Olanzapine in the treatment of behavioral problems associated with autism: an open-label trial in Kuwait

To study the efficacy and safety of olanzapine for the treatment of children with autism associated with disruptive behavior problems. A prospective open-label trial was conducted on 40 male children [mean age 12.2 +/- 2.2 years, range 7-17 years] meeting Diagnostic Statistical Manual IV criteria for autism. After a washout period from previous medications [2-14 days], patients received olanzapine [5-10 mg/day] for a 13-week treatment period. The primary efficacy measures were Aberrant Behavior Checklist [ABC] and Clinical Global Impressions-Severity [CGI-S] done at baseline and end of treatment. At the beginning and end of treatment, patients underwent laboratory and physical investigations: ECG, chest X-ray, urinalysis, serum chemistry, blood glucose and lipid profile, hematology and hepatitis B serology. Paired comparison of baseline and 13-week endpoint scores showed significant reductions in ABC subscale scores for irritability [p < 0.0001], lethargy [p < 0.0001], stereotyped behavior [p < 0.005], hyperactivity [p < 0.0001] and inappropriate speech [p < 0.005]. Of 40 patients, 12 [30%] were considered as 'improved' on CGI-S scores compared to baseline, a statistically significant difference [p < 0.05]. No liver enzyme elevation or any other serum biochemical changes resulted from treatment, which was not associated with significant body weight changes or any other treatment-emergent side effects. The study shows that olanzapine treatment can be beneficial in alleviating some behavioral symptoms [irritability, hyperactivity/noncompliance and lethargy/withdrawal] associated with autism. The short period of this trial limits inferences about adverse effects such as body weight increase and tardive dyskinesia. Further long-term placebo-controlled studies of olanzapine are required

Detrimental effects of variable work shifts on quality of sleep, general health and work performance

The aim of this study was to explore the detrimental effects of working a varying pattern of 8-hour shifts on quality of sleep, general health and work performance. The Arabic version of the Pittsburgh Sleep Quality Index [PSQI]and 2 self-administered questionnaires were used to assess quality of sleep, work performance and general health in a sample of 200 males on a schedule of varying 8-hour shifts at the Kuwait Oil Company. A matched sample of an equal number of workers on a fixed daytime shift as a control group was enrolled in the study. Compared with men working on a straight daytime shift schedule, those working on 8-hour variable shifts exhibited higher rates of heavy smoking [p < 0.003], coffee/tea consumption [p < 0.0001], constipation [p < 0.002], job stress [p < 0.0001] and poor sexual performance [p < 0.0001]. Variable-shift workers reported persistent sleep disturbances in 3 dimensions of the global score of the PSQI [p < 0.0001]. They also had significantly more complaints of fatigue [p < 0.005], poor level of work performance [p < 0.005] and loss of concentration [p < 0.005]. Shift workers were significantly more prone to making errors and having accidents at work, and were more likely to report absence from work than the controls [p < 0.0001 and p < 0.005, respectively]. These results suggest that the majority of workers on an 8-hour variable-shift schedule experienced various health problems, poor quality of sleep and an increased risk for errors and accidents at work as compared with those workers on a straight daytime shift schedule. There is a need to compare potential benefits of an alternative work shift schedule