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Olanzapine or chlorpromazine plus lithium in first episode psychotic mania: An 8-week randomised controlled trial

Published online by Cambridge University Press:  21 October 2015

P. Conus ,
M. Berk ,
S.M. Cotton ,
L. Kader ,
C. Macneil ,
M.K. Hasty ,
K. Hallam ,
M. Lambert ,
B.P. Murphy  and
P.D. McGorry
P. Conus*
Affiliation:
Treatment and Early Intervention in Psychosis Program (TIPP), département de psychiatrie CHUV, université de Lausanne, clinique de Cery, 1008Prilly, Switzerland Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
M. Berk
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, Australia Mental Health Research Institute, Parkville, Australia
S.M. Cotton
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
L. Kader
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
C. Macneil
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
M.K. Hasty
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
K. Hallam
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
M. Lambert
Affiliation:
Department for Psychiatry and Psychotherapy, Psychosis Early Detection and Intervention Centre (PEDIC), Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
B.P. Murphy
Affiliation:
Faculty of Medicine, Nursing and Health Sciences, School of Psychology, Psychiatry and Psychological Medicine, Monash University, 3800Victoria, Australia
P.D. McGorry
Affiliation:
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
*
⁎Corresponding author. Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, département psychiatrie CHUV, université Lausanne, clinique de Cery, 1008 Prilly, Switzerland. Tel.: +41 21 314 31 11; fax: +41 21 314 29 67. E-mail address:philippe.conus@chuv.ch (P. Conus).
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Abstract

Background

Treatment strategies for mental disorders may vary according to illness stage. However no data currently exist to guide treatment in first episode psychotic mania. The aim of this study was to compare the safety and efficacy profile of chlorpromazine and olanzapine, as add-on to lithium, in patients with a first episode of psychotic mania, expecting better safety profile and adherence to olanzapine but similar efficacy for both treatments.

Methods

Data from 83 patients were collected in an 8-week randomised controlled trial on clinical variables, side effects, vital signs, and weight. Analyses of treatment differences over time were based on intent-to-treat principles. Kaplan-Meier estimated survival curves were used to analyse time-to-event data and mixed effects models repeated measures analysis of variance were used to determine treatment group differences over time on safety and efficacy measures.

Results

Ethics committee approval to delay informed consent procedure until recovery from the acute episode allowed the inclusion of 83 patients highly representative of those treated in the public sector. Contrary to our hypotheses, safety profile of both medications was similar. A signal for higher rate (P=.032) and earlier occurrence (P= .043) of mania remission was observed in the olanzapine group which did not survive correction for multiple comparisons.

Conclusions

Olanzapine and chlorpromazine have a similar safety profile in a uniquely representative cohort of patients with first episode psychotic mania. The possibility for a greater impact of olanzapine on manic symptoms leading to earlier remission of the episode needs exploration in a large sample.

Keywords

Bipolar disorderManiaFirst episodePsychosisAntipsychotic treatment
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 8 , November 2015 , pp. 975 - 982
Copyright
Copyright © European Psychiatric Association 2020

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Footnotes

☆

Clinical trial registration number (http://www.ClinicalTrials.gov): NCT00202293.

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