Olanzapine in Chinese patients with schizophrenia or bipolar disorder: a systematic literature review

Figures & data

Figure 1 Publication flow diagram.

Table 1 Overview of study characteristics

Study	Type	Olanzapine type	Study design	Key sources of potential bias*	Disease stage	Age (years) overall or group means	Sex (% male)	Outcome	Primary outcome measure(s)
Schizophrenia, comparative
Cao and Xie^Citation68	CC	Dom	RCT	Allocation, attrition, confounders	Chronic	26.0–27.1	53.2	Efficacy	PANSS
Chan et al^Citation70	Int	Gen	RCT	Nil significant	Chronic	40.8, 41.1	45.7	Efficacy Safety	BPRS, CGI-S ESRS
Chan et al^Citation71	Int	Orig Br	RCT	Nil significant	Chronic	42.7, 48.0	35.0	Safety	AIMS
Chang et al^Citation59	CC	Gen	RCT	Blinding, confounders	Chronic	27.0, 28.0	48.3	Efficacy	BPRS, CGI-S
Chen et al^Citation60	Int	Gen	RCT	Allocation, attrition	Chronic	36.5–37.9	58.3	Efficacy	BPRS
Chen et al^Citation35	CC	Gen	RCT	Allocation, attrition	Chronic	73.3, 73.6	58.6	Efficacy, safety	PANSS Metabolic measures
Chen et al^Citation36	CC	Gen	RCT	Allocation, attrition, confounders	Chronic	30.3, 32.4	49.0	Efficacy	PANSS
Chen^Citation37	CC	Orig Br/Dom	RCT	Allocation, blinding, no washout, confounders	Chronic	33.8, 34.2	50.0	Efficacy, safety	PANSS, CGI-S Metabolic measures
Dong and Mei^Citation80	CC	Dom	RCT	Blinding, attrition, confounders	Chronic	64.2, 66.2	66.7	Efficacy	PANSS
Du^Citation61	CC	Gen	RCT	Blinding, attrition, confounders	Chronic	32.6	72.4	Efficacy	PANSS, CGI-S
Fang et al^Citation27	Int	Gen	OL	Blinding (outcome), attrition, confounders	Chronic	25.7–27.3	53.7	Effectiveness	SF-36
Fang et al^Citation22	CC	Gen	OL	Blinding (outcome), confounders	Chronic	NR	54.4	Effectiveness	Treatment discontinuation Time to discontinuation
Hu et al^Citation73	Int	Gen	RCT	Blinding, attrition	Chronic	25.2, 28.7	67.9	Efficacy Safety	PANSS Metabolic measures
Lee and Leung^Citation74	Int	Gen	Cross-sectional	No exclusion	Chronic	34.1, 35.9	46.7	Safety	Metabolic measures
Lee et al^Citation66	Int	Orig Br	Cohort	Retrospective (selection, classification)	Chronic	33.9, 36.3	42.9	Safety	Weight change
Li et al^Citation38	Int	Gen	RCT	Blinding, allocation, noncompleters excluded	First-episode	23.6, 25.8	68.8	Efficacy	PANSS, CGI-S
Liang^Citation67	CC	Dom	RCT	Blinding, attrition, confounders	Chronic	29.5, 30.4	53.9	Efficacy	PANSS
Ma et al^Citation64	CC	Dom	RCT	Blinding, attrition, confounders	First-episode/chronic	38.6, 39.4	53.2	Efficacy	BPRS
Ou et al^Citation75	Int	Gen	RCT	Blinding, concomitant antipsychotics	First-episode	26.9, 27.7	55.0	Efficacy, safety	PANSS, CGI-S
Su et al^Citation77	Int	Gen	Cross obs	Blinding, groups unequal, no washout	Chronic	35.7	53.3	Safety	Metabolic measures
Tan and Wang^Citation39	CC	Dom	RCT	Allocation, attrition, confounders	Chronic	26.3, 29.5	57.5	Efficacy	PANSS
Wang et al^Citation117	CC	Orig Br	RCT	Allocation, attrition, confounders	Chronic	28.0, 30.0	47.5	Efficacy	Response (via BPRS)
Wang et al^Citation19	Int	Gen	RCT	Attrition	First-episode	31.6, 34.3, 35.4	51.4	Effectiveness	Wechsler Memory Scale
Wang et al^Citation40	CC	Orig Br	RCT	Allocation, attrition, confounders	First-episode	25.8	53.3	Efficacy	PANSS
Wang et al^Citation56	CC	Gen	RCT	Blinding, allocation, attrition, confounders	Chronic	31.2, 34.6 (median)	51.1	Efficacy	PANSS
Wang et al^Citation118	Int	Gen	Cohort	No control, groups not matched	Chronic	48.2, 49.4	51.5	Safety	Heart rate variability
Wu et al^Citation78	Int	Gen	RCT	Blinding	First-episode	34.9	50.0	Safety	Metabolic measures
Wu et al^Citation79	Int	Gen	RCT	Attrition	First-episode	32.5–34.2	50.0	Safety	Metabolic measures
Xie et al^Citation21	CC	Orig Br	RCT	Blinding, allocation, attrition, confounders	Chronic	13.5, 14.6	50.7	Efficacy, effectiveness, safety	PANSS PSP TESS
Yang et al^Citation41	CC	Dom	RCT	Blinding, allocation, confounders	First-episode	26.8, 27.6	55.2	Efficacy	PANSS
