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The effects of olanzapine in reducing the emergence of psychosis among nursing home patients with Alzheimer's disease.

AbstractBACKGROUND:
Elderly patients with Alzheimer's disease (AD) commonly exhibit psychotic symptoms, prompting clinicians to administer antipsychotics. This article compares the effects of olanzapine and placebo in the emergence of hallucinations or delusions in AD patients with symptoms of agitation/aggression but little or no psychotic symptomatology at baseline.
METHOD:
A multicenter, double-blind, placebo-controlled study was conducted in nursing home patients with AD according to DSM-IV criteria and symptoms of agitation/aggression and/or psychosis. Patients (N = 206) were randomly assigned to receive either placebo or fixed-dose olanzapine (5, 10, or 15 mg/day) for up to 6 weeks. This article analyzes data from a subgroup of patients (N = 165) with no or minimal delusions and/or hallucinations at baseline as measured by the Neuropsychiatric Inventory-Nursing Home Version (NPI/NH). Three subsets of patients were identified on the basis of their symptoms at baseline: those with no clinically significant hallucinations, those with no clinically significant delusions, and those with no clinically significant delusions or hallucinations.
RESULTS:
Of the patients without hallucinations or delusions at baseline (N = 75), the placebo-treated patients showed significantly greater development of these symptoms compared with olanzapine-treated patients overall (NPI/NH hallucinations + delusions mean change score, +2.73 vs. +0.27, p = .006). Similarly, of the patients without baseline hallucinations (N = 153), the placebo-treated patients showed greater hallucinations score increases than did olanzapine-treated patients overall (+1.25 vs. +0.33, p = .026), whereas patients without baseline delusions (N = 87) showed no significant treatment effects. Olanzapine had a favorable safety profile in each patient subset.
CONCLUSION:
These results suggest that, overall, olanzapine effectively attenuated emergence of psychosis in a short-term trial of patients with Alzheimer's disease.
AuthorsW S Clark, J S Street, P D Feldman, A Breier
JournalThe Journal of clinical psychiatry (J Clin Psychiatry) Vol. 62 Issue 1 Pg. 34-40 (Jan 2001) ISSN: 0160-6689 [Print] United States
PMID11235926 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Antipsychotic Agents
  • Benzodiazepines
  • Pirenzepine
  • Olanzapine
Topics
  • Aged
  • Aged, 80 and over
  • Aggression (drug effects, psychology)
  • Alzheimer Disease (drug therapy, psychology)
  • Antipsychotic Agents (therapeutic use)
  • Benzodiazepines
  • Delusions (prevention & control, psychology)
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Hallucinations (prevention & control, psychology)
  • Humans
  • Male
  • Nursing Homes
  • Olanzapine
  • Pirenzepine (analogs & derivatives, therapeutic use)
  • Psychomotor Agitation (drug therapy, psychology)
  • Psychotic Disorders (prevention & control, psychology)
  • Treatment Outcome

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