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Olanzapine and Haloperidol for Residual Symptoms

To the Editor: Robert W. Buchanan, M.D., and colleagues (1) conducted an important study on the comparative effect of olanzapine and haloperidol on residual positive and negative symptoms in 63 outpatients with treatment-resistant schizophrenia. They concluded that olanzapine has limited differential benefit for positive and negative symptoms in these patients. However, we think that the correct conclusion must be that olanzapine has no benefit over haloperidol. Namely, the authors could not find superior efficacy for olanzapine for positive and negative symptoms, and the main side effects (extrapyramidal symptoms for haloperidol and weight gain for olanzapine) seem to balance each other out. The authors stated that "the magnitude of weight gain...may potentially offset the more benign extrapyramidal symptom profile of olanzapine" (p. 128). Furthermore, we would like to point out that the mean doses of olanzapine (20.3 mg/day) and haloperidol (18.3 mg/day) resulted in noncomparable dopamine D₂ receptor occupancy. For almost all patients receiving a dose of about 18 mg/day of haloperidol, the balance between efficacy and extrapyramidal side effects is not optimal (2, 3). Haloperidol at lower doses is thought to induce fewer extrapyramidal side effects and fewer neuroleptic-induced negative symptoms and dysphoria (4) without a change in efficacy on positive symptoms (2). Lower haloperidol doses might even further diminish the benefit of olanzapine for extrapyramidal symptoms.

Therefore, the sobering conclusion of this study seems to be that neither olanzapine nor haloperidol shows benefits for outpatients with schizophrenia who met criteria for either residual positive or residual negative symptoms.

References

1. Buchanan RW, Ball MP, Weiner E, Kirkpatrick B, Gold JM, McMahon RP, Carpenter WT Jr: Olanzapine treatment of residual positive and negative symptoms. Am J Psychiatry 2005; 162:124–129[Abstract/Free Full Text]
2. Bollini P, Pampallona S, Orza MJ, Adams ME, Chalmers TC: Antipsychotic drugs: is more worse? a meta-analysis of the published randomised control trials. Psychol Med 1994, 24:307–316
3. Kapur SJ, Zipursky R, Jones C, Remington G, Houle S: Relationship between dopamine D₂ occupancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia. Am J Psychiatry 2000; 157:514–520[Abstract/Free Full Text]
4. de Haan L, van Bruggen M, Lavalaye J, Booij J, Dingemans PMAJ, Linszen D: Subjective experience and D₂ receptor occupancy in patients with recent-onset schizophrenia treated with low-dose olanzapine or haloperidol: a randomized, double-blind study. Am J Psychiatry 2003; 160:303–309[Abstract/Free Full Text]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by de HAAN, L. Articles by van BEVEREN, N. Search for Related Content PubMed Citation Articles by de HAAN, L. Articles by van BEVEREN, N. Atypical Neuroleptics Conventional Neuroleptics Schizophrenia Spectrum Disorders Suicide

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