title: Effectiveness of maintenance treatments with atypical and typical antipsychotics in stable schizophrenia with early stage: 1-year naturalistic study Long-term (3-year) neurocognitive effectiveness of antipsychotic medications in first-episode non-affective psychosis: a randomized comparison of haloperidol, olanzapine, and risperidone Correlation between changes in quality of life and symptomatic improvement in Chinese patients switched from typical antipsychotics to olanzapine Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey Olanzapine vs risperidone in the management of schizophrenia: a randomized double-blind trial in Australia and New Zealand Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol in patients with chronic schizophrenia or schizoaffective disorder. Effects of olanzapine, quetiapine, and risperidone on neurocognitive function in early psychosis: a randomized, double-blind 52-week comparison. Effects of antipsychotic medications on quality of life and psychosocial functioning in patients with early-stage schizophrenia: 1-year follow-up naturalistic study. A randomized controlled trial of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced tardive dyskinesia. Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. The Olanzipine HGGW Study Group. Economic, clinical, and quality-of-life outcomes associated with olanzapine treatment in mania. Results from a randomized controlled trial. Ziprasidone vs olanzapine in recent-onset schizophrenia and schizoaffective disorder: results of an 8-week double-blind randomized controlled trial. Do certain countries produce only positive results? A systematic review of controlled trials. Risperidone and olanzapine versus another first generation antipsychotic in patients with schizophrenia inadequately responsive to first generation antipsychotics. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. Ziprasidone versus olanzapine, risperidone or quetiapine in patients with chronic schizophrenia: A 12-week open-label, multicentre clinical trial Olanzapine versus haloperidol in the treatment of schizophrenia and other psychotic disorders: Quality of life and clinical outcomes of a randomized clinical trial Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. Quality of life in schizophrenia: a multicenter, randomized, naturalistic, controlled trial comparing olanzapine to first-generation antipsychotics. Olanzapine versus lithium in the acute treatment of bipolar mania: a double-blind, randomized, controlled trial. Efficacy and tolerability of ziprasidone vs. olanzapine in naive first-episode schizophrenia: a 6-week, randomized, open-label, flexible-dose study. One-year double-blind study of the neurocognitive efficacy of olanzapine, risperidone, and haloperidol in schizophrenia Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Weight gain induced by haloperidol, risperidone and olanzapine after 1 year: Findings of a randomized clinical trial in a drug-naïve population Chinese authors do need CONSORT: reporting quality assessment for five leading Chinese medical journals. Early Predictors of Substantial Weight Gain in Bipolar Patients Treated with Olanzapine Long-term olanzapine therapy in the treatment of bipolar I disorder: an open-label continuation phase study. Olanzapine pharmacokinetics are similar in Chinese and Caucasian subjects. TNF-α −308 G>A polymorphism and weight gain in patients with schizophrenia under long-term clozapine, risperidone or olanzapine treatment A randomized double-blind study of risperidone and olanzapine in the treatment of schizophrenia or schizoaffective disorder. International multisite double-blind trial of the atypical antipsychotics risperidone and olanzapine in 175 elderly patients with chronic schizophrenia. A Double-Blind, Randomized Comparative Study of Aripiprazole and Olanzapine in Patients with Schizophrenia Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Olanzapine versus ziprasidone: results of a 28-week double-blind study in patients with schizophrenia. Effectiveness and safety of olanzapine in the treatment of schizophrenia among Asian patients switching from conventional antipsychotics A randomised controlled study of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced acute dystonia or parkinsonism One-year, randomized, open trial comparing olanzapine, quetiapine, risperidone and ziprasidone effectiveness in antipsychotic-naive patients with a first-episode psychosis Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: Observational versus randomized studies results
abstract: Rationale The relative effectiveness of the atypical antipsychotic drugs and conventional agents in patients with early-stage schizophrenia has not been comprehensively determined . Objectives The aim of our study was to evaluate the efficacy and safety of seven antipsychotic drugs for the maintenance treatment in patients with early-stage schizophrenia . Methods In a 12-month open-label , prospect i ve observational , multicenter study , 1,133 subjects with schizophrenia or schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine , sulpiride , clozapine , risperidone , olanzapine , quetiapine , or aripiprazole . The primary measure was the rate of treatment discontinuation for any reason . Secondary outcomes included measures for clinical and functional outcomes and tolerability . Results The percentage of patients discontinued treatment within 12 months was 41.4 % for chlorpromazine , 39.5 % for sulpiride , 36.7 % for clozapine , 40.2 % for risperidone , 39.6 % for olanzapine , 46.9 % for quetiapine , and 40.2 % for aripiprazole , a nonsignificant difference ( p = 0.717 ) ; there were no significant differences among these seven treatments on discontinuation due to relapse , intolerability , patient decision , or nonadherence ( all p values ≥ 0.260 ) . Extrapyramidal symptoms were more prominent in chlorpromazine and sulpiride treatment groups . Anticholinergic side effects were most common with clozapine and chlorpromazine . Weight gain was most common with olanzapine and clozapine . Conclusions The efficacy of seven antipsychotic medications for the maintenance treatment appeared similar in early-stage schizophrenia . With regard to the high dropout rate and side effects , special programs are needed to keep efficacy and safety of antipsychotics maintenance treatment for schizophrenia with early Introduction The initially postulated superior neurocognitive effectiveness of second-generation antipsychotics is currently under debate . Methods A prospect i ve , r and omized , open-label study was carried out to compare the long-term neurocognitive effectiveness of haloperidol , olanzapine , and risperidone in the first episode of schizophrenia spectrum disorders . A final sample of 79 patients r and omized to haloperidol ( N = 28 ) , olanzapine ( N = 23 ) , or risperidone ( N = 28 ) who completed clinical and cognitive evaluations at baseline and 3-year follow-up was included in the final analysis . Forty-one healthy individuals were also included in the final analysis . The main outcome measure was cognitive changes at 3-year follow-up . Due to the fact that some of the patients had switched their initially prescribed antipsychotic medication during the course of the study ( 6 out of 28 in haloperidol group , 18 out of 23 in olanzapine group , and 24 out of 28 in risperidone group continued with the initial study drug at 3-year assessment ) , we have also conducted a per protocol analysis . Results Overall , cognitive changes were similar in the three treatment groups and controls , although a greater improvement in Rey Auditory Verbal Learning Test , Digit Symbol , and Iowa Gambling Test was found in the treatment groups . The better performance observed on Rey Auditory Verbal Learning Test and Digit Symbol in olanzapine treatment group was likely explained by the lower prevalence of use of antimuscarinic drugs . These results were essentially similar to those found in the intention-to-treat analysis . Conclusions The major conclusion of this study is that haloperidol , olanzapine , and risperidone have not demonstrated substantial neurocognitive effectiveness , improving cognitive deficits present in the early phases of the illness . The study also underscores the importance of exploring new drugs for the treatment of cognitive impairments and associated functional disabilities in schizophrenia Purpose The aim of this study was to investigate the correlation between changes in symptoms and changes in self-reported quality of life among Chinese patients with schizophrenia who were switched from a typical antipsychotic to olanzapine during usual outpatient care . Patients and methods This post hoc analysis was conducted using data from the Chinese subgroup ( n=475 ) of a multicountry , 12-month , prospect i ve , noninterventional , observational study . The primary publication previously reported the efficacy , safety , and quality of life among patients who switched from a  typical antipsychotic to olanzapine . Patients with schizophrenia were included if their symptoms were inadequately controlled with a typical antipsychotic and they were switched to olanzapine .  