quetiapine-fumarate and Hallucinations

An 81-year-old female presented with a right pontine infarct and later developed recurrent vivid hallucinations. After a workup for delirium and hallucinosis was unrevealing, a diagnosis of peduncular hallucinosis (PH) was proposed. Treatment with quetiapine and, later, adjunctive nightly melatonin resulted in return to cognitive baseline. An array of etiologies can be responsible for visual hallucinations, including PH. Herein, we review several disorders of hallucinosis and their diagnostic workup. Additionally, we explore the pathophysiology of PH and its association with the pontine-geniculate-occipital (PGO) pathway and propose why correction of the sleep-wake cycle may benefit patients with PH.

Topics: Aged, 80 and over; Female; Hallucinations; Humans; Melatonin; Quetiapine Fumarate

Hallucinations and psychosis are common in patients with Parkinson's disease (PD), with reported prevalences of up to 48% and 80%, respectively. However, few randomized, double-blind, placebo-controlled trials evaluating the treatment options have appeared in the literature. The studies that have been published were complicated by lack of agreement on the diagnosis of psychosis in PD, poor completion rates, mixed populations that included dementia, and other issues. Several reviews, guidelines, and consensus statements have sought to establish standards for treating these symptoms of PD. In 2006, the American Academy of Neurology (AAN) published a practice guideline (based on articles published up to 2004) for management of depression, psychosis, and dementia in patients with PD. Since then, a number of relevant studies have been published.. The purpose of this article was to review data that have appeared in the literature since publication of the AAN guideline regarding the management of hallucinations and psychosis in PD.. A literature search of the PubMed, CINAHL, and PsychInfo databases was conducted for human studies published in English from January 2004 to June 2010. All clinical studies were included except case reports and case series. Studies with <20 participants were also excluded. Search terms included psychosis, hallucinosis, hallucination, delusion, Parkinson, atypical antipsychotic, neuroleptic, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone.. Thirteen studies were included in the review: 3 studies of clozapine, 7 studies of quetiapine, 2 head-to-head trials comparing quetiapine and clozapine, and 1 noncomparative trial of clozapine or quetiapine interventions. Most of the studies included participants with a mean age in the early to mid 70s and a mean duration of PD typically >10 years.. Results of the identified studies suggested that patients with PD might benefit from long-term clozapine therapy. Results of the quetiapine studies were conflicting. However, no statistically significant difference in effectiveness was found between quetiapine and clozapine in comparative trials. The significance of the differences in treatment responses between patients with dementia and those without dementia remains unclear, and it was not possible to draw conclusions for or against other atypical antipsychotics because of insufficient evidence. Further studies are needed to address the methodologic issues in the current trials and to assess safety issues in larger cohorts.

Topics: Aged; Antipsychotic Agents; Brief Psychiatric Rating Scale; Clozapine; Comorbidity; Delusions; Dementia; Depression; Dibenzothiazepines; Disease Progression; Guidelines as Topic; Hallucinations; Humans; Middle Aged; Parkinson Disease; Psychotic Disorders; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Research Report; Risperidone

Drug-induced iatrogenic hallucinations and psychosis occur in about 30% of Parkinson's disease (PD) patients and are the single most important precipitant for nursing home placement, which carries a grave prognosis. In addition, parkinsonism is a frequent accompaniment to the more common dementing syndromes, Alzheimer's disease (AD), vascular dementia, and dementia with Lewy bodies (DLB). The five most recent antipsychotic drugs approved by the Food and Drug Administration in the United States have been marketed as "atypical" antipsychotics (AA) due to their relative freedom from extrapyramidal symptoms when used in schizophrenia patients. The use of these newer antipsychotic drugs in PD and other parkinson-sensitive populations represents the most stringent test to their freedom from motor side effects. To date, clozapine, risperidone, olanzapine, and quetiapine have been studied in parkinson-vulnerable populations. This article reviews the data and highlights the differences that these four drugs have on motor function. It also emphasizes the challenges in evaluating the available data on the motor effects of AA, especially on the non-PD elderly and cognitively impaired population. Suggestions are made for future research to improve the interpretability of these studies.

