quetiapine-fumarate and Substance-Related-Disorders

Topics: Adult; Antipsychotic Agents; Behavior, Addictive; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Prescription Drug Misuse; Quetiapine Fumarate; Substance-Related Disorders

Substance use disorders (SUDs), including those for alcohol, stimulants, tobacco, opioids and cannabis, in patients with bipolar disorder are a major clinical and public health problem, and are present in the majority of these patients. Nonetheless, the development of effective pharmacological treatments for co-occurring SUDs in bipolar illness have not been well-developed and may be an important practical reason for the reduced effectiveness of these medications in community practice.. We conducted a systematic review of the literature (PubMed, Medline, Google Scholar), and identified N = 29 clinical studies, which evaluated both mental health and SUD outcomes in patients with co-occurring bipolar disorders and SUDs.. Our findings suggest the potential of valproate sodium and lamotrigine as preferred pharmacological agents for the treatment of co-occurring psychiatric and substance use outcomes in these patients. However, many of the reviewed studies are of open-label designs and of modest sample sizes.. Thus, given the gaps in our knowledge, recommendations for treatment of this common and important co-morbidity are preliminary. Accordingly, the conduct of larger, randomized controlled trials for this co-morbidity is clearly needed.

Topics: Anticonvulsants; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Comorbidity; Humans; Lamotrigine; Lithium Compounds; Quetiapine Fumarate; Substance-Related Disorders; Topiramate; Valproic Acid

A recent years' increase in both prescribing and availability of second-generation antipsychotics (SGAs) has been observed. According to the literature, typically made up by case studies/series, quetiapine seems to be the most commonly misused SGA, with both intranasal and intravenous intake modalities having been described. Another SGA that has been anecdotally reported to be misused is olanzapine. For these molecules, both a previous history of drug misuse and being an inmate have been described as factors associated with misuse. Hence, while providing here an updated literature review of the topic, we aimed at assessing all cases of quetiapine misuse/abuse/dependence/withdrawal as reported to the European Medicines Agency's EudraVigilance (EV) database; this was carried out in comparison with the reference drug olanzapine.. All spontaneous, European Medicines Agency database reports relating to both quetiapine (2005-2016) and olanzapine (2004-2016) misuse/abuse/dependence/withdrawal issues were retrieved, and a descriptive analysis was performed.. From the EV database, 18,112 (8.64% of 209,571) and 4178 (7.58% of 55,100) adverse drug reaction reports of misuse/abuse/dependence/withdrawal were associated with quetiapine and olanzapine, respectively. The resulting proportional reporting ratio values suggested that the misuse/abuse-, dependence-, and withdrawal-related adverse drug reactions were more frequently reported for quetiapine (1.07, 1.01, and 5.25, respectively) in comparison with olanzapine.. Despite data collection limitations, present EV data may suggest that, at least in comparison with olanzapine, quetiapine misuse may be a cause for concern.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Benzodiazepines; Child; Databases, Factual; European Union; Female; Humans; Male; Middle Aged; Olanzapine; Prescription Drug Misuse; Quetiapine Fumarate; Substance Withdrawal Syndrome; Substance-Related Disorders; Young Adult

Up to 75% of people with serious mental illness (SMI) such as schizophrenia and bipolar disorder have co-occurring substance use disorders (dual diagnosis). Dual diagnosis can have an adverse effect on treatment and prognosis of SMI.. To evaluate the effects of risperidone compared to treatment with other antipsychotics (first-generation and other second-generation antipsychotics) used in people with serious mental illness and co-occurring substance misuse.. On 6 January 2016 and 9 October 2017, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (including trial registers).. We selected randomised trials of risperidone versus any other antipsychotic in people with SMI and substance abuse (dual diagnosis). We included trials meeting our inclusion criteria and reporting useable data. We excluded trials that either did not meet our inclusion criteria or met our inclusion criteria but did not report any useable data.. We independently inspected citations and selected studies. For included studies, we independently extracted data and appraised study quality. For binary outcomes we calculated the risk ratios (RRs) and their 95% confidence intervals. For continuous outcomes we calculated the mean differences (MDs) and their 95% confidence intervals. We pooled data using random-effects meta-analyses and assessed the quality of evidence, creating a 'Summary of findings' table using the GRADE approach.. We identified eight randomised trials containing a total of 1073 participants with SMI and co-occurring substance misuse. Seven of these contributed useable data to the review. There was heterogeneity in trial design and measurement. Risperidone was compared to clozapine, olanzapine, perphenazine, quetiapine and ziprasidone. Few trials compared risperidone with first-generation agents. Few trials examined participants with a dual diagnosis from the outset and most trials only contained separate analyses of subgroups with a dual diagnosis or were secondary data analyses of subgroups of people with a dual diagnosis from existing larger trials.For risperidone versus clozapine we found no clear differences between these two antipsychotics in the reduction of positive psychotic symptoms (1 randomised controlled trial (RCT), n = 36, mean difference (MD) 0.90, 95% CI -2.21 to 4.01, very low quality evidence), or reduction in cannabis use (1 RCT, n = 14, risk ratio (RR) 1.00, 95% CI 0.30 to 3.35, very low quality evidence), improvement in subjective well-being (1 RCT, n = 36, MD -6.00, 95% CI -14.82 to 2.82, very low quality evidence), numbers discontinuing medication (1 RCT, n = 36, RR 4.05, 95% CI 0.21 to 78.76, very low quality evidence), extrapyramidal side-effects (2 RCTs, n = 50, RR 2.71, 95% CI 0.30 to 24.08; I² = 0%, very low quality evidence), or leaving the study early (2 RCTs, n = 45, RR 0.49, 95% CI 0.10 to 2.51; I² = 34%, very low quality evidence). Clozapine was associated with lower levels of craving for cannabis (1 RCT, n = 28, MD 7.00, 95% CI 2.37 to 11.63, very low quality evidence).For risperidone versus olanzapine we found no clear differences in the reduction of positive psychotic symptoms (1 RCT, n = 37, MD -1.50, 95% CI -3.82 to 0.82, very low quality evidence), reduction in cannabis use (1 RCT, n = 41, MD 0.40, 95% CI -4.72 to 5.52, very low quality evidence), craving for cannabis (1 RCT, n = 41, MD 5.00, 95% CI -4.86 to 14.86, very low quality evidence), parkinsonism (1 RCT, n = 16, MD -0.08, 95% CI -1.21 to 1.05, very low quality evidence), or leaving the study early (2 RCT, n = 77, RR 0.68, 95% CI 0.34 to 1.35; I² = 0%, very low quality evidence).For risperidone versus perphenazine, we found no clear differences in the number of participants leaving the study early (1 RCT, n = 281, RR 1.05, 95% CI 0.92 to 1.20, low-quality evidence).For risperidone versus quetiapine, we found no clear differences in the number of participants leaving th. There is not sufficient good-quality evidence available to determine the effects of risperidone compared with other antipsychotics in people with a dual diagnosis. Few trials compared risperidone with first-generation agents, leading to limited applicability to settings where access to second-generation agents is limited, such as in low- and middle-income countries. Moreover, heterogeneity in trial design and measurement of outcomes precluded the use of many trials in our analyses. Future trials in this area need to be sufficiently powered but also need to conform to consistent methods in study population selection, use of measurement scales, definition of outcomes, and measures to counter risk of bias. Investigators should adhere to CONSORT guidelines in the reporting of results.

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Diagnosis, Dual (Psychiatry); Humans; Mental Disorders; Olanzapine; Patient Dropouts; Perphenazine; Piperazines; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Risperidone; Schizophrenia; Substance-Related Disorders; Thiazoles

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

Recent case reports and case series suggest that the atypical antipsychotic quetiapine has the potential for misuse. This includes drug-seeking behaviors motivated by quetiapine as well as inappropriate (intranasal or intravenous) administration. We present an additional case of quetiapine misuse and review other published cases. In general, quetiapine misuse is associated with prior CNS depressant use and is more common in forensic settings. The mechanism of reinforcement for this misuse is unknown, but we hypothesize that it is related to quetiapine's pharmacological profile as an antihistamine with a relative low affinity for dopamine receptors. The risks to individuals and society of exaggerating/simulating symptoms to obtain high-dose quetiapine in the absence of a clinical indication are discussed. This includes the unwelcome possibility of restricting access to this effective medication.

Topics: Antipsychotic Agents; Dibenzothiazepines; Histamine Antagonists; Humans; Male; Middle Aged; Mood Disorders; Quetiapine Fumarate; Substance-Related Disorders; White People

Quetiapine is an atypical antipsychotic approved by the FDA (Food and Drug Administration) for use in the treatment of schizophrenia, acute mania, and bipolar depression. Pharmacologically, it has antagonistic effects on serotonin 5-HT1A and 5-HT2A, dopamine D1 and D2, histamine H1, and adrenergic alpha1 and alpha2 receptors. In addition to reports of its use in schizophrenia and bipolar disorder, many studies have examined the use of quetiapine in the treatment of anxiety disorders and substance use disorders. In the treatment of patients with psychotic or bipolar disorder with a comorbid substance abuse disorder even though quetiapine was prescribed primarily for the treatment of the underlying psychotic symptoms, patients taking this medication reported a significant reduction in substance use. Yet, there are also case reports of quetiapine abuse and dependence; in particular among prisoners and patients diagnosed with substance abuse. Though quetiapine should be used peroral, it is also used intranasally and intravenously in these patient groups. Moreover, in some cases quetiapine is combined with other substances, such as cocaine or marijuana, to increase sedation. This abuse of quetiapine is thought to occur due to the anxiolytic and sedative effects of the drug. There are no controlled studies on quetiapine dependence in the literature and it remains unknown whether or not quetiapine causes dependence. This review aimed to present all published case reports on quetiapine abuse and to discuss the possible mechanisms that underlie its abuse and dependence.

Topics: Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Humans; Psychotic Disorders; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders

Topics: Adult; Antipsychotic Agents; Deinstitutionalization; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Fear; Female; Health Services Needs and Demand; Hospitals, Psychiatric; Hospitals, State; Humans; Malingering; Mental Disorders; Prisoners; Psychiatric Nursing; Quetiapine Fumarate; Social Isolation; Substance-Related Disorders; Treatment Refusal

The abuse and diversion of pharmacological agents with CNS mechanisms of action is an important concern from governmental, regulatory, public health and safety perspectives. In recent years, there have been an increased number of reports concerning the abuse and diversion of quetiapine in forensic population and in individuals with histories of substance abuse.. To better understand this surging pattern the available body of evidence was critically examined.. A literature search from January 1991 to July 2008 restricting papers to English and using PUBMED and PsychInfo was performed.. Nine papers were identified. The content of these papers is discussed in light of recent research on drug abuse.

Topics: Animals; Antipsychotic Agents; Behavior, Addictive; Dibenzothiazepines; Drug and Narcotic Control; Humans; Quetiapine Fumarate; Substance-Related Disorders

The use of quetiapine as a drug to treat various substance use disorders as well as a drug of abuse is examined.. Quetiapine's effectiveness in treating schizophrenia and bipolar disorder is well-known; however, growing evidence has indicated that it may be useful in the treatment of various substance use disorders. Small-scale studies have been conducted to investigate the potential benefit of quetiapine in patients dependent on alcohol, cocaine, and amphetamines. The results of these two studies provide some evidence that quetiapine may benefit patients diagnosed with a mental illness who are also dependent on cocaine, amphetamines, or both, though more rigorous studies are needed. An unforeseen use of antipsychotics, specifically quetiapine, as drugs of abuse has emerged. Since antipsychotics are not classified as controlled substances, the majority of clinicians may not consider the diversion of antipsychotics for recreational purposes, but evidence of this is increasing, particularly in incarcerated individuals. Intravenous quetiapine abuse was first reported in the literature in 2005. Although most cases of quetiapine abuse have been reported in the correctional setting, inappropriate quetiapine use within the community has been documented. Thus far, all of the documented cases have involved patients with a prior history of substance abuse. Clinicians must be cognizant of the potential for quetiapine as a treatment for substance use disorders and as a drug of abuse.. Quetiapine is a promising treatment for substance use disorders alone or combined with other psychiatric diagnoses, such as bipolar disorder and schizophrenia. Quetiapine abuse has also been documented, particularly in the correctional setting.

Topics: Alcoholism; Amphetamine-Related Disorders; Antipsychotic Agents; Bipolar Disorder; Cocaine-Related Disorders; Dibenzothiazepines; Humans; Illicit Drugs; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders

This article reviews the off-label prescription of quetiapine in the treatment of a broad range of psychiatric disorders including obsessive-compulsive disorder, post-traumatic stress disorder, personality disorder, substance abuse, bipolar disorder (now US FDA approved), anxiety and depression. The article highlights the primary reliance on selective serotonin reuptake inhibitors (SSRIs) in the treatment of these disorders (cf bipolar disorder) and the high percentage of patients (30-60%) that do not respond to SSRIs. The studies suggest that low-dose quetiapine shows good tolerability and efficacy in patients diagnosed with these disorders, particularly in the case of treatment-resistant patients that do not respond to primary treatments including SSRIs and cognitive-behavioral therapy. Quetiapine generally appears to be very effective in trauma-related conditions by improving autonomic stability, and decreasing the stress and anxiety response that arises due to specific fears or triggers. Quetiapine also appears to be particularly useful for normalizing obsessions and compulsions, and improving low mood, irritability and aggressiveness. A greater understanding of the pharmacology of drug alternatives and the neurobiology of psychiatric disorders is required to permit a more personalized medicine approach.

Topics: Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Drug Prescriptions; Humans; Mental Disorders; Obsessive-Compulsive Disorder; Personality Disorders; Quetiapine Fumarate; Stress Disorders, Post-Traumatic; Substance-Related Disorders

Drug abuse affects a significant number of individuals of all ages. Health care practitioners must be knowledgeable about both the physiological effects of such drugs and the impact of drug-seeking behavior on their patients.

Topics: 4-Butyrolactone; Catha; Designer Drugs; Dibenzothiazepines; Diterpenes; Diterpenes, Clerodane; DOM 2,5-Dimethoxy-4-Methylamphetamine; Drug and Narcotic Control; Flunitrazepam; Hallucinogens; Humans; Illicit Drugs; Ketamine; Lysergic Acid Diethylamide; Methamphetamine; Motivation; N-Methyl-3,4-methylenedioxyamphetamine; Phencyclidine; Phenylpropanolamine; Piperazines; Psilocybin; Quetiapine Fumarate; Sodium Oxybate; Substance-Related Disorders; United States

Although life prevalence of substance use disorders among patients with schizophrenia is close to 50%, few studies have been carried out to date to identify an integrated pharmacological treatment for this comorbidity. So far, the most promising results, that we report here, have been obtained with clozapine. To a lesser extent, quetiapine and olanzapine, both clozapine analogues, have also shown promising results. Further to these observations, the present paper critically reviews the advantages associated with clozapine, quetiapine and olanzapine, and their relevance to the treatment of addiction among schizophrenic patients. Six characteristics seem to distinguish clozapine, quetiapine and olanzapine from the first-generation antipsychotics: (1) acting preferentially on the reward system, these second-generation antipsychotics (mainly clozapine and quetiapine) induce almost no extrapyramidal symptoms; (2) quickly dissociating from D(2), theses drugs (mainly clozapine and quetiapine) seem not to induce dysphoria, unlike conventional antipsychotics like haloperidol;(3) these drugs (mainly clozapine) seem more effective in the treatment of negative symptoms than conventional antipsychotics; (4) because of a diversified activity on several serotoninergic and noradrenergic receptors, these drugs positively alter mood, which does not seem to be the case with conventional antipsychotics, except for flupenthixol; (5) these drugs have a positive impact on cognition, which is not the case with the first-generation antipsychotics; (6) unlike conventional antipsychotics, these drugs seem to have a moderate affinity for 5-HT(3), the receptor on which ondansetron, an anti-craving medication, acts.

Topics: Affect; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Clozapine; Cognition; Comorbidity; Dibenzothiazepines; Drug Therapy, Combination; Humans; Olanzapine; Pirenzepine; Quetiapine Fumarate; Receptors, Serotonin; Receptors, Serotonin, 5-HT3; Schizophrenia; Substance-Related Disorders; Treatment Outcome

Although quetiapine was introduced as an atypical antipsychotic drug with clinical efficacy in schizophrenia patients, it has been used in a variety of disease states over the last 5 years. The most common conditions have included mood and anxiety disorders, obsessive-compulsive disorder, aggression, hostility, posttraumatic stress disorder, borderline personality disorder, delirium, and comorbid substance abuse. Considering its efficacy in a wide variety of neuropsychiatric conditions and its excellent tolerability profile, quetiapine could emerge as a broad-spectrum psychotropic medication that may be helpful in psychiatry across various diagnostic categories. Traditionally, studies on the predictive validity of psychiatric disorders help with nosologic issues and controversies. Assessing quetiapine's tolerability and its overall treatment response might help tease out the predictive validity of various psychiatric syndromes (based currently on an atheoretical descriptive approach) and may shape psychiatric nosology in the future. Quetiapine's low affinity and fast dissociation from postsynaptic dopamine-2 receptors give the least risk of producing acute extrapyramidal side effects, tardive dyskinesia, and neuroleptic malignant syndrome. These factors suggest that the clinical utility of quetiapine in psychiatric conditions other than schizophrenia has not been fully exploited thus far.

Topics: Adult; Aggression; Antipsychotic Agents; Anxiety Disorders; Bipolar Disorder; Borderline Personality Disorder; Clinical Trials as Topic; Comorbidity; Delirium; Depressive Disorder; Dibenzothiazepines; Forecasting; Hostility; Humans; Mental Disorders; Obsessive-Compulsive Disorder; Quetiapine Fumarate; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Treatment Outcome

The randomized comparative study of aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction.. Intra-group analysis of dependent variables on the scales PANSS, BPRS, VAS, SACS showed significant differences in the dinamics of the therapy in all groups. A comparative randomized study included 90 men admitted to an inpatient addiction unit. Of these, 54 (60%) had a previously established psychiatric diagnosis and 36 patients (40%) did not have an established psychiatric diagnosis. They were randomized into 3 groups of 30 patients each: group 1 received aripiprazole at a dose of up to 20 mg/day, group 2 received quetiapine at a dose of up to 600 mg/day and group 3 (controls) was treated with haloperidol at a dose of up to 30 mg/day. Treatment duration was 21 days. The efficacy of aripiprazole and quetiapine was evaluated with PANSS, BPRS, VAS and SACS on 10. An analysis of independent variables showed significant differences between aripiprazole and haloperidol in PANSS and BPRS scores at visit 4, in VAS scores at visit 3, and in SACS scores at visit 2. An intergroup analysis of independent variables showed significant differences between quetiapine and haloperidol in PANSS, VAS and SACS scores at visit 4 and between aripiprazole and quetiapine in VAS and SACS scores. According to the results of the correlation analisys it has been concluded that presenting features of schizophrenia are closely correlated with drug addiction (craving).. Цель исследования. Изучение терапевтической эффективности арипипразола и кветиапина в сравнении с галоперидолом в случаях коморбидности малопрогредиентных форм шизофрении и болезней зависимости. Материал и методы. Было проведено рандомизированное сравнительное исследование указанных антипсихотических препаратов. Были скринированы 90 мужчин, поступивших на лечение в наркологический стационар. Из них 54 (60%) пациента имели ранее установленный диагноз шизофрении, 36 (40%) его не имели. Методом простой рандомизации пациенты были разделены на три группы по 30 человек, в которых был назначен соответствующий антипсихотик: арипипразол в дозе до 20 мг/сут, кветиапин в дозе до 600 мг/сут, галоперидол в дозе до 30 мг/сут. Длительность лечения составила 21 день. Эффективность препаратов оценивали по шкалам PANSS, BPRS, визуальной аналоговой шкале (ВАШ) и шкале патологического влечения к наркотику (ПВН) на 10, 14 и 21-й дни (визиты 2-4). Безопасность препаратов определяли на основании данных о развитии нежелательных явлений или побочных реакций. Результаты и заключение. Внутригрупповой анализ зависимых переменных по шкалам ANSS, BPRS, ВАШ, ПВН показал достоверные различия во всех группах в динамике терапии. Межгрупповой анализ независимых переменных показал достоверные различия между арипипразолом и галоперидолом по PANSS, BPRS к визиту 4, по ВАШ к визиту 3, по шкале ПВН к визиту 2. Межгрупповой анализ независимых переменных показал достоверные различия между кветиапином и галоперидолом по PANSS, ВАШ, шкале ПВН - к визиту 4. Межгрупповой анализ независимых переменных показал достоверные различия между арипипразолом и кветиапином по шкале ПВН, ВАШ. По результатам корреляционного анализа сделан вывод о неразрывной связи психопатологических проявлений шизофрении и синдрома патологического влечения к психоактивным веществам.

Topics: Antipsychotic Agents; Aripiprazole; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Humans; Male; Psychiatric Status Rating Scales; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders; Treatment Outcome

Individuals with bipolar disorder have high rates of other medical comorbidity, which is associated with higher mortality rates and worse course of illness. The present study examined common predictors of medical comorbidity.. The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month, randomized comparative effectiveness trial. Baseline assessments included current and lifetime DSM-IV-TR diagnoses, demographic information, psychiatric and medical history, severity of psychiatric symptoms, level of functioning, and a fasting blood draw. Medical comorbidities were categorized into two groups: cardiometabolic (e.g., diabetes, hyperlipidemia, and metabolic syndrome) and non-cardiovascular (e.g., seizures, asthma, and cancer). Additionally, we looked at comorbid substance use (e.g., smoking and drug dependence).. We found that 96.3% of participants had at least one other medical comorbidity. Older age predicted a greater likelihood of having a cardiometabolic condition. Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition, but a greater chance of having other types of medical comorbidity. Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed, less time spent manic/hypomanic, and longer duration of illness. Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides.. There appears to be a substantial medical burden associated with bipolar disorder, highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients.