Symptom severity was measured using the Brief Psychiatric Rating Scale ( BPRS ) and the Clinical Global Impressions-Severity scale ( CGI-S ) . Health-Related Quality of Life ( HRQOL ) was assessed using the World Health Organization Quality of Life – Abbreviated ( WHOQOL-BREF ) . Paired t-tests were performed to assess changes from baseline to endpoint . Pearson ’s correlation coefficients ( r ) were used to assess the correlations between change in symptoms ( BPRS and CGI-S scores ) and change in HRQOL ( WHOQOL-BREF scores ) . Results Symptoms and HRQOL both improved significantly over the 12 months of treatment ( P<0.001 ) . Significant correlations were observed between changes from baseline to end of study on the BPRS and the CGI-S and each of the WHOQOL-BREF four domain scores and two overall quality -of-life questions . The correlation coefficients ranged from r=−0.45 to r=−0.53 for the BPRS and WHOQOL-BREF . The correlation coefficients were slightly smaller between the CGI-S and WHOQOL-BREF , ranging from r=−0.33 to r=−0.40 . Conclusion For patients with schizophrenia , assessing quality of life has the potential to add valuable information to the clinical assessment that takes into account the patient ’s own perspective of well-being BACKGROUND In China and other middle-income countries , neuropsychiatric conditions are the most important cause of ill health in men and women , but efforts to scale up mental health services have been hampered by the absence of high- quality , country-specific data for the prevalence , treatment , and associated disability of different types of mental disorders . We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China . METHODS We used multistage stratified r and om sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China ; the sampling frame of 113 million individuals aged 18 years or older included 12 % of the adult population in China . 63 004 individuals , identified with simple r and om selection methods at the sampling sites , were screened with an exp and ed version of the General Health Question naire and 16,577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist . FINDINGS The adjusted 1-month prevalence of any mental disorder was 17.5 % ( 95 % CI 16.6 - 18.5 ) . The prevalence of mood disorders was 6.1 % ( 5.7 - 6.6 ) , anxiety disorders was 5.6 % ( 5.0 - 6.3 ) , substance abuse disorders was 5.9 % ( 5.3 - 6.5 ) , and psychotic disorders was 1.0 % ( 0.8 - 1.1 ) . Mood disorders and anxiety disorders were more prevalent in women than in men , and in individuals 40 years and older than in those younger than 40 years . Alcohol use disorders were 48 times more prevalent in men than in women . Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents . Among individuals with a diagnosable mental illness , 24 % were moderately or severely disabled by their illness , 8 % had ever sought professional help , and 5 % had ever seen a mental health professional . INTERPRETATION Substantial differences between our results and prevalence , disability , and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed , country-specific situation analyses before they scale up mental health services . FUNDING China Medical Board of New York , WHO , and Sh and ong Provincial Bureau of Health Improved drug therapy for schizophrenia may represent the best strategy for reducing the costs of schizophrenia and the recurrent chronic course of the disease . Olanzapine and risperidone are atypical antipsychotic agents developed to meet this need . We report a multicenter , double-blind , parallel , 30-week study design ed to compare the efficacy , safety , and associated re source use for olanzapine and risperidone in Australia and New Zeal and . The study sample consisted of 65 patients who met DSM-IV criteria for schizophrenia , schizoaffective disorder , or schizophreniform disorder .  Olanzapine-treated patients showed a significantly greater reduction in Positive and Negative Syndrome Scale ( PANSS ) total , Brief Psychiatric Rating Scale ( BPRS ) total , and PANSS General Psychopathology scores at endpoint compared to the risperidone-treated patients . Response rates through 30 weeks showed a significantly greater proportion of olanzapine-treated patients had achieved a 20 % or greater improvement in their PANSS total score compared to risperidone-treated patients . Olanzapine and risperidone were equivalent in their improvement of PANSS positive and negative scores and Clinical Global Impression-Severity of Illness scale ( CGI-S ) at endpoint . Using generic and disease-specific measures of quality of life , olanzapine-treated patients showed significant within-group improvement in most measures , and significant differences were observed in favor of olanzapine over risperidone in Quality of Life Scale ( QLS ) Intrapsychic Foundation and Medical Outcomes Study Short Form 36-item instrument ( SF-36 ) Role Functioning Limitations -Emotional subscale scores . Despite the relatively small sample size , our study suggests that olanzapine has a superior risk : benefit profile compared to risperidone OBJECTIVE Newer antipsychotic drugs have shown promise in ameliorating neurocognitive deficits in patients with schizophrenia , but few studies have compared newer antipsychotic drugs with both clozapine and conventional agents , particularly in patients who have had suboptimal response to prior treatments . METHOD The authors examined the effects of clozapine , olanzapine , risperidone , and haloperidol on 16 measures of neurocognitive functioning in a double-blind , 14-week trial involving 101 patients . A global score was computed along with scores in four neurocognitive domains : memory , attention , motor function , and general executive and perceptual organization . RESULTS Global neurocognitive function improved with olanzapine and risperidone treatment , and these improvements were superior to those seen with haloperidol . Patients treated with olanzapine exhibited improvement in the general and attention domains but not more than that observed with other treatments . Patients treated with risperidone exhibited improvement in memory that was superior to that of both clozapine and haloperidol . Clozapine yielded improvement in motor function but not more than in other groups . Average effect sizes for change were in the small to medium range . More than half of the patients treated with olanzapine and risperidone experienced " clinical ly significant " improvement ( changes in score of at least one-half st and ard deviation relative to baseline ) . These findings did not appear to be mediated by changes in symptoms , side effects , or blood levels of medications . CONCLUSIONS Patients with a history of suboptimal response to conventional treatments may show cognitive benefits from newer antipsychotic drugs , and there may be differences between atypical antipsychotic drugs in their patterns of cognitive effects OBJECTIVE The authors sought to compare the effects of olanzapine , quetiapine , and risperidone on neurocognitive function in patients with early psychosis . METHOD In a 52-week double-blind , multicenter study , 400 patients early in the course of psychotic illness ( < 5 years ) were r and omly assigned to treatment with olanzapine ( 2.5 - 20 mg/day ) , quetiapine ( 100 - 800 mg/day ) , or risperidone ( 0.5 - 4 mg/day ) . The mean modal daily dose was 11.7 mg ( SD=5.3 ) for olanzapine , 506 mg ( SD=215 ) for quetiapine , and 2.4 mg ( SD=1.0 ) for risperidone . A total of 224 patients completed neurocognitive assessment s at baseline and at 12 weeks , and 81 patients also completed them at 52 weeks . Neurocognitive composite scores were calculated from the neurocognitive battery used in the Clinical Antipsychotic Trials of Intervention Effectiveness ( CATIE ) and from the Brief Assessment of Cognition in Schizophrenia . RESULTS At week 12 , there was significant improvement in neurocognition for each treatment ( p<0.01 ) , but no significant overall difference between treatments . Composite z score improvements on the CATIE neurocognitive battery were 0.17 for olanzapine , 0.33 for quetiapine , and 0.32 for risperidone .  