Yang et al^Citation31	Int	Gen	Retro	Selection, classification	NR	36.1	59.4	Safety	APD prescribing rate
Yang and Mei^Citation57	CC	Gen	RCT	Blinding, allocation, confounders	First-episode	29.9, 31.0	55.7	Efficacy	PANSS
Yen et al^Citation26	Int	Gen	Cross-sectional	Patient self-report, confounders	Chronic	32.5	47.9	Effectiveness	WHOQOL-BREF
Yu et al^Citation42	CC	Gen	RCT	Blinding, allocation, attrition, confounders	Chronic	31.3, 33.5	100.0	Efficacy	PANSS
Zhang et al^Citation65	CC	Gen	RCT	Allocation	NR	33.0, 34.0	54.2	Efficacy	PANSS
Zhu and Pi^Citation20	CC	Orig Br	RCT	Blinding, allocation, attrition, confounders	Chronic	32.8, 35.2	45.0	Efficacy Effectiveness	PANSS Response rate
Zhu and Pi^Citation43	CC	Orig Br	RCT	Blinding, allocation, attrition, confounders	Chronic	42.7, 43.5	NR	Efficacy	PANSS
Schizophrenia, noncomparative
Ang et al^Citation69	CC	Gen	Obs, post hoc	Patient self-report	Chronic	29.1	45.5	Safety	Factors associated with weight gain
Chen et al^Citation72	Int	Gen	Case-control	Selection, diet unequal	Chronic	36.3, 38.9	48.1	Safety	Ghrelin levels
Chiu et al^Citation119	Int	Gen	OL	Noncontrolled, populations not comparable	Chronic	37.6	63.6	Efficacy, safety	Pancreatic beta-cell function
Gao and Chen^Citation62	CC	Gen	OL	Not controlled	First-episode	29.7	65.6	Efficacy	Response rate (via BPRS)
Guo et al^Citation63	CC	Gen	OL	Selection, observer expectation	Chronic	33.7	36.4	Efficacy	PANSS, CGI-S, BPRS
Guo et al^Citation25	Int	Gen	Obs	Selection, observer expectation	Chronic	25.5–27.4	54.1	Efficacy, effectiveness	SF-36
Guo et al^Citation24	Int	Gen	Obs	Selection, observer expectation	Chronic	25.5–27.3	54.4	Efficacy, effectiveness, safety	Rate and time to treatment discontinuation
Guo et al^Citation23	Int	Gen	Obs	Selection, observer expectation	Chronic	25.4–27.4	53.7	Effectiveness	Composite cognitive score
Huang et al^Citation120	Int	Gen	Cohort	Selection, attrition, classification	Chronic	43.2, 44.3	60.2	Safety	Weight gain
Kuo et al^Citation28	Int	Gen	Case-control	Selection, confounders	Chronic	NR	NR	Safety	Risk of pneumonia
Li et al^Citation44	CC	Gen	OL	Selection, observer expectation	Chronic/first-episode	23.1	60.4	Efficacy	Response according to concentration
Lu et al^Citation29	Int	Gen	Obs	Missing data, confounders	Chronic	27.9	50.8	Efficacy	BPRS, CGI-S
Pratt et al^Citation76	Int	Gen	Distributed network model	Selection	NR	39.5	49.5	Safety	Risk of acute hyperglycemia
Shen and Li^Citation54	CC	Gen	OL	Selection, observer expectation	Chronic	27.2	50.0	Efficacy	Response rate (via PANSS)
Shu et al^Citation55	CC	Orig Br	OL	Selection, observer expectation	NR	19–56 (range)	41.5	Efficacy	Response rate (via BPRS)
Treuer et al^Citation30	Int	Gen	Obs	Patient self-report, confounders	Chronic	32.6	56.0	Safety	Factors associated with weight gain
Yang et al^Citation121	CC	Gen	OL	Selection, observer	Chronic	28.8	60.0	Efficacy	Response rate (via BPRS)
Zheng et al^Citation58	CC	Gen	OL	Selection, observer	Chronic	23.7	60.9	Efficacy	Response rate (via BPRS)
Bipolar disorder, comparative
Jian and Miao^Citation32	CC	Gen	Cross-sectional	Attrition, confounders	Chronic	31.5–34.7	47.5	Efficacy	BRMS
Liu et al^Citation45	CC	Gen	RCT	Blinding, selection	Chronic	28.7, 29.6	0.0	Efficacy	BRMS
Niufan et al^Citation46	Int	Gen	RCT	Observer (adverse effects)	NR	32.6	47.1	Efficacy	CGI-BP
Tohen et al^Citation53	Int	Gen	RCT	Nil significant	Chronic	35.0, 36.0	41.6	Efficacy	MADRS
Yang et al^Citation48	CC	Orig Br	RCT	Allocation, attrition	NR	37.2, 41.9	53.3	Efficacy	CGI-BP, YMRS, BPRS, MADRS
Yen et al^Citation26	Int	Gen	Cross-sectional	Patient self-report	Chronic	40.8	52.1	Effectiveness	WHOQOL-BREF
Bipolar disorder, noncomparative
Yang et al^Citation33	Int	Orig Br/Gen	Nested case-control	Phase of illness may be unequal, confounders	Chronic	44.1, 44.2	61.1	Safety	Risk of pneumonia