Topics: Adult; Antimanic Agents; Antipsychotic Agents; Asthma; Bipolar Disorder; Cardiovascular Diseases; Comorbidity; Comparative Effectiveness Research; Diabetes Mellitus; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Hyperlipidemias; Lithium Compounds; Male; Metabolic Syndrome; Middle Aged; Neoplasms; Quetiapine Fumarate; Seizures; Smoking; Substance-Related Disorders

No large-scale randomized trial has compared the effect of different second-generation antipsychotic drugs and any first-generation drug on alcohol, drug and nicotine use in patients with schizophrenia. The Clinical Antipsychotic Trial of Intervention Effectiveness study randomly assigned 1432 patients formally diagnosed with schizophrenia to four second-generation antipsychotic drugs (olanzapine, risperidone quetiapine, and ziprasidone) and one first-generation antipsychotic (perphenazine) and followed them for up to 18 months. Secondary outcome data documented cigarettes smoked in the past week and alcohol and drug use severity ratings. At baseline, 61% of patients smoked, 35% used alcohol, and 23% used illicit drugs. Although there were significant effects of time showing reduction in substance use over the 18 months (all p < 0.0001), this study found no evidence that any antipsychotic was robustly superior to any other in a secondary analysis of data on substance use outcomes from a large 18-month randomized schizophrenia trial.

Topics: Adolescent; Adult; Aged; Alcoholism; Antipsychotic Agents; Benzodiazepines; Chronic Disease; Comorbidity; Cross-Sectional Studies; Dibenzothiazepines; Double-Blind Method; Female; Humans; Illicit Drugs; Male; Middle Aged; Olanzapine; Perphenazine; Piperazines; Psychiatric Status Rating Scales; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Smoking; Smoking Prevention; Substance-Related Disorders; Thiazoles; Young Adult

Substance use disorders (SUDs) are associated with a variety of psychiatric disorders and mood and behavioral instability. Growing evidence suggests that the atypical antipsychotic quetiapine may be useful in the treatment of SUDs. The primary objective of the current open-label trial was to examine the effects of quetiapine on SUD outcomes in patients entering detoxification.. Thirty-three nonpsychosis SUD patients participated. Patients received quetiapine for a 12-week beginning in detoxification. Craving, quantities used and psychiatric symptoms were evaluated on baseline and at end point.. Out of 33 recruited patients, 26 completed > 9 weeks of treatment. Last observation carried forward (LOCF) analyses revealed that craving, SUD severity and quantities used improved during the study. Psychiatric and depressive symptoms also improved.. Our results cannot be attributed per se to the pharmacological effects of quetiapine owing to the open-label design of the study, the small sample size involved and the fact that patients were involved in an intensive therapy program. Nevertheless, our results indicate that quetiapine may be helpful for the treatment of SUD patients entering detoxification. Controlled studies are warranted to determine whether these results are quetiapine-related.

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Prospective Studies; Quetiapine Fumarate; Research Design; Severity of Illness Index; Substance-Related Disorders; Treatment Outcome

The aim of this study was to evaluate metabolic and hormonal side effects in children and adolescents after 6 months of treatment with 3 different second-generation antipsychotics (SGAs).. 66 children and adolescents (44 male [66.7%], mean +/- SD age = 15.2 +/- 2.9 years) treated for 6 months with risperidone (N = 22), olanzapine (N = 20), or quetiapine (N = 24) composed the study sample. 34 patients (51.5%) suffered from schizophrenia or other psychosis (according to DSM-IV criteria). Patients were consecutively attending different programs from March 2005 to October 2006. Prior to enrollment in the study, patients were either antipsychotic-naive (37.9%, N = 25) or had been taking an antipsychotic drug for fewer than 30 days. Significant weight gain was defined as a > or = 0.5 increase in body mass index (BMI) z score (adjusted for age and gender) at 6 months. Based on recent criteria for pediatric populations, patients were considered "at risk for adverse health outcome" if they met at least 1 of the following criteria: (1) > or = 85th BMI percentile plus presence of 1 or more negative weight-related clinical outcomes, or (2) > or = 95th BMI percentile.. After the 6 months, BMI z scores increased significantly in patients receiving olanzapine and risperidone. At the 6-month follow-up, 33 patients (50.0%) showed significant weight gain. The number of patients at risk for adverse health outcome increased from 11 (16.7%) to 25 (37.9%) (p = .018). The latter increase was significant only in the olanzapine group (p = .012). Total cholesterol levels increased significantly in patients receiving olanzapine (p = .047) and quetiapine (p = .016). Treatment with quetiapine was associated with a significant decrease in free thyroxin (p = .011).. Metabolic and hormonal side effects of SGAs in children and adolescents should be carefully monitored when prescribing these drugs.

Topics: Adolescent; Benzodiazepines; Blood Glucose; Body Mass Index; Child; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Female; Follow-Up Studies; Humans; Male; Obesity; Olanzapine; Prevalence; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Substance-Related Disorders; Thyroxine; Triglycerides

This double-blind study compared a second generation (atypical) antipsychotic drugs compared to a representative older agent for patients with schizophrenia who use or avoid illicit substances.. Schizophrenic subjects were recruited at 57 U.S. sites and randomly assigned to olanzapine, perphenazine, quetiapine, risperidone or ziprasidone for up to 18 months. The primary aim of this analysis was to delineate differences between the overall effectiveness of these five treatments among patients who used or did not use illicit substances.. There were no significant differences between treatment groups in time to all-cause treatment discontinuation among patients who use illicit drugs (median 3.3 to 6.8 months). Among non-users time to treatment discontinuation was significantly longer for patients treated with olanzapine (median 13.0 months) than perphenazine ( 5.9 months), risperidone (5.6 months), or quetiapine (5.0 months); time to discontinuation for ziprasidone (4.3 months) was even shorter, although the latter difference was not significant. The difference between risperidone and quetiapine, although small, was significant. All remaining differences were non-significant. Similar results were found for discontinuation due to inefficacy. There were no differences between illicit users and non-users in symptom reduction and global improvement, after adjustment for differential duration of treatment. Differences in discontinuation results were attenuated by non-compliance, but the trends persisted after controlling for treatment compliance.. Among patients with chronic schizophrenia who avoid use of illicit drugs, olanzapine was more effective than other antipsychotics as reflected by longer time to all-cause discontinuation, but illicit substance abuse attenuated this advantage, reinforcing the need for concurrent substance abuse treatment.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chronic Disease; Comorbidity; Dibenzothiazepines; Double-Blind Method; Female; Humans; Illicit Drugs; Male; Olanzapine; Patient Dropouts; Perphenazine; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Substance-Related Disorders; Time Factors; Treatment Outcome; Treatment Refusal

In this 6-week, open-label trial, combat veterans meeting DSM-IV criteria for posttraumatic stress disorder (PTSD) were treated with the atypical antipsychotic quetiapine. The starting dose was 25 mg at bedtime with subsequent titration based on tolerability and clinical response. Primary outcome was measured using the Clinician Administered PTSD Scale (CAPS). Secondary assessments of efficacy included the Positive and Negative Symptom Scale (PANSS), the Hamilton Rating Scale for Depression, and the Clinical Global Impression Scale. Safety and tolerability evaluations included neurologic ratings, vital signs, and assessment of treatment-emergent side effects. Eighteen of 20 patients enrolled in the study completed 6 weeks of open-label treatment. The dose range of quetiapine was 25 to 300 mg daily, with an average of 100+/-70 mg/d. There was significant improvement in CAPS scores, from 89.8+/-15.7 to 67.5+/-21.0 (t=4.863, df=18, <0.005), and composite PANSS ratings from baseline to endpoint. General psychopathology (PANSS) and depressive symptoms (HRSD) were also reduced at the 6-week end point. There were no serious adverse events and no clinically significant changes in vital signs or neurologic ratings. This preliminary open trial suggests that quetiapine is well tolerated and may have efficacy in reducing PTSD symptoms in patients who have not had an adequate response other medications. Studies utilizing a randomized, controlled trial design and larger sample sizes are needed to better define the potential role of quetiapine and other atypical antipsychotics in the treatment of PTSD.

Topics: Aged; Antipsychotic Agents; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Quetiapine Fumarate; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Veterans

To describe trends in and characteristics of sedative drug use from 2000 through 2019 in relation to the introduction of central regulations and new drugs.. In this descriptive study, we used individual prescription data on the entire Danish population from the Danish National Prescription Registry to calculate yearly incidence and prevalence of use of benzodiazepines, benzodiazepine-related drugs (Z-drugs), melatonin, olanzapine, low-dose quetiapine, mianserin/mirtazapine, pregabalin, and promethazine from 2000 through 2019. From the Danish National Patient Registry, we obtained data on drug users' psychiatric and somatic comorbidity.. The use of benzodiazepines and Z-drugs declined gradually from 2000 through 2019, whereas the newer alternatives, melatonin, low-dose quetiapine, pregabalin and promethazine, increased in use, while the use of olanzapine and mianserin/mirtazapine was relatively stable. This development was seen in both men and women and across all age groups except for hypnotic benzodiazepines which showed a steep increase in the oldest age group from 2010. For all sedative drugs depression, anxiety, alcohol and misuse disorder, pain and cancer were the most prevalent comorbidities. During our study period, the number of individuals without any of the selected diagnoses increased.. In Denmark different central regulations have influenced prescription practice toward more restrictive use of Z-drugs and benzodiazepines, except for hypnotic benzodiazepine prescriptions increased after the introduction of special palliative care. An increase in use of newer sedative drugs, however, indicates that the regulations do not remove the need for sedative drugs in the population.

Topics: Benzodiazepines; Denmark; Drug Prescriptions; Drug Utilization; Female; Humans; Hypnotics and Sedatives; Male; Melatonin; Mianserin; Mirtazapine; Olanzapine; Pregabalin; Promethazine; Quetiapine Fumarate; Substance-Related Disorders

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Olanzapine; Pharmacovigilance; Quetiapine Fumarate; Substance-Related Disorders; World Health Organization

Side effects restrict the optimal use of antipsychotics. Little is known about the influence of substance use on side effects. The aim of this study was to compare antipsychotic side effects in patients with psychosis with and without substance use, while also taking medication history and diagnosis into consideration.. All patients (. At baseline, 30% of the patients used substances, 54% were diagnosed with SSD, and 47% were antipsychotic naïve. The occurrence of side effects in total was not different in patients with substance use compared to without after 4-weeks of treatment, nor in the follow-up period. At 4-weeks there were some group differences in relation to substance use, diagnosis, and medication history for single side effects. Patients with substance use showed more increased dream activity, less reduced salivation, and more gynecomastia. Patients with SSD showed less neurological side effects, orgasm dysfunction, and tension/inner unrest. The medication naïve patients showed increased hypokinesia/akinesia.. Substance use alone does not influence the general magnitude of side effects of antipsychotic medication and does not indicate a different prescription practice in patients with psychosis and substance use.

