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Background: The second-generation antipsychotic drug olanzapine is an effective pharmacological treatment for psychosis. However, use of the drug is commonly associated with a range of metabolic side effects, including glucose intolerance and insulin resistance. These symptoms have been accurately modelled in rodents. Methods: We compared the effects of 3 distinct classes of anti diabetic drugs, metformin (100 and 500 mg/kg, oral), rosiglitazone (6 and 30 mg/kg, oral) and glyburide (2 and 10 mg/kg, oral), on olanzapine-induced metabolic dysregulation. After acutely treating female rats with lower (7.5 mg/kg) or higher (15 mg/kg) doses of olanzapine, we assessed glucose intolerance using the glucose tolerance test and measured insulin resistance using the homeostatic model assessment of insulin resistance equation. Results: Both doses of olanzapine caused pronounced glucose dysregulation and insulin resistance, which were significantly reduced by treatment with metformin and rosiglitazone; however, glucose tolerance did not fully return to control levels. In contrast, glyburide failed to reverse the glucose intolerance caused by olanzapine despite increasing insulin levels. Limitations: We evaluated a single antipsychotic drug, and it is unknown whether other antipsychotic drugs are similarly affected by anti diabetic treatments. Conclusion: The present study indicates that oral hypoglycemic drugs that influence hepatic glucose metabolism, such as metformin and rosiglitazone, are more effective in regulating olanzapine-induced glucose dysregulation than drugs primarily affecting insulin release, such as glyburide. The current model may be used to better understand the biological basis of glucose dysregulation caused by olanzapine and how it can be reversed. [ABSTRACT FROM AUTHOR]

The article presents a consensus statement from the Treatment Response and Resistance in Psychosis working group regarding the use of clozapine as treatment of psychiatric disorders like schizophrenia during the COVID-19 pandemic. Other topics include absolute neutrophil count (ANC) monitoring programs for clozapine dispensation, and the recommendations like the reduction of ANC monitoring and the reduction of clozapine dosage if fever and flu-like symptoms appear.

The article describes the case of a 59 year old woman presented to a tertiary care refractory psychosis unit with referral diagnosis of schizoaffective disorder. A urinary tract infection (UTI) was diagnosed and nitrofurantoin and cotrimoxaxole were initiated while clozapine and norclozapine plasma concentrations were decreased after a week of antibiotic therapy. It cites the need for clinicians to monitor for clozapine-associated adverse effects and adjust dosage accordingly.