Subjective experience and D2 receptor occupancy in patients with recent-onset schizophrenia treated with low-dose olanzapine or haloperidol:: A randomized, double-blind study

objective: The authors tested the hypothesis that a dopamine D-2 receptor Occupancy level between 60% and 70% in patients with recent-onset schizophrenia would result in optimal subjective experience. in addition, they sought preliminary evidence on whether subjective experience is better with low-dose olanzapine than with low-dose haloperidol. Method: Subjects (N=24) who met DSM-IV criteria for schizophrenia were randomly assigned to 6 weeks of double-blind treatment with either olanzapine, 7.5 mg/day, or haloperidol, 2.5 mg/day. Subjective experience, psychopathology, and extrapyramidal symptoms were assessed at baseline and at endpoint. After 6 weeks, D-2 receptor occupancy was assessed with [I-123]iodobenzamide single photon emission computed tomography. Results: The two study groups were similar at baseline. After 6 weeks, patients receiving olanzapine had a significantly lower mean dopamine D-2 receptor occupancy (51.0%, range=36%-67%) than those given halopericlol (65.5%, range=45%-75%). Receptor occupancy between 60% and 70% was associated with optimal subjective experience, and subjective experience improved significantly in the haloperidol group. Conclusions: A level of D-2 receptor occupancy between 60% and 70% is optimal for subjective experience of patients with recent-onset schizophrenia. Substantial interindividual variation in D-2 receptor occupancy was seen at fixed low-dose levels of olanzapine and halopericlol. Olanzapine, 7.5 mg/day, showed no superior subjective response over halopericlol, 2.5 mg/day. Olanzapine may need to be dosed higher than 7.5 mg/day for most patients with recent-onset schizophrenia, and halopericlol needs to be individually titrated in the very low dose range to reach optimal occupancy.