Composite z score improvements on the Brief Assessment of Cognition in Schizophrenia were 0.19 for olanzapine , 0.34 for quetiapine , and 0.22 for risperidone . Statistically significant relationships between improvements in neurocognition and functional outcome were observed at weeks 12 and 52 . CONCLUSIONS Olanzapine , quetiapine , and risperidone all produced significant improvements in neurocognition in early-psychosis patients . Although cognitive improvements were modest , their clinical importance was suggested by relationships with improvements in functional outcome BACKGROUND The relative effects of the atypical antipsychotic drugs and conventional agent on quality of life and psychosocial functioning in patients with early-stage schizophrenia is still uncertain because of an insufficient number of studies examining this issue . METHODS In a 12 months open-label , prospect i ve observational , multicenter study , 1029 subjects with schizophrenia or schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine , sulpiride , clozapine , risperidone , olanzapine , quetiapine or aripiprazole . The health-related quality of life and psychosocial functioning were assessed using Medical Outcomes Study 36-Item Short Form Health Survey ( SF-36 ) , the Global Assessment Scale ( GAS ) and the Activities of Daily Living Scale ( ADL ) , respectively . RESULTS At 12 months , treatment result ed in significant improvements in all 8 domain scores of SF-36 , GAS and ADL score ( all P-values < .001 ) . However , only olanzapine and quetiapine groups demonstrated greater improvement in the role-psychical score of SF-36 and GAS score than did the chlorpromazine group ( all P-values ≤ .002 ) . CONCLUSIONS All antipsychotics may improve quality of life and social function in patients with early-stage schizophrenia , but further studies are needed to determine whether atypical antipsychotics are superior to conventional agents OBJECTIVE To compare the efficacy of risperidone and olanzapine in schizophrenic patients with tardive dyskinesia on treatment with first-generation antipsychotics . METHOD We conducted a 24-week , rater-blinded , flexible-dose study . Sixty patients with DSM-IV schizophrenia ( n = 58 ) or schizoaffective disorder ( n = 2 ) met the DSM-IV research criteria for neuroleptic-induced tardive dyskinesia and were r and omly assigned to a risperidone or olanzapine group . The primary outcome was a comparison of the change in the total scores on the Abnormal Involuntary Movement Scale ( AIMS ) from baseline to study end point between the groups . The study was conducted from July 2000 to June 2004 . RESULTS The mean ± SD doses of risperidone and olanzapine from baseline to study end point were 1.9 ± 0.7 to 4.1 ± 1.4 mg/d and 8.1 ± 2.0 to 12.6 ± 5.4 mg/d , respectively . There were no statistically significant differences in demographic data , severity of tardive dyskinesia , or psychotic symptoms between risperidone and olanzapine groups at baseline assessment . Both groups showed significant improvement in mean ± SD AIMS total scores  ( risperidone : −7.4 ± 6.9 , P < .0001 ; olanzapine : −6.2 ± 8.0 , P = .0002 ) . However , there was a more statistically significant change in the slope of AIMS total scores in the risperidone group than in the olanzapine group ( P = .0001 ) . CONCLUSIONS Our findings demonstrated that olanzapine may not have better potential for tardive dyskinesia improvement than risperidone did . Double-blinded , fixed dose studies with a larger sample size on schizophrenic patients with tardive dyskinesia from different ethnic groups are needed to confirm the results of our study . TRIAL REGISTRATION clinical trials.gov Identifier BACKGROUND We compared the efficacy and safety of olanzapine vs placebo for the treatment of acute bipolar mania . METHODS Four-week , r and omized , double-blind , parallel study . A total of 115 patients with a DSM-IV diagnosis of bipolar disorder , manic or mixed , were r and omized to  olanzapine , 5 to 20 mg/d ( n = 55 ) , or placebo ( n = 60 ) . The primary efficacy measure was the Young-Mania Rating Scale ( Y-MRS ) total score . Response and euthymia were defined , a priori , as at least a 50 % improvement from baseline to end point and as a score of no less than 12 at end point in the Y-MRS total score , respectively . Safety was assessed using adverse events , Extrapyramidal Symptom ( EPS ) rating scales , laboratory values , electrocardiograms , vital signs , and weight change . RESULTS Olanzapine-treated patients demonstrated a statistically significant greater mean ( + /- SD ) improvement in Y-MRS total score than placebo-treated patients ( -14.8 + /- 12.5 and -8.1 + /- 12.7 , respectively ; P<.001 ) , which was evident at the first postbaseline observation 1 week after r and omization and was maintained throughout the study ( last observation carried forward ) . Olanzapine-treated patients demonstrated a higher rate of response ( 65 % vs 43 % , respectively ; P = .02 ) and euthymia ( 61 % vs 36 % , respectively ; P = . 01 ) than placebo-treated patients . There were no statistically significant differences in EPSs between groups . However , olanzapine-treated patients had a statistically significant greater mean ( + /- SD ) weight gain than placebo-treated patients ( 2.1 + /- 2.8 vs 0.45 + /- 2.3 kg , respectively ) and also experienced more treatment-emergent somnolence ( 21 patients [ 38.2 % ] vs 5 [ 8.3 % ] , respectively ) . CONCLUSION Olanzapine demonstrated greater efficacy than placebo in the treatment of acute bipolar mania and was generally well tolerated INTRODUCTION The objectives of this study were to determine the economic , clinical , and quality -of-life outcomes associated with olanzapine treatment in patients diagnosed with mania . METHODS Patients with a diagnosis of bipolar I disorder with manic or mixed episodes were enrolled in a r and omized controlled trial . The study design comprised a 3-week acute phase followed by a 49-week open label extension . In the open label extension , the use of lithium and fluoxetine was permitted for patients who experienced breakthrough symptoms . Clinical , economic , and quality -of-life outcomes of treatment were assessed . RESULTS During the acute phase , olanzapine patients experienced a statistically significant greater mean improvement from baseline on the Y-MRS total score compared to the placebo patients . In the open label extension , patients experienced a statistically significant mean change of 11.8 units on the Y-MRS from the end of the acute phase . When compared to costs incurred in the previous 12 months of therapy , patients experienced savings of almost $ 900 per month during the 49 weeks of olanzapine therapy . These cost savings were largely driven by reductions in in-patient costs during the open label extension . Health-related quality of life improvements measured by the SF-36 were seen on several dimensions both in the 3-week acute phase as well as in the 49-week open label extension . CONCLUSION From a clinical , economic , and quality -of-life outcomes st and point , olanzapine had a significant impact in the treatment of mania , and could be considered a cost-effective treatment option for use in this population if these findings are extrapolated to non- clinical trial population INTRODUCTION Head-to-head comparisons of antipsychotics have predominantly included patients with chronic conditions . The aim of the present study was to compare the efficacy and tolerability of ziprasidone and olanzapine in patients with recent-onset schizophrenia . METHODS The study was an 8-week , double-blind , parallel-group , r and omized , controlled multicenter trial ( NCT00145444 ) . Seventy-six patients with schizophreniform disorder , schizophrenia or schizoaffective disorder ( diagnosis < 5 y ) , and a maximum lifetime antipsychotic treatment < 16 weeks participated in the study . Efficacy of ziprasidone ( 80 - 160 mg/d ) and olanzapine 10 - 20 mg was measured using the Positive and Negative Syndrome Scale ( PANSS ) , the Clinical Global Impression ( CGI ) Scale , the Calgary Depression Scale for Schizophrenia ( CDSS ) , and the Heinrich Quality of Life Scale ( HQLS ) ; tolerability assessment s included laboratory assessment s , body weight , and electroencephalogram . RESULTS Olanzapine ( n = 34 ) and ziprasidone ( n = 39 ) showed equal efficacy as measured by the PANSS , CDSS , CGI , and HQLS . However , mean weight gain was significantly higher in the olanzapine group ( 6.8 vs 0.1 kg , P < .001 ) . Ziprasidone was associated with decreasing levels of triglycerides , cholesterol , and transaminases , while these parameters increased in the olanzapine group ( all P values < .05 ) . There were no significant differences in fasting glucose and prolactin levels or in cardiac or sexual side effects . Patients on ziprasidone used biperiden for extrapyramidal side effects more frequently ( P < .05 ) . DISCUSSION The results of this study indicate that ziprasidone and olanzapine have comparable therapeutic efficacy but differ in their side effect profile . However , there is a risk of a type II error with this sample size . Clinical ly significant weight gain and laboratory abnormalities appear early after initiating treatment and are more prominent with olanzapine , while more patients on ziprasidone received anticholinergic drugs to treat extrapyramidal symptoms OBJECTIVE To determine whether clinical trials originating in certain countries always have positive results . DATA SOURCES Abstract s of trials from Medline ( January 1966-June 1995 ) . STUDY SELECTION Two separate studies were conducted . The first included trials in which the clinical outcome of a group of subjects receiving acupuncture  was compared to that of a group receiving placebo , no treatment , or a nonacupuncture intervention . In the second study , r and omized or controlled trials of interventions other than  acupuncture  that were published in China , Japan , Russia/USSR , or Taiwan were compared to those published in Engl and . DATA EXTRACTION Blinded review ers determined inclusion and outcome and separately classified each trial by country of origin . DATA SYNTHESIS In the study of acupuncture  trials , 252 of 1085 abstract s met the inclusion criteria . Research conducted in certain countries was uniformly favorable to acupuncture ; all trials originating in China , Japan , Hong Kong , and Taiwan were positive , as were 10 out of 11 of those published in Russia/USSR . In studies that examined interventions other than acupuncture , 405 of 1100 abstract s met the inclusion criteria . Of trials published in Engl and , 75 % gave the test treatment as superior to control . The results for China , Japan , Russia/USSR , and Taiwan were 99 % , 89 % , 97 % , and 95 % , respectively . No trial published in China or Russia/USSR found a test treatment to be ineffective . CONCLUSIONS Some countries publish unusually high proportions of positive results . Publication bias is a possible explanation . Research ers undertaking systematic review s should consider carefully how to manage data from these countries OBJECTIVE This study compares the efficacy of risperidone and olanzapine to that of first-generation antipsychotics ( FGAs ) in patients with schizophrenia , who failed to show a response to initial trials of FGAs . METHOD This study was an 8-week treatment , r and omized , rater-blind , active-control study with 3 treatment arms . 