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Quetiapine


Presentation

  • We present the case of a 43-year-old African American male with a history of schizoaffective disorder who presented to our emergency department multiple times over a three year period with priapism, each episode related to the ingestion of quetiapine.[ncbi.nlm.nih.gov]
  • We present the first reported Han-Chinese case that developed leucopenia and thrombocytopenia after taking quetiapine.[ncbi.nlm.nih.gov]
  • Results of the present study imply that acute exacerbated schizophrenic patients with metabolism abnormalities may involve disruption of expression of cytokines, and that quetiapine may have therapeutic effects.[ncbi.nlm.nih.gov]
  • We present a case of refractory hypotension that occurred after induction of general anesthesia in a patient being treated with quetiapine. This patient was not currently taking antihypertensives and had no known cardiovascular abnormalities.[ncbi.nlm.nih.gov]
  • Here, we presented the first case of belly dancer syndrome in a 71-year-old woman with major depressive disorder after short-term use of quetiapine.[ncbi.nlm.nih.gov]
Malingering
  • Schizophr Res 2000; 43:135–145 [CrossRef] [Medline] Pierre JM, Wirshing DA, Wirshing WC: "Iatrogenic malingering" in VA substance abuse treatment. Psychiatr Serv 2003; 54:253–254 [ Free Full Text] Resnick PJ: The detection of malingered psychosis.[web.archive.org]
Developmental Disabilities
  • Singh, Practical guidelines for the use of new generation antipsychotic drugs (except clozapine) in adult individuals with intellectual disabilities, Research in Developmental Disabilities, 10.1016/j.ridd.2008.10.010, 30, 4, (613-669), (2009) ., Current[doi.org]
Sputum
  • After quetiapine treatment, he complained of fever and coughed up sputum, whereas his aggressive behavior improved. His symptoms persisted despite empirical antibiotic treatment. All diagnostic tests for infectious causes were negative.[ncbi.nlm.nih.gov]
Dysgeusia
  • 5% 2% Akathisia 4% 1% Extrapyramidal Disorder 3% 1% Paraesthesia 3% 2% Dysarthria 3% 0% Hypersomnia 3% 0% Tremor 2% 1% Restless Legs Syndrome 2% 0% Balance Disorder 2% 1% Hypoaesthesia 2% 1% Dystonia 1% 0% Dizziness, postural 1% 0% Dyskinesia 1% 0% Dysgeusia[web.archive.org]
Orthostatic Hypotension
  • hypotension associated with use Monitor for cataract Increased blood pressure in children and adolescents Leukopenia, neutropenia, and agranulocytosis may occur Somnolence may occur (especially with extended-release product) Potential for withdrawal[web.archive.org]
  • hypotension, blurred vision, dry mouth, nasal congestion, and constipation) by blockade of histamine, cholinergic, and adrenergic receptors.[chemicalland21.com]
  • Other adverse effects include extrapyramidal symptoms, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, insomnia, agitation, anxiety, orthostatic hypotension, abdominal pain, dry mouth, rhinitis, rash, asthenia, back pain, fever[medical-dictionary.thefreedictionary.com]
  • […] therapy). 1 (See Patients at Risk of Orthostatic Hypotension under Dosage and Administration.)[web.archive.org]
Motor Restlessness
  • Such side effects include acute dyskinesias, acute dystonias, motor restlessness, pseudo-Parkinsonism and tardive dyskinesias (TD).[google.com]
Agitation
  • Main outcome measures Agitation (Cohen-Mansfield agitation inventory) and cognition (severe impairment battery) at baseline and at six weeks and 26 weeks. The primary outcome was agitation inventory at six weeks.[bmj.com]
  • The withdrawal and the gradual reintroduction of quetiapine 2 weeks later, which led to another severe agitation, enabled us to attribute the agitation specifically to quetiapine.[ncbi.nlm.nih.gov]
  • For all second-generation antipsychotics including quetiapine, central nervous system clinical effects were most common, including drowsiness, confusion, and agitation.[ncbi.nlm.nih.gov]
  • Other adverse effects include extrapyramidal symptoms, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, insomnia, agitation, anxiety, orthostatic hypotension, abdominal pain, dry mouth, rhinitis, rash, asthenia, back pain, fever[medical-dictionary.thefreedictionary.com]
Seizure
  • The patient developed ventricular tachycardia and epileptic seizures 12 h after admission to the hospital.[ncbi.nlm.nih.gov]
  • Investigative and autopsy findings suggested perimortem hyperthermia and seizure-like activity. Kratom toxicity and kratom-associated fatalities are being increasingly reported.[ncbi.nlm.nih.gov]
  • Other serious clinical effects observed with second-generation antipsychotic abuse included hypotension, respiratory depression, and seizures.[ncbi.nlm.nih.gov]
  • […] incidence of suicidality and associated behaviors Contraindications Documented hypersensitivity Cautions Use with caution in cardiovascular and cerebrovascular disease May worsen hypotensive conditions Use with caution in breast cancer and history of seizure[web.archive.org]
  • […] and associated behaviors Not approved for children Contraindications Documented hypersensitivity Cautions Use with caution in cardiovascular and cerebrovascular disease May worsen hypotensive conditions Use with caution in breast cancer and history of seizure[reference.medscape.com]
Akathisia
  • The diagnoses of manic shift and akathisia were dismissed. The withdrawal and the gradual reintroduction of quetiapine 2 weeks later, which led to another severe agitation, enabled us to attribute the agitation specifically to quetiapine.[ncbi.nlm.nih.gov]
  • Four methods were used to measure EPS: (1) Simpson-Angus total score (mean change from baseline) which evaluates Parkinsonism and akathisia, (2) Barnes Akathisia Rating Scale (BARS) Global Assessment Score, (3) incidence of spontaneous complaints of EPS[dailymed.nlm.nih.gov]
  • Safety measurements included adverse events, vital signs, the Abnormal Involuntary Movement Scale, the Barnes Akathisia Scale, the Simpson-Angus Scale, and the Arizona Sexual Experiences Scale.[ncbi.nlm.nih.gov]
  • Serious adverse events identified from case reports included fatal hepatotoxicity, restless legs syndrome, akathisia, and weight gain. There are potential safety concerns when using low-dose quetiapine for treatment of insomnia.[ncbi.nlm.nih.gov]
  • […] abnormal ECG (2 RCTs, n 165, RR 0.38 CI 0.16 to 0.92, NNTH 8, CI 4 to 55), fewer overall extrapyramidal effects (8 RCTs, n 1,095, RR 0.17 CI 0.09 to 0.32, NNTH 3, CI 3 to 3, moderate quality evidence ) and fewer specific extrapyramidal effects including akathisia[web.archive.org]
Stupor
  • الصفحة 278 - Serious overdose with hydrocodone is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity[books.google.com]
  • […] vertigo, involuntary movements, confusion, amnesia, psychosis, hallucinations, hyperkinesia, libido increased *, urinary retention, incoordination, paranoid reaction, abnormal gait, myoclonus, delusions, manic reaction, apathy, ataxia, depersonalization, stupor[web.archive.org]
  • […] vertigo, involuntary movements, confusion, amnesia, psychosis, hallucinations, hyperkinesia, libido increased 1, urinary retention, incoordination, paranoid reaction, abnormal gait, myoclonus, delusions, manic reaction, apathy, ataxia, depersonalization, stupor[web.archive.org]

