European Neuropsychopharmacology 11 (2001) 97–98 www.elsevier.com / locate / euroneuro Manic symptoms induced by olanzapine * Lefteris Lykouras , Rossetos Gournellis, Elias Angelopoulos Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sophias Avenue, 115 28 Athens, Greece Received 7 November 2000; received in revised form 9 November 2000; accepted 14 November 2000 Abstract We present the case of a never medicated patient with a diagnosis of DSM-IV paranoid schizophrenia in which olanzapine therapy induced manic symptoms. The latter remitted after drug discontinuation.  2001 Elsevier Science B.V. All rights reserved. Keywords: Olanzapine; Mania ´ 1. Introduction (Fregoli syndrome). Physical and laboratory investigation revealed negative findings. EEG and brain CT scan were A recent study has shown that olanzapine, a new normal. atypical antipsychotic agent, when compared to placebo A trial of olanzapine (15 mg/day) was initiated to has superior efficacy for the symptoms of acute mania control her positive and negative symptomatology. Three (Tohen et al., 1999). However, olanzapine has been weeks later, her psychotic symptoms — including the reported to induce manic states in some patients. This is a misidentification delusions remitted however she de- report of one such case. veloped euphoria, psychomotor agitation, hypersexuality and decreased need for sleep. She was talkative, spoke loudly, singing, and referred to a subjective experience that 2. Case report her thought was racing. She began to abuse alcohol, her self-esteem was inflated, her goal-directed activity was Mrs. P., a 36-year-old unmarried female was referred to increased and the Young Mania Rating Scale (YMRS) the Outpatients’ Psychiatric Department of Eginition score was 30 (Young et al., 1978). The clinical picture met Hospital in March 2000 complaining of anxiety and the DSM-IV diagnostic criteria of a hypomanic episode. insomnia. A careful review of her psychiatric history did The dose of olanzapine was reduced to 10 mg / day and not reveal any history of manic or hypomanic symptoms, then to 5 mg / day with minimal improvement of her manic personality disorders, cyclothymia or drug abuse. Her symptoms (YMRS score 27). Olanzapine treatment was mother had been diagnosed as suffering from schizoaffec- discontinued and a conventional antipsychotic treatment tive disorder. Although this was her first referral to a was instituted. The manic episode resolved in the sub- psychiatrist, she had already had a 3-year history of sequent 4 days (YMRS score: 5). untreated DSM-IV paranoid schizophrenia. She was rest- less, suspicious, affectively blunted and her speech was poor. She reported auditory hallucinations and delusional 3. Discussion beliefs of misidentification. She believed that her father was replaced by a double (Capgras syndrome) and she Olanzapine has been reported to induce mania in five totally misidentified strangers with a former friend of hers patients with schizophrenia (John et al., 1998; Fitz-Gerald et al., 1998; Lindenmayer and Klebanov, 1998; Pozo and Alcantara, 1998), three patients with schizoaffective disor- *Corresponding author. Tel.: 130-1-728-9128; fax: 130-1-724-2032. E-mail address: gnchrist@compulink.gr (L. Lykouras). der (Benazzi and Rossi, 1998; Reeves et al., 1998; 0924-977X / 01 / $ – see front matter  2001 Elsevier Science B.V. All rights reserved. PII: S0924-977X(00)00132-2