quetiapine-fumarate and Dystonia

We present the case of a young gentleman with diagnoses of bipolar affective disorder, high body mass index, and obstructive sleep apnoea. He was commenced on zuclopenthixol due to an inadequate response to quetiapine, but this swiftly led to marked physical health deterioration including shortness of breath, back pain, tachycardia, tachypnoea, and hypoxia. He was urgently transferred to hospital where he required intubation and intensive care admission. AFTER excluding other causes, it was felt that commencing zuclopenthixol had induced laryngo-pharyngeal dystonia leading to upper airway compromise and severely impaired respiratory function. He progressively recovered after zuclopenthixol was stopped, and he was transferred back to the psychiatric hospital after eight days. THIS case highlights the potential challenges in diagnosing this rare but potentially fatal reaction to antipsychotics. We review the available literature on other cases including a potential interaction between typical antipsychotics and serotonin-specific reuptake inhibitors. Psychiatrists and emergency physicians should be aware of this condition and be alert in considering the administration of anticholinergics, which could be a simple yet life-saving intervention.

Topics: Antipsychotic Agents; Bipolar Disorder; Clopenthixol; Dystonia; Humans; Male; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors

Topics: Acute Disease; Akathisia, Drug-Induced; Antipsychotic Agents; Basal Ganglia Diseases; Dibenzothiazepines; Dopamine D2 Receptor Antagonists; Dystonia; Humans; Indoles; Isoindoles; Parkinsonian Disorders; Quetiapine Fumarate; Receptors, Muscarinic; Receptors, Serotonin; Risperidone; Serotonin Antagonists; Syndrome; Thiazoles

Antipsychotic agents remain the most effective treatment for both acute and chronic schizophrenia. However, conventional antipsychotic agents are frequently associated with significant side effects including, perhaps most notably, extrapyramidal symptoms (EPS). The emergence of EPS can significantly compromise patient compliance with treatment and can have profound effects on long-term treatment outcomes. Providing effective symptom relief with minimal side effects and without inducing EPS is, therefore, a primary goal in the treatment of schizophrenia. Atypical antipsychotic agents are now regarded as first-line therapies for the treatment of schizophrenia because of their lower propensity to induce EPS compared with conventional antipsychotics, and evidence exists that these agents are associated with a lower relapse rate, which perhaps reflects an improvement in patient compliance.

Topics: Adult; Akathisia, Drug-Induced; Antipsychotic Agents; Basal Ganglia Diseases; Dibenzothiazepines; Dystonia; Female; Humans; Male; Movement Disorders; Parkinsonian Disorders; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

The incidence of acute extrapyramidal symptoms (EPS)--akathisia, dystonia, and parkinsonism--associated with traditional antipsychotics varies, but most researchers agree that neuroleptic-induced EPS occur in 50% to 75% of patients who take conventional antipsychotics. Atypical antipsychotics were developed to widen the therapeutic index and to reduce EPS. Although the mechanisms are unclear, the risk of EPS is less with the novel antipsychotics than with conventional drugs, and agents that produce low levels of acute EPS are likely to produce less tardive dyskinesia. Nevertheless, clinicians should exercise caution when comparing data from investigations of the novel antipsychotics and, until long-term data become available, should administer the new drugs at doses below the EPS-producing level.

Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Clinical Trials as Topic; Clozapine; Dibenzothiazepines; Drug Administration Schedule; Dyskinesia, Drug-Induced; Dystonia; Humans; Olanzapine; Parkinson Disease, Secondary; Pirenzepine; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Substance Withdrawal Syndrome

Topics: Adolescent; Antiparkinson Agents; Antipsychotic Agents; Aripiprazole; Benztropine; Bipolar Disorder; Dystonia; Humans; Lithium; Male; Marijuana Abuse; Quetiapine Fumarate; Risk-Taking

Topics: Adolescent; Akathisia, Drug-Induced; Antipsychotic Agents; Aripiprazole; Autism Spectrum Disorder; Delusions; Dystonia; Female; Hallucinations; Humans; Hypnotics and Sedatives; Intellectual Disability; Lorazepam; Loxapine; Olanzapine; Paranoid Disorders; Psychotic Disorders; Quetiapine Fumarate; Tourette Syndrome

Quetiapine is a low-affinity dopamine D2 receptor antagonist, approved for the treatment of bipolar disorder and schizophrenia in children and adolescents by the Food and Drug Administration, but not by European Medicine Agency. Although knowledge of adverse drug reactions in children and adolescents is scarce, quetiapine is increasingly being used for youth in Denmark. The aim of this case study is to discuss adverse drug events (ADEs) spontaneously reported to the Danish Medicines Agency on quetiapine used in the pediatric population in relation to adversive drug reactions (ADRs) reported in the European Summary of Product Characteristics (SPCs). The ADE report database at Danish Medicines Agency was searched for all quetiapine ADRs involving individuals (<18 years) in the period 1997-2015. Fifteen ADE case reports were retrieved, scrutinized, and categorized. The average age was 14.8 years (range 10-17 years) and six patients were boys. The main reported ADEs were (i) endocrine, for example, hyperprolactinemia and hyperthyroidism, (ii) cardiac, for example, tachycardia and QT prolongation, (iii) neurological, for example, seizures and cerebral hemorrhage, and (iv) psychiatric, for example, hallucinations. As some of the reported ADEs are life threatening and not listed as ADRs in the SPCs, off-label use of quetiapine in children and adolescents gives rise to safety concerns.