Topics: Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Clozapine; Dementia, Vascular; Dibenzothiazepines; Hallucinations; Humans; Iatrogenic Disease; Lewy Body Disease; Olanzapine; Parkinson Disease; Pirenzepine; Psychotic Disorders; Quetiapine Fumarate; Risperidone

Hallucinations are prevalent in schizophrenia and related psychotic disorders and may have severe consequences for the affected patients. Antipsychotic drug trials that specifically address the anti-hallucinatory effectiveness of the respective drugs in representative samples are rare. The aims of the present study were to investigate the rate and severity of hallucinations in acutely admitted psychotic patients at hospital admission and discharge or after 6 weeks at the latest, if not discharged earlier (discharge/6 weeks); and to compare the anti-hallucinatory effectiveness of risperidone, olanzapine, quetiapine, and ziprasidone with up to 2 years' follow-up.. Adult patients acutely admitted to an emergency ward for psychosis were consecutively randomized to risperidone, olanzapine, quetiapine, or ziprasidone and followed for up to 2 years in a pragmatic design. Participants were assessed repeatedly using the hallucinatory behavior item of the Positive and Negative Syndrome Scale (PANSS).. A total of 226 patients, 30.5% of those assessed for eligibility, were randomized and 68% were hallucinating at baseline. This proportion was reduced to 33% at discharge/6 weeks. In the primary analyses based on intention to treat groups of patients experiencing frequent hallucinations, the quetiapine and ziprasidone groups both had faster decreases of the mean hallucination scores than the risperidone group.. Hallucinations are fairly responsive to antipsychotic drug treatment and differential anti-hallucinatory effectiveness may be found among existing antipsychotic drugs. If replicated, this could pave the way for a more targeted pharmacotherapy based on individual symptom profiles, rather than on the diagnostic category.. ClinicalTrials.gov ID; NCT00932529.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Female; Hallucinations; Hospitalization; Humans; Male; Middle Aged; Olanzapine; Piperazines; Psychiatric Status Rating Scales; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Thiazoles; Treatment Outcome

Polysomnographic studies of Parkinson's disease (PD) patients with visual hallucinations (VH) usually reveal short, fragmented rapid eye movement (REM) sleep, with lower sleep efficiency and reduced total REM sleep. Quetiapine has been demonstrated in open-label trials to be effective for the treatment of insomnia and VH in PD. To confirm quetiapine's efficacy in improving VH, and to determine whether the mechanism was due to its effect on REM sleep architecture, we performed a pilot, double-blind, placebo-controlled study. Sixteen PD patients experiencing VH were recruited. Eight patients were randomized to quetiapine and eight patients to placebo. Patients underwent pre- and post-treatment polysomnography. The Clinical Global Impression Scale (CGIS), Brief Psychiatric Rating Scale (BPRS), and Unified Parkinson Disease Rating Scale (UPDRS) motor subscale were obtained. There were no differences in baseline characteristics between the treatment arms except that the placebo group had more sleep in stage REM (74.7 min vs. 40.1 min; p < .001). Data were imputed for all patients who prematurely discontinued (four quetiapine and one placebo) in an intention-to-treat analysis. The average quetiapine dose was 58.3 mg/day. While there was no significant difference in the change in REM duration pre- vs. post-treatment in either arm, patients randomized to quetiapine improved on the CGIS (p = .03) and the hallucination item of the BPRS (p = .02). No difference was noted in the UPDRS motor scores. Despite the small sample, this is the first double-blind trial to show quetiapine's efficacy over placebo in controlling VH in the PD population. However, normalization of sleep architecture was not supported as the mechanism.

