quetiapine-fumarate and Sleep-Initiation-and-Maintenance-Disorders

The second-generation antipsychotic drug quetiapine (Seroquel) is increasingly being used off-label for treating insomnia in the general population, possibly to avoid standard medications with known addictive qualities and adverse side effects. However, evidence to support using it in this way is scant, and quetiapine is associated with weight gain and other metabolic effects. It must be used cautiously and with appropriate monitoring for adverse effects and abuse.

Topics: Antipsychotic Agents; Humans; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Observational evidence suggests that atypical antipsychotics such as quetiapine are increasingly being used to manage insomnia. This is concerning given the uncertain efficacy and potential adverse effects associated with these medications.. The objectives of this study are to evaluate the benefits and adverse effects of atypical antipsychotics used specifically for insomnia.. The methods used in this study are systematic review and narrative synthesis.. The data were collected from PubMed; EMBASE; Cochrane Library; PsycINFO; grey literature; and the manufacturers of risperidone, quetiapine and olanzapine.. Adult patients ≥18 years of age using atypical antipsychotics specifically for primary or co-morbid insomnia for ≥ 1 week were compared to those receiving active intervention or placebo.. Two independent reviewers screened titles, abstracts and full-text articles; extracted data; and conducted risk-of-bias analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment was completed.. One double-blind randomized controlled trial (n = 13) met the eligibility criteria. Statistically significant differences were not observed from baseline between quetiapine and placebo after 2 weeks for primary insomnia in terms of total sleep time (mean difference (MD) 52.68 min, 95% CI -27.27 to 132.6), reduction in sleep latency (MD 72.44 min, 95% CI -2.65 to 147.5) or improved sleep satisfaction measured with a visual analogue scale out of 100 (MD 6.16, 95% CI -12.32 to 24.64), despite a trend towards improved sleep parameters. The study was rated as very low quality.. Very low quality evidence suggests that quetiapine does not significantly improve sleep parameters compared with placebo in primary insomnia, despite a trend towards clinical improvements. Atypical antipsychotics should be avoided in the first-line treatment of primary insomnia until further evidence is available.

Topics: Antipsychotic Agents; Humans; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Sleep Initiation and Maintenance Disorders

Insomnia in patients with alcohol dependence has increasingly become a target of treatment due to its prevalence, persistence, and associations with relapse and suicidal thoughts, as well as randomized controlled studies demonstrating efficacy with behavior therapies and non-addictive medications. This article focuses on assessing and treating insomnia that persists despite 4 or more weeks of sobriety in alcohol-dependent adults. Selecting among the various options for treatment follows a comprehensive assessment of insomnia and its multifactorial causes. In addition to chronic, heavy alcohol consumption and its effects on sleep regulatory systems, contributing factors include premorbid insomnia; co-occurring medical, psychiatric, and other sleep disorders; use of other substances and medications; stress; environmental factors; and inadequate sleep hygiene. The assessment makes use of history, rating scales, and sleep diaries as well as physical, mental status, and laboratory examinations to rule out these factors. Polysomnography is indicated when another sleep disorder is suspected, such as sleep apnea or periodic limb movement disorder, or when insomnia is resistant to treatment. Sobriety remains a necessary, first-line treatment for insomnia, and most patients will have some improvement. If insomnia-specific treatment is needed, then brief behavioral therapies are the treatment of choice, because they have shown long-lasting benefit without worsening of drinking outcomes. Medications work faster, but they generally work only as long as they are taken. Melatonin agonists; sedating antidepressants, anticonvulsants, and antipsychotics; and benzodiazepine receptor agonists each have their benefits and risks, which must be weighed and monitored to optimize outcomes. Some relapse prevention medications may also have sleep-promoting activity. Although it is assumed that treatment for insomnia will help prevent relapse, this has not been firmly established. Therefore, insomnia and alcohol dependence might be best thought of as co-occurring disorders, each of which requires its own treatment.

Topics: Acamprosate; Alcohol Deterrents; Alcoholism; Amines; Anti-Anxiety Agents; Anticonvulsants; Antipsychotic Agents; Cognitive Behavioral Therapy; Comorbidity; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Dyssomnias; Fructose; Gabapentin; gamma-Aminobutyric Acid; Humans; Polysomnography; Quetiapine Fumarate; Sleep Apnea Syndromes; Sleep Initiation and Maintenance Disorders; Stress, Psychological; Taurine; Topiramate; Trazodone

The safety and efficacy of quetiapine for the treatment of insomnia in adults are reviewed.. Quetiapine was developed for the treatment of psychiatric disorders, but its antagonism of histamine H1- and serotonin type 2A receptors has the added effect of causing sedation. As such, quetiapine is widely used off-label as a treatment for insomnia. Due to quetiapine's potential adverse effects, guidelines for the treatment of insomnia have recommended the drug's use only in patients with specific comorbid psychiatric disorders. The use of quetiapine for the treatment of insomnia in the absence of comorbid conditions has been evaluated in only two clinical trials of 31 patients in total, and very few studies have evaluated quetiapine use in patients with insomnia and other comorbidities. No trials have been conducted comparing quetiapine with an active control (e.g., zolpidem); the data that exist compare quetiapine to a placebo or there is no comparison and all patients are treated with quetiapine. Very few studies have evaluated quetiapine's efficacy in the treatment of insomnia using sleep objective testing, another limitation of the available data on quetiapine.. Robust studies evaluating the safety and efficacy of quetiapine for the treatment of insomnia are lacking. Given its limited efficacy data, its adverse-effect profile, and the availability of agents approved by the Food and Drug Administration for the treatment of insomnia, quetiapine's benefit in the treatment of insomnia has not been proven to outweigh potential risks, even in patients with a comorbid labeled indication for quetiapine.

Topics: Adult; Aged; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder, Major; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Sleep Initiation and Maintenance Disorders

Quetiapine (Seroquel(®)) is a potent U.S. Food and Drug Administration (FDA)-approved antipsychotic agent that has been used extensively for off-label indications. The current study was performed to ascertain the efficacy of some of the most prevalent off-label uses of this agent. An extensive search of electronic databases was completed using the search terms quetiapine or Seroquel, off-label and anxiety, substance abuse, dementia, delirium, personality disorder, insomnia, and sleep. Data were predictably mixed according to the indication being examined. The strongest evidence exists for anxiety and delirium. Moderate evidence exists for quetiapine as a pharmacological intervention for insomnia, dementia, and specific personality disorders. Evidence for quetiapine as a treatment for substance abuse is limited. More data are needed to establish specific dosing regimens for off-label uses and to examine the dose relationship to metabolic side effects and extrapyramidal side effects to determine whether various off-label uses justify the risk incurred with using this powerful drug.