48 patients , who showed inadequate response to 1 FGA , were enrolled and r and omized into risperidone , olanzapine , or FGA ( haloperidol or trifluoperazine ) groups . They were blindly assessed with the Positive and Negative Syndrome Scale ( PANSS ) , the Clinical Global Impression Scale-Severity , and the Extrapyramidal Symptom Rating Scale ( ESRS ) at baseline and biweekly . RESULTS All 3 groups demonstrated a significant decrease in the PANSS total , positive , and general scores from baseline to endpoint ( p-values range from 0.003 to 0.021 ) . There were no significant differences among the 3 groups in score changes . The olanzapine group had significant score reductions than the risperidone and FGAs groups in terms of the ESRS subjective total score and did not experience a significant increase in the dose of anticholinergics . The FGA group demonstrated that extrapyramidal syndrome ( EPS ) worsened under an increased dosage of anti-EPS drugs . Olanzapine was associated with significant body weight gain ( 2.69 ± 4.0 kg , p=0.026 ) , but there were no significant group differences on weight gain . CONCLUSIONS Haloperidol or trifluoperazine demonstrated similar efficacy as risperidone or olanzapine for patients with schizophrenia who had failed their first trial with a FGA . Related double-blind , fixed dose studies with a larger sample size are needed to confirm the results of our study BACKGROUND Relatively little is known about the relationships between medication adherence and long-term functional outcomes in the treatment of schizophrenia . To extend previous research , we prospect ively examined the relationships between adherence with any antipsychotic medication and functional outcomes among schizophrenia patients treated over a 3-year period , assessed the stability of adherence over time , and examined whether adherence in the first year predicts changes in functional outcomes over the following 2 years . METHOD Analyses included 1906 participants with DSM-IV diagnoses of schizophrenia or schizoaffective or schizophreniform disorder in a multi-site , 3-year , prospect i ve , naturalistic study conducted in the United States between July 1997 and September 2003 . Outcome measures were assessed at 6-month intervals using systematic medical record abstract ion and structured interview of patients . Adherence with antipsychotic regimen was assessed using patient-reported adherence and the medication possession ratio ( percent days with prescription for any antipsychotic ) , dichotomized into adherence and non-adherence . Analyses employed generalized estimating equations and mixed models with repeated measures . RESULTS Nonadherence was associated with poorer functional outcomes , including greater risks of psychiatric hospitalizations , use of emergency psychiatric services , arrests , violence , victimizations , poorer mental functioning , poorer life satisfaction , greater substance use , and more alcohol-related problems ( all p < .001 ) . Adherence was relatively stable , with 77.3 % of patients maintaining the same adherence status from the first year to the second year . Nonadherence in the first year predicted significantly poorer outcomes in the following 2 years . CONCLUSIONS Findings highlight the importance of adherence with antipsychotic medication in the long-term treatment of schizophrenia and its potential beneficial impact on the mental health and criminal justice delivery systems The efficacy , safety and tolerability of ziprasidone versus the comparators olanzapine , risperidone or quetiapine were investigated in adult patients with chronic schizophrenia , schizoaffective and schizophreniform disorders , with lack of efficacy or intolerance to their previous antipsychotic treatment based on clinical judgement of the investigator . A total of 293 patients were r and omized to 12 weeks treatment with either ziprasidone 80–160 mg/day ( n=147 ) or with one of the comparator drugs ( n=146 ) . In the latter group the investigator could choose between olanzapine 10–20 mg/day ( n=24 ) , risperidone 4–8 mg/day ( n=22 ) or quetiapine 300–750 mg/day ( n=97 ) . The study comprised four visits including a baseline examination prior to r and omization and further examinations at the end of weeks 1 , 4 and 12 . Ziprasidone was non-inferior ( defined as a difference of = 7 units or less on the PANSS scale to the disadvantage of ziprasidone . ) to the composite group ( olanzapine , risperidone or quetiapine ) on the total PANSS score as well as on all subscores ( P<0.0001 ) ; there were no significant between-group differences in the CGI-S and I and UKU scores . Ziprasidone-treated patients lost an average of 2.1 kg in the 12 weeks of the study , the mean weight for risperidone and quetiapine remained unchanged , and patients receiving olanzapine gained 3.1 kg on average Background : Little information is available on the impact of the atypical antipsychotic olanzapine on quality of life ( QOL ) . A 6-week , double-blind r and omized multicenter trial , with a long-term extension , was conducted to evaluate the clinical efficacy and QOL of olanzapine and haloperidol in treating schizophrenia and other psychotic disorders . Methods : A total of 828 out patients provided QOL data . Study patients were aged greater than 18 years with a DSM-III-R diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder and baseline BPRS ( items scored on 0–6 scale ) total scores , ≥18 were r and omized to 6 weeks of treatment with olanzapine 5 to 20 mg/day or haloperidol 5 to 20 mg/day . Patients entered a 46-week double-blind extension if they demonstrated minimal clinical response and were tolerant to study medication . The Quality of Life Scale ( QLS ) and SF-36 Health Survey were used to evaluate QOL . Results : During the 6-week acute phase , olanzapine treatment significantly improved BPRS total ( p = 0.004 ) , PANSS total scores ( p = 0.043 ) , QLS total ( p = 0.005 ) , intrapsychic foundations ( p < 0.001 ) and interpersonal relations scores ( p = 0.036 ) , and SF-36 mental component summary scores ( p < 0.001 ) compared with haloperidol . During the extension phase , olanzapine treatment significantly improved PANSS negative scores ( p = 0.035 ) and improved QLS total ( p = 0.001 ) , intrapsychic foundations ( p < 0.001 ) , and instrumental role category scores ( p = 0.015 ) versus haloperidol treatment . Significantly more  haloperidol patients discontinued treatment due to adverse events during the acute and extension phases ( p = 0.041 and p = 0.014 , respectively ) . Changes in QLS total and MCS scores were associated with changes in clinical symptoms , depression scores and extrapyramidal symptoms . Conclusions : Olanzapine was more effective than haloperidol in reducing severity of psychopathology and in improving QOL in patients with schizophrenia and other psychotic disorders . The QOL benefits of olanzapine , although modest , may be important for long-term treatment BACKGROUND The relative effectiveness of second-generation ( atypical ) antipsychotic drugs as compared with that of older agents has been incompletely addressed , though newer agents are currently used far more commonly . We compared a first-generation antipsychotic , perphenazine , with several newer drugs in a double-blind study . METHODS A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and r and omly assigned to receive olanzapine ( 7.5 to 30 mg per day ) , perphenazine ( 8 to 32 mg per day ) , quetiapine ( 200 to 800 mg per day ) , or risperidone ( 1.5 to 6.0 mg per day ) for up to 18 months . Ziprasidone ( 40 to 160 mg per day ) was included after its approval by the Food and Drug Administration . The primary aim was to delineate differences in the overall effectiveness of these five treatments . RESULTS Overall , 74 percent of patients discontinued the study medication before 18 months ( 1061 of the 1432 patients who received at least one dose ) : 64 percent of those assigned to olanzapine , 75 percent of those assigned to perphenazine , 82 percent of those assigned to quetiapine , 74 percent of those assigned to risperidone , and 79 percent of those assigned to ziprasidone . The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine ( P<0.001 ) or risperidone ( P=0.002 ) group , but not in the perphenazine ( P=0.021 ) or ziprasidone ( P=0.028 ) group . The times to discontinuation because of intolerable side effects were similar among the groups , but the rates differed ( P=0.04 ) ; olanzapine was associated with more discontinuation for weight gain or metabolic effects , and perphenazine was associated with more discontinuation for extrapyramidal effects . CONCLUSIONS The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons . Olanzapine was the most effective in terms of the rates of discontinuation , and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine , risperidone , and ziprasidone . Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism OBJECTIVE To assess the effectiveness of olanzapine for treating schizophrenia and to assess if olanzapine promotes a better quality of life than first-generation antipsychotics ( FGAs ) . METHOD Multicenter , naturalistic , r and omized controlled study , comparing olanzapine with FGAs , at hospitalization and during a 9-month follow-up . Outcome assessors were blind to the allocated drug . The dose of antipsychotic was determined by doctors according to their clinical practice routines . Data collection was performed from April 1999 to August 2001 . RESULTS 197 patients with DSM-IV-diagnosed schizophrenia were allocated to olanzapine ( N = 104 ) and FGA ( N = 93 ) . Patients taking olanzapine  showed greater improvements in Positive and Negative Syndrome Scale ( PANSS ) negative symptoms ( mean difference = 2.3 , 95 % CI = 0.6 to 4.1 ) and general psychopathology ( mean difference = 4.0 , 95 % CI = 0.8 to 7.2 ) sub-scales and fewer incidences of tardive dyskinesia ( RR = 2.4 , 95 % CI = 1.4 to 4.2 , p < .0001 ) . Olanzapine was also associated with greater improvement in a number of health-related quality -of-life outcomes on the Medical Outcomes Study 36-item Short-Form Health Survey , including physical functioning ( mean difference = 6.6 , 95 % CI = 1.2 to 11.9 ) , physical role limitations ( mean difference = 13.7 , 95 % CI = 3.0 to 24.3 ) , and emotional role limitations ( mean difference = 12.1 , 95 % CI = 0.7 to 23.5 ) . Patients taking olanzapine  gained significantly more weight during the trial than patients taking  FGAs  , with a correspondent endpoint increase in the body mass index ( BMI ) of 28.7 versus 25.3 ( p < .001 ) . CONCLUSION Compared with FGAs , olanzapine has advantages in terms of improvements of negative symptoms and quality of life . It is also associated with fewer incidences of tardive dyskinesia and greater increases in weight and BMI . These findings are highlighted by the naturalistic approach adopted in this trial BACKGROUND This multicenter , double-blind , r and omized , controlled study conducted in China examined the efficacy and safety of olanzapine versus lithium in the treatment of patients with bipolar manic/mixed episodes . METHODS Patients with bipolar manic or mixed episode ( DSM-IV criteria ) and Young Mania Rating Scale ( YMRS ) score > or = 20 at screening received olanzapine ( 5 - 20 mg/day , n=69 ) or lithium carbonate ( 600 - 1800 mg/day , n=71 ) for 4 weeks . The primary outcome was mean change from baseline in Clinical Global Impressions-Bipolar Version Overall Severity of Illness ( CGI-BP ) score . Secondary efficacy measures included YMRS , Brief Psychiatric Rating Scale ( BPRS ) , and Montgomery-Asberg Depression Rating Scale ( MADRS ) scores . Safety was also assessed . RESULTS A significantly greater mean change was observed in olanzapine versus lithium patients in CGI-BP ( Overall Severity ) ( P=0.009 ) , YMRS ( P=0.013 ) , BPRS ( P=0.032 ) , and CGI-BP ( Severity of Mania ) ( P=0.012 ) scores . More olanzapine than lithium patients experienced at least one adverse event possibly related to study drug ( P=0.038 ) . More olanzapine patients had a clinical ly significant weight increase ( > or = 7 % of baseline weight ) compared to lithium patients ( P=0.009 ) . More olanzapine patients completed the study than lithium patients , although this difference was not statistically significant ( olz , 91.3 % ; lith , 78.9 % ; P=0.057 ) . LIMITATIONS No placebo arm was included ; however both treatments have previously been reported to be more effective than placebo . CONCLUSIONS These results suggest that olanzapine has superior efficacy to lithium in the acute treatment of patients with bipolar mania over a 4-week period . However , adverse events were experienced by a greater number of olanzapine patients than lithium patients INTRODUCTION Although some previous studies have compared the 2 medicines , ziprasidone and olanzapine most selected chronic patients as subjects . Therefore , the present study was design ed to compare the efficacy and safety of ziprasidone vs. olanzapine in naive first-episode schizophrenia . METHODS 80 patients were r and omly assigned to a 6-week treatment either with 80 - 160 mg/day of ziprasidone or 10 - 20 mg/day of olanzapine . The primary efficacy measurements were the Positive and Negative Syndrome Scale and Clinical Global Impression-severity scale scores . The second efficacy measurement was the response rate of treatment . Tolerability assessment s were also performed . RESULTS 79 patients completed the trial . The average dose was 127.5 mg/day with ziprasidone and 19.1 mg/day with olanzapine . No significant differences were found between the 2 groups in primary or secondary efficacy measurements at each visit point ( all p>0.05 ) . Body weight significantly increased with olanzapine , and more extrapyramidal symptoms were observed with ziprasidone ( all p<0.05 ) . Both medicines were well tolerated , and no serious adverse events were observed . CONCLUSION Ziprasidone was as effective as olanzapine in short-term treatment for first-episode schizophrenia , and both medicines were well tolerated Neurocognitive deficits in schizophrenia can reach 1 to 2 st and ard deviations below healthy controls . The comparative effect of typical and atypical antipsychotic medications on neurocognition is controversial , and based primarily on studies with small sample s and large doses of typical comparator medications . The present study assessed neurocognitive efficacy . It was hypothesized that olanzapine treatment would improve neurocognitive deficits to a greater degree than either risperidone or haloperidol treatment . This was a double-blind , r and omized , controlled , parallel study with neurocognition assessed at baseline , and 8 , 24 , and 52 weeks . Per protocol , the haloperidol arm was discontinued . Four hundred and fourteen in patients or out patients with schizophrenia and schizoaffective disorder were treated with oral olanzapine ( n = 159 ) , risperidone ( n = 158 ) , or haloperidol ( n = 97 ) . Individual domains ( executive function , learning and memory , processing speed , attention/vigilance , verbal working memory , verbal fluency , motor function , and visuospatial ability ) were transformed into composite scores and compared between treatment groups . At the 52-week endpoint , neurocognition significantly improved in each group ( p < 0.01 for olanzapine and risperidone , p = 0.04 for haloperidol ) , with no significant differences between groups . Olanzapine- and risperidone-treated patients significantly ( p < 0.05 ) improved on domains of executive function , learning/memory , processing speed , attention/vigilance , verbal working memory , and motor functions . Additionally , risperidone-treated patients improved on domains of visuospatial memory .  Haloperidol-treated patients improved only on domains of learning/memory . However , patients able to remain in treatment for the entire 52 weeks benefited more from olanzapine or risperidone treatment than haloperidol treatment OBJECTIVE This international , multicenter double-blind trial was design ed to compare the therapeutic profile of an atypical antipsychotic , olanzapine , with that of a conventional dopamine D2 antagonist , haloperidol . METHOD A total of 1,996 patients at 174 sites in Europe and North America were r and omly assigned to treatment with olanzapine ( N = 1,336 ) or haloperidol ( N = 660 ) over 6 weeks . The primary efficacy analysis involved the mean change from baseline to endpoint in total scores on the Brief Psychiatric Rating Scale ( BPRS ) . Secondary analyses included comparisons of the mean change in positive and negative symptoms , comorbid depression , extrapyramidal symptoms , and overall drug safety . RESULTS Olanzapine demonstrated clinical results superior to those of haloperidol on overall improvement according to the BPRS and on every secondary measure , including depression .  