Note:

* Main identifiable sources of bias (other potential sources of bias may exist but are difficult to assess because of lack of reporting detail).

Abbreviations: AIMS, Abnormal Involuntary Movement Scale; APD, anti-parkinsonian drug; BPRS, Brief Psychiatric Rating Scale; BRMS, Bech–Rafaelsen Mania Scale; CC, Chinese core (journal type); CGI-BP, Clinical Global Impression-Bipolar; CGI-S, Clinical Global Impression-Severity; Dom, domestic; ESRS, Extrapyramidal Syndrome Rating Scale; Gen, generic; Int, international (journal type); MADRS, Montgomery–Åsberg Depression Rating Scale; NR, not reported; Obs, observational; OL, open-label; Orig Br, originator brand; PANSS, Positive and Negative Symptom Scale; PSP, Personal and Social Functioning Scale; RCT, randomized controlled trial; Retro, retrospective; SF-36, Short Form-36; TESS, Treatment-Emergent Symptom Scale; WHOQOL-BREF, World Health Organization Questionnaire on Quality of Life: Short Form-Taiwan version; YMRS, Young Mania Rating Scale.

Table 2 Efficacy of olanzapine in randomized controlled trials of patients receiving treatment for schizophrenia

Reference	Blind	Treatment arms	Dose (mg/day)	Number of patientsa	Duration (weeks)	Mean change (% reduction versus baseline)			Pb	Response rate (%)
						BPRS	CGI	PANSS
Clozapine
Tan and Wang^Citation39	NR	Olanzapine	5–20	40/40	8	–	–	−48.2 (49.8)**	NS	85.0A
		Clozapine	50–300	40/40		–	–	−44.6 (48.6)**		87.5A
Wang et al^Citation117	NR	Olanzapine	5–20	30/30	8	−32.0 (59.6)**	–	–	NS	77.0B
		Clozapine	25–400	31/31		−31.5 (57.5)**	–	–		74.0B
Zhu and Pi^Citation20	NR	Olanzapine	5–20	30/30	12	–	–	−50.2 (58.7)**	NS	93.3C
		Clozapine	25–400	30/30		–	–	−45.0 (53.9)**		90.0C
Paliperidone
Cao and Xie^Citation68	NR	Olanzapine	5–20	32/32	12	–	–	−49.1 (59.7)**	NS	90.6C
		Paliperidone	3–12	30/30		–	–	−52.9 (61.9)**		93.3C
Hu et al^Citation73	Nil, OL	Olanzapine	15c	40/23	12	–	–	−23.4 (31.6)***	NS
		Paliperidone	6c	40/33		–	–	−20.3 (27.6)***
Liang^Citation67	Nil, OL	Olanzapine	5–20	39/38	6	–	–	−53.3 (55.2)*	<0.05	92.1C
		Paliperidone	3–12	39/38		–	–	−57.5 (59.3)*		94.7C
Ma et al^Citation64	NR	Olanzapine	10–20	76/76	8	−28.9(57.1)***	–	–	NS	65.8D
		Paliperidone	3–12	80/80		−28.5 (55.4)***	–	–		68.8D
Xie et al^Citation21	Nil, OL	Olanzapine	2.5–20	40/32	12	–	–	−35.6(41.2)**	NS	87.5C
		Paliperidone	3–12	40/35		–	–	−38.6 (43.4)**		85.7C
Zhang et al^Citation65	NR	Olanzapine	5–15	145/134	6	–	−2.2(41.4)	−34.1 (39.8)***	NS	69.1E
		Paliperidone	3–12	143/127		–	−2.5 (46.2)	−32.3 (38.8)***		71.0E
Zhu and Pi^Citation43	NR	Olanzapine	5–20	15/15	12	–	–	−26.3 (29.4)*	NS	67.0C
		Paliperidone	3–12	15/15		–	–	−30.9 (34.6)*		73.0C
Risperidone
Chan et al^Citation70	Single (rater)	Olanzapine	2.5–20	35/29	8	−4.7 (12.8)***	−0.9 (19.1)***	–	NS	–
		Risperidone	0.5–6	35/28		−4.9(12.0)***	−0.5(11.1)***	–		–
Chan et al^Citation71	Single (rater)	Olanzapine	2.5–20	30/23	24	−2.7 (7.5)	−0.5(11.9)	–	NS	–
		Risperidone	0.5–6	30/21		−4.4(10.9)	−0.6(13.3)	–		–
Chen et al^Citation60	Single (rater)	Olanzapine	<20	16/13	8	–	−1.3(24.1)**	−14.8 (17.0)**	NS	31.0C
		Risperidone	<6	16/13		–	−1.2(23.1)**	−12.7 (15.3)**		25.0C
		FGA		16/13		–	−1.1 (22.9)*	−14.9 (18.7)**		38.0C
Yang et al^Citation41	NR	Olanzapine	5–20	34/33	8	–	–	−52.5 (55.6)*	NS	81.8F
		Risperidone	1–6	33/31		–	–	−51.4 (55.0)*		83.0F
Yang and Mei^Citation57	NR	Olanzapine	5–15	36/36	8	–	–	−48.7 (56.3)	NS	80.6B
		Risperidone	1–6	34/34		–	–	−44.1 (52.3)		67.7B
Yu et al^Citation42	NR	Olanzapine	<20	30/30	12	–	–	−23.2 (29.4)***	NS	–
		Risperidone	<6	25/25		–	–	−21.0 (26.0)***		–
Ziprasidone
Chen et al^Citation35	NR	Olanzapine	10–20	38/35	12	–	–	−37.3 (47.4)***	NS	91.4C
		Ziprasidone	80–120	37/35		–	–	−37.0 (47.6)***		88.6C
Chen et al^Citation36	NR	Olanzapine	10–20	49/NR	12	–	–	−54.2 (56.9)*	NS	82.2G
		Ziprasidone	20–160	49/NR		–	–	−51.8 (55.0)*		81.3G
Du^Citation61	NR	Olanzapine	10	29/29	8	–	−2.7 (52.9)*	−34.6 (36.5)*	<0.05	–
		Ziprasidone	40	29/29		–	−3.2 (64.0)*	−36.4 (38.6)*		–
Li et al^Citation38 (RCT, OL)		Olanzapine	5–20	40/40	6	–	−2.5 (45.9)***	−42.7 (45.5)***	NS	82.5F
		Ziprasidone	40–160	40/39		–	−2.9 (53.4)***	−42.8 (45.4)***		80.0F
Ou et al^Citation75	Nil, OL	Olanzapine	5–20	130/111	6	–	−2.7 (47.4)***	−46.3 (45.4)***	0.044	–
		Ziprasidone	40–160	130/119		–	−2.8 (48.5)***	−43.4 (41.8)***		–
Other agents
Chang et al^Citation59	NR	Olanzapine	5–20	31/31	8	−33.0 (61.1)**	–	–	<0.0I	80.0H
		Chlorpro	25–600	27/27		−27.0 (50.0)**	–	–		52.0H
Chen^Citation37	NR	Olanzapine (Zyprexa^®)	>5	47/47	8	–	−3.5 (35.3)	−56.4 (59.9)**	NS	80.8G
		Olanzapine (Oulanning)	>5	51/51		–	−3.2 (32.9)	−55.0 (59.0)**		78.4G
Dong and Mei^Citation80	NR	Olanzapine	2.5–15	30/30	8	–	–	−29.6 (34.3)*	NS	93.3G
		Quetiapine	50–400	30/30		–	–	−30.1 (35.7)*		90.0G
Wang et al^Citation40	NR	Olanzapine	10–20	42/42	8	–	–	−45.9 (52.7)**	NS	79.0G
		Aripiprazole	10–30	48/48		–	–	−45.9 (53.1)**		83.0G
Wang et al^Citation56	NR	Olanzapine	5–20	252/199	6	–	–	−35.9 (40.6)**	NS	62.7G
		Haloperidol	6–20	120/95		–	–	–29.8 (32.9)**		66.7G

Notes:

a Enrolled/completed;

b between treatment arms in main efficacy outcome; ctarget dose;

* P<0.05 versus baseline;

** P<0.01 versus baseline;

*** P<0.001 versus baseline. Response rate definitions:

A response = significant improvement + improvement (improvement PANSS reduction ≥25%, significant improvement PANSS reduction ≥50%);

B response rate = relief + significant improvement + improvement (relief BPRS reduction ≥80%, significant improvement BPRS reduction 50%–79%, improvement BPRS reduction 30%–49%);

C response = relief + significant improvement + improvement (relief = PANSS reduction ≥75%, significant improvement = PANSS reduction 25%–49%, improvement = PANSS reduction <25%);

D response = BPRS reduction ≥50%;

E response = PANSS reduction ≥50%;

F response = PANSS reduction >50%;

G response = not described;

H response = relief + significant improvement (relief = BPRS reduction ≥80%, significant improvement = BPRS reduction 50%–79%).