Topics: Antipsychotic Agents; Anxiety Disorders; Delirium; Dementia; Dibenzothiazepines; Humans; Mental Disorders; Off-Label Use; Personality Disorders; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders; Treatment Outcome

To evaluate the safety of low doses of quetiapine when used for insomnia.. A literature search was performed using PubMed and EMBASE (January 1990-November 2011) using the terms quetiapine, insomnia, sleep, low-dose, subtherapeutic, safety, and weight gain.. Two prospective trials were identified that evaluated the effect of quetiapine in primary insomnia. In addition, 2 retrospective cohort studies were identified that evaluated the safety of low doses of quetiapine when used for insomnia. Several case reports on adverse effects with low doses of the drug were also included.. Quetiapine is commonly used off-label for treatment of insomnia. When used for sleep, doses typically seen are less than the Food and Drug Administration-recommended dosage of 150-800 mg/day; those evaluated in the studies reviewed here were 25-200 mg/day). At recommended doses, atypical antipsychotics such as quetiapine are associated with metabolic adverse events (diabetes, obesity, hyperlipidemia). Adverse effects in the prospective trials were patient-reported and were minor, including drowsiness and dry mouth; however, the trials were limited by their small sample size and short duration. The retrospective cohort studies found that quetiapine was associated with significant increases in weight compared to baseline. 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. These concerns should be evaluated in further prospective studies. Based on limited data and potential safety concerns, use of low-dose quetiapine for insomnia is not recommended.

Topics: Antipsychotic Agents; Dibenzothiazepines; Dose-Response Relationship, Drug; Humans; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

To evaluate the use of immediate-release quetiapine for the treatment of insomnia.. Pre-MEDLINE and MEDLINE were searched (1966 to October 2008) using the terms quetiapine, sleep, insomnia, and antipsychotics.. All studies and case reports evaluating insomnia as a primary endpoint were reviewed.. The role of quetiapine for improving sleep in various patient populations is uncertain. Quetiapine has moderately sedative properties, and doses used in treatment of insomnia have ranged from 12.5 to 800 mg. Results of clinical trials and observations in case studies have revealed possible beneficial effects of quetiapine on several subjective and objective sleep parameters. In most studies, significant improvements in sleep were found in areas of total sleep time, sleep efficiency, and subjective sleep scores. However, some of these results may not be clinically significant. Also, quetiapine has been found to have adverse effects such as periodic leg movements, akathisia, and metabolic complications. Additionally, changes in rapid eye movement (REM) and percentage of REM sleep have been noted in different populations and need further study. Despite quetiapine's sedative properties, current data do not appear to support its use as first-line treatment for sleep complications. However, it may be useful for treatment of insomnia in patients with psychiatric disorders (eg, bipolar, schizophrenia) who do not respond to primary or secondary treatments.. Further studies are needed to define the placement, dose, and adverse effects of quetiapine for the treatment of sleep problems.

Topics: Animals; Dibenzothiazepines; Humans; Mental Disorders; Quetiapine Fumarate; Sleep; Sleep Initiation and Maintenance Disorders

The primary aim of this study was to investigate the effect of quetiapine on insomnia and alcohol craving (craving) in subjects with co-occurring insomnia and AUD.. Insomnia was assessed with the Insomnia Severity Index (ISI) and craving with the Penn Alcohol Craving Scale (PACS, primary) and Obsessive-Compulsive Drinking Scale (OCDS, secondary). A multivariable model adjusted for covariates (N = 123) evaluated the relationship between craving (PACS and OCDS total scores) and insomnia (ISI total score). To simultaneously assess the effects of treatment arm allocation and insomnia status, subjects (N = 115) were stratified into 4 groups, quetiapine-insomnia(N = 38), quetiapine-No insomnia(N = 19), placebo-insomnia(N = 38), and placebo-No insomnia(N = 20). Linear mixed-effects regression models adjusted for covariates compared the trajectories of ISI, PACS, and OCDS total scores across 12 weeks of treatment and at post-treatment follow-up at week 24, between the four groups.. The ISI total score was positively associated with the PACS (p = 0.006) and OCDS (p = 0.001) total scores in the multivariable models. In the longitudinal analysis, when compared to the three other groups, subjects with insomnia treated with quetiapine showed a marked reduction in their insomnia scores with a return of insomnia after stopping treatment. There was no significant difference between the groups for the PACS and OCDS total score trajectories.. Although craving is associated with insomnia, treatment with quetiapine may improve insomnia but not craving in patients with co-occurring AUD and insomnia.

Topics: Alcoholism; Craving; Humans; Hypnotics and Sedatives; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

This preliminary investigation evaluated the link between alcohol craving and insomnia in actively drinking patients with alcohol dependence (AD).. We conducted a secondary analysis of data from a clinical trial of treatment-seeking patients with AD who drank heavily (N = 61). The Penn Alcohol Craving Scale (PACS) evaluated alcohol craving, and the Short Sleep Index (SSI) assessed insomnia symptoms. We used linear regression models for baseline cross-sectional assessments. Linear mixed effects regression models evaluated craving scores longitudinally across insomnia groups (+/-), and insomnia scores longitudinally across craving groups(high/low). These longitudinal analyses were conducted separately in those treated with placebo (N = 32) and quetiapine (N = 29).. The mean (standard deviation) for PACS total score was 15.9 (8.5) and for SSI was 2.1 (2.3). Alcohol craving was associated with the insomnia symptom of difficulty falling asleep (P = 0.03; effect size = -0.7) and with the SSI total score (P = 0.04, effect size = -0.7). In the longitudinal analysis, insomnia+ subjects had consistently higher PACS total scores, relative to the insomnia- group. The PACS score demonstrated significant group × time interactions in both treatment groups. Insomnia+ individuals demonstrated a relatively steeper rate of decline in the craving with quetiapine treatment (P = 0.03). Insomnia- individuals in the placebo group demonstrated a transient reduction in craving until week 8, followed by an increase in scores(P = 0.004). The SSI score did not demonstrate any interactive effect over time across the craving groups in either treatment arm.. Insomnia was associated with higher alcohol craving and quetiapine differentially reduced craving in those with insomnia.

Topics: Adolescent; Adult; Aged; Alcoholism; Antidepressive Agents; Craving; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Male; Middle Aged; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders; Young Adult

Low doses of the antidepressant mirtazapine or the neuroleptic quetiapine are often prescribed off-label for insomnia. However, studies on the effects on sleep and hangover effects the following day are scarce. In this randomised, double-blind, cross-over, placebo-controlled trial, the influence of 7.5 mg mirtazapine and 50 mg quetiapine on both normal sleep and sleep disturbed by acoustic stress (traffic noise) as a model for transient insomnia was assessed. Additionally, hangover effects on next-day alertness and cognitive functioning were examined. A total of 19 healthy men without sleep complaints completed three treatment sessions, each session consisting of three consecutive nights in one of the mirtazapine, quetiapine or placebo conditions. Sleep was assessed using polysomnography and the Leeds Sleep Evaluation Questionnaire. Daytime sleepiness and cognitive functioning were assessed using the Leeds Sleep Evaluation Questionnaire, Karolinska Sleepiness Scale, Digit Symbol Substitution Task, Psychomotor Vigilance Task and an addition task. Under acoustic stress, both mirtazapine and quetiapine increased total sleep time by half an hour and reduced the number of awakenings by 35-40% compared to placebo. While quetiapine specifically increased the duration of non-rapid eye movement sleep, stage N2, mirtazapine mainly increased deep sleep stage N3. Subjects reported that both mirtazapine and quetiapine eased getting to sleep and improved sleep quality. Both drugs caused daytime sleepiness and lessened sustained attention. These findings support the use of low doses of mirtazapine and quetiapine for the treatment of insomnia. Further prospective studies on the long-term effects regarding effectiveness and adverse effects are needed.