Topics: Adult; Benzodiazepines; Female; Humans; Male; Olanzapine; Piperazines; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Substance-Related Disorders; Thiazoles

The antipsychotic drug quetiapine is widely used, and increasingly prescribed off-label. Furthermore, quetiapine use has been linked to increased mortality rates, most likely due to a range of cardiovascular and metabolic adverse effects. This makes quetiapine a relevant substance in forensic toxicology casework. Quetiapine is believed to undergo significant post mortem redistribution. Herein, we present tissue distribution and concentration levels of quetiapine in post mortem whole blood, brain tissue, skeletal muscle, and liver tissue in a series of 14 quetiapine-implicated forensic autopsy cases along with the quetiapine concentrations determined in femoral whole blood in conjunction with the autopsies. Quantification was performed using liquid-liquid extraction and a validated UPLC-MSMS method. Six deaths were attributed to intoxication with quetiapine in combination with other substances; there were no quetiapine monointoxications. In eight cases, death was attributed to other causes than drug toxicity. In a majority of the cases, liver tissue contained the highest quetiapine concentrations, while whole blood levels were the lowest. Central (heart) blood concentrations were generally higher than peripheral (femoral) blood levels. Quetiapine concentrations in femoral blood correlated most strongly with concentrations in skeletal muscle. Otherwise, there was no consistent hierarchy of quetiapine tissue concentrations, and the tissue distribution showed no clear relationship with the length of the post mortem interval.

Topics: Adult; Aged; Antipsychotic Agents; Brain Chemistry; Female; Forensic Toxicology; Humans; Liver; Male; Middle Aged; Muscle, Skeletal; Postmortem Changes; Quetiapine Fumarate; Substance-Related Disorders; Young Adult

Quetiapine is increasingly being used as a sedative and hypnotic drug, especially in the treatment of addiction disorders. Some have warned against this practice. However, a review of the research literature lends little support to these warnings.

Topics: Antipsychotic Agents; Dibenzothiazepines; Humans; Quetiapine Fumarate; Substance-Related Disorders

Topics: Humans; Quetiapine Fumarate; Substance-Related Disorders

Topics: Amines; Anticonvulsants; Antidiarrheals; Antipsychotic Agents; Antitussive Agents; Cyclohexanecarboxylic Acids; Dextromethorphan; Drug Misuse; Gabapentin; gamma-Aminobutyric Acid; Humans; Loperamide; Pregabalin; Quetiapine Fumarate; Substance Withdrawal Syndrome; Substance-Related Disorders

Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal.. Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner.. Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) "downers" from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of "trip" (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine).. PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients' substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.

Topics: Adult; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Cocaine-Related Disorders; Drug Interactions; Drug Users; Female; Heroin Dependence; Humans; Hypnotics and Sedatives; Ill-Housed Persons; Male; Middle Aged; Psychotropic Drugs; Quebec; Quetiapine Fumarate; Risk-Taking; Substance-Related Disorders; Young Adult

The aim of the present paper is to open the discourse regarding the unmet needs of specific patients, especially those with substance use disorder and/or personality disorder where 'multimorbidities', and/or 'overdiagnosis' and/or 'diagnosis overlap' are frequent. An additional aim is to review the main therapeutic purpose and concepts of Gestalt therapy which might be appropriate in the treatment of these patients often characterized by their difficulties in being aware and in contact in the 'here and now'.. I first start with an overview of Gestalt therapy concepts. Then, I illustrate Gestalt's 'here and now' and awareness concepts applied during 18 sessions with an inpatient diagnosed with substance use and bipolar disorders. In addition, the patient had to face an open criminal charge, was regarded as having an antisocial personality disorder and argued suffering from post-traumatic stress disorder.. After this two-month therapy period, the patient entered for the first time a daily rehabilitation program in the community, where he was doing well (this after a few prior hospitalizations). The awareness development in the 'here and now' through which different contact styles and cycles of experiences are experienced is a process that allowed the patient to start experiencing contact with himself, his true needs and his environment. This contributed to his well-being improvement, led and supported his rehabilitation and reinsertion within the society and decrease his relapses, either with drugs or criminal activities. Copyright © 2016 John Wiley & Sons, Ltd.. People with substance use disorder (where 'multimorbidities', 'overdiagnosis' or 'diagnosis overlap' are frequent), people with personality disorder(s) or people who have difficulties in defining what really disturbs them are the same people who could benefit of GT encouraging awareness and contact development in the 'here and now'. Gestalt therapy should not be regarded as a practitioner's toolbox but as a therapeutic process allowing awareness and I-boundaries development in the 'here and now' through authentic and genuine relationships. The therapist's awareness and contact with themselves and their environment are reflected in the therapist's relaxed but awake and aware state of mind as well as their wise, spontaneous and mindful approach.

