A Naturalistic Comparison of Clozapine, Risperidone, and Olanzapine in the Treatment of Bipolar Disorder

Department of Psychiatry, Massachusetts General Hospital, Boston, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 10/2000; 61(9):638-42. DOI: 10.4088/JCP.v61n0907
Source: PubMed


Our purpose was to evaluate the overall efficacy and tolerability of novel antipsychotic medications for patients with bipolar disorder type I.
A retrospective study of the Massachusetts General Hospital Bipolar Clinic database was carried out to identify 50 consecutive treatment trials in patients with DSM-IV bipolar disorder type I who had received adjunctive treatment with risperidone, olanzapine, or clozapine, along with standard mood stabilizers. The treatment charts of those patients (N = 42) were reviewed for details of adverse effects, tolerability, and efficacy of medication.
Overall results indicated equivalent efficacy in novel antipsychotic treatments according to change in Clinical Global Impressions scale score. Levels of extrapyramidal symptoms were similar in all groups and occurred in 12/42 patients (28.6%). Prolactin-related side effects were not observed in any patients. There were no cases of affective switch or worsening of mania. Substantial weight gain of more than 10 lb (4.5 kg) was significantly greater in patients treated with olanzapine.
These results suggest that the efficacy and tolerability of risperidone, olanzapine, and clozapine are similar in patients with bipolar disorder. One major differentiation factor of these drugs appears to be weight gain, particularly between olanzapine and risperidone. This may, in part, also be related to the need to use mood-stabilizing agents, like lithium or divalproex sodium, which may potentiate the weight-gain effect of novel antipsychotics.

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    • "This strategy has been widely used in patients with chronic schizophrenia, although the evidence for any beneficial effect, particularly for patients without an affective component, remains inconclusive [24]. While somewhat uncommon in FEP, the technique of combining lithium and atypical antipsychotics has been widely utilised in patients with bipolar disorder with combinations resulting in greater clinical improvements for many patients [25]. Tohen and colleagues [26] demonstrated that in bipolar patients, atypical antipsychotic and lithium combination therapy in patients nonresponsive to lithium or valproate monotherapy led to significant improvements with few additional side effects. "
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    ABSTRACT: Patients experiencing a first psychotic episode have high rates of extrapyramidal symptoms (EPSs) when treated with the doses of neuroleptics used in multiepisode or chronic schizophrenia. There is some evidence that lower doses may be equally, if not more, effective but less toxic in this population. Here, we report the results of a biphasic open label trial designed to assess the efficacy, safety, and tolerability of low-dose (2-4 mg/day) risperidone treatment in a group of 96 first-episode nonaffective psychosis patients. At the end of the trial, 62% of patients met the response criteria although approximately 80% had achieved a response at some time during the study. Reports of EPS remained low, and there were no dystonic reactions. We conclude that even at a dose of 2 mg/day, risperidone was highly effective in reducing acute symptomatology in a real world sample of young first-episode psychosis patients.
    02/2011; 2011(33):631690. DOI:10.1155/2011/631690
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    • "There have been concerns about the long-term use of risperidone with regard to its potential to induce EPS. A naturalistic, retrospective study comparing clozapine, risperidone, and olanzapine found no significant difference in efficacy or occurrence of EPS among the three groups.9 "
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    ABSTRACT: Bipolar disorder is a life-long psychiatric illness characterized by a high frequency of relapses and substantial societal costs. Almost half of the patients are prescribed second generation antipsychotics for treatment of manic states, or as the maintenance therapy. Risperidone long acting injection (RLAI) as a monotherapy or as adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder was approved by Food and Drug Administration (FDA) in United States in May 2009. In this review we will consider the aspects of pharmacology, pharmacokinetics, metabolism, safety and tolerability, and clinical trials focusing on the efficacy of RLAI in bipolar disorder. The patients' perspective and attitudes to long-acting injections will also be discussed.
    Neuropsychiatric Disease and Treatment 09/2010; 6:455-64. DOI:10.2147/NDT.S7608 · 1.74 Impact Factor
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    • "Aumento di peso con olanzapina e risperidone in 50 studi controllati (Guille et al., 2000). "

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