Efficacy Of Olanzapine On The Treatment Of Early-onset Schizophrenia And Influential Factors Of Efficacy

Objectives:To explore the efficacy of olanzapine in the treatment of patients with early-onset schizophrenia(EOS)and the related factors that influence the efficacy,and to compare the characteristics and efficacy between childhood and adolescence onset schizophrenia,based on which to guide clinical practice in related areas.Methods:97 cases 7-18 years old,onset before 18 years old,and International Classification of Diseases-10(ICD-10)defined schizophrenia were enrolled in the present study.They were all outpatients or inpatients from Psychiatry Department,the First Affiliated Hospital of Kunming Medical University,not limited first or recurrent episodes.Diagnoses for patients were confirmed using the Mini International Neuropsychiatric Interview(MINI)and the Child and Adolescent Mini International Neuropsychiatric Interview(MINI-KID).8 weeks olanzapine monotherapy was applied for enrolled patients.Relevant clinical information was collected at baseline including general demographic data,age of onset,initial symptoms,form of onset,and duration of untreated Psychosis(DUP).Positive and Negative Syndrome Scale(PANSS),Calgary Depression Scale for Schizophrenia(CDSS),Treatment Emergent Symptom Scale(TESS)and Personal and Social Performance(PSP)were used at baseline and 1,2,4,6,and 8 weeks after treatment for assessing patient’s psychotic symptoms,depression,side effects and social function,respectively.At baseline and after 8 weeks of treatment,cognitive function was assessed using Digit Span Test(DST),Trail-Making Test(TMT),and Continuous Performance Task(CPT).Results:1.Ninety-seven patients were enrolled in this study.45(46.4%)were males and 52(53.6%)were females.The average age was 15.48±2.31 years.The daily olanzepine dose was 5-20 mg(0.29±0.08 mg/kg.day).2.36 cases(37.1%)were ineffective,47 cases(48.5%)were improved,14 cases(14.4%)were significantly improved,and the total effective rate was 62.9%.The total scores of PANSS,positive symptoms,negative symptoms,and CDSS scores were significantly decreased after treatment,and all the differences were statistically significant(all P<0.01).One-way analysis of variance showed that there was a statistically significant difference on reduction rate of scores between positive symptoms and negative symptoms,and between common pathological symptoms and.negative symptoms,(both P<0.05),suggesting efficacy for positive symptoms and general pathological symptoms is superior to negative symptoms.3.Difference of PSP score before treatment(60.67±12.38)and after treatment(74.69±8.39)was statistically significant(t=-11.557,P<0.01),and suggested social function of patients improved after treatment.4.There were differences on missing number of CPT and TMT between endpoint and baseline assessment(before treatment 7.71±3.29,65.26±14.52,after treatment 10.22±3.37,59.43±14,09,t=-5.993,2.669,P<0.05),indicating that patient’s attention and information processing speed improved,while the remaining cognitive function tests did not differ statistically.5.Average weight before treatment was 52.61±11.27kg and 56.77±11.49kg after treatment for 97 patients(t=-11.980,P<0.01).Weight gain of 51 cases(52.6%)was≥7%.Other common side effects included sleepiness(31.9%),dry mouth(31.9%),prolactin increase(17.5%),and constipation(14.5%).In terms of laboratory indicators,transient liver function transaminase elevations occurred in 3 patients(3.1%).The above side effects were all improved by itself or after symptomatic treatment.No serious adverse events occurred and no cases were withdrawn due to adverse reactions in present study.6.Multiple linear regression revealed:Baseline manifesting apathy and poverty of speech,poor communication skills,less treatment period,and poor academic performance indicated less endpoint PANSS score reduction;baseline poor relationship with fathers and suicidal behaviors indicated less endpoint CDSS score reduction;baseline manifesting difficulty in concentrating,poor communication skills,and less treatment period indicated lower endpoint psp score;father’s education length less than 9,baseline manifesting delusion,shorter education length,the lower olanzapine plasma concentration and younger onset of age indicated poor endpoint cognitive functioning.7.Compared with the adolescent onset group(n=73),percentage of manifesting bizarre behavior was higher in childhood onset group(n=24)(χ2=15.536,p=0.000)Percentage of poverty of speech is also higher in childhood onset group,however,this difference was close to but not statistically significant(x2=3.328,p=0.068).Conclusions:8-week olanzapine monotherapy improved positive,negative,general pathological.symptoms,and depressive symptoms of EOS patients in Yunnan Province.Improvement of positive and general pathological symptoms was better than that of negative symptoms.When PANSS score reduction rate was used as efficacy index,61 patients(62.9%)were defined as responder to the treatment.Baseline abnormalities,olanzapine plasma concentrations,duration of treatment have indicted better efficacy in different psychopathology and functioning areas.Proportion of bizarre behavior was higher in childhood onset patients compared with adolescence onset patients.No difference was found in the therapeutic efficacy of olanzapine in two groups.