Olanzapine was also associated with significantly fewer discontinuations of treatment due to lack of drug efficacy or adverse events . Substantially more olanzapine-treated patients ( 66.5 % ) than haloperidol-treated patients ( 46.8 % ) completed 6 weeks of therapy . Statistically significant advantages of olanzapine treatment were related to 1 ) change in negative symptoms , 2 ) extrapyramidal symptom profile , 3 ) effect on prolactin levels , and 4 ) response rate . CONCLUSIONS Olanzapine shows a superior and broader spectrum of efficacy in the treatment of schizophrenic psychopathology , with a substantially more favorable safety profile , than haloperidol . It meets several of the criteria for a novel atypical antipsychotic agent BACKGROUND There is little information about weight gain induced by antipsychotics at long-term . OBJECTIVE To quantify the weight gain induced by first ( haloperidol ) and second generation antipsychotics ( olanzapine and risperidone ) in a cohort of drug-naïve subjects after 1 year of treatment . METHODS This is a prospect i ve , r and omized clinical trial , including a representative sample of first episode psychotic incident cases from a population area of 555.000 people . The main outcome measures were changes in body weight and body mass index at 3 months and at 12 months . Both a per protocol analysis and an intention to treat analysis were conducted . RESULTS A total of 164 drug-naïve patients were included . At 12 months 144 patients were evaluated . Of them , 66 % completed the protocol and 34 % needed treatment switch . We found statistically significant differences in weight gain at 3 months : 3.8 kg ( + /-4.1 ) for haloperidol , 5.9 kg ( + /-5.1 ) for risperidone and 8.4 kg ( + /-5.0 ) for olanzapine ( F=7.045 ; p=0.002 ) . After 1 year the difference in weight gain had disappeared : 9.7 kg ( + /-5.7 ) for haloperidol , 8.9 kg ( + /-8.8 ) for risperidone and 10.9 kg ( + /-7.2 ) for olanzapine ( F=0.817 ; p=0.445 ) . CONCLUSIONS Drug-naïve patients experience an extraordinary weight gain after 1 year of treatment with haloperidol , olanzapine or risperidone . The main difference among these treatments is the pattern of weight gain but not the final amount of weight gain OBJECTIVE Only a few Chinese medical journals have recommended CONSORT in their " Instruction for authors or Guide for authors " . This study aims to evaluate the reporting quality of r and omized  controlled trials ( RCTs ) published in the five leading Chinese medical journals indexed by MEDLINE . METHODS We identified RCTs published from 2004 to January 2007 in five leading Chinese medical journals by search ing three important Chinese data bases systematic ally , namely CNKI ( China National Knowledge Infrastructure/Chinese Academic Journals full text Data base ) , VIP ( a full text data base of China ) and CBM disc ( China Biomedicine Data base Disc ) and assessed the quality of each RCT by using the Consoli date d St and ards for Reporting of Trials ( CONSORT ) and the 5-point Jadad scale . RESULTS One hundred and forty two RCTs were included . Based on the items in the revised CONSORT statement , 130 ( 91.55 % ) of the 142 RCTs mentioned " r and omization " in the title or abstract , but only 38 ( 26.76 % ) RCTs described the method to generate the r and om sequence ; only 6 RCTs had adequate allocation concealment ; 24 ( 17.61 % ) RCTs mentioned " masking " , but only 7 described the process of masking . Three out of 40 items were reported clearly in all included trials , while five items were not mentioned at all . The quality of RCTs was low as assessed by the Jadad scale and 22 RCTs were high- quality research ( > /=3 points ) . CONCLUSIONS The reporting quality of RCTs published in the five leading Chinese medical journals is low . Chinese journals should adopt the CONSORT statement to improve the reporting quality of Chinese r and omized controlled trials Abstract : To determine predictors of substantial weight gain ( SWG ) during treatment of bipolar disorder with olanzapine , data were pooled from 4 long-term r and omized , multicenter studies in patients with bipolar mania or mixed mania ( N = 948 at initiation of olanzapine ) .  SWG was defined as gaining 5 kg or 7 % of initial weight in 30 ± 2 weeks . Logistic regression estimated odds ratios associated with early weight gain and baseline risk factors for predicting SWG . A classification system to identify patients at risk for  SWG was constructed by recursive data partitioning . Baseline characteristics significantly associated with SWG included younger age , nonwhite ethnicity , lower body mass index ( BMI ) , nonrapid cycling , and psychotic features . Weight gain of 2 or more kg in the first 3 weeks of therapy predicted SWG by 30 weeks ( sensitivity = 57 % ; specificity = 71 % ) . A classification system with thresholds for early weight gain , baseline BMI , and ethnicity further improved SWG predictability ( sensitivity = 79 % ; specificity = 70 % ) . In conclusion , patients with bipolar disorder who gained 2 to 3 kg during the first 3 weeks of treatment with olanzapine  , SWG was predicted after 30 weeks of treatment . Patients with less pronounced early weight gain might still be at risk for later SWG if they have close to normal BMI ( ≤27 kg/m2 ) at treatment initiation BACKGROUND Olanzapine has demonstrated efficacy in the treatment of acute mania in 2 double-blind , placebo-controlled trials . We describe the results of the open-label extension from one of these trials . METHOD In a 3-week , double-blind study of patients with DSM-IV bipolar I disorder , olanzapine was superior to placebo for the treatment of acute manic symptoms . Of the 139 patients who entered the double-blind phase of the 3-week study , 113 patients continued into the 49-week open-label extension .  Efficacy measurements including the Young Mania Rating Scale ( YMRS ) , the 21-item Hamilton Rating Scale for Depression ( HAM-D-21 ) , the Clinical Global Impressions scale-Bipolar Version , and the Positive and Negative Syndrome Scale and safety measurements including the Simpson-Angus scale , the Barnes Akathisia Scale , and the Abnormal Involuntary Movement Scale were completed throughout . The analysis considered all treatment results , starting with the first olanzapine dose . Adjunctive lithium and fluoxetine were allowed during the open-label extension . RESULTS The mean length of olanzapine treatment was 6.6 months , with a mean modal dose of 13.9 mg/day . A significant mean improvement in the YMRS total score , baseline to endpoint ( -18.01 , p < .001 ) , was observed . During treatment , 88.3 % of patients experienced a remission of manic symptoms ( YMRS total score < or = 12 ) , and only 25.5 % subsequently relapsed ( YMRS total score > or = 15 ) . Significant improvement in HAM-D-21 scores was observed ( p < .001 ) . Forty-one percent of patients were maintained on olanzapine monotherapy . The most common treatment-emergent adverse events reported were somnolence ( 46.0 % ) , depression ( 38.9 % ) , and weight gain ( 36.3 % ) . CONCLUSION During up to 1 year of olanzapine therapy , either as monotherapy or in combination with lithium and /or fluoxetine , patients with bipolar disorder demonstrated significant improvement in mania and depression symptoms with a favorable safety profile . Further double-blind , controlled studies are needed to confirm these results AIM To compare the pharmacokinetic profiles and dose proportionality of olanzapine in Chinese and Caucasian subjects . METHODS R and omized , three-period study with 12 Chinese and 12 Caucasian , healthy , male subjects administered 2.5 , 5 and 10 mg olanzapine . Noncompartmental pharmacokinetic parameters were derived . RESULTS No statistically significant racial differences in the weight-normalized pharmacokinetic parameters were observed except for Vz/Fnorm , which was 17 % lower at the 5- and 10-mg dose in the Chinese group ( 95 % confidence interval 8.49 , 10.1 and 8.05 , 9.73 , respectively ) , compared with the Caucasian group ( 9.53 , 12.8 and 9.39 , 12.0 , respectively ) .  