Broadmoor Hospital, West London Mental Health NHS Trust, UK.
Consultant Psychiatrist, Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK.
Ther Adv Psychopharmacol. 2014 Oct;4(5):186-92. doi: 10.1177/2045125314531982.
Oral olanzapine is a well-established treatment for patients suffering from schizophrenia. Advantages of depot olanzapine may include improved compliance. However, it is expensive, causes metabolic side effects, and carries a risk of postinjection syndrome. Clinical trials have shown olanzapine pamoate to be effective, but further work is needed in this area. This study was a retrospective service evaluation, carried out in a high-security hospital, where the majority of patients have complex, treatment resistant schizophrenia spectrum disorder and a very high propensity for violence. Compliance is a significant problem, both in the high-security setting and on discharge. There has been no previous published work that the authors are aware of evaluating the effects of olanzapine pamoate in this subgroup of patients.
The aim of the study was to evaluate the clinical efficacy of olanzapine pamoate, its effect on violence as well as its side effects, in a high-security setting for the first time. Anonymized patient records were used to identify the main outcome measure and clinical global improvement, and to ascertain secondary outcome measures which included seclusion hours, risk of violence and side effects. Metabolic parameters and number of incidents were also recorded. Eight patients were treated with olanzapine pamoate.
Six showed an improvement in symptoms, with an associated decrease in violence and number of incidents. Four showed an associated decrease in seclusion hours. Two showed an increase in body mass index and two showed an increase in glucose.
The findings of this study are important in showing that all patients who responded to olanzapine pamoate also showed a decrease in violent behaviour. The potential anti-aggression effects of olanzapine pamoate may represent a very promising area for further work. A depot antipsychotic medication that reduces violence could have significant implications for management of high-security patients.
奥氮平口服制剂是治疗精神分裂症患者的成熟疗法。长效奥氮平的优势可能包括提高依从性。然而，其价格昂贵，会引起代谢副作用，并存在注射后综合征风险。临床试验表明奥氮平癸酸酯有效，但该领域还需要进一步研究。本研究为回顾性服务评估，在一家高度戒备的医院进行，该医院的大多数患者都患有复杂、治疗抵抗的精神分裂症谱系障碍，且暴力倾向极高。在高度戒备的环境中和出院后，患者的依从性都是一个重大问题。据作者所知，以前没有发表过评估奥氮平癸酸酯在这组患者中的疗效的研究。
该研究旨在首次评估奥氮平癸酸酯在高度戒备环境中的临床疗效、对暴力行为的影响及其副作用。使用匿名患者记录来确定主要结局指标和临床总体改善，并确定包括隔离时间、暴力风险和副作用在内的次要结局指标。还记录了代谢参数和事件数量。8 名患者接受了奥氮平癸酸酯治疗。
6 名患者的症状改善，暴力行为和事件数量减少。4 名患者的隔离时间减少。2 名患者的体重指数增加，2 名患者的血糖增加。
本研究的发现很重要，表明所有对奥氮平癸酸酯有反应的患者的暴力行为也都有所减少。奥氮平癸酸酯的潜在抗攻击作用可能是进一步研究的一个很有前途的领域。一种能减少暴力行为的长效抗精神病药物可能对高度戒备患者的管理具有重要意义。
