The prevalence of tardive dyskinesia after a nine month naturalistic randomized trial comparing olanzapine with conventional treatment for schizophrenia and related disorders

  • Jair de Jesus Mari
  • M. S. Lima
  • A. Niccolai Costa
  • N. Alexandrino
  • S. Rodrigues–Filho
  • I. Reis de Oliveira
  • G. D. Tollefson
ORIGINAL PAPER

Abstract

Aims of the study

To assess the impact of olanzapine versus conventional neuroleptic therapy among subjects with schizophrenia on ratings of tardive dyskinesia (TD).

Method

The naturalistic study was conducted in three psychiatric hospitals in Brazil. Patients had a diagnosis of schizophrenia and related disorders (DSMIV) and with a BPRS score > 24. Patients were evaluated by means of the PANSS scale for symptomatology (Kay et al. 1986), the Clinical Global Impression, The UKU side effect rating scale (Lingjaerde et al. 1987), and the Tardive Dyskinesia AIMS scale (Guy et al. 1976). Patients were seen by the treating physician routinely while hospitalized and then monthly on an out-patient basis. All scale assessments were repeated after 9 months of discharge.

Result

The sample was comprised of 190 patients (99 in the olanzapine and 91 in the standard treatment), with a completion rate of 88.2 % for olanzapine and 84.9% for the conventional treatment (p=0.385, n. s.). The mean change from baseline in the PANSS total score favored olanzapine regarding negative symptoms (2.3, 95% C. I. 0.6–4.1, p < 0.001); and general psychopathology (4.0, 95% C.I. 0.8–7.2, p < 0.02) factors. TD was defined by applying Morgenstern & Glazer (1993) and Schooler & Kane (1982) criteria, on the basis of the AIMS scale. Both results favored olanzapine at the end of the follow-up (Morgenstern & Glazer: 25.6% versus 56.3%; Schooler & Kane: 16.3% versus 45.2 %). At the end of the follow-up, by using the overall rating of the AIMS scale, the presence of TD was 2.3% for olanzapine (2/87), and 16.7% (12/72) for the conventional treatment.

Conclusions

The results of this open label naturalistic trial showed that olanzapine had an impact on negative symptoms, decreased general psychopathology and reduced the risk of tardive dyskinesia.