Olanzapine 's pharmacokinetics were linear and dose proportional in both racial groups . CONCLUSION The pharmacokinetics of olanzapine are similar in both Chinese and Caucasian racial groups Atypical or second-generation antipsychotics ( SGAs ) are associated with excessive body weight gain ( BWG ) and other components of metabolic syndrome . Among all SGAs , clozapine and olanzapine are known to cause the most significant weight gain , followed by risperidone and quetiapine . The genetic variant of tumor necrosis factor α ( TNF-α ) , -308 G > A polymorphism ( rs1800629 ) , has been implicated in clozapine-induced BWG in several studies . We hypothesized that TNF-α -308 G > A polymorphism has a general effect on SGA-induced BWG . The present study was conducted to examine the association between TNF-α -308 G > A polymorphism and BWG during treatment for schizophrenia using a variety of second generation antipsychotics ( SGAs ) . A total of 500 patients with schizophrenia treated with clozapine ( n=275 ) , olanzapine ( n=79 ) or risperidone ( n=146 ) for an average of 49.9 months were recruited . Subjects with an increase in weight of more than 7 % from the baseline before the current SGA treatment to the weight at the survey point were defined as having BWG . The association between TNF-α -308 G > A polymorphism and BWG was studied , and the effect of non-genetic factors such as baseline BMI , SGA treatment duration and SGA type on the association was controlled by logistic regression . The results revealed that there was no significant association between BWG and TNF-α -308 G > A polymorphism ( GG/GA/AA or GG/GA+AA ) in each separate SGA group or collectively . These findings suggest that TNF-α -308 G > A polymorphism does not play a major role in SGA-induced weight gain OBJECTIVE The safety and efficacy of risperidone and olanzapine were compared in a double-blind trial that used doses widely accepted in clinical practice . METHOD Subjects ( N=377 ) who met DSM-IV criteria for schizophrenia or schizoaffective disorder were r and omly assigned to receive 2 - 6 mg/day of risperidone ( mean modal dose=4.8 mg/day ) or 5 - 20 mg/day of olanzapine ( mean modal dose=12.4 mg/day ) for 8 weeks . RESULTS The two study groups were similar at baseline except that the  olanzapine group was slightly younger than the  risperidone group . Seventy-five percent of the participants completed the trial , with no between-treatment differences in the proportion of dropouts . Similar proportions of the risperidone and olanzapine groups reported extrapyramidal symptoms ( 24 % and 20 % , respectively ) . Severity of extrapyramidal symptoms was low in both groups , with no between-group differences . Total Positive and Negative Syndrome Scale scores and scores on the five Positive and Negative Syndrome Scale factors were improved in both groups at week 8 ( subjects who completed the study ) and endpoint ( all subjects , including dropouts ) . There were overall between-treatment differences in efficacy . Comparison of individual factors found no significant differences at endpoint ; at week 8 , however , improvements on Positive and Negative Syndrome Scale factors for positive symptoms and anxiety/depression were greater with risperidone than olanzapine . An increase in body weight of > or = 7 % was seen in 27 % of olanzapine participants and 12 % of risperidone participants . CONCLUSIONS Both treatments were well tolerated and efficacious . The frequency and severity of extrapyramidal symptoms were similar in the two treatment groups . Greater reductions in severity of positive and affective symptoms were seen with risperidone than with olanzapine treatment among study completers . There was no measure on which olanzapine was superior . Greater weight gain was associated with olanzapine than with risperidone treatment OBJECTIVE The authors compared the effects of the two most commonly used atypical antipsychotics , risperidone and olanzapine , in elderly patients with schizophrenia . METHODS In an 8-week , international , double-blind study , patients ( out patients , hospital in patients , and residents of nursing or boarding homes ) were r and omly assigned to receive risperidone ( 1 mg to 3 mg/day ) or olanzapine ( 5 mg to 20 mg/day ) . The main outcome measures were changes in Positive and Negative Syndrome Scale ( PANSS ) total scores and rates of extrapyramidal symptoms ( EPS ) . RESULTS Subjects were 175 patients age 60 years or over with schizophrenia or schizoaffective disorder . The mean duration of illness was 36.5 years . Median doses were 2 mg/day of risperidone and 10 mg/day of olanzapine .  PANSS total scores and four of the five PANSS factor scores ( positive symptoms , negative symptoms , disorganized thoughts , and anxiety/depression ) improved significantly at all time-points and at endpoint in both groups ; between-treatment differences were not significant . EPS-related adverse events were reported by 9.2 % of patients in the risperidone group and 15.9 % in the olanzapine group ; the between-treatment difference was not significant . Total scores on the Extrapyramidal Symptom Rating Scale were reduced in both groups at endpoint ; between-treatment differences were not significant . Clinical ly relevant weight gain was seen in both groups , but was significantly less frequent in risperidone patients than in olanzapine patients . CONCLUSIONS Stable elderly patients with chronic schizophrenia receiving appropriate doses of risperidone or olanzapine over an 8-week period experienced significant reductions in the severity of psychotic and extrapyramidal symptoms , with a relatively low risk of side effects BACKGROUND Few studies have directly compared the efficacy and tolerability of atypical agents . METHODS This multicenter , r and omized , double-blind study compared the efficacy and tolerability of aripiprazole  ( n = 355 ) with olanzapine  ( n = 348 ) in patients with schizophrenia experiencing acute relapse . After a 6-week acute treatment phase , patients with Clinical Global Impression-Improvement = 1 - 3 or > or = 20 % reduction in the Positive and Negative Symptom Scale ( PANSS ) Total score could progress to the 46-week outpatient extension phase . Co- primary study objectives were to compare efficacy at Week 6 and weight gain liability from baseline to Week 26 . RESULTS The mean olanzapine dose was 15.4 mg/day compared with a mean aripiprazole dose of 23.0 mg/day . More patients treated with olanzapine ( 47 % ) completed the 52-week study than those treated with aripiprazole ( 39 % ) ; time to discontinuation was significantly in favor of olanzapine ( p < .05 ) . At Week 6 , mean change in PANSS Total score  ( olanzapine , -29.5 ; aripiprazole , -24.6 [ r and om regression model ] ) showed a treatment difference of 4.9 points . As the pre-specified non-inferiority margin ( 6 points ) was within the 95 % confidence interval ( 2.2 - 7.6 ) for treatment difference , olanzapine proved to be superior to aripiprazole on this measure . More patients experienced significant weight gain at Week 26 with olanzapine ( 40 % ) than with aripiprazole ( 21 % ; p < .05 [ weighted generalized estimating equation analysis ] ) , with significant differences observed from Week 3 . Mean weight gain at Week 26 was significantly greater with olanzapine than with aripiprazole ( + 4.30 kg vs. + .13 kg , respectively ) . CONCLUSIONS Olanzapine had a statistically significant efficacy advantage over aripiprazole , whereas aripiprazole was associated with significantly less weight gain Most prescription pattern surveys have found a high rate of  antipsychotic polypharmacy . To date few studies have investigated antipsychotic polypharmacy  in Chinese patients with schizophrenia in general and out patients in particular . This study examined the frequency and sociodemographic and clinical correlates of antipsychotic polypharmacy  in Hong Kong ( HK ) and Beijing ( BJ ) , China . Three hundred and ninety-eight clinical ly stable out patients with schizophrenia were r and omly selected and interviewed in HK and BJ using st and ardized assessment instruments .  Antipsychotic polypharmacy  was found in 17.6 % ( N=70 ) of the whole sample and in 28 % and 7.1 % of the HK and BJ sample s , respectively . Polypharmacy was associated with monthly income , severity of negative symptoms and extrapyramidal side effects ( EPS ) , use of depot antipsychotic and anticholinergic drugs , doses of antipsychotics , and the number of hospitalizations . In multiple logistic regression analysis , younger age , number of hospitalizations , site ( HK vs. BJ ) , and the use of depot antipsychotics were all significantly associated with antipsychotic polypharmacy . Although the ethnic and clinical characteristics of the two cohorts were nearly identical , there was a wide variation in the prescription frequency of antipsychotic polypharmacy between HK and BJ , suggesting that sociocultural and economical factors and traditions of psychiatric practice all played a role in determining antipsychotic polypharmacy . Clinicians should bear in mind that , at least for clinical ly stable patients , no scientifically sound therapeutic principles for antipsychotic polypharmacy exist OBJECTIVE In a placebo-controlled , double-blind study , the authors investigated the efficacy and safety of olanzapine as monotherapy in relapse prevention in bipolar I disorder . METHOD Patients achieving symptomatic remission from a manic or mixed episode of bipolar I disorder ( Young Mania Rating Scale [ YMRS ] total score < or = 12 and 21-item Hamilton Depression Rating Scale [ HAM-D ] score < or = 8) at two consecutive weekly visits following 6 - 12 weeks of open-label acute treatment with 5 - 20 mg/day of olanzapine were r and omly assigned to double-blind maintenance treatment with olanzapine ( N=225 ) or placebo ( N=136 ) for up to 48 weeks . The primary measure of efficacy was time to symptomatic relapse into any mood episode ( YMRS score > or = 15 , HAM-D score > or = 15 , or hospitalization ) . RESULTS Time to symptomatic relapse into any mood episode was significantly longer among patients receiving olanzapine ( a median of 174 days , compared with a median of 22 days in patients receiving placebo ) . Times to symptomatic relapse