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Olanzapine in Somatic Symptom Disorder

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Olanzapine in Somatic Symptom Disorder e-Poster number EP.1062 Olanzapine in Somatic Symptom Disorder Chioccioli M*, Crapanzano C*, Politano A*, Beccarini Crescenzi B*, Fagiolini A* * AOUS Siena, Department of Molecular Medicine and Development – Psychiatry Section, Siena, Italy. Introduction: Results: Somatic symptom and related disorders (SSD formerly known as Wilcoxon Signed Ranks Test indicates a statistically significant "somatoform disorder" or "somatization disorder") include a (p<0.005) improvement in scores on CGI from T0 (6.14 ± 0.53) group of psychiatric disorders where patients present a wide to T1 (2.00 ± 0.87). Olanzapine average daily dosage per patient range of physical symptoms that are partially or completely was 5.25 mg. Paroxetine was prescribed in 3 patients for consistent with any underlying general medical or neurologic depressive symptoms, with a reduction of olanzapine dose, condition. DSM 5 includes in this category five different owing to the increased blood concentration of olanzapine (up to syndromes: somatic symptom disorder, illness anxiety disorder, 40%) that has been described when this medication is conversion disorder, psychological factors affecting other prescribed in combination with strong inhibitors of CYP2D6 [5]. medical conditions and factitious disorder [1]. Tolerability was good and side effects rated were generally mild Clinical studies and treatment trials for these diseases are (sedation), with no patient that was withdrawn because of it. scarce, with most trials/reports that have focused on antidepressants [2-3]. Other pharmacological classes at the Discussion: moment are less evaluated and only a few reports have focused The clinical improvement achieved by using olanzapine in on the use of olanzapine. patients affected by Somatic Symptom Disorders could be related to its effectiveness on anxiety symptoms, widely Materials and methods: presented by patients, and/or its feature to act upon We conducted an observational study to evaluate olanzapine “disproportionate and persistent concern about the medical efficacy for the treatment of Somatic Symptoms Disorder in seriousness of one’s symptoms”. H1, 5HT-2a,5HT-2c, α1 fourteen patients (mean age: 56 y, 9 males, 5 females) admitted antagonist activity could explain its sedative and anxiolytic action to our Division of Psychiatry from July 2015 to March 2018. All [4]. Anti-D2 effect could contribute to the treatment of partially patients were affected by Somatic Symptoms Disorder and the altered reality testing, affecting a continuum of cognitive most frequent comorbidity was Illness Anxiety Disorder. Oral alteration (prevailing ideation, obsessional and psychotic olanzapine was at a mean dose of 5.9 ± 2.1 mg/die (range: thinking). Based on our experience, olanzapine may be a valid 2.5-10 mg/die). Efficacy was assessed by the Clinical Global pharmacological choice for treating anxiety SSD, owing to its Impression scale (CGI), which was completed at each efficacy on anxiety and psychotic symptoms. However, our study psychiatric evaluation. Olanzapine efficacy was measured as a has several limitations, including retrospective design, small change in the CGI total score from baseline T0 (i.e. when sample size, use of several concomitant medications, lack of olanzapine was started) to T1 (week 4, i.e. after 4 week of randomization and control condition. Larger, prospective, treatment with olanzapine). randomized trials are warranted to confirm our preliminary observations. Olanzapine daily average dosage (mg) for patient Efficacy of treatment evalued by CGI 100% Frequency 50% 14 12 0% 10 2,5 Frequency % 5 7,5 8 10 Olanzapine average dose (mg/die) 6 T1 4 T0 2 References 0 T0 (1) American Psychiatric Association (2013a). Diagnostic and Statistical Manual of Mental Sample T1 Disorders, Fifth Edition (DSM-5). Washington, D.C.: APA Average CGI (2) Kroenke, K., 2007. Efficacy of treatment for somatoform disorders: a review of randomized Minimum CGI Maximum controlled trials. Psychosom Med 69(9):881-8. CGI (3) Sumathipala, A., 2007. What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med 69(9):889-900. (4) Bymaster, FP., Calligaro, DO., Falcone, JF., Marsh, RD., The Moore, NA., Tye, NC., Seeman, P., Wong, DT., 1996. Radioreceptor binding profile of the atypical antipsychotic olanzapine. Copyright © 2018 No potential conflict of interest Neuropsychopharmacology 14, 87–96. Chioccioli Marco, Crapanzano Calogero, Politano Andrea, Beccarini Crescenzi Bruno, Fagiolini Andrea (5) Olesen, OV., Linnet K., 1999. Olanzapine serum concentrations in psychiatric patients given Siena University, Department of Molecular Medicine and Development, Psychiatry Section standard doses: The influence of comedication. Ther Drug Monit 21:87–90. Phone: 00390577233435 [email protected] .
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