Key words

schizophrenia tardive dyskinesia randomized controlled trial olanzapine typical antipsychotic 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Beasley CM, Hamilton S, Crawford AM, et al. (1997) Olanzapine versus Haloperidol: acute phase results of the international double-blind olanzapine trial. Eur Neuropsychopharmacol 7:125–137Google Scholar
  2. 2.
    Beasley CM, Dellva MA, Tamura RN, et al. (1999) Randomized double blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long term treatment with olanzapine or haloperidol. Br J Psychiatry 174:23–30PubMedGoogle Scholar
  3. 3.
    Bymaster FP, Calligaro DO, Falcone JF, et al. (1996) Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology 14(2):87–96CrossRefPubMedGoogle Scholar
  4. 4.
    Duggan L, Fenton M, Dardennes RM, et al. (2003) Olanzapine for schizophrenia. Cochrane Database Syst Rev (1):CD001359Google Scholar
  5. 5.
    Glazer WM, Morgenstern H, Doucette JT (1993) Predicting the long term risk of tardive dyskinesia in outpatients maintained on neuroleptic medications. J Clin Psychiatry 54:133–139PubMedGoogle Scholar
  6. 6.
    Glazer WM (2000) Review of incidence studies of tardive dyskinesia associated with typical antipsychotics. J Clin Psychiatry 61(Suppl 4):15–20Google Scholar
  7. 7.
    Guy W (1976) Psychopharmacology Research Branch, NIMH. Abnormal Involuntary Scale (AIMS). In: ECDEU Assessment Manual for Psychopharmacology, revised. DHEW Pub. No (ADM) 76–338. Rockville, MD: National Institute of Mental Health, pp 534–537Google Scholar
  8. 8.
    Hotopf M, Churchill R, Lewis G (1999) Pragmatic randomized controlled trials in psychiatry. Br J Psychiatry 175:217–223PubMedGoogle Scholar
  9. 9.
    Kapur S, Seeman P (2001) Does fast dissociation from the dopamine D-2 receptor explain the action of atypical antipsychotics? A new hypothesis. Am J Psychiatry 158:360–369CrossRefPubMedGoogle Scholar
  10. 10.
    Kapur S, Remington G (2001) Dopamine D-2 receptors and their role in atypical antipsychotic action: Still necessary and may even be sufficient. Biol Psychiatry 50(11):873–883CrossRefPubMedGoogle Scholar
  11. 11.
    Kay SR, Opler LA, Fizbein A (1986) Positive and Negative Syndrome Scale (PANSS) Manual. North Tonawanda, New York, Multi Health Systems, IncGoogle Scholar
  12. 12.
    Leitão R, Ferraz MB, Mari JJ (2002) A prevalence based cost of illness study of schizophrenia in São Paulo State, Brazil. Schizophr Res 53(Suppl 3):259Google Scholar
  13. 13.
    Lingjaerde O, Ahlfors UG, Bech P, et al. (1987) The UKU side effect rating scale. Acta Psychiatr Scand 76(Suppl 334):1–100Google Scholar
  14. 14.
    Llorca PM, Chereeau I, Bayle F, et al. (2002) Tardive dyskinesias and antipsychotics: a review. Eur Psychiatry 17:129–138CrossRefPubMedGoogle Scholar
  15. 15.
    Loza N, El-Dosoky AM, Okasha TA, et al. (1999) Olanzapine compared to chlorpromazine in acute schizophrenia. Eur Neuropsychopharmacol 9(Suppl 5):291Google Scholar
  16. 16.
    Mitchell IJ, Cooper AC, Griffiths MR, et al. (2002) Acute administration of haloperidol induces apoptosis of neuron in the striatum and substantia nigra in the rat. Neuroscience 109(1):89–99Google Scholar
  17. 17.
    Morgenstern H, Glazer WM (1993) Identifying risk factors for tardive dyskinesia among chronic outpatients maintained on neuroleptic medications: results of the Yale tardive dyskinesia study. Arch Gen Psychiatry 50:723–733PubMedGoogle Scholar
  18. 18.
    Schooler NR, Kane JM (1982) Research diagnoses for tardive dyskinesia (letter). Arch Gen Psychiatry 39:486–487Google Scholar
  19. 19.
    Seeman P, Tallerico T (1998) Antipsychotic drugs which elicit little or no Parkinsonism bind more loosely than dopamine to brain D2 receptors, yet occupy high levels of these receptors. Mol Psychiatry 3(2):123–134PubMedGoogle Scholar
  20. 20.
    Seeman P (2002) Atypical antipsychotics: Mechanism of action. Can J Psychiatry 47(1):27–38PubMedGoogle Scholar
  21. 21.
    Tollefson GD, Beasley CM, Tran PV, et al. (1997a) Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry 154(4):457–465 Google Scholar
  22. 22.
    Tollefson GD, Beasley CM, Tamura RN et al. (1997b) Blind, controlled, long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haloperidol. Am J Psychiatry 154(9):1248–1254 Google Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • Jair de Jesus Mari
    • 1
  • M. S. Lima
    • 2
  • A. Niccolai Costa
    • 1
  • N. Alexandrino
    • 3
  • S. Rodrigues–Filho
    • 4
  • I. Reis de Oliveira
    • 5
  • G. D. Tollefson
    • 6
  1. 1.Universidade Federal de São PauloDepartamento de PsiquiatriaSão PauloBrazil
  2. 2.Department of PsychiatryFederal University of Pelotas & Catholic University of PelotasEli LillyBrazil
  3. 3.Hospital Anna RechCaxias do SulRio Grande do SulBrazil
  4. 4.Pax Clinica Psiquiatrica in GoianiaGoiasBrazil
  5. 5.Department of Neuropsychiatry and NeurologyFederal University of BahiaBahiaBrazil
  6. 6.Lilly research LaboratoriesBrazil

Personalised recommendations