Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-18T16:40:40.016Z Has data issue: false hasContentIssue false
  • English
  • Français

Olanzapine or chlorpromazine plus lithium in first episode psychotic mania: An 8-week randomised controlled trial

Published online by Cambridge University Press:  21 October 2015

P. Conus ,
M. Berk ,
S.M. Cotton ,
L. Kader ,
C. Macneil ,
M.K. Hasty ,
K. Hallam ,
M. Lambert ,
B.P. Murphy  and
P.D. McGorry
P. Conus*
Affiliation:
Treatment and Early Intervention in Psychosis Program (TIPP), département de psychiatrie CHUV, université de Lausanne, clinique de Cery, 1008Prilly, Switzerland Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
M. Berk
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, Australia Mental Health Research Institute, Parkville, Australia
S.M. Cotton
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
L. Kader
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
C. Macneil
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
M.K. Hasty
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
K. Hallam
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
M. Lambert
Affiliation:
Department for Psychiatry and Psychotherapy, Psychosis Early Detection and Intervention Centre (PEDIC), Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
B.P. Murphy
Affiliation:
Faculty of Medicine, Nursing and Health Sciences, School of Psychology, Psychiatry and Psychological Medicine, Monash University, 3800Victoria, Australia
P.D. McGorry
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
*
⁎Corresponding author. Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, département psychiatrie CHUV, université Lausanne, clinique de Cery, 1008 Prilly, Switzerland. Tel.: +41 21 314 31 11; fax: +41 21 314 29 67. E-mail address:[email protected] (P. Conus).
Get access

Abstract

Background

Treatment strategies for mental disorders may vary according to illness stage. However no data currently exist to guide treatment in first episode psychotic mania. The aim of this study was to compare the safety and efficacy profile of chlorpromazine and olanzapine, as add-on to lithium, in patients with a first episode of psychotic mania, expecting better safety profile and adherence to olanzapine but similar efficacy for both treatments.

Methods

Data from 83 patients were collected in an 8-week randomised controlled trial on clinical variables, side effects, vital signs, and weight. Analyses of treatment differences over time were based on intent-to-treat principles. Kaplan-Meier estimated survival curves were used to analyse time-to-event data and mixed effects models repeated measures analysis of variance were used to determine treatment group differences over time on safety and efficacy measures.

Results

Ethics committee approval to delay informed consent procedure until recovery from the acute episode allowed the inclusion of 83 patients highly representative of those treated in the public sector. Contrary to our hypotheses, safety profile of both medications was similar. A signal for higher rate (P=.032) and earlier occurrence (P= .043) of mania remission was observed in the olanzapine group which did not survive correction for multiple comparisons.

Conclusions

Olanzapine and chlorpromazine have a similar safety profile in a uniquely representative cohort of patients with first episode psychotic mania. The possibility for a greater impact of olanzapine on manic symptoms leading to earlier remission of the episode needs exploration in a large sample.

Keywords

Bipolar disorderManiaFirst episodePsychosisAntipsychotic treatment
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 8 , November 2015 , pp. 975 - 982
Copyright
Copyright © European Psychiatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

☆

Clinical trial registration number (http://www.ClinicalTrials.gov): NCT00202293.

References

Addoniozio, G.. Rapid induction of extrapyramidal side effects with combined use of lithium and neurolpetics. J Clin Psychopharmacol 1985;5:296–298.CrossRefGoogle Scholar
American Psychiatric Association, Diagnostic and statistical manual of mental disorders Fourth EditionWashington, DC: American Psychiatric Association; 1994.Google Scholar
American Psychiatric Association, Global assessment of functioning scale. Diagnostic and statistical manual of mental disorders Fourth EditionWashington, DC: American Psychiatric Association; 1994.Google Scholar
Andreasen, N.C.Scale for the assessment of negative symptoms (SANS). Iowa City, IA: University of Iowa; 1984.Google Scholar
Andreasen, N.C.Scale for the assessment of positive symptoms (SAPS). Iowa City, IA: University of Iowa; 1984.Google Scholar
Berk, M.Conus, P.Lucas, N.Hallam, K.Malhi, G.Dodd, S., et al.Setting the stage: from prodrome to treatment resistance in bipolar disorder. Bipolar Disord 2007;9(7):671–678.CrossRefGoogle ScholarPubMed
Berk, M.Hallam, K.T.McGorry, P.D.. The potential utility of a staging model as a course specifier: a bipolar disorder perspective. J Affect Disord 2007;100(1–3):279–281.CrossRefGoogle ScholarPubMed
Cannon-Spoor, E.H.Potkin, S.G.. Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 1982;8:470–484.CrossRefGoogle ScholarPubMed
Conus, P.Berk, M.McGorry, P.D.. Pharmacological treatment in the early phase of bipolar disorders: what stage are we at?. Aust N Z J Psychiatry 2006;40:199–207.CrossRefGoogle Scholar
First, M.B.Spitzer, R.L.Gibbon, M.Williams, J.B.Structured clinical interview for the diagnostic and statistical manual for mental disorders Fourth Edition, Patient versionWashington, DC: American Psychiatric Press; 1997.Google Scholar
Gentile, S.. Atypical antipsychotics for the treatment of bipolar disorder: more shadows than lights. CNS Drugs 2007;21(5):367–387.CrossRefGoogle ScholarPubMed
Gentile, S.. Extrapyramidal adverse events associated with atypical antipsychotic treatment of bipolar disorder. J Clin Psychopharmacol 2007;27(1):35–45.CrossRefGoogle ScholarPubMed
Guy, W.ECDEU assessment manual for psychopharmacology. Rockville MD: National Institute of Mental Health; 1976. [DHEW Pub. No. (ADM) 76-338]Google Scholar
Haddad, P.M.Sharma, S.G.. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs 2007;21(11):911–936.CrossRefGoogle ScholarPubMed
Hamilton, M.. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278–296.CrossRefGoogle ScholarPubMed
Heinrichs, D.Hanlon, T.. The Quality of Life Scale: an instrument for rating the schizophrenia deficit syndrome. Schizophr Bull 1984;10:388–398.CrossRefGoogle ScholarPubMed
Hetrick, S.E.Parker, A.G.Hickie, I.B.Purcell, R.Yung, A.R.McGorry, P.D.. Early identification and intervention in depressive disorders: towards a clinical staging model. Psychother Psychosom 2008;77(5):263–270.CrossRefGoogle ScholarPubMed
Jones, P.B.Barnes, T.R.E.Davies, L.Dunn, G.Lloyd, H.Hayhurst, K.P., et al.Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia: cost utility of the latest antipsychotic drugs in schizophrenia (CUtLASS 1). Arch Gen Psychiatry 2006;63:1079–1087.CrossRefGoogle Scholar
Kahn, R.Fleischhacker, W.W.Boter, H.Davidson, M.Vergouwe, Y.Keet, I.P., et al.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371:1085–1097.CrossRefGoogle ScholarPubMed
Kane, J.M.. Tardive dyskinesia in affective disorders. J Clinical Psychiatry 1999;60(Suppl. 5):43–47.Google ScholarPubMed