Abbreviations: BPRS, Brief Psychiatric Rating Scale; Chlorpro, chlorpromazine; CGI, Clinical Global Impression; FGA, first-generation antipsychotic; NR, not reported; NS, not significant; OL, open-label; PANSS, Positive and Negative Syndrome Scale (total score); RCT, randomized controlled trial.

Table 3 Efficacy of olanzapine in noncomparative studies with patients receiving treatment for schizophrenia

Reference	Design	Dose (mg/day)	Number of patientsa	Duration (weeks)	Mean change (%)			Responseb rate (%)
					BPRS	CGI-S	PANSS
Chiu et al^Citation119	Open-label	5–20	42/33	8	–	−0.3 (7.3)*	–	–
Gao and Chen^Citation62	Open-label	5–15	32/32	8	Symptom reductione	–	–	90.6A
Guo et al^Citation63	Open-label	10–20	33/33	6	−20.9 (45.4)*	–	−38.0 (45.5)*	84.8B
Guo et al^Citation24	Observational	5–20	149/90 1,133/674d	52	–	−0.6 (26.1)**	−5.5 (13.0)**	–
Guo et al^Citation25	Observational	5–20	139/NR 1,133/1,029d	52	–	–	−5.9 (14.0)***	–
Li et al^Citation44	Open-label	5–20	48/48	8	−19.1 (38.9)**	–	−30.8 (34.1)**	87.5C
Lu et al^Citation29	Observational	5–20	494/449 1,267/954d	52	−32.0 (NR)	−3.0 (NR)	–	95.9D
Shen and Li^Citation54	Open-label	5	12/12	6	−21.9 (42.7)**	–	−32.5 (57.3)**	83.4E
Shu et al^Citation55	Open-label	5–20	65/62	6	−18.8 (70.2)**	–	−35.0 (68.9)**	80.0F
Yang et al^Citation121	Open-label	5–20	75/70	6	−19.3 (71.8)***	–	−37.0 (69.6)***	82.9G
Zheng et al^Citation58	Open-label	5–15	23/14	78	−34.1 (73.0)	–	−29.6 (73.3)	73.9c,F

Notes:

a Enrolled/completed;

b definition of response varied between studies;

c rate after 12 weeks of therapy;

d enrolled/completed for whole study population;

e extent of reduction not quantified;

* P<0.05 versus baseline;

** P<0.01 versus baseline;

*** P<0.001 versus baseline. Response rate definitions:

A response = significant improvement + improvement (significant improvement = BPRS reduction ≥30%–59%);

B response = relief + significant improvement (relief = BPRS reduction ≥75%, significant improvement = BPRS reduction 50%–74%, improvement = BPRS reduction 25%–49%);

C response = BPRS reduction ≥20%;

D response = BPRS reduction ≥30%;

E response = significant improvement + improvement (significant improvement = PANSS reduction ≥60%, improvement = PANSS reduction 40%–59%);

F response = relief + significant improvement (relief = BPRS reduction >75%, significant improvement = BPRS reduction ≥50%);

G response = relief + significant improvement + improvement (relief = BPRS reduction ≥75%, significant improvement = BPRS reduction 50%–74%, improvement = BPRS reduction 25%–49%).

Abbreviations: BPRS, Brief Psychiatric Rating Scale; CGI-S, Clinical Global Impression-Severity; NR, not reported; PANSS, Positive and Negative Syndrome Scale (total score).

Table 4 Efficacy of olanzapine in comparative studies of patients receiving treatment for bipolar disorder

Reference (design)	Treatment arms	Dose (mg/day)	Number of patientsa	Duration (weeks)	Mean change (% versus baseline)				Responseb rate (%)
					BRMS	BPRS	MADRS	YMRS
Jian and Miao^Citation32 (Cross-sectional)	Olanzapine	10–20	40/40	8	−26.3 (94.7)**	All treatments combined with sodium valproate 0.5–1.8 mg/day			100.0A
	Risperidone	3–6	40/40		−26.6 (94.6)**				100.0A
	Quetiapine	400–800	40/40		−29.5 (95.7)**				100.0A
Liu et al^Citation45 (RCT)	Olanzapine	5–20	24/24	8	−15.7 (87.7)**				87.5A
	Quetiapine	200–800	25/25		−16.1 (89.0)**				84.0A
Niufan et al^Citation46 (RCT)	Olanzapine	5–20	69/63	4		−11.2 (NR)***	−3.3 (NR)***	−24.6 (NR)***	87.0B
	Lithium	600–1,800	71/56			−9.0 (NR)***	−2.5 (NR)***	−20.2 (NR)***	73.2B
Tohen et al^Citation53 (RCT)	Olanzapine	5–20	343/267	6			−13.8 (NR)c	−0.67 (NR)	52.5C
	Placebo		171/122				−11.7 (NR)c	+0.32 (NR)	43.3C
Yang et al^Citation48 (RCT)	Olanzapine	5–20	28/27	4		−9.7 (71.8)**	−2.7 (77.1)	−25.9 (77.3)**	85.7B
	Lithium	300–1,800	32/31			−10.6 (73.1)**	−0.7 (18.9)	−24.9 (78.8)**	84.4B

Notes:

a Enrolled/completed;

b definition for response varied between studies;

c least-squares mean;

* P<0.05 versus baseline;

** P<0.01 versus baseline;

*** P<0.001 versus baseline. Response rate definitions:

A response = relief rate + significant improvement (relief = BRMS reduction ≥75%, significant improvement = BRMS reduction ≥50%, improvement = BRMS reduction ≥25%);

B response = YMRS reduction ≥50%;

C response = MADRS reduction ≥50%.

Abbreviations: BRMS, Bech–Rafaelsen Mania Scale; BPRS, Brief Psychiatric Rating Scale; MADRS, Montgomery–Åsberg Depression Rating Scale; NR, not reported; OL, open-label; RCT, randomized controlled trial; YMRS, Young Mania Rating Scale.

Figure 2 Discontinuation rates in long-term (12-month) maintenance studies.

Notes: Dark bar represents data from Fang et al²² and gray bar represents data from Guo et al.²⁴

Figure 3 Mean change in Short Form-36 domain scores from baseline after 12 months of treatment with olanzapine in patients with schizophrenia reported in two quality of life studies.

Notes: Long dashed lines represent data from Guo et al;²⁵ short dashed lines represent data from Fang et al.²⁷

Table 5 Characteristics of quality of life and functioning studies in schizophrenia and bipolar disorder

Reference (design)	Treatment arms	Number of patientsa	Duration (weeks)	Assessment measure(s)	Results for olanzapine-treated patients
Fang et al^Citation27 (Observational)	Olanzapine	158/111	52	SF-36	QOL improved in all domains; greatest improvements in role physical and role emotional domains
	Chlorpromazine	174/120
	Sulpiride	185/129
	Clozapine	193/135
	Risperidone	221/155
	Quetiapine	151/99
	Aripiprazole	133/99
Guo et al^Citation25 (Observational)	Olanzapine	139/86	52	SF-36 GAS ADL	At 12 months, significant improvements in all eight SF-36 domains, GAS and ADL (all P≤0.001); greater improvement in the SF-36 role physical score and GAS score than chlorpromazine (all P=0.002)
	Chlorpromazine	151/90
	Sulpiride	150/91
	Clozapine	158/101
	Risperidone	185/111
	Quetiapine	125/73
	Aripiprazole	121/73
Xie et al^Citation21 (OL)	Olanzapine	40/32	12	PSP	Scores increased from baseline to week 12 (31.47±7.66 to 60.13±12.54, P<0.01 versus baseline)
	Paliperidone	40/35
Yen et al^Citation26 (Cross-sectional)	Olanzapine	NR/27		WHOQOL-BREF-Taiwan	Psychological domain: higher scores for olanzapine than risperidone or no atypical antipsychotic (P<0.01) Social relationship domain: higher scores for olanzapine than no atypical antipsychotic (P<0.05)
	Risperidone	NR/55
	Clozapine	NR/8
	Other	NR/7
Zhu and Pi^Citation20 (RCT)	Olanzapine	30/30	12	GQOLI	Total GQOLI, physical health, psychological health, and social function: higher scores for olanzapine than clozapine (P<0.01)
	Clozapine	30/30

Note:

a Enrolled/completed.

Abbreviations: ADL, Activities of Daily Living scale: GAS, Global Assessment Scale; GQOLI, General Quality of Life Inventory; NR, not reported; OL, open-label; PSP, Personal and Social Performance Scale; QOL, Quality of Life; SF-36, Short Form-36; WHOQOL-BREF-Taiwan, World Health Organization Questionnaire on Quality of Life: Short Form (Taiwanese version); RCT, randomized controlled trial.

Table 6 Characteristics of studies including a specific safety or tolerability objective in studies of schizophrenia or bipolar disorder

