A Preliminary Open Trial of Olanzapine in Paediatric Acute and Transient Psychotic Disorders

Article excerpt

Byline: Vivek. Agarwal, Prabhat. Sitholey

Background: Acute and transient psychotic disorders (ATPD) have been characterized by the development of florid psychotic symptoms within 2 weeks and complete remission of symptoms. Although there are no definite guidelines, these are usually treated by antipsychotic medication. Aim: This preliminary study examined the effectiveness of olanzapine in paediatric ATPD. Methods: In this 6-week open trial of olanzapine in paediatric ATPD, the patients were rated weekly on the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) Scale and Dosage Record Treatment Emergent Symptom Scale (DOTES). Results: Twenty-three patients (11 males, 12 females; mean age 14.0[+ or -]1.3 years; range 11-16 years) were included in the study. The mean olanzapine dosage was 12.7[+ or -]3.9 mg/day (range 5-20 mg/day). All the patients showed significant improvement in 6 weeks. The results showed a significant decrease (p< 0.0001) in scores of BPRS (mean at baseline 46.2[+ or -]7.0 to 21.4[+ or -]3.9 at week 6). Severity of illness (CGI) decreased from 4.7[+ or -]0.8 to 1.6[+ or -]0.9 in 6 weeks. Also, global improvement (CGI) showed marked improvement in 14 (60.9%), good improvement in 8 (34.8%) and minimal improvement in 1 (4.3%) patient. Some common side-effects were dryness of mouth (n=14, 60.9%), increase in appetite (n=12, 52%), weight gain (n=12, 52%) and drowsiness (n=8, 34.8%). No patient developed extrapyramidal symptoms. Conclusion: Olanzapine was safe and effective in paediatric ATPD.

Introduction

Acute and transient psychotic disorders (ATPD) have been characterized by the development of florid psychotic symptoms within 2 weeks and complete remission of symptoms.[1] These may or may not be associated with stress. ATPD has been reported to occur more frequently in women, rural populations and developing countries.[2],[3] ATPD may persist for 1-3 months depending upon the specific diagnosis as per ICD-10.[4] A study in 2000 reported 2-4 months' duration of ATPD in both developing and industrialized nations.[5] Although ATPD is self-remitting, it has florid symptoms and it persists long enough to cause impairment to the patient and family. Therefore, ATPD should be treated. Although there are no definite guidelines, it is usually treated by antipsychotic medication. The use of typical antipsychotic drugs in children and adolescents (hereafter referred to as children unless specified) is limited because of the development of extrapyramidal symptoms (EPS), prolactin elevation and cognitive impairment. Atypical antipsychotics are used more often in children because of these drugs have a better tolerability profile.[6]

There are few studies on the use of antipsychotic medication in ATPD in children. An open trial of haloperidol[7] and a placebo-controlled trial of risperidone[8] are the only 2 studies known to the authors. In both the studies, all the children developed EPS and were given anticholinergic medication. Olanzapine, an atypical antipsychotic, has a similar receptor-binding profile as clozapine but produces less adverse effects. Olanzapine has been found safe and effective in the treatment of schizophrenia, bipolar disorder, pervasive developmental disorders and Tourette disorder in the paediatric population.[9] Comparative studies of olanzapine with haloperidol and risperidone in adults have reported it to be better tolerated. Olanzapine produces significantly less EPS and patients require less anticholinergic medication than in the case of haloperidol or risperidone.[10] The risk of new-onset tardive dykinesia was much less with olanzapine than with haloperidol or risperidone.[10] To our knowledge, there is no study of olanzapine in ATPD in children. Therefore, this study aimed to examine the efficacy and tolerability of olanzapine in children and adolescents with acute psychosis.

Methods

Sample

All children aged 6-16 years consecutively attending the child psychiatry department and presenting with symptoms suggestive of ATPD were assessed initially by a psychiatry postgraduate resident and then jointly with VA or PS. …