapine. Pre‐operative haloperidol decreased severity and duration of post‐surgery delirium. All studies were small and should be repeated.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Amisulpride versus other atypical antipsychotics for schizophrenia

This review compared the effects of amisulpride with those of other so called second generation (atypical) antipsychotic drugs. For half of the possible comparisons not a single relevant study could be identified. Based on very limited data there was no difference in efficacy comparing amisulpride with olanzapine and risperidone, but a certain advantage compared with ziprasidone. Amisulpride was associated with less weight gain than risperidone and olanzapine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Second‐generation antipsychotic drugs for obsessive compulsive disorder

This review found some trials comparing the effects of adding second‐generation antipsychotic drugs or placebo to antidepressants in obsessive compulsive disorder. There were only 11 trials on three second‐generation antipsychotic drugs (olanzapine, quetiapine and risperidone). While not much can be said about olanzapine, quetiapine and risperidone showed some efficacy benefit, but also adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for psychotic symptoms occurring with epilepsy

Little evidence exists to inform the treatment of psychosis in people with epilepsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Antipsychotic drugs for elderly people with late‐onset schizophrenia

A significant proportion of the world's growing elderly population suffers from schizophrenia that started very late in life. Antipsychotic drugs are often used to treat this distressing and severe illness. In this review we attempted to find good quality trial‐based evidence to support this practice but found none. Currently this vulnerable group is not well served by the research community.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Second‐generation antipsychotic drugs for anxiety disorders 

Anxiety disorders are a prevalent and disabling condition. Because of high rates of treatment resistance, there is interest in new pharmacological treatment options such as second‐generation antipsychotics. This systematic review evaluated the efficacy and tolerability of second‐generation antipsychotics in the treatment of anxiety disorders. We found eleven randomised placebo‐controlled trials, comparing quetiapine, olanzapine and risperidone with placebo and antidepressants. The vast majority of the available data was on quetiapine (> 3000 participants). Participants with generalised anxiety disorder responded significantly better to quetiapine than to placebo, measured as a reduction in the Hamilton Anxiety Scale (HAM‐A). Participants treated with quetiapine were more likely to drop out due to adverse events, to gain weight, to suffer from sedation or to suffer from extrapyramidal side effects. The evidence on the other second‐generation antipsychotics is currently too limited to draw any conclusions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Treatment for amphetamine psychosis

A minority of individuals who use amphetamines develop full‐blown psychosis requiring care at emergency departments or psychiatric hospitals. In such cases, symptoms of amphetamine psychosis commonly include paranoid and persecutory delusions as well as auditory and visual hallucinations in the presence of extreme agitation. More common (about 18%) is for frequent amphetamine users to report psychotic symptoms that are sub‐clinical and that do not require high‐intensity intervention. Clinical reports suggest the development of amphetamine psychosis and of sub‐clinical psychosis symptoms is related to the individual's lifetime history of amphetamine use, i.e., cumulative quantity and frequency of exposure to amphetamines. In one of the only randomised trials of antipsychotic medications for treating amphetamine psychosis, Leelahanaj (2005) reported that olanzapine and haloperidol delivered at clinically relevant doses both showed similar efficacy in resolving psychotic symptoms (93% and 79%, respectively), with olanzapine showing significantly greater safety and tolerability than haloperidol as measured by frequency and severity of extrapyramidal symptoms. These outcomes are consistent with treatments for schizophrenia indicating equivalent efficacy between atypical anti‐psychotics and conventional anti‐psychotics, mostly haloperidol with older drugs causing more severe side effects (Leucht 1999).While anti‐psychotic medications demonstrate efficacy in providing short‐term relief when a heavy user of amphetamines experiences psychosis, there is no evidence to guide decisions regarding long‐term clinical care using these medications for preventing relapse to psychosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Atypical antipsychotics benefit people with dementia but the risks of adverse events may outweigh the benefits, particularly with long term treatment

Atypical antipsychotics have become the pharmacological treatment of choice for many clinicians in the treatment of behavioural and psychiatric symptoms in people with dementia, and the largest evidence base for double blind placebo controlled trials in this area is for risperidone. Particularly in view of recent safety concerns, a meta‐analysis of efficacy and adverse events to inform clinical practice is timely. Modest efficacy is evident, but the elevated risk of cerebrovascular adverse events, mortality, upper respiratory infections, oedema and extrapyramidal symptoms is a concern, particularly as selective reporting makes interpretation of other potential adverse outcomes impossible.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Haloperidol alone or in combination for the treatment of mania

Fifteen trials met the inclusion criteria and are included in the review. Interpretation of the results was hindered by the small total sample size and by the low quality of reporting of the included trials. There was some evidence that haloperidol was more efficacious than placebo in terms of reduction of manic and psychotic symptom scores, when used both as monotherapy and as add‐on treatment to lithium or valproate. There is no evidence of difference in efficacy between haloperidol and risperidone, olanzapine, valproate, carbamazepine, sultopride and zuclopentixol. There was a statistically significant difference with haloperidol being probably less effective than aripiprazole. No comparative efficacy data with quetiapine, lithium or chlorpromazine were reported. Haloperidol caused more extrapyramidal symptoms (EPS) than placebo and more movement disorders and EPS but less weight gain than olanzapine. Haloperidol caused more EPS than valproate but no difference was found between haloperidol and lithium, carbamazepine, sultopride and risperidone in terms of side effects profile.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Haloperidol for long‐term aggression in psychosis

People experiencing distressing delusions and hallucinations can often become agitated and aggressive. The antipsychotic drug haloperidol is widely used for the treatment of schizophrenia and psychosis‐induced agitation despite the possibility it can cause a number of serious side effects such as nausea, vomiting, dizziness, restlessness and muscle spasms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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