Topics: Adolescent; Adult; Antipsychotic Agents; Attention; Cognition; Cross-Over Studies; Double-Blind Method; Humans; Male; Mianserin; Mirtazapine; Quetiapine Fumarate; Sleep; Sleep Initiation and Maintenance Disorders; Sleep Stages; Wakefulness; Young Adult

The aim of this hypothesis-generating pilot study was to assess prospectively the objective and subjective effects of treatment with quetiapine XR on sleep during early recovery from alcohol dependence (AD).. Recovering subjects with AD and sleep disturbance complaints were treated with quetiapine XR (n = 10) or matching placebo pills (n = 10) for 8 weeks. Polysomnography was used to assess sleep objectively, and the Insomnia Severity Index and Pittsburgh Sleep Quality Index were used to measure subjective insomnia. Other assessment measures included the 10-minute psychomotor vigilance task (for neurobehavioral functioning), the time-line follow-back measure (for alcohol consumption), the Penn Alcohol Craving Scale (for alcohol craving), the Patient Health Questionnaire-9 item scale (for depressive symptoms), and the Beck Anxiety Inventory (for anxiety symptoms).. Although there was no effect of quetiapine XR on sleep efficiency (time spent asleep/total recording time), there was a pre-to-post reduction in wake after sleep onset time (P = 0.03) and nonsignificant trends for increases in sleep onset latency (SOL) and stage 2 sleep time. A time × drug interaction was seen for the subjective insomnia, such that quetiapine XR-treated subjects reported greater initial improvement in their subjective insomnia, but the difference was not sustained. There were no differences between treatment groups on other measures or medication compliance.. Quetiapine XR improves objective sleep continuity and transiently improves subjective insomnia early in recovery from AD.

Topics: Alcoholism; Antipsychotic Agents; Craving; Delayed-Action Preparations; Dibenzothiazepines; Double-Blind Method; Follow-Up Studies; Humans; Male; Middle Aged; Pilot Projects; Polysomnography; Prospective Studies; Psychomotor Performance; Quetiapine Fumarate; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; Treatment Outcome

To evaluate the clinical efficacy of Quetiapine 25 mg for the treatment of primary insomnia.. A randomized, double-blind, placebo-controlled clinical trial was conducted. Patients with DSM-IV-TR defined primary insomnia were asked to record a sleep diary one week prior to treatment, followed by 2 weeks of nightly treatment with either Quetiapine 25 mg or placebo. The primary outcomes were total sleep time (TST), sleep latency (SL), daytime alertness and functioning and sleep satisfaction; side effects were recorded as secondary outcome. Data were collected between January 2007 and December 2007, at Srinagarind Hospital of Khon Kaen University.. Thirteen patients completed the present study (mean age 45.95 years old; range 25-62). Quetiapine group increased mean TST by 124.92 minutes and 72.24 minutes in the placebo group. Mean SL was reduced by 96.16 minutes in the Quetiapine group and 23.72 minutes in the placebo group. Statistical significance was not reached between both groups. In the Quetiapine group two patients reported side effects of dry lips, dry tongue and morning drowsiness.. The present study is the first study to evaluate the effect of Quetiapine in primary insomnia in a randomized controlled trial. Quetiapine at 25 mg at night did show a trend for improvement of TST and reduced SL in primary insomnia with few side effects but not reaching statistical significance. A study with a larger sample size is needed to demonstrate its efficacy.

Topics: Adult; Antipsychotic Agents; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Polysomnography; Quetiapine Fumarate; Sleep; Sleep Initiation and Maintenance Disorders; Socioeconomic Factors; Treatment Outcome; Wakefulness

Combining antipsychotics is common practice in the treatment of schizophrenia. This study investigated aripiprazole adjunctive to risperidone or quetiapine for treating schizophrenia and schizoaffective disorder.. In this multicenter, double-blind, 16-week, placebo-controlled study conducted at 43 American sites from July 2006 to October 2007, patients with chronic, stable schizophrenia or schizoaffective disorder diagnosed with DSM-IV-TR were randomly assigned to receive aripiprazole (2-15 mg/d) or placebo in addition to a stable regimen of quetiapine (400-800 mg/d) or risperidone (4-8 mg/d). The primary outcome measure was the mean change from baseline to endpoint (week 16, last observation carried forward) in the Positive and Negative Syndrome Scale (PANSS) total score.. 323 subjects being treated with either risperidone (n = 177) or quetiapine (n = 146) were randomly assigned to receive adjunctive aripiprazole (n = 168) or placebo (n = 155). Baseline characteristics were similar (mean PANSS total score: aripiprazole, 74.5; placebo, 75.9) except for history of suicide attempts (aripiprazole, 27%; placebo, 40%). Nearly 70% of subjects in each arm completed the trial. Adjunctive aripiprazole and placebo groups were similar in the mean change from baseline to endpoint in the PANSS total score (aripiprazole, -8.8; placebo, -8.9; P = .942). The incidence of treatment-emergent adverse events was similar between groups. Mean changes in Simpson-Angus Scale, Abnormal Involuntary Movement Scale, and Barnes Akathisia Rating Scale scores were not statistically significantly different. Adjunctive aripiprazole was associated with statistically significantly greater decreases in mean serum prolactin levels from baseline than was adjunctive placebo (-12.6 ng/mL for aripiprazole vs -2.2 ng/mL for placebo; P < .001), an effect that was seen in the risperidone subgroup (-18.7 ng/mL vs -1.9 ng/mL; P < .001) but not in the quetiapine subgroup (-3.01 ng/mL vs +0.15 ng/mL; P = .104).. The addition of aripiprazole to risperidone or quetiapine was not associated with improvement in psychiatric symptoms but was generally safe and well tolerated. Further research is warranted to explore whether antipsychotic combination therapy offers benefits to particular patient populations-for example, in cases of hyperprolactinemia.. clinicaltrials.gov Identifier: NCT00325689.

