Exploring High-Dose Olanzapine for Psychosis in an Adolescent With Treatment-Resistant Schizophrenia

High-dose olanzapine has shown efficacy in treating adult patients with treatment-resistant schizophrenia, though evidence in adolescents remains limited. This report describes the case of a 17-year-old male patient with treatment-resistant schizophrenia who showed significant clinical improvement with a supratherapeutic dose of orally disintegrating olanzapine. The patient, with a 16-month history of schizophrenia and multiple hospitalizations, presented with acute psychosis and aggression after medication non-adherence. Following failed trials of paliperidone and standard-dose olanzapine, and unable to initiate clozapine due to blood draw refusal, the patient was gradually titrated to 50 mg daily of orally disintegrating olanzapine (20 mg early morning, 30 mg at bedtime). This intervention marked improvements in thought process, thought content, and paranoia, with minimal side effects. This case adds to the limited literature on high-dose olanzapine in adolescents. It suggests that supratherapeutic doses may be a viable option for treatment-resistant cases in which standard treatments are ineffective or unfeasible.