Topics: Aged; Antipsychotic Agents; Cohort Studies; Dibenzothiazepines; Double-Blind Method; Female; Hallucinations; Humans; Male; Middle Aged; Parkinson Disease; Pilot Projects; Polysomnography; Psychiatric Status Rating Scales; Quetiapine Fumarate; Severity of Illness Index; Sleep; Sleep, REM; Treatment Outcome; Visual Perception

We completed a single site, double-blind, placebo-controlled, parallel design study of quetiapine for hallucinations in PD. Thirty-one subjects with PD and prominent visual hallucinations and Mini-Mental State Examination score >21 were randomly assigned in a 2:1 drug to placebo ratio, up to 200 mg daily of quetiapine or matching placebo given in two doses. They were seen at 3 weeks (100 mg/day) and 12 weeks (200 mg/day, with optional dose reduction). Evaluation included the Unified Parkinson's Disease Rating Scale (UPDRS), the Baylor PD Hallucination Questionnaire, and a battery of neuropsychological tests. The demographics between subjects randomized to drug (n = 21) vs. placebo (n = 10) were similar. The final dose of active drug was 200 (n = 11), 150 (n = 2), 100 (n = 3), and 75 (n = 1) mg per day. All placebo subjects were on the equivalent of 200 mg per day. The UPDRS Activities of Daily Living and Motor scores did not significantly change compared to placebo. Compared to placebo, there were no significant changes in our hallucination questionnaire, the Brief Psychiatric Rating Scale (BPRS), or question 12 (hallucination item) of the BPRS. There were no significant changes on any of the neuropsychological measures. Adverse events on drug included sedation (n = 9), but no drug-related adverse events precipitated discontinuation and none were rated as serious. Quetiapine, up to 200 mg daily, was well tolerated and did not worsen UPDRS scores; however, there was no significant improvement in psychosis rating scales compared to placebo. Larger doses of drug and greater sample sizes might be considered in future studies.

Topics: Adult; Aged; Aged, 80 and over; Antipsychotic Agents; Brief Psychiatric Rating Scale; Dibenzothiazepines; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Evaluation; Female; Hallucinations; Humans; Male; Middle Aged; Neuropsychological Tests; Parkinson Disease; Placebos; Quetiapine Fumarate; Surveys and Questionnaires; Treatment Outcome

Twenty-nine elderly patients who failed treatment with clozapine, risperidone, or olanzapine entered this 24-week, single-center, open-label trial to assess the efficacy of quetiapine (12.5-400 mg/day) for psychosis in patients with Parkinson's disease (PD). Psychiatric, motor, and cognitive assessments were administered at baseline and at periodic intervals for 24 weeks. These included the Brief Psychiatric Rating Scale (BPRS), Neuropsychiatric Inventory (NPI), Unified Parkinson's Disease Rating Scale (UPDRS) and tests of intellectual functioning, attention, and memory. Repeated measures statistical analysis was used to assess change from baseline. The results revealed significant improvements in the 24-week BPRS total score and NPI psychosis subscale scores, with no decline in UPDRS total or motor subscale scores. There was also significant improvement in recall scores on cognitive measures. These results indicate that quetiapine may treat psychotic symptoms and improve cognition without worsening motor function in patients with PD, suggesting that quetiapine is an effective and well-tolerated antipsychotic in this population.

Topics: Aged; Aged, 80 and over; Antiparkinson Agents; Antipsychotic Agents; Brief Psychiatric Rating Scale; Delusions; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Hallucinations; Humans; Levodopa; Male; Middle Aged; Neurologic Examination; Neuropsychological Tests; Parkinson Disease; Psychoses, Substance-Induced; Quetiapine Fumarate

We report a case of refractory psychosis after carbon monoxide poisoning in a 65-year-old woman who attempted suicide by charcoal burning in 2018. On discharge from hospital, she was bedbound, tube-fed, and had limited verbal output. In early 2019, she was able to resume oral feeding and her physical condition improved. However, she started to have paranoid ideas and auditory hallucinations. She was diagnosed as having organic brain syndrome and was prescribed with quetiapine 300 mg every night. Because of the poor clinical response, quetiapine was switched to olanzapine 20 mg every night and augmented with amisulpride and valproate sodium. However, she remained distressed, psychotic, and suicidal. She was then prescribed with clozapine 300 mg every night. Her symptoms improved despite residual auditory hallucinations remained, but she was less distressed about them.