Topics: Adult; Ambulatory Care; Antipsychotic Agents; Aripiprazole; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Double-Blind Method; Drug Therapy, Combination; Fatigue; Female; Headache; Humans; Male; Piperazines; Placebos; Psychiatric Status Rating Scales; Psychotic Disorders; Quetiapine Fumarate; Quinolones; Risperidone; Schizophrenia; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Treatment Outcome

This study examined the efficacy and safety of quetiapine in combination with lithium or divalproex compared with placebo with lithium or divalproex in the prevention of recurrent mood events in bipolar I patients, most recent episode mania, depression, or mixed.. Patients received open-label quetiapine (400-800 mg/day; flexible, divided doses) with lithium or divalproex (target serum concentrations 0.5-1.2 mEq/L and 50-125 microg/mL, respectively) for up to 36 weeks to achieve at least 12 weeks of clinical stability. Patients were subsequently randomized to double-blind treatment with quetiapine (400-800 mg/day) plus lithium/divalproex or placebo plus lithium/divalproex for up to 104 weeks. The primary endpoint was time to recurrence of any mood event.. Treatment with quetiapine in combination with lithium/divalproex significantly increased the time to recurrence of any mood event compared with placebo plus lithium/divalproex. The proportion of patients having a mood event was markedly lower in the quetiapine than in the placebo group (18.5% versus 49.0%). The hazard ratio for time to recurrence of a mood event was 0.28 (P<0.001), a mania event 0.30 (P<0.001), and a depression event 0.26 (P<0.001) corresponding to risk reductions of 72%, 70%, and 74%, respectively. During the randomization phase, the most common adverse events occurring in > or =5% in the quetiapine group were somnolence, nasopharyngitis, and headache. Insomnia was more common in the placebo group. During the randomization phase, there was an increase in weight of 0.5 kg in the quetiapine group and a reduction of 1.9 kg in the placebo group. The incidence and incidence density of a single emergent fasting blood glucose value> or =126 mg/dL was higher with quetiapine than with placebo (9.3% versus 4.1%; 17.6 versus 9.5 patients per 100 patient-years).. This was an enriched sample of patients with bipolar I disorder responding to treatment with quetiapine plus lithium/divalproex.. Maintenance treatment with quetiapine in combination with lithium/divalproex significantly increased time to recurrence of any event (mania, depression, or mixed) irrespective of the polarity of the index episode compared with placebo with lithium/divalproex. Long-term treatment with quetiapine was generally well-tolerated. Quetiapine with lithium/divalproex can provide an effective long-term treatment option for bipolar I disorder to prevent recurrences not only of mania but also depression.

Topics: Antipsychotic Agents; Bipolar Disorder; Demography; Dibenzothiazepines; Disorders of Excessive Somnolence; Female; Headache; Humans; International Cooperation; Lithium Carbonate; Male; Nasopharyngitis; Quetiapine Fumarate; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Valproic Acid; Young Adult

The authors investigated the influence of aging on the improvement of subjective sleep quality by atypical antipsychotic drugs in patients with schizophrenia.. Subjects were 86 inpatients (mean age: 61.4 years) who had been receiving treatment with conventional antipsychotic drugs and who met DSM-IV criteria for schizophrenia. Their antipsychotic medication was changed from conventional antipsychotics to one of four atypical antipsychotic drugs (olanzapine, perospirone, quetiapine, or risperidone). Patients were grouped by age (older or younger than 65 years). Subjective sleep quality and psychopathology were assessed twice: 1) at baseline, and 2) 8 weeks after switching to the atypical antipsychotic drugs. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and the Positive and Negative Syndrome Scale (PANSS) was used to measure psychopathology.. The proportion of the patients who experienced improved subjective sleep quality was significantly higher in the elderly than in the middle-aged group. Logistic-regression analysis revealed that the improvement in subjective sleep quality through administration of atypical antipsychotic drugs was predicted by increased age, daytime dysfunction, and longer sleep latency at baseline.. These results demonstrate that atypical antipsychotic drugs are beneficial to the quality of sleep in elderly patients with schizophrenia.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Female; Humans; Indoles; Isoindoles; Male; Middle Aged; Olanzapine; Polysomnography; Psychiatric Status Rating Scales; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Sleep Initiation and Maintenance Disorders; Sleep Stages; Thiazoles

This is the first investigation of the pharmacokinetics, tolerability, and efficacy of quetiapine fumarate in adolescents with chronic or intermittent psychotic disorders.. Ten patients with DSM-IV chronic or intermittent psychotic disorders (ages 12.3 through 15.9 years) participated in an open-label, rising-dose trial and received oral doses of quetiapine twice daily (b.i.d.), starting at 25 mg b.i.d. and reaching 400 mg b.i.d. by day 20. The trial ended on day 23. Key assessments were pharmacokinetic analysis of plasma quetiapine concentrations and neurologic, safety, and efficacy evaluations.. No statistically significant differences were observed between 100-mg b.i.d. and 400-mg b.i.d. quetiapine regimens for total body clearance, dose-normalized area under the plasma concentration-time curve, or dose-normalized premorning- or postmorning-dose trough plasma values obtained under steady-state conditions after multiple-dose regimens. No unexpected side effects occurred with quetiapine therapy, and no statistically significant changes from baseline were observed for the UKU Side Effect Rating Scale items that were rated. No serious adverse events or clinically important changes in hematology or clinical chemistry variables were reported. The most common adverse events were postural tachycardia and insomnia. Extrapyramidal side effects improved, as evidenced by significant (p < .05) decreases from baseline to endpoint in the mean Simpson-Angus Scale total scores and Barnes Akathisia Scale scores. Quetiapine improved positive and negative symptoms, as shown by significant (p < .05) decreases from baseline to endpoint in the mean Brief Psychiatric Rating Scale total score, the Clinical Global Impressions-Severity of Illness scale, and the Modified Scale for the Assessment of Negative Symptoms summary score.. Quetiapine pharmacokinetics were dose proportional in adolescents and were similar to those previously reported for adults. Quetiapine was well tolerated and effective in the small number of adolescents studied.

Topics: Adolescent; Adult; Age Factors; Antipsychotic Agents; Basal Ganglia Diseases; Brief Psychiatric Rating Scale; Child; Dibenzothiazepines; Drug Administration Schedule; Humans; Psychotic Disorders; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology; Sleep Initiation and Maintenance Disorders; Tachycardia; Treatment Outcome

Quetiapine is widely used to treat psychiatric disorders such as major depression, generalized anxiety disorder, dysthymic disorder, and insomnia other than schizophrenia and bipolar disorder. This study investigated the diagnostic distribution of quetiapine use in patients in a psychiatric hospital, the doses of quetiapine prescribed, and the plasma concentrations (Cps) of quetiapine and active metabolites.. We enrolled 107 patients who had been prescribed quetiapine for at least 4 weeks. Diagnoses, demographics, and concomitant medications were recorded. Blood sampling was performed in the morning, approximately 12 h after the before-bed dose of quetiapine.. Diagnoses comprised schizophrenia (n = 25), bipolar disorder (n = 51), major depression (n = 15), dysthymic disorder (n = 9), and others (n = 7). The daily dose (DD) of quetiapine ranged from 25 to 800 (175.9 ± 184.4) mg, with the mean Cp being 105.6 ± 215.3 ng/ml, with a mean Cps/DD ratio of 0.58 ± 0.55 ng/ml/mg. There was a moderate positive linear correlation between the dose and Cps of quetiapine (r = 0.60), and the interpatient variation in Cps/DD ratio was up to 26-fold.. Quetiapine is used in various doses to treat many psychiatric disorders other than psychosis, and it is usually prescribed as a secondary antipsychotic for symptoms such as insomnia or agitation. A wide interpatient variation of the Cps/DD ratio was noticed. Patients of East Asian descent may exhibit a 50% to 100% increase in the Cps/DD ratio for quetiapine compared with patients of Western descent.