Ketter, T.A.Houston, J.P.Adams, D.H.Risser, R.C.Meyers, A.L.Williamson, D.J., et al.Differential efficacy of olanzapine and lithium in preventing manic or mixed recurrence in patients with bipolar disorder based on number of previous manic or mixed episodes. J Clin Psychiatry 2006;67(1):95–101.CrossRefGoogle ScholarPubMed
Kukopoulos, A.Reginladi, D.Laddomana, P.. Course of the manix-depressive cycle and changes caused by treatment. Pharmakopsychiatr Neuropsychopharmakol 1980;13:156–157.CrossRefGoogle Scholar
Lieberman, J.A.Stroup, S.McEvoy, J.Swartz, M.S.Rosenheck, R.A.Perkins, D.O., et al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353:1209–1223.CrossRefGoogle ScholarPubMed
Liebermann, J.A.. Comparative effectiveness of antipsychotic drugs. Arch Gen Psychiatry 2006;63:1069–1072.CrossRefGoogle Scholar
Lingjaerde, O.Ahlfors, U.G.Bech, P.Dencker, S.J.Elgen, K.. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 1987;334:1–100.CrossRefGoogle Scholar
McGorry, P.D.Hickie, I.B.Yung, A.R.Pantelis, C.Jackson, H.J.. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective intervention. Aust N Z J Psychiatry 2006;40:616–622.CrossRefGoogle Scholar
McGorry, P.D.Kilackey, E.Yung, A.R.. Early intervention in psychotic disorders: detection and treatment of the first episode and the critical early stages. Med J Aust 2007;187(Suppl.):8–10.CrossRefGoogle ScholarPubMed
McLellan, A.T.Kushner, H.Metzger, D.Peters, R.Smith, I.Grissom, G., et al.The fifth edition of the Addiction Severity Index. J Subst Abuse 1998;9:199–213.CrossRefGoogle Scholar
National Early Psychosis Project Clinical Guidelines Working Party Australian clinical guidelines for early psychosis. Melbourne: University of Melbourne; 1998.Google Scholar
Overall, J.E.Gorham, D.R.The brief psychiatric rating scale. Psychol Rep 1962;10:799–812.CrossRefGoogle Scholar
Scott, J.Paykel, E.Morriss, R.Bentall, R.Kinderman, P.Johnson, T., et al.Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. Br J Psychiatry 2006;188:313–320.CrossRefGoogle ScholarPubMed
Simonsen, E.Friis, S.Haahr, U.Johannessen, J.O.Larsen, T.K.Melle, I., et al.Clinical epidemiologic first-episode psychosis: 1-year outcome and predictors. Acta Psychiatr Scand 2007;116:54–61.CrossRefGoogle ScholarPubMed
Spearing, M.K.Post, P.M.Modification of the Clinical Global Impressions (CGI) Scales for use in bipolar illness (BP): the CGI-BP. Psychiatry Res 1997;73:159–171.CrossRefGoogle ScholarPubMed
Swann, A.C.Bowden, C.L.Calabrese, J.R.Dilsaver, S.C.Morris, D.D.Differential effect of number of previous episodes of affective disorder on response to lithium or divalproex in mania. Am J Psychiatry 1999;156:1264–1266.Google ScholarPubMed
Thase, M.E.Denko, T.Pharmacotherapy of mood disorders. Ann Rev Clin Psychol 2008;4:53–91.CrossRefGoogle ScholarPubMed
Tohen, M.Goldberg, J.F.Gonzales-Pinto, A.M.Azorin, J.M.Vieta, E.Hardy-Bayle, M.C., et al.A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Arch Gen Psychiatry 2003;60:1218–1226.CrossRefGoogle ScholarPubMed
Tohen, M.Golddberg, J.F.Gonzalez-Pinto Arrillaga, A.M.Azorin, J.M.Vieta, E.Hardy-Bayle, M.C., et al.A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Arch Gen Psychiatry 2003;17:227–237.Google Scholar
Wunderink, L.Sytema, S.Nienhuis, F.J.Wiersma, D.Clinical recovery in first-episode psychosis. Schizophr Bull Mar 2009 2009;35(2):362–369. [Epub 2008 Nov 5].Google ScholarPubMed
Young, R.C.Biggs, J.T.A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429–435.CrossRefGoogle ScholarPubMed
Zarate, C.A.Tohen, M.Double-blind comparison of the continued use of antipsychotic treatment versus its discontinuation in remitted manic patients. Am J Psychiatry 2004;161:169–171.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.