Topics: Aged; Carbon Monoxide Poisoning; Female; Hallucinations; Humans; Olanzapine; Psychotic Disorders; Quetiapine Fumarate

This study aims to identify neuropsychiatric manifestations in neurological Wilson disease (NWD), and their correlation with MRI changes and glutamate excitotoxicity. Forty-three consecutive patients with NWD from a tertiary care teaching hospital were evaluated prospectively who fulfilled the inclusion criteria. The neuropsychiatric evaluation was done using Neuropsychiatric Inventory (NPI) battery that assesses 12 domains including delusion, hallucination, agitation/aggression, dysphoria/depression, anxiety, euphoria, apathy, disinhibition, irritability, aberrant motor activity, appetite change, and abnormal nighttime behavior. Cranial MRI was done using a 3 T machine, and locations of signal changes were noted including the total number of MRI lesions. Serum glutamate level was measured by a fluorescence microplate reader. Abnormal NPI in various domains and total NPI scores were correlated with MRI lesions, serum and urinary copper, and glutamate level. The median age of the patients was 16 years. Forty-one (48.8%) patients had cognitive impairment and 37 (86%) had movement disorder. Neurobehavioral abnormality was detected in all-commonest being agitation (90.7%) followed by appetite change (81.4%), elation (74.4%), irritability (69.8%), anxiety (67.4%), depression (65.1%), apathy (44.2%), night time abnormal behavior (32.6%), aberrant motor behavior (20.9%), delusions (16.3%), and hallucination (18.6%). The thalamic lesion was associated with depression, globus pallidus with depression and anxiety, caudate with anxiety and agitation, brainstem with irritability, and frontal cortex with apathy. Serum glutamate level was higher in NWD. NPI sum score correlated with MRI load and glutamate level. Varying severity of neurobehavioral abnormalities are common in the patients with NWD and correlate with the location of MRI lesion and glutamate level.

Topics: Adolescent; Adult; Behavioral Symptoms; Brain Mapping; Cognition Disorders; Copper; Feeding and Eating Disorders; Female; Glutamic Acid; Hallucinations; Hepatolenticular Degeneration; Humans; Liver; Magnetic Resonance Imaging; Male; Mood Disorders; Movement Disorders; Neuroimaging; Neurotransmitter Agents; Quetiapine Fumarate; Severity of Illness Index; Young Adult

A 76-year-old man presented with complaints of increased confusion, visual hallucinations and decline in memory. He was admitted to the hospital and started on quetiapine 50 mg daily for symptom management. Shortly after, he was diagnosed with Lewy body dementia and started on rivastigmine, a cholinesterase inhibitor (ChEI), at 1.5 mg two times per day. The patient's symptoms continued to worsen and antipsychotics increased for aggressive behaviour. After he became physically aggressive, an extensive medication management review was conducted, prompting an alternative treatment strategy. The quetiapine dose was reduced from 150 mg daily to 12.5 mg daily, his rivastigmine was increased to 3 mg two times per day and all other antipsychotics were discontinued. The up-titration of his rivastigmine after 10 days of therapy was well tolerated with no adverse effects. He demonstrated a clear clinical response to optimised ChEI therapy and low dose quetiapine, showing improvements in alertness and functioning.

