Intramuscular olanzapine in patients with schizophrenia: an observational study in an emergency room.
BACKGROUND
Between 2001 and 2005 important changes were observed in expert opinion about the clinical management of patients with schizophrenia (SCZ) and agitation requiring an IM psychotropic, with a growing interest for IM atypical antipsychotics.


OBJECTIVE
In an effort to acquire a typical, medically and psychiatrically unselected population of severely agitated patients with SCZ, we conducted a naturalistic study in an emergency setting, consecutively enrolling agitated patients who refused oral treatment.


METHODS
Measures were collected prospectively for patients with acute agitation and schizophrenia (DSM IV diagnosis criteria) who consulted consecutively two ED: one in Belgium and the other one in Switzerland. Consent was obtained subsequently. A group of 40 patients with severe agitation and SCZ received olanzapine 10 mg IM. Efficacy and safety data (blood pressure, pulse, extrapyramidal symptoms) were assessed at baseline, two hours post-injection and at discharge.


RESULTS
Significant reductions of agitation associated with good tolerance were observed two hours after the first IM olanzapine (PANSS EC declined from 28.6 +/- 4.13 to 16.8 +/- 4.8). Only 5% of patients required a second IM olanzapine. The absence of clinically significant extrapyramidal and cardiovascular side effects is promising, but considering the statistically significant reduction of systolic and diastolic blood pressure and pulse, vital signs should be checked especially in the first 2 hours post injection.


CONCLUSIONS
This naturalistic study suggest a promising efficacy and safety balance of intramuscular olanzapine in patients with acute agitation and schizophrenia in emergency.
Damsa
Cristian
C
Service d'urgences, Cantonal Universitary Hospital Geneva, 24, rue Micheli-du-Crest, 1211 Geneva, Switzerland. c.damsa@bluewin.ch
Adam
Eric
E
Lazignac
Coralie
C
De Gregorio
François
F
Mihai
Adriana
A
Lejeune
Jean
J
Sarasin
François
F
Allen
Michael H
MH
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016292:Procedural Sedation / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012449:Safety; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine