Olanzapine in the treatment of schizophrenia in adolescents – mechanisms of action and therapeutic efficacy.
Bibliographic record
Abstract
BACKGROUND: Olanzapine is widely used for schizophrenia and bipolar I disorder, yet its role in adolescents remains debated due to metabolic risks. OBJECTIVE: To review mechanisms, efficacy, safety, pharmacokinetics, and guideline positions of olanzapine in youth, with comparison to adults. METHODS: Narrative synthesis of randomized trials, open-label studies, meta-analyses, and major guidelines (APA, NICE, Canadian), with focused appraisal of pediatric data. RESULTS: Olanzapine's multi-receptor antagonism (D₂, 5-HT₂A/2C, H₁, muscarinic, α₁) underpins robust antipsychotic effects. In adolescents, short-term RCTs show significant improvement in PANSS/BPRS-C and YMRS versus placebo; efficacy is broadly comparable to risperidone and aripiprazole. Pharmacokinetics are similar to adults, though exposure is ~27-34% higher in youth. Adverse effects-especially weight gain, dyslipidemia, hyperprolactinemia, and glycemic abnormalities-are more pronounced in adolescents. Guidelines endorse olanzapine as an option for schizophrenia and as first-line for acute mania; OFC is recommended for bipolar depression by most but not NICE. LAI olanzapine is not approved <18 years. CONCLUSIONS: Olanzapine is effective in adolescent psychosis and mania but carries substantial metabolic liability. Given no clear efficacy advantage over other SGAs, it is best positioned as a second-line agent in youth, with preference for monotherapy, cautious dosing, and stringent metabolic monitoring. Evidence for benefits on negative and cognitive symptoms in adolescents remains limited.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".