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High-dose olanzapine in treatment resistant schizophrenia. A case report and literature review

Published online by Cambridge University Press:  18 June 2021

Ciara Clarke ,
Clodagh Rushe  and
Fintan Byrne
Ciara Clarke*
Affiliation:
Mayo University Hospital
Clodagh Rushe
Affiliation:
Mayo University Hospital
Fintan Byrne
Affiliation:
Mayo University Hospital
*
*corresponding author.
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Abstract

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Objective

We report a case of a 58-year-old gentleman who was hospitalised intermittently for one year due to treatment resistant schizophrenia. Prior to hospitalisation he had been prescribed standard antipsychotics for decades without full resolution of positive psychotic symptoms. During his final admission lasting six months he was guarded, suspicious, irritable, constantly paced the corridor and displayed thought block and paranoid persecutory delusions. He would not enter the assessment room or allow any blood or ECG monitoring, however, he was compliant with oral medication. He was successfully treated with high dose olanzapine (40mg/day) and was discharged to the community. The aim of this study is to bring awareness and add to the body of evidence for the use of high-dose olanzapine in patients with treatment resistant schizophrenia in whom a trial of clozapine is not possible.

Case report

The patient gave written consent for this case report to be written and presented. An extensive literature review was performed and key papers were identified. Discussion focuses on the key areas in the literature.

Discussion

This case demonstrates that high-dose olanzapine can be used effectively as an alternative to clozapine in treatment resistant schizophrenia.

Conclusion

This case highlights the need for further evaluation of high-dose olanzapine as an alternative to clozapine in patients with treatment-resistant schizophrenia.

Type
Case Study
Information
BJPsych Open , Volume 7 , Supplement S1: Abstracts of the RCPsych Virtual International Congress 2021, 21–24 June , June 2021 , pp. S115
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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