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275. Is olanzapine a mood-stabilizer?
Friday Abstracts
BIOL PSYCHIATRY 2000;47:1S–173S
83S
another 6 weeks of treatment the PET scan was repeated. Images were stereotactically normalized and voxel-by-voxel comparisons were performed using repeated measures ANOVA of absolute and normalized cerebral blood flow (CBF). Differential regional changes in CBF were seen between responders and nonresponders across both drugs. Furthermore, the pattern of regional CBF change among venlafaxine responders differed from the pattern of regional CBF change seen with bupropion responders. Clinical and imaging differences across both drugs will be presented. These preliminary findings support the idea that the topography of brain activity may be linked to antidepressant treatment response and may provide clues to the mechanisms of treatment response variability.
273. HOSTILITY AND ASSOCIATED CHOLESTEROL LEVELS IN PANIC DISORDER PATIENTS D. Bailey, K. McManus, G. Tait, J.-M. Le Melle´do Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada T6G 2B7 Studies have suggested that panic disorder (PD) patients display an increased risk for cardiovascular disease and/or cardiovascular death. The reasons for this potential increased cardiovascular risk in PD patients have not been elucidated. Some studies have suggested that PD patients have elevated basal serum cholesterol concentration, a well identified cardiovascular risk factor. The personality traits of anger, hostility and aggressiveness also confer an increased risk of coronary heart disease and premature mortality. Furthermore, correlations between high hostility and elevated cholesterol levels have been suggested. We therefore decided to compare cholesterol levels and hostility levels in panic disorder patients and healthy volunteers. We categorized subjects as Hostile or non-Hostile based on a cut-off score of 13 on the Cook-Medley Hostility scale. Total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured 12 hours after fasting. Thus far, we have included 32 panic patients (based on DSM-IV diagnostic criteria) and 20 healthy volunteers. Our preliminary results did not show statistically significant differences in total cholesterol, LDL, HDL cholesterol and triglycerides between panic patients and healthy volunteers. Sixtynine percent of panic patients were classified as Hostile whereas 15% of healthy volunteers were classified as Hostile (p ⬍ 0.01). In addition, we observed that concentrations of total and LDL cholesterol but neither HDL cholesterol nor triglycerides were elevated in Hostile subjects vs non Hostile subjects (p ⬍ 0.05). A greater level of Hostility and associated elevated LDL cholesterol in panic disorder patients may contribute to the reported increased cardiovascular risk in this cohort.
274. WITHDRAWN
275. IS OLANZAPINE A MOOD-STABILIZER? M.F. Tohen, T.G. Jacobs, P.D. Feldman, V. Toma, B.J. Francis, F. Zhang, T.M. Sanger, A. Breier Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN A double-blind, placebo-controlled 4-week study was conducted to provide additional information on efficacy and safety of olanzapine in the treatment of acute mania. Patients with a DSM-IV diagnosis of bipolar I disorder, manic or mixed, with or without psychotic features, were randomized to receive a dose range of 5, 10, 15, or 20 mg/day of olanzapine or placebo for a 4-week period. The mean modal dose of olanzapine was 16.4 mg/day. Compared to placebo, olanzapine-treated patients had a statistically significantly greater mean improvement on the Y-MRS total score (⫺8.13 placebo vs ⫺14.78 olanzapine, p ⬍ .001); statistical significance was evident within one week of olanzapine treatment and was maintained throughout the 4-week acute phase. Statistically significantly more olanzapine-treated patients responded (ⱖ50% improvement on the YMRS total score) than did placebo-treated patients (64.8% vs 42.9%, respectively; p ⫽ .023). In addition, relative to placebo-treated patients, olanzapine-treated patients had a statistically significantly greater mean improvement on the HAMD-21 total score in patients presenting with depressive symptoms (⫺6.81 placebo vs ⫺12.29 olanzapine, p ⫽ .046), CGI-BP Severity of Overall Illness score (⫺0.73 placebo vs ⫺1.72 olanzapine, p ⬍ .001), and the PANSS total score (⫺7.43 placebo vs ⫺21.19 olanzapine, p ⬍ .001). Olanzapine was generally well tolerated; only 2 olanzapine-treated patients discontinued due to adverse events (unintended pregnancy and rash) and there were no statistically significant differences on measures of parkinsonism or akathisia between olanzapine- and placebo-treated patients. Compared to placebo, olanzapine demonstrated superior efficacy and a favorable safety profile in the treatment of acute mania.
