Olanzapine compared to quetiapine in adolescents with a first psychotic episode

  • Celso Arango
  • Olalla Robles
  • Mara Parellada
  • David Fraguas
  • Ana Ruiz-Sancho
  • Oscar Medina
  • Arantzazu Zabala
  • Igor Bombín
  • Dolores Moreno



To compare the efficacy, safety, and tolerability of olanzapine and quetiapine in adolescents with first episode psychosis.


Fifty adolescents (age 16 ± 1.25) with a first episode of psychosis were randomized to quetiapine or olanzapine in a 6-month open label study. Efficacy and side effect scales, as well as vital signs and laboratory data were recorded at baseline, 7, 15, 30, 90, and 180 days (end of study).


Out of the total sample included in the study, 32 patients completed the trial (quetiapine n = 16, olanzapine n = 16). Patients in both treatment groups had a significant reduction in all clinical scales with the exception of the negative scale of the Positive and Negative Symptom Scale (PANSS) for olanzapine and the general psychopathology scale of the PANSS for quetiapine. The only difference between treatment arms on the clinical scales was observed on the patients’ strength and difficulties questionnaire (SDQ) scale, with greater improvement for olanzapine. Patients on olanzapine gained 15.5 kg and patients on quetiapine gained 5.5 kg.


Olanzapine and quetiapine reduced psychotic symptoms in this adolescent sample. Patients on olanzapine gained significantly more weight. Side effects with both drugs seemed to be more prevalent than those reported in adult studies.


