Zusammenfassung
Atypische Antipsychotika werden in zunehmendem Ausmaß auch für die Behandlung älterer Patienten eingesetzt. Es liegen bislang allerdings nur wenige Untersuchungen über ihre Wirksamkeit und Nebenwirkungen bei dieser Patientengruppe vor. Es wird über einen 67-jährigen Patienten berichtet, bei dem es unter Behandlung mit Olanzapin in üblicher Dosierung zu einem Anstieg des Serumspiegels weit über den therapeutischen Bereich kam. Diese Olanzapinüberdosierung war begleitet von ausgeprägten Gedächtnisstörungen für visuelles und verbales Material und von einer mittelschweren Allgemeinveränderung im EEG. Beide Veränderungen lassen sich auf die anticholinerge Wirkung von Olanzapin zurückführen und bildeten sich nach Dosisreduktion und Normalisierung des Olanzapinserumspiegels rasch zurück.
Abstract
Atypical antipsychotics are increasingly used for the treatment of elderly patients. However, there are only few studies on their efficacy and side effects in this patient group. The case of a 67-year old patient is presented, in whom under treatment with olanzapine in usual dosage, serum level increased into the toxic range. This olanzapine overdosage was accompanied by severe impairments in visual and verbal memory and by an increase of slow-frequency activity in the EEG. Both alterations may be attributed to the anticholinergic effects of olanzapine and reversed rapidly after dose reduction and normalization of the olanzapine serum level.
Literatur
-
1
Bymaster F P, Calligaro D O, Falcone J F, Marsh R D, Moore N A, Tye N C, Seeman P, Wong D T.
Radioreceptor binding profile of the atypical antipsychotic olanzapine.
Neuropsychopharmacol.
1996;
14
87-96
-
2
Bever B A, Perry P J.
Olanzapine: a serotonin-dopamine-receptor antagonist for antipsychotic therapy.
Am Health-Syst Pharm.
1998;
55
1003-1016
-
3
Bhana N, Foster R H, Olney R, Plosker G L.
Olanzapine: an updated review of its use in the management of schizophrenia.
Drugs.
2001;
61
111-161
-
4
Briken P, Nika E, Krausz M, Naber D.
Atypische Neuroleptika in der Behandlung von Aggressivität und Feindseligkeit bei schizophrenen Patienten.
Fortschr Neurol Psychiat.
2002;
70
139-144
-
5
Stephenson C M, Pilowsky L S.
Psychopharmacology of olanzapine. A review.
Br J Psychiatry.
1999;
38, Suppl
52-58
-
6
Tollefson G D, Sanger T M.
Anxious-depressive symptoms in schizophrenia: a new treatment target for pharmacotherapy?.
Schizophr Res.
1999;
35
13-21
-
7
Fulton B, Goa K L.
Olanzapine. A review of its pharmacological properties and therapeutic efficacy in the management of schizophrenia and related psychoses.
Drugs.
1997;
53
281-298
-
8
Hale A S.
Olanzapine.
Br J Hosp Med.
1997;
58
442-445
-
9
Sajatovic M, Perez D, Brescan D, Ramirez L F.
Olanzapine therapy in elderly patients with schizophrenia.
Psychopharmacol Bull.
1998;
34
819-823
-
10
Weiser M, Shneider-Beeri M, Nakash N, Brill N, Bawnik O, Reiss S, Hocherman S, Davidson M.
Improvement in cognition associated with novel antipsychotic drugs: a direct drug effect or reduction of EPS?.
Schizophr Res.
2000;
46
81-89
-
11
Kassahun K, Mattiuz E, Nyhart E, Obermeyer B, Gillespie T, Murphy A, Goodwin R M, Tupper D, Callaghan J T, Lemberger L.
Disposition and biotransformation of the antipsychotic agent olanzapine in humans.
Drug Metab Dispos.
1997;
25
81-93
-
12
Rao M L, Hiemke C, Grasmäder K, Baumann P.
Olanzapin: Pharmakologie, Pharmakokinetik und Therapeutisches Drug Monitoring.
Fortschr Neurol Psychiat.
2001;
69
510-517
-
13
Byerly M J, Weber M T, Brooks D L, Snow L R, Worley M A, Lescouflair E.
Antipsychotic medications and the elderly: effects on cognition and implications for use.
Drugs Aging.
2001;
18
45-61
-
14
Madhusoodanan S, Brenner R, Suresh P, Concepcion N M, Florita C D, Menon G, Kaur A, Nunez G, Reddy H.
Efficacy and tolerability of olanzapine in elderly patients with psychotic disorders: a prospective study.
Ann Clin Psychiatry.
2000;
12
11-18
-
15
Reeves R R, McBride W A, Brannon G E.
Olanzapine-induced mania.
J Am Osteopath Assoc.
1998;
98
549-550
-
16
Johnson V, Bruxner G.
Neuroleptic malignant syndrome associated with olanzapine.
Aust N Z J Psychiatry.
1998;
32
884-886
-
17
Gerber J E, Cawthon B.
Overdose and death with olanzapine: two case reports.
Am J Forensic Med Pathol.
2000;
21
249-251
-
18
Reich L.
Use of High-Dose Olanzapine in Refractory Psychosis.
Am J Psychiatry.
1999;
156
661
-
19
Robertson M D, McMullin M M.
Olanzapine concentrations in clinical serum and postmortem blood specimens - when does therapeutic become toxic?.
J Forensic Sci.
2000;
45
418-421
-
20
Cockroft D W, Gault M H.
Prediction of creatinine clearance from serum creatinine.
Nephron.
1976;
16
31-41
-
21 Taylor L B. Psychological assessment of neurosurgical patients. In: Rasmussen T, Marino R (eds) Functional neurosurgery. New York; Raven Press 1979
-
22
Helmstaedter C, Durwen H F.
VLMT: Verbaler Lern- und Merkfähigkeitstest.
Schweiz Arch Neurol Psychiat.
1990;
141
21-30
-
23 Brickenkamp R. Test d2. Aufmerksamkeits-Belastungs-Test. Göttingen; Hogrefe 1994 8. Auflage
-
24
Adler G, Brassen S.
Short-term rivastigmine treatment reduces EEG slow-wave power in Alzheimer patients.
Neuropsychobiology.
2001;
43
273-276
-
25
Tune L, Carr S, Hoag E, Cooper T.
Anticholinergic effects of drugs commonly prescribed for the elderly: potential means of assessing the risk of delirium.
Am J Psychiat.
1992;
149
1393-1394
-
26
Bartus R T, Dean R L, Beer B, Lippa A S.
The cholinergic hypothesis of geriatric memory dysfunction.
Science.
1982;
17
408-417
-
27
Sloan E P, Fenton G W, Standage K P.
Anticholinergic drug effects on quantitative electroencephalogram, visual evoked potential and verbal memory.
Biol Psychiat.
1992;
31
600-606
Prof. Dr. Georg Adler
Altentagesklinik am Zentralinstitut für Seelische Gesundheit
J5
68159 Mannheim
eMail: adler@zi-mannheim.de