Topics: Aged; Antipsychotic Agents; Cholinesterase Inhibitors; Dose-Response Relationship, Drug; Hallucinations; Humans; Lewy Body Disease; Male; Psychotic Disorders; Quetiapine Fumarate; Rivastigmine

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

Topics: Antipsychotic Agents; Female; Hallucinations; Humans; Middle Aged; Parkinson Disease; Quetiapine Fumarate; Treatment Outcome

Topics: Adult; Baclofen; Hallucinations; Humans; Male; Quetiapine Fumarate; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Diagnosis, Differential; Female; Hallucinations; Humans; Porphyria, Acute Intermittent; Psychotic Disorders; Quetiapine Fumarate; Twins, Monozygotic

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Female; Hallucinations; Humans; Music; Quetiapine Fumarate

Topics: Antipsychotic Agents; Clozapine; Delusions; Hallucinations; Humans; Male; Quetiapine Fumarate; Schizophrenia; Vision Disparity

Topics: Alcoholism; Benzodiazepines; Clonazepam; Depressive Disorder; Dibenzothiazepines; Disulfiram; Female; Fluoxetine; Foreign Bodies; Hallucinations; Humans; Middle Aged; Movement Disorders; Olanzapine; Pharynx; Quetiapine Fumarate; Tetrabenazine; Tongue Habits

Exacerbation of symptoms in mood disorders such as bipolar disorders, major depressive disorders and premenstrual dysphoric disorders could be influenced by the hormonal changes of the menstrual cycles in female patients. Menarche has been related to onset of mood symptoms, which at times have been described as menstrual psychoses and could represent an early presentation of Pediatric bipolar disorders. Pediatric bipolar disorders appear to be characterized by less clearly defined mood episodes, shorter duration of these episodes, and different hallmark symptoms than in adults. This report describes a pediatric patient who had no previous psychiatric symptoms and for whom menstrual psychosis was the presenting symptom of bipolar disorder not otherwise specified.

Topics: Adolescent; Age of Onset; Anorexia; Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Estrogens; Female; Hallucinations; Humans; Menarche; Paranoid Disorders; Periodicity; Premenstrual Syndrome; Psychomotor Agitation; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Topics: Aged, 80 and over; Antimanic Agents; Antipsychotic Agents; Asian People; Bipolar Disorder; Dementia, Vascular; Dibenzothiazepines; Drug Monitoring; Drug Therapy, Combination; Female; Hallucinations; Humans; Male; Middle Aged; Neutropenia; Psychomotor Agitation; Quetiapine Fumarate; Treatment Outcome; Valproic Acid

Marijuana (cannabis) is the most commonly abused drug by adolescents and young adults and also by people with schizophrenia or other psychotic disorders. An increasing number of studies suggest that regular cannabis users can show psychotic episodes similar to schizophrenic disorders but it still unclear if cannabis induced psychotic disorder is a distinct entity requiring special therapy or regular cannabis use consequently leads to schizophrenia. Therefore, we retrospectively compared psychotic patients with and without cannabis use by clinical profile. Clinical data of 85 patients with schizophrenia spectrum disorder were analyzed retrospectively. Cannabis use was not reported by 43 persons (Cnbs0 subgroup) and 42 patients used regularly cannabis during at least 1 year (Cnbs1 subgroup). Clinical data were collected from electronic medical documentation of patients concerning anamnesis, family history, socio-demographic condition, symptoms and psychiatric state, acute and long-term therapies. Men were over-represented in the cannabis abuser group while mean age was lower among them compared to the Cnbs0 subgroup. Prevalence of suicidal attempts was increased in men without cannabis use. Patients without cannabis use spent more time in hospital and smoking was more frequent among them. Positive and negative symptoms and family history did not differ significantly between the two subgroups. Dosage, intensity and length of pharmacotherapy was different between the two subgroups. These results revealed that certain clinical aspects were different in case of cannabis-related schizophrenia spectrum disorder compared to schizophrenia.

Topics: Adolescent; Adult; Aggression; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Dibenzothiazepines; Hallucinations; Haloperidol; Humans; Hungary; Male; Marijuana Abuse; Olanzapine; Paranoid Disorders; Piperazines; Psychomotor Performance; Quetiapine Fumarate; Quinolones; Retrospective Studies; Risperidone; Schizophrenia; Schizophrenic Psychology

The present paper reports on a 68-year-old man with a 10-year history of parkinsonism who developed hallucinations and delusions after admission to an intensive care unit for the treatment of organophosphate intoxication. His initial diagnosis was delirium. On the basis of brain computed tomography findings and clinical symptoms, we diagnosed drug-induced psychosis in parkinsonism with multiple cysts in the bilateral striata.