olanzapine quetiapine safety tolerability adolescent first episode psychosis 


  1. 1.
    Arango C, Parellada M, Moreno DM (2004) Clinical effectiveness of new generation antipsychotics in adolescent patients. Eur Neuropsychopharmacol 14:S471–S479PubMedCrossRefGoogle Scholar
  2. 2.
    Barnes TR (2003) The Barnes Akathisia rating scale—revisited. J Psychopharmacol 17:365–370PubMedCrossRefGoogle Scholar
  3. 3.
    Conley RR, Kelly DL (2005) Second-generation antipsychotics for schizophrenia: a review of clinical pharmacology and medication-associated side effects. Isr J Psychiatry Relat Sci 42:51–60PubMedGoogle Scholar
  4. 4.
    Correll CU, Malhotra AK (2004) Pharmacogenetics of antipsychotic-induced weight gain. Psychopharmacology (Berl) 174:477–489CrossRefGoogle Scholar
  5. 5.
    Correll CU, Penzner JB, Parikh UH, Mughal T, Javed T, Carbon M, Malhotra AK (2006) Recognizing and monitoring adverse events of second-generation antipsychotics in children and adolescents. Child Adolesc Psychiatr Clin N Am 15:177–206PubMedCrossRefGoogle Scholar
  6. 6.
    Charach A, Volpe T, Boydell KM, Gearing RE (2008) A theoretical approach to medication adherence for children and youth with psychiatric disorders. Harv Rev Psychiatry 16:126–135PubMedCrossRefGoogle Scholar
  7. 7.
    Fedorowicz VJ, Fombonne E (2005) Metabolic side effects of atypical antipsychotics in children: a literature review. J Psychopharmacol 19:533–550PubMedCrossRefGoogle Scholar
  8. 8.
    Findling RL (2005) Update on the treatment of bipolar disorder in children and adolescents. Eur Psychiatry 20:87–91PubMedCrossRefGoogle Scholar
  9. 9.
    Findling RL, McNamara NK, Youngstrom EA, Branicky LA, Demeter CA, Schulz SC (2003) A prospective, open-label trial of olanzapine in adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 42:170–175PubMedCrossRefGoogle Scholar
  10. 10.
    Fraguas D, Merchan-Naranjo J, Laita P, Parellada M, Moreno D, Ruiz-Sancho A, Cifuentes A, Giraldez M, Arango C (2008) Metabolic and hormonal side effects in children and adolescents treated with second-generation antipsychotics. J Clin Psychiatry 69:1166–1175PubMedCrossRefGoogle Scholar
  11. 11.
    Goodman R (1999) The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40:791–799PubMedCrossRefGoogle Scholar
  12. 12.
    Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586PubMedCrossRefGoogle Scholar
  13. 13.
    Gothelf D, Apter A, Reidman J, Brand-Gothelf A, Bloch Y, Gal G, Kikinzon L, Tyano S, Weizman R, Ratzoni G (2003) Olanzapine, risperidone and haloperidol in the treatment of adolescent patients with schizophrenia. J Neural Transm 110:545–560PubMedCrossRefGoogle Scholar
  14. 14.
    Guy W (1976) Clinical Global Impression. ECDEU Assessment Manual for Psychopharmacology revised. National Institute of Mental Health, RockvilleGoogle Scholar
  15. 15.
    Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 6:278–296PubMedGoogle Scholar
  16. 16.
    Jones PB, Barnes TR, Davies L, Dunn G, Lloyd H, Hayhurst KP, Murray RM, Markwick A, Lewis SW (2006) 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 study (CUtLASS 1). Arch Gen Psychiatry 63:1079–1087PubMedCrossRefGoogle Scholar
  17. 17.
    Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, Gheorghe MD, Rybakowski JK, Galderisi S, Libiger J, Hummer M, Dollfus S, Lopez-Ibor JJ, Hranov LG, Gaebel W, Peuskens J, Lindefors N, Riecher-Rossler A, Grobbee DE (2008) Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 371:1085–1097PubMedCrossRefGoogle Scholar
  18. 18.
    Kay SR, Opler LA, Lindenmayer JP (1989) The positive and negative syndrome scale (PANSS): rationale and standardisation. Br J Psychiatry Suppl, pp 59–67Google Scholar
  19. 19.
    Keefe RS, Sweeney JA, Gu H, Hamer RM, Perkins DO, McEvoy JP, Lieberman JA (2007) Effects of olanzapine, quetiapine, and risperidone on neurocognitive function in early psychosis: a randomized, double-blind 52-week comparison. Am J Psychiatry 164:1061–1071PubMedCrossRefGoogle Scholar
  20. 20.
    Kopala LC, Good KP, Milliken H, Buiteman C, Woodley H, Rui Q, Whitehorn D, Love L, Balshaw R, Kiss I, Honer WG (2006) Treatment of a first episode of psychotic illness with quetiapine: an analysis of 2 year outcomes. Schizophr Res 81:29–39PubMedCrossRefGoogle Scholar
  21. 21.
    Kumra S, Frazier JA, Jacobsen LK, McKenna K, Gordon CT, Lenane MC, Hamburger SD, Smith AK, Albus KE, Alaghband-Rad J, Rapoport JL (1996) Childhood-onset schizophrenia. A double-blind clozapine-haloperidol comparison. Arch Gen Psychiatry 53:1090–1097PubMedGoogle Scholar
  22. 22.
    Laita P, Cifuentes A, Doll A, Llorente C, Cortes I, Parellada M, Moreno D, Ruiz-Sancho A, Graell M, Arango C (2007) Antipsychotic-related abnormal involuntary movements and metabolic and endocrine side effects in children and adolescents. J Child Adolesc Psychopharmacol 17:487–502PubMedCrossRefGoogle Scholar
