Comparison of Olanzapine versus Other Second-Generation Antipsychotics in the Improvement of Insight and Medication Discontinuation Rate in Schizophrenia

In the last decade, olanzapine became widely used in mental health service worldwide even after being criticized for its metabolic side effects. Patients with schizophrenia on olanzapine were usually found to stay on their medications longer than the other second-generation antipsychotics (SGAs) except clozapine. The reason for this is unknown.This prospective study compared the influences of olanzapine and other SGAs except clozapine on improving insight and medication discontinuation rate in schizophrenia.A total of 148 patients with schizophrenia medically indicated for initiation of treatment with olanzapine or other SGAs were evaluated for symptoms, insight, attitudes toward medication, side effects, body weight and fasting lipid and glucose parameters at admission and before discharge, and follow-up calls one-year after discharge documented whether they were regularly taking prescribed psychotropic medication or not.After an average of 72.8 days of inpatient treatment, the olanzapine and other SGAs group exhibited similar levels of symptom improvement with an average reduction of 28.7 in the Positive and Negative Syndrome Scale (PANSS) total score. The Olanzapine group exhibited better improvement in insight assessed using the G12 item of PANSS and Insight and Treatment Attitudes Questionnaire (ITAQ), more metabolic side effects indexed with total cholesterol, triglycerides levels and weight gain, and a lower medication discontinuation rate than the other SGAs group.Although general symptom improvement was similar, olanzapine significantly improved insight and presented less medication discontinuation compared to other SGAs, which might partially explain why patients on olanzapine stayed longer on their medications.在过去10 年中，奥氮平即使被指出具有代谢副 作用但依然被广泛应用于精神卫生服务中。服用奥氮 平的精神分裂症患者通常服药时间比除了氯氮平外的 其他二代抗精神病药物（SGAs）更长，而原因不明。.该前瞻性研究旨在比较奥氮平与其他除氯氮平 以外的二代抗精神病药物（SGAs）治疗对改善精神分 裂症患者自知力和药物停药率的影响。.共有148 例精神分裂症患者起始治疗就采用奥 氮平或其他SGAs，对他们进行评估入院前和出院前的 症状、自知力、用药态度、副作用、体重和空腹血脂 和血糖参数。出院后一年的随访电话包括是否定期服 用精神药物。.平均72.8 天的住院治疗后，奥氮平和其他SGA 组表现的症状改善水平相似，阳性和阴性症状量表 （PANSS）总分平均减少28.7。采用PANSS 的G12 项 目和自知力及治疗态度问卷（ITAQ）评估后奥氮平组 自知力方面有了更好的改善，总胆固醇、甘油三酯水平、 和体重增加引起的代谢副作用更多，而药物停药率比 其他二代抗精神病药物组低。.虽然奥氮平和其他二代抗精神病药物对一般症 状的改善相差不大，但是奥氮平比其他SGAs 明显改善 了自知力并且停药率也较低，这可能部分解释了为什 么患者服用奥氮平的时间会更长。.