276. IMPAIRED FACIAL FEAR RECOGNITION IN MANIC BUT NOT EUTHYMIC BIPOLAR PATIENTS A. Lembke, N. Sachs, P. Ekman, T.A. Ketter Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723 Depressed unipolar and bipolar disorder patients have decreased ability to recognize sad and happy facial emotional expressions, and show a bias
BIOL PSYCHIATRY 2000;47:1S–173S
83S
another 6 weeks of treatment the PET scan was repeated. Images were stereotactically normalized and voxel-by-voxel comparisons were performed using repeated measures ANOVA of absolute and normalized cerebral blood flow (CBF). Differential regional changes in CBF were seen between responders and nonresponders across both drugs. Furthermore, the pattern of regional CBF change among venlafaxine responders differed from the pattern of regional CBF change seen with bupropion responders. Clinical and imaging differences across both drugs will be presented. These preliminary findings support the idea that the topography of brain activity may be linked to antidepressant treatment response and may provide clues to the mechanisms of treatment response variability.
273. HOSTILITY AND ASSOCIATED CHOLESTEROL LEVELS IN PANIC DISORDER PATIENTS D. Bailey, K. McManus, G. Tait, J.-M. Le Melle´do Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada T6G 2B7 Studies have suggested that panic disorder (PD) patients display an increased risk for cardiovascular disease and/or cardiovascular death. The reasons for this potential increased cardiovascular risk in PD patients have not been elucidated. Some studies have suggested that PD patients have elevated basal serum cholesterol concentration, a well identified cardiovascular risk factor. The personality traits of anger, hostility and aggressiveness also confer an increased risk of coronary heart disease and premature mortality. Furthermore, correlations between high hostility and elevated cholesterol levels have been suggested. We therefore decided to compare cholesterol levels and hostility levels in panic disorder patients and healthy volunteers. We categorized subjects as Hostile or non-Hostile based on a cut-off score of 13 on the Cook-Medley Hostility scale. Total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured 12 hours after fasting. Thus far, we have included 32 panic patients (based on DSM-IV diagnostic criteria) and 20 healthy volunteers. Our preliminary results did not show statistically significant differences in total cholesterol, LDL, HDL cholesterol and triglycerides between panic patients and healthy volunteers. Sixtynine percent of panic patients were classified as Hostile whereas 15% of healthy volunteers were classified as Hostile (p ⬍ 0.01). In addition, we observed that concentrations of total and LDL cholesterol but neither HDL cholesterol nor triglycerides were elevated in Hostile subjects vs non Hostile subjects (p ⬍ 0.05). A greater level of Hostility and associated elevated LDL cholesterol in panic disorder patients may contribute to the reported increased cardiovascular risk in this cohort.
274. WITHDRAWN
275. IS OLANZAPINE A MOOD-STABILIZER? M.F. Tohen, T.G. Jacobs, P.D. Feldman, V. Toma, B.J. Francis, F. Zhang, T.M. Sanger, A. Breier Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN A double-blind, placebo-controlled 4-week study was conducted to provide additional information on efficacy and safety of olanzapine in the treatment of acute mania. Patients with a DSM-IV diagnosis of bipolar I disorder, manic or mixed, with or without psychotic features, were randomized to receive a dose range of 5, 10, 15, or 20 mg/day of olanzapine or placebo for a 4-week period. The mean modal dose of olanzapine was 16.4 mg/day. Compared to placebo, olanzapine-treated patients had a statistically significantly greater mean improvement on the Y-MRS total score (⫺8.13 placebo vs ⫺14.78 olanzapine, p ⬍ .001); statistical significance was evident within one week of olanzapine treatment and was maintained throughout the 4-week acute phase. Statistically significantly more olanzapine-treated patients responded (ⱖ50% improvement on the YMRS total score) than did placebo-treated patients (64.8% vs 42.9%, respectively; p ⫽ .023). In addition, relative to placebo-treated patients, olanzapine-treated patients had a statistically significantly greater mean improvement on the HAMD-21 total score in patients presenting with depressive symptoms (⫺6.81 placebo vs ⫺12.29 olanzapine, p ⫽ .046), CGI-BP Severity of Overall Illness score (⫺0.73 placebo vs ⫺1.72 olanzapine, p ⬍ .001), and the PANSS total score (⫺7.43 placebo vs ⫺21.19 olanzapine, p ⬍ .001). Olanzapine was generally well tolerated; only 2 olanzapine-treated patients discontinued due to adverse events (unintended pregnancy and rash) and there were no statistically significant differences on measures of parkinsonism or akathisia between olanzapine- and placebo-treated patients. Compared to placebo, olanzapine demonstrated superior efficacy and a favorable safety profile in the treatment of acute mania.
276. IMPAIRED FACIAL FEAR RECOGNITION IN MANIC BUT NOT EUTHYMIC BIPOLAR PATIENTS A. Lembke, N. Sachs, P. Ekman, T.A. Ketter Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723 Depressed unipolar and bipolar disorder patients have decreased ability to recognize sad and happy facial emotional expressions, and show a bias