Topics: 3-Iodobenzylguanidine; Aged; Antiparkinson Agents; Antipsychotic Agents; Brain Ischemia; Delirium; Delusions; Diagnosis, Differential; Dibenzothiazepines; Dominance, Cerebral; Drug Therapy, Combination; Encephalomalacia; Hallucinations; Humans; Levodopa; Magnetic Resonance Imaging; Male; Neostriatum; Neurologic Examination; Organophosphate Poisoning; Parkinsonian Disorders; Psychoses, Substance-Induced; Quetiapine Fumarate; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adult; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Cyclohexanols; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Female; Hallucinations; Humans; Psychiatric Status Rating Scales; Quetiapine Fumarate; Schizophrenia, Paranoid; Syndrome; Venlafaxine Hydrochloride

Two weeks after starting the oral contraceptive pill, a 16-year-old girl developed increasingly violent chorea and an evolving psychosis with prominent hallucinations, ideas of reference, and paranoia. An erythematous skin rash subsequently developed and Sydenham's chorea (SC) was diagnosed. Following neuroleptic medication and steroids, her chorea and psychosis subsided. This case illustrates that severe psychotic features can occur in SC. It is recommended that antistreptolysin O titres and antibasal ganglia antibodies are checked early in patients with evolving movement disorders and prominent neuropsychiatric features, as the window for modifying the course of this immune-mediated disorder may be narrow.

Topics: Adolescent; Antipsychotic Agents; Antistreptolysin; Basal Ganglia; Chorea; Contraceptives, Oral; Dibenzothiazepines; Female; Hallucinations; Humans; Methylprednisolone; Neuroprotective Agents; Paranoid Disorders; Psychotic Disorders; Quetiapine Fumarate; Risk Factors; Steroids; Streptococcal Infections

Topics: Aged; Dibenzothiazepines; Female; Hallucinations; Humans; Parkinson Disease; Quetiapine Fumarate

Visually handicapped patients can be tormented by complex visual hallucinations (Charles Bonnet syndrome). Likewise, deaf patients and patients with impaired hearing can be plagued by auditory hallucinations, mostly involving music. Our article focuses on three female patients who suffered from musical hallucinations. In one of these patients the hallucinations ceased when her hearing was restored. In the second patient the hallucinations ceased when carbamazepine was prescribed. Quetiapine reduced the musical hallucinations in the third patient. The differential diagnoses and therapeutic options are discussed.

Topics: Aged; Aged, 80 and over; Carbamazepine; Dibenzothiazepines; Female; Hallucinations; Hearing Disorders; Humans; Music; Quetiapine Fumarate

Topics: Adolescent; Antipsychotic Agents; Dibenzothiazepines; Female; Hallucinations; Humans; Parkinsonian Disorders; Psychomotor Agitation; Quetiapine Fumarate; Risperidone

Topics: Aged; Alzheimer Disease; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Delirium; Depressive Disorder; Diagnosis, Differential; Dibenzothiazepines; Hallucinations; Humans; Male; Olanzapine; Oxazepam; Psychotic Disorders; Quetiapine Fumarate; Tachycardia

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Brain; Carrier Proteins; Dibenzothiazepines; Disease Progression; Electroencephalography; Female; Genetic Predisposition to Disease; Hallucinations; Humans; Lafora Disease; Mutation; Quetiapine Fumarate; Seizures; Treatment Outcome; Ubiquitin-Protein Ligases

Topics: Adult; Antipsychotic Agents; Auditory Perception; Cognition; Dibenzothiazepines; Female; Hallucinations; Haloperidol; Humans; Male; Quetiapine Fumarate; Retreatment; Time Factors; Treatment Outcome

