The use of olanzapine in non-compliant or treatment resistant clozapine populations in hospital

AIM: To record any evidence of a treatment effect with olanzapine in patients who had been withdrawn from clozapine for a variety of reasons (category A) or were resistant to conventional antipsychotics and were clozapine naive (Category B). DESIGN: Retrospective study. SUBJECTS AND SETTING: 16 category A and 7 category B patients prescribed olanzapine between October, 1996, and June, 1997, at St Andrew's hospital, Northampton. OUTCOME MEASURES: Incidence of side effects, reasons for discontinuation, and treatment response with olanzapine (based on responsible consultant psychiatrist's subjective impression of improvement in mental state). RESULTS: Olanzapine demonstrated an acceptable degree of overall tolerability. Only one patient was discontinued from the drug due to the experience of side effects (skin rash). The most common reason for withdrawal of treatment was patient refusal (4 patients). The same 4 patients had similarly refused clozapine. Six of the patients in Category A (38 per cent) and 5 of patients in Category B (71 per cent) were judged to have demonstrated moderate to marked improvement in their mental state. CONCLUSIONS: Olanzapine appears to offer a promising new option for treating resistant schizophrenia. This is a result of specific pharmacological properties but is also due to the drug's acceptable degree of tolerability. A depot preparation of an atypical antipsychotic medication seems the next logical step.