Workup

QTc Interval Prolonged
  • The objective of this analysis was to describe the impact of quetiapine on QTc interval prolongation in critically ill patients.[ncbi.nlm.nih.gov]
Hepatocellular Carcinoma
  • A case of a patient with hepatocellular carcinoma that developed neutropenia after treatment with quetiapine is described here. A 62-year-old Taiwanese widow with bipolar disorder was diagnosed with hepatocellular carcinoma at age 60.[ncbi.nlm.nih.gov]

Treatment

  • Treatment resistant depression is associated with a poorer prognosis and higher mortality rates. One treatment option is to augment an existing antidepressant with a second agent.[ncbi.nlm.nih.gov]
  • Treatment Major Depressive Disorder (MDD) 8 3 Completed Treatment Major Depressive Disorder (MDD) / Treatment Resistant Depression (TRD) 1 3 Completed Treatment Moods Disorders 1 3 Completed Treatment Obsessive Compulsive Disorder (OCD) 1 3 Completed[drugbank.ca]
  • Quetiapine has also proven efficacy and tolerability in the treatment of moderate to severe manic episodes, and in the treatment of juveniles with oppositional-defiant or conduct disorders, and in the geriatric dementia population.[ncbi.nlm.nih.gov]
  • Moreover, treatment did not result in lower toxicity to tested organisms. In conclusion, UV treatment of QUT should be considered critically as a potential treatment for QUT in aquatic systems. Copyright 2016 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment resistant depression is associated with a poorer prognosis and higher mortality rates. One treatment option is to augment an existing antidepressant with a second agent.[ncbi.nlm.nih.gov]
  • Tomotaka Suzuki, Masayuki Takase, Toshihiro Moriyama, Hiroyuki Watanabe, Toyoaki Hirata, Makoto Asano and Masaomi Iyo, Impact of dopamine supersensitivity psychosis in treatment-resistant schizophrenia: An analysis of multi-factors predicting long-term prognosis[doi.org]