Ziprasidone, a novel antipsychotic agent for the treatment of schizophrenia, undergoes partial metabolism by cytochrome P450 3A4. It is associated with moderate prolongation of QT interval, but no increased risk for ventricular tachyarrhythmia or sudden death was demonstrated.. A 70-year-old male was initiated on quetiapine therapy for an acute exacerbation of chronic schizophrenia. The baseline electrocardiogram (ECG) showed a normal QT interval (QTc: 417 ms). In combination therapy of quetiapine and ziprasidone the patient developed suddenly cardiac arrhythmia with extrasystoles and the ECG revealed a prolonged QTc interval of 482 ms. After breaking off treatment with quetiapine and reduction of ziprasidone a normalized QT interval (QTc: 428 ms) was measured.. We suppose a potential of pharmacokinetic interaction between quetiapine and ziprasidone because of the same metabolic pathway by CYP3A4. Combining treatment of quetiapine and ziprasidone is therefore contraindicated. In addition we suggest caution using ziprasidone with any potential 3A4 substrate or inhibitor.

Topics: Acute Disease; Aged; Antipsychotic Agents; Dibenzothiazepines; Drug Interactions; Drug Therapy, Combination; Electrocardiography; Hallucinations; Humans; Long QT Syndrome; Male; Piperazines; Quetiapine Fumarate; Schizophrenia, Paranoid; Thiazoles

Psychosis characterized by hallucination or delusion, which occurs during drug therapy of parkinsonian patients, is one of the limiting factors for the control of motor symptoms or complications. In the present study, we encountered three patients with Parkinson's disease (PD) at advanced stages; all three patients had severe psychosis and severe wearing-off phenomenon and one had severe orthostatic hypotension. Their psychotic symptoms were successfully treated by administration of quetiapine, resulting in the favorable control of motor fluctuations and elevation of therapeutic levels unless any aggravation of parkinsonism occurs. Although the measure against drug-induced psychosis is principally a reduction of the doses or withdrawal of causative drugs, the effective use of antipsychotic drugs, such as quetiapine, is helpful to suppress psychosis and allow the patient to adjust to antiparkinsonian drugs for the control of symptoms other than psychosis.

Topics: Aged; Antiparkinson Agents; Antipsychotic Agents; Cabergoline; Dibenzothiazepines; Ergolines; Hallucinations; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Psychoses, Substance-Induced; Quetiapine Fumarate

Topics: Aged; Antipsychotic Agents; Dibenzothiazepines; Donepezil; Drug Resistance; Drug Synergism; Drug Therapy, Combination; Female; Hallucinations; Humans; Indans; Lewy Body Disease; Male; Nootropic Agents; Piperidines; Quetiapine Fumarate

Topics: Aged; Antipsychotic Agents; Dibenzothiazepines; Hallucinations; Humans; Male; Parkinson Disease; Quetiapine Fumarate

Topics: Adolescent; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Fluoxetine; Hallucinations; Humans; Male; Psychotic Disorders; Quetiapine Fumarate

Musical release hallucinations are complex auditory phenomena, affecting mostly the deaf geriatric population, in which individuals hear vocal or instrumental music. Progressive hearing loss from otosclerosis disrupts the usual external sensory stimuli necessary to inhibit the emergence of memory traces within the brain, thereby "releasing" previously recorded perceptions. Responses to conventional antipsychotic agents have been variable and extrapyramidal and other side effects have limited their use. We report the first case of hypnogogic release hallucinations successfully treated with the atypical antipsychotic quetiapine. The patient is an 88-year-old woman with progressive deafness who complained of hearing the piano, drums, or a full orchestra every time she was about to fall asleep. She accused her neighbor of hosting loud parties. Physical, neurologic, and psychiatric examination and work-up were unremarkable. She was treated with low-dose quetiapine affording near total resolution of hallucinations without adverse effects.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Blindness; Dibenzothiazepines; Female; Hallucinations; Humans; Mental Recall; Music; Quetiapine Fumarate