Randomized controlled trial of olanzapine or chlorpromazine as addition to lithium in the treatment of a first manic episode with psychotic features: an 8 weeks, flexible dose, single blind trial

  • Dr Philippe Conus, Treatment and early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Switzerland
  • Dr Sue Cotton, Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Australia
  • Linda Kader, Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Australia
  • Dr Craig Macneil, Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Australia
  • Dr Melissa Hasty, Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Australia
  • Dr Karen Hallam, Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Australia
  • Pat McGorry, Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville Victoria 3052, Australia
  • Prof Michael Berk, Department of Clinical and Biomedical Sciences: Barwon Health, University of Melbourne, Geelong, Australia, Australia

    • Background: Association of mood stabiliser and antipsychotic medication is indicated in psychotic mania, but specific guidelines for the treatment of a first episode of psychotic mania are needed.

    Aims: To compare safety and efficacy profile of chlorpromazine and olanzapine augmentation of lithium treatment in a first episode of psychotic mania.

    Methods: 83 patients were randomised to either lithium + chlorpromazine of lithium + olanzapine in an 8 weeks trial. Data was collected on side effects, vital signs and weight modifications, as well on clinical variables.

    Results: There were no differences in safety profile of both medications, but patients in the olanzapine group were significantly more likely to have reached mania remission criteria after 8 weeks. Mixed effects models repeated measures analysis of variance showed that patients in the olanzapine group reached mania remission significantly earlier than those in the chlorpromazine group.

    Conclusions: These results suggest that while olanzapine and chlorpromazine have a similar safety profile in a cohort of patients with first episode of psychotic mania, the former has a greater efficacy on manic symptoms. On this basis, it may be a better choice for such conditions.