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BackgroundSubstantial weight gain is common with many atypical antipsychotics.AimsTo evaluate the extent, time course and predictors of weight gain and its effect on study retention among people with first-episode psychosis treated with olanzapine or haloperidol.MethodSurvival analysis assessed time to potentially clinically significant weight gain (⩾7%) and the effect of weight gain on study retention. Weight gain during the 2-year study was summarised using last-observation-carried-forward (LOCF), observed cases and study completion approaches.ResultsAfter 2 years of treatment, LOCF mean weight gain was 10.2 kg (s.d.=10.1) for olanzapine (n=131) and 4.0 kg (s.d.=7.3) for haloperidol (n=132); observed cases mean weight gain was 15.4 kg (s.d.=10.0) for olanzapine and 7.5 kg (s.d.=9.2) for haloperidol. Change in body mass index was significantly predicted only by treatment group (P< 0.0001).ConclusionsOlanzapine was associated with significantly greater weight gain than haloperidol, with both leading to greater weight gain than previously described.

BackgroundData concerning appropriate treatment in panic disorder following an initial response to acute therapy are limited.AimsTo assess the safety and efficacy of continued fluoxetine treatment following successful acute therapy of panic disorder.MethodPatients who responded to acute fluoxetine treatment were randomised to 24 weeks of continued fluoxetine or placebo.ResultsFluoxetine responders randomised to continue on their acute-phase fluoxetine dose experienced statistically significant improvement in panic attack frequency and phobia rating scale score over 24 weeks of therapy, while those switched to placebo experienced statistically significant worsening in Hamilton Anxiety (HAM–A), Hamilton Depression (HAM–D) and SCL–90–R rating scores.ConclusionsFluoxetine was associated with improved clinical outcomes compared with placebo during continuation therapy.

Olanzapine is a novel antipsychotic agent displaying a unique and pleotrophic pharmacology, which distinguishes it from other existing treatments. Clinical investigations employing olanzapine have demonstrated a number of potential therapeutic advantages in reference not only to placebo but also to contemporary drug standards in the management of psychosis. This paper reviews data on the pharmacokinetics, efficacy and safety of olanzapine, its benefits for quality of life, and economic aspects to assist clinicians in determining where they can usefully employ it.

BackgroundTardive dyskinesia is important in the side-effect profile of antipsychotic medication.AimsThe development of tardive dyskinesia was evaluated in patients treated with double-blind, randomly assigned olanzapine or haloperidol for up to 2.6 years.MethodsTardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS) and Research Diagnostic Criteria for Tardive Dyskinesia (RD-TD); it was defined as meeting RD-TD criteria at two consecutive assessments. The risk of tardive dyskinesia, the relative risk, incidence rate, and incidence rate ratio were estimated.ResultsThe relative risk of tardive dyskinesia for the overall follow-up period for haloperidol (n=522) v. olanzapine (n=1192) was 2.66 (95% CI=1.50–4.70). Based on data following the initial six weeks of observation (during which patients underwent medication change and AIMS assessments as frequently as every three days), the one-year risk was 0.52% with olanzapine (n=513) and 7.45% with haloperidol (n=114). The relative risk throughout this follow-up period was 11.37 (95% Cl=2.21–58.60).ConclusionOur results indicated a significantly lower risk of tardive dyskinesia with olanzapine than with haloperidol.

The augmentation of serotonin (5-HT) neurotransmission attenuates alcohol consumption, whereas depletion enhances use. A number of serotonin-specific pharmacological probes appear to be effective in reducing the voluntary consumption of alcohol. The 5-HT1Areceptor agonist buspirone is an anxiolytic which has been shown to diminish the desire to consume alcohol in anxious alcoholic patients. Thus, serotonin may represent a common denominator for a spectrum of behavioural disorders including anxiety and alcoholism. Novel serotonin drugs, such as the azapirones, may usefully supplement conventional treatment strategies for substance abuse.