Reference (design)	Treatment arms	Number of patientsa	Duration (weeks)	Primary or specified safety objective	Outcomes
Ang et al^Citation69 (observational, post hoc)	Olanzapine	330/325	26	Identify factors associated with weight gain during olanzapine therapy	Factors associated with weight gain: preoccupied with food thoughts, evening snacks, excessive food consumed to feel full, red meat, comfortably full sensation when finished eating, amount of daily continuous walking, location of meals, social activity level, meal regularity, sex
Chan et al^Citation70 (RCT)	Olanzapine Risperidone	35/29 35/28	8	Compare effects in patients with intolerable EPS receiving an FGA	Incidence of concomitant anticholinergic drug use higher for risperidone than olanzapine (14/35 versus 4/35, OR 5.17 (1.49–17.88; P=0.013); no significant difference in EPS
Chan et al^Citation71 (RCT)	Olanzapine Risperidone	30/23 30/21	24	Compare effects in patients with tardive dyskinesia receiving an FGA	Significant reduction in total AIMS for olanzapine (−6.2±8.0) and risperidone (−7.4±6.9); weight gain for risperidone and olanzapine 4.9±7.1 kg and 4.6±6.0 kg, respectively
Chen et al^Citation35 (RCT)	Olanzapine Ziprasidone	35/32 35/33	12	Explore the impact on glucose/lipid metabolism of olanzapine and ziprasidone in older patients	FBG, TC, TG, HDL-C, LDL-C, and BMI did not change significantly in ziprasidone group but increased in olanzapine group (P<0.001 between-group)
Chen^Citation37 (RCT)	Oulanning (generic) Zyprexa^® (originator brand)	51/51 47/47	8	Compare glucose/lipid metabolism of generic olanzapine and Zyprexa	Mean blood glucose, TC, and TG all significantly higher at study end from baseline for both groups (P<0.05)
Chen et al^Citation72 (case-control)	Olanzapine Control	66/66 119/119	–	Explore association between weight gain and ghrelin levels with olanzapine	Olanzapine-treated patients had larger waist size, WHR than control; patients with weight gain had lowest serum ghrelin levels (822.3±253.1 pg/mL versus 1,261.2±1,639.7 pg/mL for control group, P=0.01)
Chiu et al^Citation119 (open-label)	Olanzapine	42/33	8	Investigate the continuous changes of insulin secretion and other metabolic indices after olanzapine therapy	At end point, olanzapine-treated patients had significant increases in body weight, TG, TC, and LDL-C; insulin secretion initially decreased, returned to baseline, then significantly increased at study end point
Guo et al^Citation24 (observational)	Olanzapine Chlorpromazine Sulpiride Clozapine Risperidone Quetiapine Aripiprazole	149/90 169/99 162/98 177/112 199/119 145/77 132/79	52	Compare the safety of seven antipsychotic agents for maintenance therapy in schizophrenia	Olanzapine associated with a higher incidence of weight gain than other agents (P<0.005) but a relatively low incidence of EPS and anticholinergic effects; incidence of drowsiness (41.6%) was higher than other agents except clozapine (47.5%)
Hu et al^Citation73 (RCT)	Olanzapine Paliperidone	40/23 40/33	12	Compare effects on metabolic profile, weight, insulin resistance, and beta-cell function	Weight, BMI, mean subcutaneous fat, and WHR increased significantly in both treatment groups but more so for olanzapine (mean change in weight after 12 weeks, 4.66 kg, P<0.001 versus baseline); mean FBG, mean LDL-C increased significantly in the olanzapine group; fasting TC and TG increased significantly in both groups (P<0.05 for paliperidone, P<0.01 for olanzapine versus baseline)
Huang et al^Citation120 (cohort)	Olanzapine Clozapine Risperidone	79/79 275/275 146/146		Examine association between TNF-α-308 G>A polymorphism and weight gain	Study found no significant association between body weight gain and TNF-α-308 G>A polymorphism
Kuo et al^Citation28 (case-control)	Nationwide cohort	33,024	–	Assess the association between SGA and risk of pneumonia requiring hospitalization	Adjusted RR for pneumonia (current use): clozapine 3.18, olanzapine 1.83, quetiapine 1.63, zotepine 1.48, risperidone 1.32, amisulpride 1.14; dose-dependent increase in risk for clozapine only
Lee and Leung^Citation74 (cross-sectional)	Olanzapine Risperidone	45/45 30/30	–	Determine the metabolic outcomes in patients treated with olanzapine or risperidone	Mean weight gain for olanzapine (7.0±6.3 kg) greater than for risperidone (3.1±6.2 kg); dyslipidemia found in 50% of olanzapine group and 12.5% of risperidone group; no statistically significant difference between groups for metabolic syndrome
Lee et al^Citation66 (cohort)	Olanzapine Risperidone	28/28 28/28	103.5 93.2	Compare the effects of olanzapine and risperidone on weight gain in matched pairs	Weight change (mean ± SD) for olanzapine group (8.34±5.97 kg) greater than for risperidone group (2.74±8.09 kg, P<0.005 for difference between groups); mean weight gain was negatively associated with baseline body weight and pretreatment BMI for both groups
Ou et al^Citation75 (RCT)	Olanzapine Ziprasidone	130/111 130/119	6	Compare metabolic effects in first-episode schizophrenia	Weight change (mean ± SD) for olanzapine (4.22±3.49 kg) greater than for ziprasidone (–0.84±2.04 kg, P<0.001 for difference between groups); significant increases in FBG, insulin, TC, LDL-C, HDL-C, and TG at week 6 (P<0.05)
Pratt et al^Citation76 (distributed network model)	Model	10^6 simulated	–	Investigate the risk of acute hyperglycemia with antipsychotic use	Olanzapine initiation associated with significantly increased risk of insulin initiation in USA and Swedish databases but not in Taiwanese database (trend toward increased risk)
Su et al^Citation77 (observational, crossover)	Olanzapine Risperidone	15/15 15/15	12	Compare changes in glucose/lipids and body weight in patients switching from olanzapine to risperidone or vice versa	Olanzapine associated with greater mean body weight (P=0.001), BMI (P=0.015), and TG (P=0.001), compared with risperidone; no significant difference in FBG (P=0.39) and LDL-C (P=0.72) between groups
Treuer et al^Citation30 (observational)	Olanzapine	380	26	Examine clinical, eating and lifestyle factors associated with weight gain when initiating/switching to olanzapine	Weight gain (mean, 95% CI) after 6 months: People’s Republic of China (5.01 kg, 4.36–5.65 kg), Taiwan (3.52 kg, 2.01–5.03 kg); factors associated with weight gain: country, housing conditions, stronger appetite, excessive amount of food needed to feel full, eating until uncomfortably full, thoughts preoccupied with food, meal location, increased meal frequency, evening snack consumption, lower amount of vigorous exercise
Wang et al^Citation118 (cohort)	Olanzapine Amisulpride	18/NR 15/NR	12	Monitor heart rate variability in patients switching to olanzapine or amisulpride due to tardive dyskinesia	Amisulpride had a more vagotonic effect: statistically significant increases in the mean, variance and high-frequency power of RR intervals with amisulpride, but not olanzapine
Wu et al^Citation78 (RCT)	Olanzapine Clozapine Risperidone Sulpiride	NR/24 NR/30 NR/29 NR/29	8	Investigate the effects on glucose/lipid metabolism in first-episode schizophrenia	Statistically significant increases in BMI and WHR with clozapine, olanzapine, and sulpiride; statistically significant increases in insulin, C-peptide, and IRI levels in all groups (higher for clozapine and olanzapine); clozapine and olanzapine associated with greater increases in TG
Wu et al^Citation79 (RCT)	Olanzapine Clozapine Risperidone Sulpiride	25/24 33/30 31/29 31/29	8	Investigate the sex difference in effects of clozapine, olanzapine, risperidone, sulpiride on glucose and lipid metabolism in first-episode schizophrenia	Significant increase in mean BMI for olanzapine, clozapine and sulpiride from baseline (olanzapine: 1.21±0.76 in males and 0.76±0.37 in females, P=0.178); significant increase in mean WHR for males receiving olanzapine (0.03±0.03 in males versus −0.01±0.02 for females, P=0.042 for difference between groups); significant increase in insulin, C-peptide and IRI in all groups (P<0.05); increase in TG levels significantly greater in males (P=0.002)
Yang et al^Citation31 (retrospective review)	Nil, claims data	40,561	–	Compare the prevalence of EPS between FGA and SGA using anti-parkinsonian agent prescribing rates	Crude coprescribing rate of anti-parkinsonian agents: quetiapine < clozapine < olanzapine < thioridazine < zotepine < chlorpromazine < risperidone < sulpiride < clotiapine < flupentixol < haloperidol < zuclopenthixol < trifluoperazine < loxapine
Yang et al^Citation33 (nested case-control)	Pneumonia Controls	571 2,227	–	Explore the association between antipsychotics/mood stabilizers and the risk of pneumonia	Dose-dependent increase in risk of pneumonia: olanzapine (adjusted RR 2.97, P<0.001), clozapine (RR 2.59, P<0.01), haloperidol (RR 3.68, P<0.001); lithium associated with decreased risk

Note:

a Enrolled/completed.

Abbreviations: AIMS, Abnormal Involuntary Movement Scale; BMI, body mass index; CI, confidence interval; EPS, extrapyramidal syndrome; FBG, fasting blood glucose; FGA, first-generation antipsychotics; HDL-C, high-density lipoprotein cholesterol; IRI, insulin resistance index; LDL-C, low-density lipoprotein cholesterol; NR, not reported; OR, odds ratio; RCT, randomized controlled trial; RR, relative risk; SGA, second-generation antipsychotics; TC, total cholesterol; TG, triglyceride; TNF, tumor necrosis factor; WHR, waist-hip ratio.