Topics: Adolescent; Adverse Drug Reaction Reporting Systems; Age Factors; Antipsychotic Agents; Case-Control Studies; Child; Databases, Factual; Denmark; Drug-Related Side Effects and Adverse Reactions; Dystonia; Female; Humans; Hypotension, Orthostatic; Male; Quetiapine Fumarate; Tachycardia; Treatment Outcome

Topics: Antidepressive Agents; Depression, Postpartum; Dibenzothiazepines; Dystonia; Female; Humans; Middle Aged; Postural Balance; Quetiapine Fumarate; Sensation Disorders; Sertraline

Topics: Aged, 80 and over; Antipsychotic Agents; Dementia; Dibenzothiazepines; Dystonia; Humans; Male; Parkinson Disease; Psychomotor Agitation; Quetiapine Fumarate

Topics: Aged; Antipsychotic Agents; Cognition Disorders; Dibenzothiazepines; Dystonia; Female; Humans; Quetiapine Fumarate; Spasm

Topics: Adolescent; Amisulpride; Anemia, Iron-Deficiency; Antipsychotic Agents; Dibenzothiazepines; Dystonia; Female; Hemoglobins; Humans; Piperazines; Quetiapine Fumarate; Schizophrenia; Sulpiride; Thiazoles

Dystonia is a syndrome of involuntary, repetitive (or sustained) muscle contractions of opposing muscles, which may result in torsions and abnormal postures. Tardive dystonia is a form of the disorder that starts after longer term use of dopamine antagonists. It occurs in approximately 3% of patients receiving ongoing antipsychotic treatment and is often difficult to reverse. Dystonia can also be induced by compounds other than antipsychotics, such as antidepressants, levodopa, carbamazepine, dextroamphetamine, and diphenylhydantoin. In these cases, it is transient, generally disappearing after the dose is reduced or the causative drug is stopped. Dystonia induced by injury can also be transient. We report a case of transient oromandibular dystonia following a dental filling in a woman receiving quetiapine, a second-generation antipsychotic. The timing, localization, and transience of the dystonia suggested that the dental procedure may have played a triggering role. The dystonia symptoms responded within 8 weeks to benztropine and a dose reduction of quetiapine, and they did not return when benztropine was discontinued. This case benefited from prompt attention and has led to practical recommendations for psychiatric clinicians.

Topics: Dibenzothiazepines; Dystonia; Female; Humans; Middle Aged; Movement Disorders; Quetiapine Fumarate

Frontotemporal dementia (FTD) often presents with behavioural changes warranting treatment with antipsychotic medications. It is known that patients with Lewy body dementia are sensitive to developing extrapyramidal symptoms (EPS) from these medications. This has not been emphasized in FTD. We report three patients with FTD that developed parkinsonism and prominent antecollis after treatment with newer antipsychotics, including olanzapine, risperidone and quetiapine. Patients with FTD might have increased sensitivity to antipsychotic medications as with Lewy body dementia. Although newer antipsychotics have favourable side effect profiles, there is increasing evidence that EPS develop more frequently than previously thought.

Topics: Antipsychotic Agents; Benzodiazepines; Dementia; Dibenzothiazepines; Dystonia; Humans; Male; Middle Aged; Neck Muscles; Olanzapine; Parkinsonian Disorders; Quetiapine Fumarate; Risperidone

Pisa syndrome (or pleurothotonus), consisting of a tonic flexion of the trunk, has been recently reported also in association with atypical antipsychotics. We describe the first case of Pisa syndrome during aripiprazole treatment in an elderly (77-year-old) woman, admitted to hospital for behavioural and psychological symptoms of dementia. The ongoing treatment with quetiapine was rapidly tapered and stopped, and a switch to aripiprazole (15 mg/die) was attempted the subsequent day. Six days later, an acute tonic flexion of trunk and head towards the right was observed. Aripiprazole was discontinued and the Pisa syndrome completely disappeared within 3 days, without any adjunctive treatment.

Topics: Aged; Antipsychotic Agents; Aripiprazole; Dementia; Dibenzothiazepines; Dystonia; Female; Humans; Piperazines; Quetiapine Fumarate; Quinolones

Topics: Antipsychotic Agents; Dibenzothiazepines; Dyskinesia, Drug-Induced; Dystonia; Female; Humans; Middle Aged; Quetiapine Fumarate; Treatment Outcome

Antipsychotic-induced extrapyramidal side effects have a negative impact on treatment for mental illness. Acute dystonic reactions are uncomfortable and frightening to the patient, and often lead to early discontinuation of drug therapy and worsened long-term outcome. The lower propensity of the atypical antipsychotic agents to cause extrapyramidal symptoms (EPS) has been associated with multiple benefits, including improved adherence. The authors describe a 57-year-old male patient who was in the treatment refractory unit. This patient exhibited extreme sensitivity to antipsychotic agents, experiencing acute dystonic reactions with quetiapine and olanzapine, in addition to older typical antipsychotic agents. The patient has not experienced acute EPS since therapy with aripiprazole was initiated. Further complicating this patient's course is his unusual sensitivity to experiencing dystonic reactions. We have observed acute dystonias in the absence of antipsychotic treatment and in the context of seizure activity (or paroxysmal dyskinetic activity). The true etiology of the latter dystonic activity has not been completely determined due to the patient's unwillingness to cooperate with invasive testing. None of the gene variations tested (CYP2D6 phenotype, two dopamine D2 receptor variants and one D3 receptor variant) appeared to explain the patient's vulnerability to acute dystonic reactions.

Topics: Anticonvulsants; Antipsychotic Agents; Chronic Disease; Cytochrome P-450 CYP2D6; Dibenzothiazepines; Dystonia; Genotype; Humans; Male; Middle Aged; Phenytoin; Psychotic Disorders; Quetiapine Fumarate; Seizures; Valproic Acid

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Drug Administration Schedule; Dyskinesia, Drug-Induced; Dystonia; Humans; Male; Quetiapine Fumarate; Schizophrenia; Treatment Outcome