Topics: Antipsychotic Agents; Dibenzothiazepines; Humans; Psychotic Disorders; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Antipsychotics with dopamine (D2) receptor antagonism can be effective for emesis in cancer patients. Extrapyramidal symptoms (EPS) induced by typical antipsychotics can be exacerbated by other D2 receptor antagonists. We describe a case of persistent EPS induced by long-term, intermittent administration of low-dose olanzapine along with metoclopramide for emesis.. A 59-year-old pancreatic cancer patient underwent chemotherapy for 7 months. He was referred to the psychiatry department because of restlessness and insomnia. Although he did not have obvious depressive symptoms, he was anxious about the cancer treatment. For chemotherapy-induced nausea, he had been prescribed 5 mg of olanzapine intermittently for 7 months. He had last used the drug 9 days before presenting it to us. Additionally, he received metoclopramide and palonosetron as antiemetics. We considered akathisia and cancer-related anxiety/agitation as possible causes of restlessness and insomnia, and prescribed clonazepam. However, his symptoms worsened, resulting in hospitalization. We reconsidered his symptoms as cancer-related anxiety/agitation and prescribed quetiapine. Although it was effective, he had tremors and was assessed by a neurologist. Considering the clinical manifestations of rigidity, postural reflex disorder, and a mask-like face, we suspected drug-induced parkinsonism and replaced quetiapine with biperiden on the next day, leading to his discharge after 2 weeks. He did not have symptom recurrence even after discontinuation of biperiden.. Long-term, intermittent administration of low-dose antipsychotics with other antiemetics having D2 receptor antagonism can cause prolonged EPS. Especially in cancer patients, who often require polypharmacy, clinicians should consider exacerbated adverse effects due to drug interactions.

Topics: Antiemetics; Antineoplastic Agents; Antipsychotic Agents; Biperiden; Clonazepam; Dopamine; Humans; Male; Metoclopramide; Middle Aged; Olanzapine; Palonosetron; Psychomotor Agitation; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders; Vomiting

No consensus has been reached on the association between the risk of falls and antipsychotic and antidepressant drug use. In this study, we evaluated the risk of falls with trazodone, risperidone, and quetiapine, which are recommended for use at Kanazawa Medical University Hospital.. We reviewed all patients who were admitted to Kanazawa Medical University Hospital between January 1st and December 31st, 2018. We excluded those aged <20 years and those admitted to pediatric, intensive care, and psychiatric wards. Finally, 9273 patients were included. We reviewed the incidence in these patients of accidental falls reported to the medical safety department. We noted whether these patients received trazodone, quetiapine, or risperidone. We also observed whether they were taking a benzodiazepine receptor agonist, which is a known risk factor. We further examined each patient's age, sex, the department they were visiting, and their diseases. Patients were considered to have taken medication if it was administered within 24 hours before an accidental fall. Multiple logistic regression analysis was used to evaluate the risk of accidental fall.. Multivariate analysis showed that the adjusted odds ratios (OR) for each medication (with 95% confidence intervals) were: trazodone (OR, 0.47 [0.27-0.80]), quetiapine (OR, 1.06 [0.46-2.46]), and risperidone (OR, 0.82 [0.41-1.63]).. The association of risperidone and quetiapine with accidental falls was unclear. Interestingly, however, trazodone may help reduce the risk, which makes it a potential pharmacologic treatment option for insomnia in patients at high risk for accidental falls.

Topics: Accidental Falls; Case-Control Studies; Child; Humans; Quetiapine Fumarate; Risk Assessment; Risperidone; Sleep Initiation and Maintenance Disorders; Trazodone

Topics: Azepines; Humans; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders; Triazoles

Use of the antipsychotic drug quetiapine to treat sleep disorders has become widespread, also in Norway. Its efficacy is poorly documented, and even low doses may have substantial side effects. There is thus reason to warn against prescribing quetiapine for sleep.

Topics: Antipsychotic Agents; Drug Prescriptions; Humans; Norway; Quetiapine Fumarate; Sleep Aids, Pharmaceutical; Sleep Initiation and Maintenance Disorders

A 30-year-old insomniac, an off-label user of quetiapine, presented with blurring of central vision, eventually diagnosed as central serous chorioretinopathy. A potential association was suspected based on the drug's actions on the autonomic nervous system. He showed improvement on drug withdrawal; then he unwittingly resumed quetiapine and had a recurrence. Possible underlying mechanisms that include alteration in choroidal perfusion through serotonin and dopamine receptors are discussed. Although retinal vein occlusions and pigment epithelial detachment have been described with quetiapine, to the author's knowledge, this is the first case report of quetiapine-associated central serous chorioretinopathy.

Topics: Adult; Antipsychotic Agents; Central Serous Chorioretinopathy; Dopamine; Fluorescein Angiography; Fundus Oculi; Humans; Male; Quetiapine Fumarate; Retinal Pigment Epithelium; Serotonin; Sleep Initiation and Maintenance Disorders; Tomography, Optical Coherence; Visual Acuity

Although the sedative and extrapyramidal side effects associated with first-generation antipsychotics are well known, some second-generation antipsychotics are also associated with substantial sedation and activation effects. In this Academic Highlights article, 4 experts on depression from the fields of psychiatry and primary care take a closer look at activation and sedation effects of atypical antipsychotics in patients with MDD. They examine the likelihood of each agent to cause these effects; the impact of these effects on patient functioning, quality of life, and treatment adherence; and the question of whether leveraging activation and sedation to address acute symptoms is ever advisable.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Aripiprazole; Arousal; Comorbidity; Delayed-Action Preparations; Depressive Disorder, Major; Drug Approval; Drug Therapy, Combination; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Practice Patterns, Physicians'; Quality of Life; Quetiapine Fumarate; Quinolones; Sleep Initiation and Maintenance Disorders; Thiophenes