Etiology

  • Its etiology is still unclear and there are few studies reporting its association with antipsychotics. Quetiapine is an atypical antipsychotic that causes lower risk of extrapyramidal symptoms than typical antipsychotics.[ncbi.nlm.nih.gov]
  • Lingual protrusion dystonia: frequency, etiology and botulinum toxin therapy. Parkinsonism Relat Disord. 2010;16(7):438–41. PubMed CrossRef Google Scholar 39. Hennings JM, Bötzel KE, Wetter TC.[doi.org]
  • Psychogenic polydipsia review: etiology, differential, and treatment. Curr Psychiatry Rep 2007; 9: 236–41 PubMed CrossRef Google Scholar 64. Ananth J, Lin KM. SIADH: a serious side effect of psychotropic drugs.[dx.doi.org]
  • Hyperprolactinemia, regardless of etiology, may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotrophin secretion.[web.archive.org]

Epidemiology

  • Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. 2 The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China. 3 Zhejiang University School of Medicine, Hangzhou 310058, China. 4 Epidemiology[ncbi.nlm.nih.gov]
  • Schizophrenia: the epidemiological horizon. In: Hirsch SR, Weinberger DR, editors. Schizophrenia; Oxford: Blackwell Science, 1995: 206–52 Google Scholar 33. Royal College of Psychiatrists.[doi.org]
  • Ford DE, Kamerow DB: Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989, 262 :1479–1484. PubMed CrossRef Google Scholar 8.[doi.org]
  • […] about SEROQUEL, please visit the psychiatry resource internet site at: www.psychiatry-in-practice.com This psychiatry resource features educational materials relating to severe mental illness, including background information on schizophrenia as well as epidemiological[web.archive.org]
  • Barbui, New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base, Epidemiology and Psychiatric Sciences, 10.1017/S2045796016001025, 26, 3, (231-233), (2016).[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Abstract Although the etiopathogenic mechanisms of schizophrenia (SCZ) are unknown, evidences suggest that excessive free radical production or oxidative stress may be involved in the pathophysiology of SCZ.[ncbi.nlm.nih.gov]
  • Histology and Embryology, School of Basic Medical Sciences, Southern Medical University, No. 1023-1063 Sha Tai Road, Baiyun District, Guangzhou 510515, China. dzwuyjun@163.com. 7 Key Laboratory of Functional Proteomics of Guangdong Province, Department of Pathophysiology[ncbi.nlm.nih.gov]
  • الصفحة 660 - Corticotropin releasing hormone in the pathophysiology of melancholic and atypical depression and in the mechanism of action of antidepressant drugs. ‏[books.google.com]
  • […] respected and read medical text in all of pharmacology, Goodman & Gilman’s The Pharmacological Basis of Therapeutics represents the pinnacle of authority and accuracy in describing the actions and uses of therapeutic agents in relation to physiology and pathophysiology[books.google.com]
  • Atypical antipsychotic medications may have a role in the treatment of headache, especially migraine. 35 Several neurotransmitters, such as dopamine and serotonin, may be involved in the pathophysiology of migraine. 35 Quetiapine may prevent headache[ncbi.nlm.nih.gov]

Prevention

  • Immediate intervention is needed to prevent destructive and irreversible complications, such as erectile dysfunction, disfigurement, inability of the penis to stay erect, and related social/emotional problems.[ncbi.nlm.nih.gov]
  • Pretreatment with domperidone largely prevented withdrawal so that he finally could successfully discontinue quetiapine administration.[ncbi.nlm.nih.gov]
  • We report on a case of a patient with schizophrenia who was taking 700 mg extended release quetiapine fumarate during her entire pregnancy to prevent relapse. At week 41 she gave birth to a healthy boy.[ncbi.nlm.nih.gov]
  • RESULTS: Review of the available trials suggested comparable efficacy of quetiapine and lithium in acute mania, and possibly greater efficacy for quetiapine compared with lithium in acute bipolar depression and in prevention of recurrent (particularly[ncbi.nlm.nih.gov]
  • Its manic/hypomanic induction properties should not prevent its administration to patients suffering from bipolar disorder.[ncbi.nlm.nih.gov]

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