Abstract
Paddy Burges Watson, Hobart, Australia:
Currently Olanzapine (Zyprexa) appears in MIMS requiring Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme approval for the treatment of schizophrenia only, although the recommended dose for treatment of acute mania is also detailed. Parker and Malhi [1] report on its use in treatment-resistant depressed patients and Ashton [2] on its use with refractory trichotillomania. Currently, it is also used and authority freely given by the Department of Veterans’ Affairs for treatment of posttraumatic stress disorder (PTSD).
In my experience it is useful in PTSD with veterans who have high levels of arousal. The seven cases reported by Parker and Malhi all experienced ‘agitation’ and ‘diffuse insomnia’. Trichotillomania likewise involves increased arousal – Criterion B in DSM-IV being ‘an increasing sense of tension immediately before pulling out the hair or when attempting to resist the behaviour’. It therefore seems pertinent to question whether Olanzapine is fundamentally an atypical antipsychotic or an antiarousal agent.
It is also relevant to ask when this drug might become available to civilian as well as ex-service personnel with a range of diagnoses involving heightened arousal.