into manic , depressive , and mixed episodes were all significantly longer among patients receiving olanzapine than among patients receiving placebo . The relapse rate was significantly lower in the olanzapine group ( 46.7 % ) than in the placebo group ( 80.1 % ) . During olanzapine treatment , the most common emergent event was weight gain ; during the open-label phase , patients who received olanzapine gained a mean of 3.1 kg ( SD=3.4 ) . In double-blind treatment , placebo patients lost a mean of 2.0 kg ( SD=4.4 ) and patients who continued to take olanzapine gained an additional 1.0 kg ( SD=5.2 ) . CONCLUSIONS Compared to placebo , olanzapine delays relapse into subsequent mood episodes in bipolar I disorder patients who responded to open-label acute treatment with olanzapine for a manic or mixed episode OBJECTIVE The efficacy and safety of olanzapine were compared with those of ziprasidone . METHOD This was a multicenter r and omized , double-blind , parallel-group , 28-week study of patients with schizophrenia . Patients were r and omly assigned to treatment with 10 - 20 mg/day of olanzapine or 80 - 160 mg/day of ziprasidone . The primary efficacy measure was the Positive and Negative Syndrome Scale total score . Secondary efficacy and safety measures included Positive and Negative Syndrome Scale subscales as well as mood , quality of life , and extrapyramidal symptom scales . Safety was evaluated by recording treatment-emergent adverse events and measuring vital signs and weight . RESULTS The study was completed by significantly more  olanzapine-treated patients ( 165 of 277 , 59.6 % ) than ziprasidone-treated patients ( 115 of 271 , 42.4 % ) . At 28 weeks , the olanzapine-treated patients showed significantly more improvement than the ziprasidone-treated patients on the Positive and Negative Syndrome Scale overall scale and all subscales and on the Clinical Global Impression ratings of severity of illness and improvement . The responder rate was higher for olanzapine than for ziprasidone .  Extrapyramidal symptoms were not significantly different between groups in change-to-endpoint analyses , but results favored olanzapine on baseline-to-maximum changes . Weight change was significantly greater with olanzapine ( mean=3.06 kg , SD=6.87 ) than with ziprasidone ( mean=-1.12 kg , SD=4.70 ) . Fasting lipid profiles were significantly superior in the ziprasidone group ; there was no significant difference in fasting glucose level . CONCLUSIONS Olanzapine treatment result ed in significantly greater psychopathology improvement and higher response and completion rates than ziprasidone treatment , while ziprasidone was superior for weight change and lipid profile OBJECTIVES The objectives of this study were : ( 1 ) to investigate , in a clinical practice setting , the effectiveness of olanzapine in the treatment of schizophrenia among partially-responding , symptomatic Asian patients who switch from conventional antipsychotic treatment , ( 2 ) to assess the safety of olanzapine and ( 3 ) to assess the change in quality of life  in Asian patients with schizophrenia who switch to olanzapine .  METHODS Effectiveness , safety and quality of life were assessed in out patients with schizophrenia ( n=1267 ) who lacked symptomatic control with conventional antipsychotics and were switched to olanzapine therapy .  Data for this prospect i ve , observational study were collected for 12 months from Asian patients in China , Hong Kong , the Philippines , South Korea and Taiwan . RESULTS Significant clinical improvements ( P<0.05 ) were observed following 12 months of olanzapine treatment and 87.3 % of the subjects responded to treatment at endpoint ( i.e. Brief Psychiatric Rating Scale Total score reduced by > or = 30 % relative to baseline ; last observation carried forward ) . Abnormal involuntary movements ( mean change in Abnormal Involuntary Movement Scale : -3.20 , P<0.001 ) and quality of life were significantly improved in patients treated with olanzapine . However , some patients experienced significant weight gain ( 3.60+/-4.50 kg , P<0.001 ) with olanzapine treatment , relative to baseline . CONCLUSIONS This study shows that switching to olanzapine may be effective in improving symptoms , may be well-tolerated and may improve the quality of life  in Asian patients who are only partially responsive to treatment with conventional antipsychotics . The pragmatic design and naturalistic setting of this large study make the findings relevant for treating patients from some Asian countries in routine clinical practice The objective of this study was to compare the effects of risperidone and olanzapine in schizophrenic patients with intolerant extrapyramidal side effects ( EPS ) on first generation antipsychotics . We conducted an 8-week , rater-blinded , flexible dose study . Seventy patients with schizophrenia , who met the DSM-IV research criteria of having neuroleptic-induced acute dystonia or parkinsonism , were r and omly assigned to  risperidone or olanzapine group . The primary outcome was a comparison of the incidence of concomitant anticholinergic drugs usage between the groups to manage their acute dystonia and parkinsonism . The average doses of risperidone and olanzapine from baseline to study end point were 1.8—3.5 mg/day and 7.7—11.7 mg/day , respectively . There were no significant differences in demographic data , severity of EPS or psychotic symptoms between the groups at baseline assessment . Patients taking risperidone had significantly higher incidence of using anticholinergic drugs to manage acute dystonia or parkinsonism overall during the study ( OR = 5.17 , 95%CI = 1.49—17.88 , P = 0.013 ) . There was no significant between-group difference in the changing of rating scales of EPS and psychotic symptoms . The results of our study favour olanzapine as a better choice in schizophrenic patients with intolerant EPS .  Double-blinded , fixed dose and different ethnical study for EPS-intolerant schizophrenic patients is needed to confirm the results of our study The aim of this study was to compare the 12-month effectiveness of several second-generation antipsychotic drugs , with that of haloperidol in never-treated patients with first-episode psychosis . In total , 114 patients without life time exposure to any psychotropic medication were r and omized to haloperidol , olanzapine , risperidone , quetiapine or ziprasidone . Primary outcome was time to all-cause discontinuation . Secondary outcomes included discontinuation rates and symptom change as measured by the Positive and Negative Syndrome Scale ( PANSS ) . The overall discontinuation rate 64 % . At 12 months , the proportion of patients discontinuing treatment was 40.0 % for olanzapine , 56.5 % for quetiapine , 64.0 % for risperidone , 80.0 % for ziprasidone and 85.7 % for haloperidol .  Mean time to antipsychotic discontinuation was higher in patients r and omized to second-generation antipsychotics than in those taking haloperidol . Significantly lower discontinuation was noted in patients on olanzapine than on haloperidol , or ziprasidone . Our results suggest that olanzapine might lead to longer treatment continuation in treatment naïve FEP patients than haloperidol and , possibly ziprasidone .  Global psychopathology was significantly less reduced by haloperidol than with each individual SGA in this earliest phase of treatment Antipsychotic discontinuation rates are a powerful indicator of medication effectiveness in schizophrenia . We examined antipsychotic discontinuation in the Schizophrenia Outpatient Health Outcomes ( SOHO ) study , a 3-year prospect i ve , observational study in out patients with schizophrenia in 10 European countries . Patients ( n=7728 ) who started antipsychotic monotherapy were analyzed .  Medication discontinuation for any cause ranged from 34 % and 36 % for clozapine and olanzapine , respectively , to 66 % for quetiapine . Compared to olanzapine , the risk of treatment discontinuation before 36 months was significantly higher for quetiapine , risperidone , amisulpride , and typical antipsychotics ( oral and depot ) , but similar for clozapine .  Longer medication maintenance was associated with being socially active and having a longer time since first treatment contact for schizophrenia , whereas higher symptom severity , treatment with mood stabilizers , substance abuse , having hostile behaviour were associated with lower medication maintenance . Antipsychotic maintenance in SOHO was higher than the results of previous r and omized studies
target: Findings related to effectiveness ( treatment discontinuation , quality of life , and neurocognitive improvements ) were generally consistent with those observed in non-Chinese population s. No new safety signals specific for Chinese population s were raised for olanzapine .
  Chinese and non-Chinese population s with schizophrenia or bipolar disorder treated with olanzapine display broadly similar responses .
background: BACKGROUND Despite the burden of schizophrenia and bipolar disorder in the Chinese population , country-specific data to guide practitioners regarding antipsychotic therapy are lacking .