  23. 23.
    Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353:1209–1223PubMedCrossRefGoogle Scholar
  24. 24.
    Lieberman JA, Tollefson G, Tohen M, Green AI, Gur RE, Kahn R, McEvoy J, Perkins D, Sharma T, Zipursky R, Wei H, Hamer RM (2003) Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol. Am J Psychiatry 160:1396–1404PubMedCrossRefGoogle Scholar
  25. 25.
    Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K (1987) 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 334:1–100PubMedCrossRefGoogle Scholar
  26. 26.
    McConville B, Carrero L, Sweitzer D, Potter L, Chaney R, Foster K, Sorter M, Friedman L, Browne K (2003) Long-term safety, tolerability, and clinical efficacy of quetiapine in adolescents: an open-label extension trial. J Child Adolesc Psychopharmacol 13:75–82PubMedCrossRefGoogle Scholar
  27. 27.
    McConville BJ, Arvanitis LA, Thyrum PT, Yeh C, Wilkinson LA, Chaney RO, Foster KD, Sorter MT, Friedman LM, Brown KL, Heubi JE (2000) Pharmacokinetics, tolerability, and clinical effectiveness of quetiapine fumarate: an open-label trial in adolescents with psychotic disorders. J Clin Psychiatry 61:252–260PubMedGoogle Scholar
  28. 28.
    Mozes T, Ebert T, Michal SE, Spivak B, Weizman A (2006) An Open-label randomized comparsion of olanzapine versus risperidone in the treatment of childhood-onset schizophrenia. J Child Adolesc Psychopharmacol 16:393–403PubMedCrossRefGoogle Scholar
  29. 29.
    Mozes T, Toren P, Chernauzan N, Mester R, Yoran-Hegesh R, Blumensohn R, Weizman A (1994) Clozapine treatment in very early onset schizophrenia. J Am Acad Child Adolesc Psychiatry 33:65–70PubMedCrossRefGoogle Scholar
  30. 30.
    Naber D, Karow A, Lambert M (2005) Subjective well-being under the neuroleptic treatment and its relevance for compliance. Acta Psychiatr Scand Suppl, pp 29–34Google Scholar
  31. 31.
    Naber D, Moritz S, Lambert M, Pajonk FG, Holzbach R, Mass R, Andresen B (2001) Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs. Schizophr Res 50:79–88PubMedCrossRefGoogle Scholar
  32. 32.
    Olfson M, Blanco C, Liu L, Moreno C, Laje G (2006) National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 63:679–685PubMedCrossRefGoogle Scholar
  33. 33.
    Purdon SE, Snaterse M (1998) Selective serotonin reuptake inhibitor modulation of clozapine effects on cognition in schizophrenia. Can J Psychiatry 43:84–85PubMedGoogle Scholar
  34. 34.
    Sengupta SM, Klink R, Stip E, Baptista T, Malla A, Joober R (2005) Weight gain and lipid metabolic abnormalities induced by olanzapine in first-episode, drug-naive patients with psychotic disorders. Schizophr Res 80:131–133PubMedCrossRefGoogle Scholar
  35. 35.
    Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatry 40:1228–1231PubMedGoogle Scholar
  36. 36.
    Shaw JA, Lewis JE, Pascal S, Sharma RK, Rodriguez RA, Guillen R, Pupo-Guillen M (2001) A study of quetiapine: efficacy and tolerability in psychotic adolescents. J Child Adolesc Psychopharmacol 11:415–424PubMedCrossRefGoogle Scholar
  37. 37.
    Shaw P, Sporn A, Gogtay N, Overman GP, Greenstein D, Gochman P, Tossell JW, Lenane M, Rapoport JL (2006) Childhood-onset schizophrenia: a double-blind, randomized clozapine-olanzapine comparison. Arch Gen Psychiatry 63:721–730PubMedCrossRefGoogle Scholar
  38. 38.
    Sikich L, Hamer RM, Bashford RA, Sheitman BB, Lieberman JA (2004) A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: a double-blind, randomized, 8-week trial. Neuropsychopharmacology 29:133–145PubMedCrossRefGoogle Scholar
  39. 39.
    Simpson GM, Angus JW (1970) A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 212:11–19PubMedCrossRefGoogle Scholar
  40. 40.
    Velligan DI, Newcomer J, Pultz J, Csernansky J, Hoff AL, Mahurin R, Miller AL (2002) Does cognitive function improve with quetiapine in comparison to haloperidol? Schizophr Res 53:239–248PubMedCrossRefGoogle Scholar
  41. 41.
    Voruganti LP, Awad AG, Parker G, Forrest C, Usmani Y, Fernando ML, Senthilal S (2007) Cognition, functioning and quality of life in schizophrenia treatment: results of a one-year randomized controlled trial of olanzapine and quetiapine. Schizophr Res 96:146–155PubMedCrossRefGoogle Scholar
  42. 42.
    Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133:429–435PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2009

Authors and Affiliations

  • Celso Arango
    • 1
  • Olalla Robles
    • 1
  • Mara Parellada
    • 1
  • David Fraguas
    • 2
  • Ana Ruiz-Sancho
    • 1
  • Oscar Medina
    • 1
  • Arantzazu Zabala
    • 1
  • Igor Bombín
    • 3
  • Dolores Moreno
    • 1
  1. 1.Psychiatry Department, Adolescent UnitHospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
  2. 2.Department of PsychiatryHospital Infanta SofiaMadridSpain
  3. 3.Neurological Rehabilitation CenterOviedoSpain

Personalised recommendations