CaoGXXieGJ[Observation of efficacy and safety of paliperidone sustained release tablets and domestic olanzapine in treatment of schizophrenia]Chongqing Medical Journal2011401716951696 Chinese

 Google Scholar

ChanHYChangCJChiangSCA randomised controlled study of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced acute dystonia or parkinsonismJ Psychopharmacol2010241919818801830

 PubMed Web of Science ®Google Scholar

ChanHYChiangSCChangCJA randomized controlled trial of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced tardive dyskinesiaJ Clin Psychiatry20107191226123320441726

 PubMed Web of Science ®Google Scholar

ChangFWWangCHZhaoZ[A comparison of clinical efficacy between olanzapine and chlorpromazine in the treatment of positive symptoms of schizophrenia]Chinese Journal of New Drugs and Clinical Remedies2003226357359 Chinese

 Google Scholar

ChenJJChanHYChenCHGauSSHwuHGRisperidone and olanzapine versus another first generation antipsychotic in patients with schizophrenia inadequately responsive to first generation antipsychoticsPharmacopsychiatry2012452647122086749

 PubMed Web of Science ®Google Scholar

ChenJXWuSYLinR[The efficacy and impacts on glucose and lipid metabolism of ziprasidone and olanzapine in the treatment of elder patients with schizophrenia]Guangdong Medical Journal201233710061008 Chinese

 Google Scholar

ChenQLiuXLChenYZ[Research on efficacy and safety of olanzapine and ziprasidone in the treatment of schizophrenia]Chinese Journal of Hospital Pharmacy2008282118561858 Chinese

 Google Scholar

ChenXH[The efficacy of domestic and imported olanzapine in the treatment of schizophrenia and the impacts on glucose and lipid metabolism]Guangdong Medical Journal2010311317361738 Chinese

 Google Scholar

DongHXMeiHB[The comparison of quetiapine with olanzapine in the treatment of aged patients with schizophrenia]Herald of Medicine2012312184185 Chinese

 Google Scholar

DuNQ[The analysis for comparison of efficacy and safety of ziprasidone and olanzapine in treatment of early schizophrenia]Chongqing Medical Journal2012412829382939 Chinese

 Google Scholar

FangMLiLZhaoJ[Effect of antipsychotic drugs on life quality of schizophrenic patients: one year follow-up study]Zhong Nan Da Xue Xue Bao Yi Xue Ban2009349850855 Chinese19779255

 PubMedGoogle Scholar

FangMSZhaoJPGuoXF[Maintenance treatment effectiveness of seven antipsychotic drugs in schizophrenic patients: a 1-year follow-up study]Chinese Journal of Psychiatry200942116 Chinese

 Google Scholar

HuSYaoMPetersonBSA randomized, 12-week study of the effects of extended-release paliperidone (paliperidone ER) and olanzapine on metabolic profile, weight, insulin resistance, and beta-cell function in schizophrenic patientsPsychopharmacol (Berl)20132301313

 Web of Science ®Google Scholar

LeeELeungCMAtypical antipsychotics and metabolic outcomes in Chinese patients: a comparison of olanzapine and risperidoneJ Clin Psychopharmacol200828670770919011445

 PubMed Web of Science ®Google Scholar

LeeELeungCMWongEAtypical antipsychotics and weight gain in Chinese patients: a comparison of olanzapine and risperidoneJ Clin Psychiatry200465686486615291666

 PubMed Web of Science ®Google Scholar

LiYMZhaoJPOuJJWuRREfficacy and tolerability of ziprasidone vs olanzapine in naive first-episode schizophrenia: a 6-week, randomized, open-label, flexible-dose studyPharmacopsychiatry201245517718122290206

 PubMed Web of Science ®Google Scholar

LiangY[A clinical comparative study on paliperidone ER in treating acute phase schizophrenia patients]Chinese Journal of New Drugs2011202424422445 Chinese

 Google Scholar

MaQLiLXLianHT[A controlled comparison study on paliperidone extended-release tablets and olanzapine in the treatment of schizophrenia]Chinese Journal of New Drugs2012212226582661 Chinese

 Google Scholar

OuJJXuYChenHHComparison of metabolic effects of ziprasidone versus olanzapine treatment in patients with first-episode schizophreniaPsychopharmacol (Berl)20132253627635

 PubMed Web of Science ®Google Scholar

SuKPWuPLParianteCMA crossover study on lipid and weight changes associated with olanzapine and risperidonePsychopharmacol (Berl)20051833383386

 Web of Science ®Google Scholar

TanHWangJM[Controlled clinical trial of domestic olanzapine in the treatment of schizophrenia]Chongqing Medical Journal2009387787788 Chinese

 Google Scholar

WangCHFengYGWangDH[A double-blind randomized controlled study of olanzapine and clozapine on treatment of schizophrenia]Shanghai Archives of Psychiatry2002143143145 Chinese

 Google Scholar

WangCHLiYYangJA randomized controlled trial of olanzapine improving memory deficits in Han Chinese patients with first-episode schizophreniaSchizophr Res20131441–312913523352776

 PubMed Web of Science ®Google Scholar

WangXFCuiGMMaJ[The efficacy observation of aripiprazole in the treatment of 48 patients with first-episode schizophrenia]Shandong Medical Journal201050315758 Chinese

 Google Scholar

WangYCaiLWZhangHX[The efficacy and adverse effects of haloperidol and olanzapine: a randomized controlled study]Chinese Journal of Nervous and Mental Diseases2012384217221 Chinese

 Google Scholar

WangYCYangCCBaiYMKuoTBHeart rate variability in schizophrenic patients switched from typical antipsychotic agents to amisulpride and olanzapine. 3-month follow-upNeuropsychobiology200857420020518679039

 PubMed Web of Science ®Google Scholar

WuRRZhaoJPLiuZNEffects of typical and atypical antipsychotics on glucose-insulin homeostasis and lipid metabolism in first-episode schizophreniaPsychopharmacol (Berl)20061864572578

 Web of Science ®Google Scholar

WuRRZhaoJPZhaiJGGuoXFGuoWBSex difference in effects of typical and atypical antipsychotics on glucose-insulin homeostasis and lipid metabolism in first-episode schizophreniaJ Clin Psychopharmacol200727437437917632222

 PubMed Web of Science ®Google Scholar

XieQFengSHZengHL[Efficacies of paliperidone extended-release tablets and olanzapine for treating schizophrenia in children and adolescents]Chinese Journal of New Drugs2012211619161919 Chinese

 Google Scholar

YangLHWeiKLSuSY[Clinical efficacy and safety of olanzapine and risperidone in the treatment of first episode schizophrenia]Chinese Journal of Clinical Pharmacology2010269647649 Chinese

 Google Scholar

YangSYKao YangYHChongMYYangYHChangWHLaiCSRisk of extrapyramidal syndrome in schizophrenic patients treated with antipsychotics: a population-based studyClin Pharmacol Ther200781458659417235331

 PubMed Web of Science ®Google Scholar

YangXNMeiQY[A comparison of olanzapine and risperidone in the treatment of first-episode schizophrenia]Shanghai Archives of Psychiatry2003156338340 Chinese