To evaluate the impact of 2 policy changes on quetiapine dispensing in Australia: removal of prior authorisation for prescribing (policy 1: July 2007) and removal of repeat prescriptions for 25-mg quetiapine (policy 2: January 2014).. We performed an interrupted time series analysis using Pharmaceutical Benefits Scheme claims data (July 2005 to December 2015). We assessed the impact of both policies on monthly quetiapine dispensing (25 mg and >25 mg) and the impact of policy change 2 on monthly rates of 25-mg discontinuation and switching from 25 mg to other quetiapine strengths. We also estimated the impact of both policies on the proportion of people with potentially inappropriate therapy (no evidence of dose escalation) following 25-mg initiation.. Following removal of prior authorisation, 25-mg and >25-mg quetiapine dispensing in the Pharmaceutical Benefits Scheme 10% sample increased by 11/month (95% CI: 2-21) and 14/month (95% CI: 8-20), respectively. After removing 25-mg repeats, there was a permanent decrease of 1072 (95% CI 773-1371) dispensings and an increase in discontinuation of this strength; 48% of people dispensed the 25-mg strength that discontinued, discontinued quetiapine completely; the remainder continued to use higher quetiapine strengths. We observed minimal switching to other quetiapine strengths. There was no change in inappropriate 25-mg therapy following policy change 1 and a small decrease (79% to 76%, P = 0.05) following policy change 2.. More nuanced policies are needed to ensure the appropriate access to 25-mg quetiapine for dose escalation while discouraging use for indications where the evidence of risk and benefit is unclear.

Topics: Antipsychotic Agents; Anxiety; Australia; Bipolar Disorder; Dose-Response Relationship, Drug; Drug and Narcotic Control; Drug Prescriptions; Drug Utilization; Drug Utilization Review; Humans; Interrupted Time Series Analysis; Off-Label Use; Policy Making; Practice Patterns, Physicians'; Quetiapine Fumarate; Schizophrenia; Sleep Initiation and Maintenance Disorders

Topics: Antipsychotic Agents; Anxiety; Depression; Drug Prescriptions; Humans; New Zealand; Off-Label Use; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Quetiapine, an atypical antipsychotic drug, is recommended for the treatment of schizophrenia and mood disorders. In addition, given its sedative effects, a low dose of the agent is also widely used in the treatment of anxiety disorders, personality disorders, substance abuse, and sleep disturbances. In this case study, quetiapine was the first effective drug in reducing chronic insomnia in a male patient with a long treatment history. Because its effect declined over time, in the course of two years, a gradual dose increase led to a posology 50 times higher than the off-label dosage used to obtain sedation, i.e. 25-100 mg quetiapine administered once daily. This case raises awareness of the ease with which dose escalation of quetiapine occurs. The risk of side effects and, possibly, dependence and abuse underlines the importance of regular and careful patient monitoring. Given the unexpected effectiveness of the agent and the absence of side effects in the described case, we argue that in treatment-resistant insomnia, a high dose of quetiapine may be justifiable in selected cases but also urge that further research on the long-term effects and potential adverse events of quetiapine for this indication is of the utmost importance.

Topics: Adult; Antipsychotic Agents; Humans; Male; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Spinocerebellar ataxia (SCA) is a hereditary disease characterized by central nervous system-related motor dysfunctions. Sleep disorders and frequent non-motor manifestations are commonly comorbid with SCA. To elucidate this relationship, we present three cases in a family that included multiple SCA type 2 patients with various sleep disorders. Complete physical examination, and genetic and imaging studies were performed. Anti-parkinsonism medications were prescribed after neurological examination. Clonazepam and/or quetiapine were administered for sleep disorders but failed to resolve insomnia and excessive daytime sleepiness (EDS). Based on DSM-5 criteria, all cases were diagnosed with depression. After treatment with serotonin-norepinephrine reuptake inhibitors and noradrenergic and specific serotonergic antidepressants, symptoms of insomnia and EDS, which are strongly associated with depression in SCA type 2 patients, improved significantly. It is crucial to recognize insomnia and EDS in neurodegenerative diseases, not only for earlier diagnosis, but also to improve quality of life.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Clonazepam; Depressive Disorder; Disorders of Excessive Somnolence; Family; Female; GABA Modulators; Humans; Male; Middle Aged; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors; Sleep Initiation and Maintenance Disorders; Spinocerebellar Ataxias; Treatment Outcome

Topics: Aged, 80 and over; Antipsychotic Agents; Consciousness Disorders; Hospitalization; Humans; Male; Off-Label Use; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Female; Hospitalization; Humans; Male; Middle Aged; Off-Label Use; Patient Discharge; Prospective Studies; Quebec; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Topics: Adult; Aged; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders; Somnambulism

Anecdotal evidence suggests that second-generation antipsychotic agents are increasingly used to treat sleep problems. This study sought to quantify the proportion of new prescriptions for second-generation antipsychotic agents started for sleep/sedation and the correlates of such use.. A cross-sectional survey of provider decision making at the time second-generation antipsychotic agents were prescribed, documenting the reasons for the medication, patient demographics, psychiatric and medical diagnoses, patient health characteristics, and provider background.. A single Veterans Affairs Medical Center over a 20-month period.. Prescribers of second-generation antipsychotic agents.. N/A.. Seven hundred seven (32.2%) of 2,613 surveys indicated sleep/sedation was at least one reason for using a second-generation anti-psychotic agent, whereas for 266 (12.1%) it was the only reason. Quetiapine was most frequently prescribed overall as well as for sleep/sedation (47.0% and 73.6% respectively). Second-generation antipsychotic agent use for sleep/sedation was unrelated to sociodemographic characteristics, least likely in patients with schizophrenia or bipolar disorder, and most likely as a newly started second-generation antipsychotic agent.. Sleep/sedation is a common reason given for new prescriptions of second-generation antipsychotic agents. Quetiapine is most frequently used for this purpose. A greater understanding of why providers use second-generation antipsychotic agents rather than safer and less costly alternatives for sleep problems may advance the development of interventions to reduce adverse effects.

Topics: Adult; Aged; Antipsychotic Agents; Cross-Sectional Studies; Dibenzothiazepines; Female; Health Care Surveys; Humans; Hypnotics and Sedatives; Male; Middle Aged; Practice Patterns, Physicians'; Quetiapine Fumarate; Sleep; Sleep Initiation and Maintenance Disorders; Treatment Outcome; United States; United States Department of Veterans Affairs

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

The prescribing of low doses of quetiapine for the treatment of sleeping disorders appears to be widespread. Recently, in a systematic literature review on low-dose quetiapine use for the treatment of sleeping disorders, it was concluded that evidence for its efficacy is currently lacking. Furthermore, quetiapine is probably associated with potentially severe adverse effects, also at low doses. In conclusion, sufficient scientific evidence that justifies the current practice of off-label prescribing of low-dose quetiapine for the treatment of sleeping disorders is insufficient; further research into its efficacy and safety is needed.

