0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Dr. Buchanan and Colleagues Reply
ROBERT W. BUCHANAN, M.D.; M. PATRICIA BALL, R.N.; ELAINE WEINER, M.D.
Am J Psychiatry 2005;162:1393-1393. doi:10.1176/appi.ajp.162.7.1393

To the Editor: Drs. de Haan and van Beveren raise two points concerning our recent article on the comparative efficacy of olanzapine and haloperidol for residual positive or negative symptoms. First, they note that in the abstract of our article we stated that "Olanzapine has limited differential benefit for either positive or negative symptoms in patients with treatment-resistant schizophrenia" (p. 124). They suggest that the proper conclusion should be that "olanzapine has no benefit over haloperidol." The qualification in our statement reflects the fact that our study is not the only one to have addressed this issue. In our Discussion section, we reviewed two studies that asserted a benefit for olanzapine in this population (1, 2). Although we believe that these studies have serious methodological flaws, they remain in contradistinction to our results. Second, Drs. de Haan and van Beveren suggest that the mean doses of haloperidol and olanzapine achieved in our study result in noncomparable D2 receptor occupancy, with the haloperidol dose associated with increased D2 receptor occupancy, which could potentially lead to increased extrapyramidal symptoms, dysphoria, and secondary negative symptoms. Although we agree with the theoretical concern, we note that the haloperidol-treated patients did not exhibit a mean worsening of either extrapyramidal symptoms or depressive symptoms (as measured by the Hamilton Depression Scale) nor a worsening of negative symptoms (Tables 2 and 3). The alternative concern, which we raised in our Discussion section, is that the olanzapine dose was relatively low for this population. A higher olanzapine dose may have led to increased symptomatic improvement.

Breier A, Hamilton SH: Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia. Biol Psychiatry  1999; 45:403–411
[PubMed]
[CrossRef]
 
Tollefson GD, Birkett MA, Kiesler GM, Wood AJ (Lilly Resistant Schizophrenia Study Group): Double-blind comparison of olanzapine versus clozapine in schizophrenic patients clinically eligible for treatment with clozapine. Biol Psychiatry  2001; 49:52–63
[PubMed]
[CrossRef]
 
+

References

Breier A, Hamilton SH: Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia. Biol Psychiatry  1999; 45:403–411
[PubMed]
[CrossRef]
 
Tollefson GD, Birkett MA, Kiesler GM, Wood AJ (Lilly Resistant Schizophrenia Study Group): Double-blind comparison of olanzapine versus clozapine in schizophrenic patients clinically eligible for treatment with clozapine. Biol Psychiatry  2001; 49:52–63
[PubMed]
[CrossRef]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 26.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 26.  >
APA Practice Guidelines > Chapter 7.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 10.  >
Topic Collections
Psychiatric News
APA Guidelines