 Google Scholar

YenCFChengCPHuangCFYenJYKoCHChenCSQuality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remissionBipolar Disord200810561762418657246

 PubMed Web of Science ®Google Scholar

YuLLWangXYJinGX[The effects of anti-schizophrenia on serum level of estrogen in male patients with schizophrenia]Chinese Journal of Nervous and Mental Diseases20123812742746 Chinese

 Google Scholar

ZhangHYLiHFGangW[The efficacy and safety of flexible dose of paliperidone extended-release tablets in the treatment of acute schizophrenia: a randomized, double blind olanzapine-controlled study]Chinese Journal of Psychiatry2009423153157 Chinese

 Google Scholar

ZhuQYPiJF[The effect of olanzapine on the quality of life of patients with schizophrenia]Herald of Medicine2012313334336 Chinese

 Google Scholar

ZhuQYPiJF[A comparative study of paliperidone and olanzapine in the treatment of treatment-refractory schizophrenia]Chinese Journal of New Drugs2012216666669 Chinese

 Google Scholar

AngQTangJZhaoJP[Factors associated with weight gain during six-month olanzapine therapy]Chinese Journal of Psychiatry201144316 Chinese

 Google Scholar

ChenVCWangTNLuMLWeight gain and ghrelin level after olanzapine monotherapyProg Neuropsychopharmacol Biol Psychiatry201135263263521256176

 PubMed Web of Science ®Google Scholar

ChiuCCChenCHChenBYYuSHLuMLThe time-dependent change of insulin secretion in schizophrenic patients treated with olanzapineProg Neuropsychopharmacol Biol Psychiatry201034686687020394794

 PubMed Web of Science ®Google Scholar

GaoGLChenL[The effectiveness of olanzapine in the treatment of first episode schizophrenia]Shanghai Archives of Psychiatry20031513334 Chinese

 Google Scholar

GuoJHWengYZFangZ[Open-label trial of olanzapine in the treatment of 33 patients with schizophrenia]Shanghai Archives of Psychiatry20001214648 Chinese

 Google Scholar

GuoXZhangZZhaiJEffects of antipsychotic medications on quality of life and psychosocial functioning in patients with early-stage schizophrenia: 1-year follow-up naturalistic studyCompr Psychiatry20125371006101222516246

 PubMed Web of Science ®Google Scholar

GuoXFangMZhaiJEffectiveness of maintenance treatments with atypical and typical antipsychotics in stable schizophrenia with early stage: 1-year naturalistic studyPsychopharmacology (Berl)2011216447548421369751

 PubMed Web of Science ®Google Scholar

GuoXZhaiJWeiQNeurocognitive effects of first- and second-generation antipsychotic drugs in early-stage schizophrenia: a naturalistic 12-month follow-up studyNeurosci Lett2011503214114621888948

 PubMed Web of Science ®Google Scholar

HuangHHWangYCWuCLTNF-alpha -308 G>A polymorphism and weight gain in patients with schizophrenia under long-term clozapine, risperidone or olanzapine treatmentNeurosci Lett2011504327728021967963

 PubMed Web of Science ®Google Scholar

KuoCJYangSYLiaoYTSecond-generation antipsychotic medications and risk of pneumonia in schizophreniaSchizophr Bull201339364865722282455

 PubMed Web of Science ®Google Scholar

LiHJWuAGZhaoHY[The correlation analysis between the efficacy of olanzapine in the treatment of schizophrenia and the blood concentration]Chinese Journal of Nervous and Mental Diseases2003295363365 Chinese

 Google Scholar

LuZHuJChenCKEffectiveness and safety of olanzapine in the treatment of schizophrenia among Asian patients switching from conventional antipsychoticsProg Neuropsychopharmacol Biol Psychiatry2007311324016843580

 PubMed Web of Science ®Google Scholar

PrattNAndersenMBergmanUMulti-country rapid adverse drug event assessment: the Asian Pharmacoepidemiology Network (AsPEN) antipsychotic and acute hyperglycaemia studyPharmacoepidemiol Drug Saf201322991592423696036

 PubMed Web of Science ®Google Scholar

ShenTLiWJ[The efficacy analysis of small-dose olanzpine in treatment of 12 patients with schizophrenia]Shanghai Archives of Psychiatry20001214849 Chinese

 Google Scholar

ShuLLiuPZhouM[Olanzapine in the treatment of schizophrenia: an open trial clinical study]Chinese Journal of Psychiatry1999324223225 Chinese

 Google Scholar

TreuerTHoffmannVPChenAKFactors associated with weight gain during olanzapine treatment in patients with schizophrenia or bipolar disorder: results from a six-month prospective, multinational, observational studyWorld J Biol Psychiatry2009104 Pt 372974019606406

 PubMed Web of Science ®Google Scholar

YangXHHuangJZYanHS[Open-label trial of olanzapine in the treatment of 70 patients with schizophrenia]Shanghai Archives of Psychiatry20021429496 Chinese

 Google Scholar

ZhengHBDengHHZhouL[Open-label trial of olanzapine in the maintenance treatment of 23 patients with schizophrenia]Shanghai Archives of Psychiatry20001214344 Chinese

 Google Scholar

JianWYMiaoGD[The efficacy and safety of atypical antipsychotic drugs combined with sodium valproate in the treatment of bipolar mania]Guangdong Medical Journal2013344641616 Chinese

 Google Scholar

LiuYPLiuEYLanXE[Controlled study of quetiapine and olanzapine combined with sodium valproate in the treatment of female patients with acute manic episode]J Pract Med2009251123125 Chinese

 Google Scholar

NiufanGTohenMQiuqingAOlanzapine versus lithium in the acute treatment of bipolar mania: a double-blind, randomized, controlled trialJ Affect Disord20081051–310110817531327

 PubMed Web of Science ®Google Scholar

TohenMMcDonnellDPCaseMRandomised, double-blind, placebo-controlled study of olanzapine in patients with bipolar I depressionBr J Psychiatry2012201537638222918966

 PubMed Web of Science ®Google Scholar

YangPDLiJChenDC[A random and controlled trial for evaluating the efficacy and safety of olanzapine and lithium in the treatment of bipolar or mixed type mania]Chinese Journal of New Drugs20081716770 Chinese

 Google Scholar

YangSYLiaoYTLiuHCChenWJChenCCKuoCJAntipsychotic drugs, mood stabilizers, and risk of pneumonia in bipolar disorder: a nationwide case-control studyJ Clin Psychiatry2013741e79e8623419234

 PubMed Web of Science ®Google Scholar