Topics: Antipsychotic Agents; Dibenzothiazepines; Dose-Response Relationship, Drug; Humans; Off-Label Use; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders; Treatment Outcome

Benzodiazepines (antianxiety medications) and quetiapine (an antipsychotic medication) are subject to abuse in prison. Quetiapine is also expensive and has serious side effects. The prescription of these medications in prison for anxiety and insomnia is not the preferred choice. In order to reduce these prescriptions, the University of Medicine and Dentistry of New Jersey-University Correctional HealthCare (UCHC), working within the New Jersey Department of Corrections, provided its psychiatrists with a guideline to the treatment of insomnia in prison. The guideline discouraged pharmacological treatment of insomnia. UCHC then anonymously compared the prescribing practices of its psychiatrists to each other, and educated the psychiatrists about the disadvantages of benzodiazepines and low-dose quetiapine in prison. These techniques reduced the numbers of inmates prescribed benzodiazepines by 38% after 20 months and reduced the numbers of inmates prescribed low-dose quetiapine by 59% after 22 months.

Topics: Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Drug Utilization; Guideline Adherence; Health Education; Humans; New Jersey; Peer Group; Practice Guidelines as Topic; Practice Patterns, Physicians'; Prisons; Psychiatry; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Topics: Aged; Antipsychotic Agents; Chemical and Drug Induced Liver Injury; Dibenzothiazepines; Dose-Response Relationship, Drug; Fatal Outcome; Female; Humans; Liver Failure; Liver Function Tests; Multiple Organ Failure; Psychomotor Agitation; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Insomnia associated with chronic schizophrenia and after clozapine discontinuation represents a common, but mostly not predominant, complaint and often does not respond sufficiently to classical hypnotics. We report the case of a 46-year-old patient with schizophrenia who developed a rebound insomnia confirmed by polysomnography after discontinuation of long-term treatment with clozapine and changing to sertindole therapy. Zolpidem, zolpiclone and chloral hydrate only led to short-term improvement of subjective sleep quality. An add-on therapy with 300 mg quetiapine resulted in improved subjective quality of sleep regarding sleep latency and the number of nocturnal awakenings. The combination of the two neuroleptics did not lead to increased QTc intervals (normal QTc < 450 ms) or metabolic side effects. In conclusion, the combination of sertindole and quetiapine might be a safe and effective combination in therapy-refractory insomnia after clozapine discontinuation in schizophrenia.

Topics: Antipsychotic Agents; Clozapine; Dibenzothiazepines; Drug Therapy, Combination; Humans; Hypnotics and Sedatives; Imidazoles; Indoles; Male; Middle Aged; Polysomnography; Quetiapine Fumarate; Schizophrenia; Sleep; Sleep Initiation and Maintenance Disorders

to examine the use of quetiapine for sleep in patients with dementia admitted to a geriatric psychiatry ward.. retrospective cross-sectional study (January 2007 to December 2009).. geriatric psychiatric unit located near a metropolitan city in North Carolina.. all patients admitted with a diagnosis of dementia who were also receiving quetiapine were eligible. One hundred one patients met the criteria and were included in the study.. none.. descriptive statistics defining quetiapine prescribing. Based on a priori criteria, quetiapine was considered to be used for sleep if it were prescribed: 1) only at bedtime, as needed, for sleep, 2) once daily, only at bedtime, or 3) multiple times daily, but with at least 75% of the daily dose administered at bedtime.. forty-three of the 101 patients included in the study were prescribed quetiapine, probably for sleep. Quetiapine, when used as a sedative-hypnotic, was generally employed at doses between 50 mg and 100 mg nightly. Several published studies report beneficial sleep-promoting effects of quetiapine and other atypical antipsychotics for primary and secondary sleep complaints; however, most of these trials involve young and middle-aged adults, have diagnostic variability, and are limited methodologically.. quetiapine prescribed as a sedative-hypnotic in patients with dementia, while common, is understudied and not without risk.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Cross-Sectional Studies; Dementia; Dibenzothiazepines; Female; Humans; Male; Middle Aged; North Carolina; Off-Label Use; Quetiapine Fumarate; Retrospective Studies; Sleep Initiation and Maintenance Disorders; Treatment Outcome

Quetiapine is frequently prescribed for insomnia that is comorbid with psychiatric disorders, but there has been no documentation of metabolic adverse effects associated with this practice. The objective of this study was to document changes in weight, body mass index, and waist circumference that occurred when low-dose quetiapine was used at bedtime for insomnia. The study was a retrospective chart review conducted at a community mental health center. Patients were non-elderly (19-65 years old) psychiatric patients who received quetiapine at < or =200 mg at bedtime for the explicit indication of insomnia. Forty-three patients were included in the study. Weight and BMI increased by an average of 4.9 lb. (P = 0.037) and 0.8 points (P = 0.048), respectively. Males experienced statistically significant increases in weight and BMI, and Caucasians experienced a statistically significant increase in BMI. There were no significant differences between baseline and endpoint metabolic parameters when examined by baseline BMI, age category, psychiatric diagnosis, or concomitant psychotropic medication. Despite the low doses typically used when quetiapine is prescribed for insomnia, metabolic adverse effects can occur and should be considered in the overall benefit to risk analysis.

Topics: Adult; Alabama; Antipsychotic Agents; Body Mass Index; Comorbidity; Dibenzothiazepines; Female; Humans; Male; Medical Audit; Mental Disorders; Middle Aged; Quetiapine Fumarate; Retrospective Studies; Sleep Initiation and Maintenance Disorders; Weight Gain; Young Adult

Psychomotor retardation (PR) is among the most important features of depression. This study investigates the development of day- and night-time as well as intensity and quantity of circadian motor activity during a 4-week course of treatment among 27 patients with depression compared to 27 healthy controls. A diagnosis of major depression was made using SCID. Motor activity was continuously measured with an actigraph during the study and clinical course of depression with HAM-D-21. Motor activity was described as the quantity and intensity of movements during day- and night- time. Clinically improved patients had significantly intensified movements after 4 weeks, compared to subjects with <50% improvement on HAM-D. While the measures of day-time level of movements captured the clinical improvement of depression, clinical improvement was not reflected by the night-time measurements. This study demonstrates that the separated analysis of level and quantity of movements supports a better understanding of the nature of psychomotor retardation during depression. The subdivision in day- and night-time activity objectively measured with actigraphy captures distinct patterns of motor activity and represents prognostic factors in the treatment outcome of depression. The study also highlights the importance of studying the intensity of movements separately from the quantity of movements in relation to treatment outcome.

