quetiapine-fumarate and Phobic-Disorders

Anxiety disorders are among the most frequent psychiatric disorders. Current treatment guidelines recommend antidepressants, the calcium modulator gabapentin, and benzodiazepines as pharmacological treatments. However, delayed onset of action precludes the use of antidepressants as an acute treatment, while benzodiazepines can be recommended only as an emergency treatment due to their inherent risk of dependence. Therefore, an alternative pharmacological agent with acute efficacy is needed. Preliminary evidence points towards possible anxiolytic properties of the atypical antipsychotic quetiapine. The goals of this study were to test the acute anxiolytic properties of quetiapine in patients suffering from arachnophobia in a challenge paradigm, and to assess the effects of quetiapine on the central nervous fear network.. In a randomized, double-blind, placebo-controlled proof-of-concept study, n=58 arachnophobic patients underwent an fMRI scan while looking at phobia-related and neutral stimuli. Subjective anxiety was evaluated retrospectively in questionnaires.. The functional imaging data revealed that patients showed stronger amygdala activation to phobia-related than to neutral stimuli. However, no effect of quetiapine on fear network activity was detected. Further, on questionnaire measures, quetiapine significantly reduced somatic anxiety symptoms, but had no effect on general psychological anxiety.. Viewing phobic pictures resulted in a robust amygdala activation in arachnophobic patients. Quetiapine seems to have no influence on activation in anxiety-related brain areas but appears to reduce acute somatic anxiety symptoms in patients with specific phobia. The central nervous correlates of the anxiolytic effects of quetiapine remain to be clarified in future studies.

Topics: Adult; Amygdala; Anti-Anxiety Agents; Antipsychotic Agents; Double-Blind Method; Female; Humans; Magnetic Resonance Imaging; Male; Phobic Disorders; Proof of Concept Study; Quetiapine Fumarate; Young Adult

Anxiety disorders are among the most frequent psychiatric disorders. With regard to pharmacological treatment, antidepressants, the calcium modulator pregabalin and benzodiazepines are recommended according to current treatment guidelines. With regard to acute states of anxiety, so far practically only benzodiazepines provide an immediate anxiolytic effect. However, the risk of tolerance and dependency limits the use of this class of medication. Therefore, there is still a need for alternative pharmacologic strategies. Increasing evidence points towards anxiety-reducing properties of atypical antipsychotics, particularly quetiapine. Therefore, we aimed to evaluate the putative acute anxiolytic effects of this compound, choosing the induction of acute anxiety in patients with specific phobia as a model for the evaluation of ad-hoc anxiolytic properties in a proof-of-concept approach. In a randomized, double-blind, placebo-controlled study, 58 patients with arachnophobia were treated with a single dose of quetiapine XR or placebo prior to a virtual reality spider challenge procedure. Treatment effects were monitored using rating scales for acute anxiety as well as measurements of heart rate and skin conductance. Overall, quetiapine showed significant anxiolytic effects compared to placebo. However, effects were not seen on the primary outcome measure (VAS Anxiety), but were limited to somatic anxiety symptoms. Additionally, a significant reduction of skin conductance was observed. Further exploratory analyses hint towards a mediating role of the (COMT) val158met genotype on treatment response. The present results thus suggest a possible suitability of quetiapine in the acute treatment of anxiety, particularly with regard to somatic symptoms.

Topics: Adolescent; Adult; Animals; Anti-Anxiety Agents; Antipsychotic Agents; Anxiety; Catechol O-Methyltransferase; Delayed-Action Preparations; Dibenzothiazepines; Double-Blind Method; Female; Galvanic Skin Response; Genetic Predisposition to Disease; Heart Rate; Humans; Male; Phobic Disorders; Polymorphism, Single Nucleotide; Psychiatric Status Rating Scales; Quetiapine Fumarate; Spiders; Symptom Assessment; User-Computer Interface

Clinical practice and open-label studies suggest that quetiapine (an atypical anti-psychotic) might improve symptoms for individuals with social anxiety disorder (SAD). The purpose of this study was to provide a rigorous test of the acute impact of a single dose of quetiapine (25mg) on SAD symptoms.. Individuals with SAD (N=20) were exposed to a 4-min virtual reality (VR) public speaking challenge after having received quetiapine or placebo (double-blind) 1h earlier. A parallel VR challenge occurred 1 week later using a counter-balanced cross-over (within subject) design for the medication-placebo order between the two sessions.. There was no significant drug effect for quetiapine on the primary outcome measures. However, quetiapine was associated with significantly elevated heart rate and sleepiness compared with placebo.. Study findings suggest that a single dose of 25mg quetiapine is not effective in alleviating SAD symptoms in individuals with fears of public speaking.

Topics: Antipsychotic Agents; Depression; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Disorders of Excessive Somnolence; Double-Blind Method; Drug Administration Schedule; Female; Heart Rate; Humans; Male; Phobic Disorders; Quetiapine Fumarate; Severity of Illness Index; Speech; Surveys and Questionnaires; User-Computer Interface; Young Adult

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Disability Evaluation; Female; Humans; Male; Personality Inventory; Phobic Disorders; Psychiatric Status Rating Scales; Quetiapine Fumarate; Treatment Outcome

A 27-year-old man treated with quetiapine for anxiety disorder developed hypertriglyceridaemia-induced acute pancreatitis and diabetic ketoacidosis. He was otherwise physically healthy with no family history of hyperlipidaemia. Despite aggressive intensive therapy he died of multiorgan failure within 36 h from initial presentation. While second-generation antipsychotics are well known to be causally linked to diabetes and hyperlipidaemia, this is to my knowledge the first-described case of a fatal triad of extreme hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine. Clinicians should be aware of this rare clinical presentation since rapid progression to multiorgan failure can occur. Early supportive therapy should be initiated. Lactescent serum and ketoacidosis in severe acute pancreatitis should not be overlooked-initiate insulin therapy and possibly plasmapheresis in case of extreme hypertriglyceridaemia.

Topics: Adult; Antipsychotic Agents; Anxiety Disorders; Delayed Diagnosis; Diabetic Ketoacidosis; Diagnosis, Differential; Dibenzothiazepines; Dose-Response Relationship, Drug; Fatal Outcome; Humans; Hypertriglyceridemia; Male; Pancreas; Pancreatitis, Acute Necrotizing; Phobic Disorders; Psychotic Disorders; Quetiapine Fumarate; Tomography, X-Ray Computed

Topics: Animals; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Bufonidae; Citalopram; Combined Modality Therapy; Dibenzothiazepines; Female; Humans; Middle Aged; Phobic Disorders; Psychotherapy; Quetiapine Fumarate; Ranidae

Topics: Adult; Anticonvulsants; Bipolar Disorder; Darkness; Dibenzothiazepines; Dose-Response Relationship, Drug; Female; Humans; Phobic Disorders; Quetiapine Fumarate

Topics: Adult; Antipsychotic Agents; Anxiety; Bipolar Disorder; Comorbidity; Dibenzothiazepines; Female; Humans; Phobic Disorders; Quetiapine Fumarate; Treatment Outcome