e-Poster number EP.
1062
Olanzapine in Somatic Symptom Disorder
Chioccioli M*, Crapanzano C*, Politano A*, Beccarini Crescenzi B*, Fagiolini A*
* AOUS Siena, Department of Molecular Medicine and Development – Psychiatry
Section, Siena, Italy.
Introduction:
Somatic symptom and related disorders (SSD formerly known as
"somatoform disorder" or "somatization disorder") include a
group of psychiatric disorders where patients present a wide
range of physical symptoms that are partially or completely
consistent with any underlying general medical or neurologic
condition. DSM 5 includes in this category five different
syndromes: somatic symptom disorder, illness anxiety disorder,
conversion disorder, psychological factors affecting other
medical conditions and factitious disorder [1].
Clinical studies and treatment trials for these diseases are
scarce, with most trials/reports that have focused on
antidepressants [2-3]. Other pharmacological classes at the
moment are less evaluated and only a few reports have focused
on the use of olanzapine.
Materials and methods:
We conducted an observational study to evaluate olanzapine
efficacy for the treatment of Somatic Symptoms Disorder in
fourteen patients (mean age: 56 y, 9 males, 5 females) admitted
to our Division of Psychiatry from July 2015 to March 2018. All
patients were affected by Somatic Symptoms Disorder and the
most frequent comorbidity was Illness Anxiety Disorder. Oral
olanzapine was at a mean dose of 5.9 ± 2.1 mg/die (range:
2.5-10 mg/die). Efficacy was assessed by the Clinical Global
Impression scale (CGI), which was completed at each
psychiatric evaluation. Olanzapine efficacy was measured as a
change in the CGI total score from baseline T0 (i.e. when
olanzapine was started) to T1 (week 4, i.e. after 4 week of
treatment with olanzapine).
Olanzapine daily average dosage (mg)
for patient
100%
50% Frequency
0%
2,5
5 Frequency %
7,5
10
Olanzapine average dose (mg/die)
References
(1) American Psychiatric Association (2013a). Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5). Washington, D.C.: APA
(2) Kroenke, K., 2007. Efficacy of treatment for somatoform disorders: a review of randomized
controlled trials. Psychosom Med 69(9):881-8.
(3) Sumathipala, A., 2007. What is the evidence for the efficacy of treatments for somatoform
disorders? A critical review of previous intervention studies. Psychosom Med 69(9):889-900.
(4) Bymaster, FP., Calligaro, DO., Falcone, JF., Marsh, RD., The Moore, NA., Tye, NC., Seeman,
P., Wong, DT., 1996. Radioreceptor binding profile of the atypical antipsychotic olanzapine.
Neuropsychopharmacology 14, 87–96.
(5) Olesen, OV., Linnet K., 1999. Olanzapine serum concentrations in psychiatric patients given
standard doses: The influence of comedication. Ther Drug Monit 21:87–90.
Results:
Wilcoxon Signed Ranks Test indicates a statistically significant
(p<0.005) improvement in scores on CGI from T0 (6.14 ± 0.53)
to T1 (2.00 ± 0.87). Olanzapine average daily dosage per patient
was 5.25 mg. Paroxetine was prescribed in 3 patients for
depressive symptoms, with a reduction of olanzapine dose,
owing to the increased blood concentration of olanzapine (up to
40%) that has been described when this medication is
prescribed in combination with strong inhibitors of CYP2D6 [5].
Tolerability was good and side effects rated were generally mild
(sedation), with no patient that was withdrawn because of it.
Discussion:
The clinical improvement achieved by using olanzapine in
patients affected by Somatic Symptom Disorders could be
related to its effectiveness on anxiety symptoms, widely
presented by patients, and/or its feature to act upon
“disproportionate and persistent concern about the medical
seriousness of one’s symptoms”. H1, 5HT-2a,5HT-2c, α1
antagonist activity could explain its sedative and anxiolytic action
[4]. Anti-D2 effect could contribute to the treatment of partially
altered reality testing, affecting a continuum of cognitive
alteration (prevailing ideation, obsessional and psychotic
thinking). Based on our experience, olanzapine may be a valid
pharmacological choice for treating anxiety SSD, owing to its
efficacy on anxiety and psychotic symptoms. However, our study
has several limitations, including retrospective design, small
sample size, use of several concomitant medications, lack of
randomization and control condition. Larger, prospective,
randomized trials are warranted to confirm our preliminary
observations.
Efficacy of treatment evalued by CGI
14
12
10
8
6 T1
4 T0
2
0 T0
Sample T1
Average CGI
Minimum CGI
Maximum
CGI
Copyright © 2018 No potential conflict of interest
Chioccioli Marco, Crapanzano Calogero, Politano Andrea,
Beccarini Crescenzi Bruno, Fagiolini Andrea
Siena University, Department of Molecular Medicine and Development, Psychiatry Section
Phone: 00390577233435 m.chioccioli22@gmail.com