Topics: Actigraphy; Adult; Aged; Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Circadian Rhythm; Citalopram; Cyclohexanols; Depressive Disorder, Major; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Longitudinal Studies; Male; Middle Aged; Motor Activity; Personality Inventory; Prognosis; Prospective Studies; Quetiapine Fumarate; Signal Processing, Computer-Assisted; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Venlafaxine Hydrochloride

Topics: Antipsychotic Agents; Dibenzothiazepines; Dose-Response Relationship, Drug; Humans; Pilot Projects; Polysomnography; Quetiapine Fumarate; Sleep; Sleep Initiation and Maintenance Disorders; Treatment Outcome

Severe paradoxical insomnia, documented by actigraphy, was the predominant presenting complaint of a 48-year-old woman subsequently diagnosed with major depression. Both disorders remitted following a course of 5 electroconvulsive therapy treatments in spite of being previously refractory to hypnotic and antidepressant pharmacotherapy.

Topics: Combined Modality Therapy; Cyclohexanols; Depressive Disorder, Major; Diagnosis, Differential; Dibenzothiazepines; Drug Therapy, Combination; Electroconvulsive Therapy; Female; Humans; Middle Aged; Quetiapine Fumarate; Sick Role; Sleep Initiation and Maintenance Disorders; Suicide; Suicide Prevention; Venlafaxine Hydrochloride

To report the successful treatment of phenelzine-associated insomnia with low-dose quetiapine in a patient with refractory depression.. A 42-year-old white man with severe major depression unresponsive to selective serotonin-reuptake inhibitors, bupropion, and tricyclic antidepressants improved following treatment with the monoamine oxidase inhibitor (MAOI) phenelzine. Insomnia, present to a moderate degree prior to antidepressant therapy, worsened markedly following phenelzine treatment and failed to respond to diphenhydramine, temazepam, triazolam, clonazepam, zolpidem, or trazodone given at high therapeutic doses. Sleep disturbance resolved with low-dose (50 mg) adjunctive quetiapine, with no adverse effects.. Major depression refractory to standard therapy is a common and serious condition. Some cases respond to MAOIs; however, orthostatic hypotension and insomnia frequently occur. Potentially serious MAOI interactions with psychotropic drugs have raised concerns about combining these agents. In this case, a failure of a number of other medications known to treat MAOI-associated insomnia safely prompted a trial of quetiapine. Despite the possibility that enhanced serotonergic activity might have resulted in serotonin syndrome, no adverse interactions between phenelzine and quetiapine were noted. The use of low-dose, once-daily quetiapine, along with its unique binding properties, may account for its increased safety in combination with phenelzine.. This case illustrates that low-dose quetiapine may be an alternative treatment for phenelzine-associated insomnia. Further case reports are needed to establish the safety and effectiveness of combining these agents.

Topics: Adult; Antipsychotic Agents; Depressive Disorder, Major; Dibenzothiazepines; Humans; Male; Monoamine Oxidase Inhibitors; Phenelzine; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

Topics: Aggression; Amphetamines; Attention Deficit Disorder with Hyperactivity; Child; Clonidine; Depression; Dibenzothiazepines; Domestic Violence; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Humans; Irritable Mood; Length of Stay; Male; Methylphenidate; Patient Admission; Psychiatric Department, Hospital; Psychomotor Agitation; Psychotropic Drugs; Quetiapine Fumarate; Recurrence; Sertraline; Sleep Initiation and Maintenance Disorders; Substance Withdrawal Syndrome; Valproic Acid

This research assesses the development of the night-activity rhythm and quality of sleep during course of treatment among patients with unipolar or bipolar depression and receiving antidepressant treatment plus quetiapine. Twenty-seven patients with major depressive episode were included into a 4-week follow-up study and compared with 27 healthy controls. Motor activity was continuously measured with an electronic wrist device (actigraphy), sleep was assessed with the Pittsburgh Sleep Quality Index, and patients were clinically assessed with the Hamilton depression score. All patients received a standard antidepressant treatment plus quetiapine. Whereas we found a rapid and maintaining improvement of subjective sleep parameters during the 4-week study, we observed a rapid improvement of some objective sleep parameters (actigraph) within the first week, but no further significant change of objective sleep parameters during the rest of the study. Another main finding of this study is that changes of subjectively and objectively assessed sleep parameters do not necessarily reflect clinical improvement of depression during the same timeline. Despite partial clinical remission, objective sleep parameters still showed significantly different patterns compared with controls. This study is the first to examine the effect of quetiapine on locomotor activity alongside with sleep in depression. As the studied patients with depression showed improvement in subjective and objective sleep parameters, quetiapine may be a promising drug for patients with depression and insomnia. Further studies need to investigate in detail the timeline of clinical remission and alterations of objective and subjective sleep parameters.

Topics: Adult; Aged; Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Case-Control Studies; Circadian Rhythm; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Motor Activity; Polysomnography; Psychiatric Status Rating Scales; Quetiapine Fumarate; Research Design; Sleep; Sleep Initiation and Maintenance Disorders; Time Factors

Topics: Adult; Antipsychotic Agents; Chronic Disease; Dibenzothiazepines; Humans; Male; Pain; Pain Measurement; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders

The purpose of this study was to examine the effectiveness and tolerability of quetiapine for aggression, hyperactivity, and self-injury in pervasive developmental disorders (PDDs).. The medical records of all patients with PDDs diagnosed according to DSM-IV criteria and treated with quetiapine were retrospectively reviewed. Patients who received quetiapine for at least 4 weeks and who were not concurrently treated with another antipsychotic or mood stabilizer were included. Improvement was measured with the Clinical Global Impressions-Improvement scale (CGI-I), with response determined by ratings of "much improved" or "very much improved." Data were collected from May 15, 2003 through November 30, 2003.. Of 857 records reviewed, 20 patients (16 male, 4 female) (mean +/- SD age = 12.1 +/- 6.7 years; range, 5-28 years) received a quetiapine trial (mean +/- SD dosage = 248.7 +/- 198.4 mg/day; range, 25-600 mg/day) over a mean duration of 59.8 +/- 55.1 weeks (range, 4-180 weeks). Eight (40%) of 20 patients were judged "responders" to quetiapine; the mean CGI-I score for the entire group was 3.0 +/- 1.1 (minimally improved). A statistically significant improvement (p = .002) was found between a mean pretrial CGI-Severity of Illness scale (CGI-S) score of 5.1 +/- 0.6 (markedly ill) and a posttrial CGI-S score of 4.2 +/- 1.1 (moderately ill). Adverse effects occurred in 50% (N = 10) of patients and led to drug discontinuation in 15% (N = 3) of patients.. Quetiapine was modestly effective for maladaptive behavior in patients with a PDD. Controlled studies are needed to further assess these preliminary findings.

Topics: Adolescent; Adult; Aggression; Antipsychotic Agents; Child; Child Development Disorders, Pervasive; Child, Preschool; Dibenzothiazepines; Dyskinesia, Drug-Induced; Humans; Hyperkinesis; Male; Psychiatric Status Rating Scales; Quetiapine Fumarate; Retrospective Studies; Self-Injurious Behavior; Severity of Illness Index; Sleep; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Weight Gain