RESUMO
Background: Long-acting injectable medications have become an important tool in the treatment of schizophrenia and schizoaffective disorder due to the high rates of medication nonadherence. Olanzapine long-acting injection (OLAI) is a useful therapeutic option for patients who have good tolerability and efficacy to oral olanzapine. Postinjection delirium/sedation syndrome (PDSS) is a rare but potentially serious event with the proposed mechanism of inadvertent intravascular injection of OLAI. This concern necessitates the requirement of a 3-hour monitoring period postinjection. Based on a literature review, there are no clearly defined risk factors for developing PDSS. Case Report: A case is presented that describes PDSS in a transgender man undergoing hormone therapy with testosterone. The patient received OLAI for more than 3 years and developed PDSS 9 months after the initiation of injectable testosterone. Discussion: There are published case reports of PDSS with the use of OLAI; however, there are no documented cases in a patient undergoing concurrent testosterone therapy. The effect that testosterone has on the vascular system and how it may alter the pharmacokinetics of OLAI has not been studied. Conclusion: Despite proper injection technique, PDSS can occur after injection with OLAI. Further research is necessary to identify specific risk factors for the development of PDSS, including the potential effect that hormone therapy may have.
RESUMO
OBJECTIVE: Clozapine, an evidence-based treatment of refractory schizophrenia, is associated with increased weight gain and metabolic dysregulation compared with most antipsychotics in short-term clinical trials. However, there are limited data describing comparative long-term metabolic risks. In this report, we examined whether short-term differences persist with long-term exposure to clozapine. METHODS: The data of all patients in a university-based clinic with a psychotic illness or a mood disorder with psychotic features, based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis, and treated with an antipsychotic in calendar year 2012 were examined. A total of 307 patients met the criteria; 96 patients were treated with clozapine and the remaining 211 patients were treated with 1 or more non-clozapine antipsychotics. Body mass index, type 2 diabetes, hypertension, dyslipidemia, and obesity were compared. RESULTS: The mean duration of the clozapine treatment was 7.6 years (range, 2 months to 21 y). On all metabolic measures, there were no statistically significant differences between the clozapine and non-clozapine groups (mean body mass index, 31 vs 32; type 2 diabetes, 17% vs 18%; dyslipidemia, 35% vs 38%; hypertension, 32% vs 39%; and obesity, 48% vs 54%). Removing the olanzapine-treated patients (n = 51) from the non-clozapine group did not change the findings. CONCLUSIONS: In this university-based clinic sample with a large number of clozapine-treated patients, we found no evidence of increased risk in any individual measure for those receiving clozapine. Although speculative, the relative contribution of the increased short-term metabolic risk associated with clozapine may be diminished over time because multiple other variables likely also impact metabolic risk during the life span. Although speculative, the relative contribution of the increased short-term metabolic risk associated with clozapine may be diminished over time due to the accumulated impact of other variables that also impact metabolic risk across the life span.