Topics: Adult; Antisocial Personality Disorder; Awareness; Bipolar Disorder; Child; Child Abuse; Combined Modality Therapy; Comorbidity; Diagnosis, Dual (Psychiatry); Follow-Up Studies; Gestalt Therapy; Hospitalization; Humans; Illicit Drugs; Israel; Life Change Events; Male; Quetiapine Fumarate; Substance-Related Disorders

Carisoprodol, a centrally acting muscle relaxant with a high abuse potential, has barbiturate-like properties at the GABA-A receptor, leading to central nervous system depression and desired effects. Its tolerance and dependence has been previously demonstrated in an animal model, and withdrawal has been described in several recent case reports. Many cases can be effectively managed with a short course of benzodiazepines or antipsychotic agents. However, abrupt cessation in a patient with a history of long-term and high-dose carisoprodol abuse may result in symptoms that are more difficult for providers to treat.. We present a case of a 34-year-old man with a long history of carisoprodol abuse who was found unresponsive after having ingested 7.5 grams of carisoprodol. He was intubated and admitted to the intensive care unit. He was given propofol, dexmedetomidine, fentanyl, ketamine, lorazepam, midazolam, quetiapine, and haloperidol, some at high-dose infusions, before his agitation and ventilator asynchrony could be controlled. His improvement coincided with the addition of carisoprodol and phenobarbital to his treatment regimen. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trends show increasing emergency department presentations for drug-related disorders and treatment. This case highlights an uncommon case of carisoprodol withdrawal that may be encountered by emergency physicians, and demonstrates that benzodiazepines may not be sufficient to suppress severe withdrawal symptoms. Treatment with carisoprodol and phenobarbital provided additional benefit and can be considered in cases of severe carisoprodol withdrawal.

Topics: Adult; Carisoprodol; Dexmedetomidine; Drug Overdose; Fentanyl; Haloperidol; Humans; Hypnotics and Sedatives; Intensive Care Units; Ketamine; Lorazepam; Male; Midazolam; Propofol; Quetiapine Fumarate; Respiration, Artificial; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Alprazolam; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Humans; Male; Quetiapine Fumarate; Substance-Related Disorders

Prescribers and pharmacists should be aware of the problem.

Topics: Adolescent; Adult; Antipsychotic Agents; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Substance-Related Disorders

Quetiapine is an atypical antipsychotic licensed for the treatment of schizophrenia and bipolar disorder and as an adjunctive for patients with unipolar depression. Case reports suggest a potential for drug abuse, especially among individuals with prior or current abuse of other substances.

Topics: Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Humans; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders

Topics: Adolescent; Adult; Antipsychotic Agents; Community Health Services; Dibenzothiazepines; Female; Humans; Male; Methadone; Middle Aged; Nova Scotia; Opiate Substitution Treatment; Quetiapine Fumarate; Substance-Related Disorders; Young Adult

The abuse of medications in prison is a phenomenon well known among correctional health care professionals, and quetiapine has emerged as a drug of abuse in these settings. Considering the risks of abuse and diversion and the high cost compared with effective alternative antipsychotic medications, the New Jersey Department of Corrections (NJDOC) Pharmacy and Therapeutics Committee voted to remove quetiapine from the formulary. In a retrospective chart review, clinically relevant outcome measures were evaluated in patients prescribed quetiapine at the time of this change. Psychiatrists attempted to stop the quetiapine in 63.4 percent of the cases and were successful (not requiring continuation or restarting of the medicine) 95.7 percent of the time. There were no statistically significant differences in the number of patients who needed a higher level of care, days in a higher level of care, number of patients needing constant (e.g., suicide) watch, days on constant watch, suicidal behavior, or disciplinary charges when the subjects in whom an attempt to discontinue quetiapine was made was compared with those in whom it was continued. In 44.7 percent of cases in which an attempt was made to stop quetiapine (and in 28.3% of cases in the entire NJDOC population as of January 2009), no antipsychotic medication was needed to manage the patients during the study period. This study supports the decision to remove quetiapine from the NJDOC formulary.

Topics: Antipsychotic Agents; Cost Savings; Dibenzothiazepines; Drug Costs; Drug Substitution; Formularies as Topic; Humans; Illicit Drugs; Mental Disorders; New Jersey; Prescription Drugs; Prisons; Quality Assurance, Health Care; Quetiapine Fumarate; Retrospective Studies; Substance-Related Disorders

Some but not all antipsychotics have been shown to modulate plasma cytokine levels in schizophrenia patients. Thus far, the most consistent finding has been the increase in plasma levels of soluble interleukin (IL)-2 receptor (sIL-2R) associated with clozapine treatment. Quetiapine is a second-generation antipsychotic with a pharmacological profile similar to that of clozapine, but its immunomodulatory effects have not been investigated in schizophrenia yet. The purpose of this exploratory study was to examine the changes in plasma levels of sIL-2R in schizophrenia during quetiapine treatment and association with psychopathology.. Participants were 29 schizophrenia-spectrum disorder patients (DSM-IV criteria), and 28 healthy controls. Patients had a comorbid substance use disorder (cannabis>alcohol>cocaine), since quetiapine is increasingly used in this population of dual diagnosis. No participant suffered from infection or overt inflammatory diseases. On baseline, patients taking mostly second-generation antipsychotics were switched to quetiapine for a 12-week open-label trial. Five patients were drop-outs. Mean dose of quetiapine for trial completers (n=24) was 466.6mg±227.3. Psychiatric variables were evaluated with the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia. Plasma sIL-2R levels were assessed at baseline, weeks 6 and 12 in patients, and in healthy controls, using sandwich immunoassay. Plasma IL-6 and IL-1 receptor antagonist (IL-1RA) were measured for comparison purposes.. On baseline, plasma sIL-2R, IL-6 and IL-1RA levels were higher in dual-diagnosis patients, compared to controls. Plasma sIL-2R further increased after quetiapine treatment (p=0.037), while plasma IL-6 and IL-1RA did not change. Clinical improvements were observed in positive, negative and depressive symptoms, and substance abuse severity (all p<0.01). Interestingly, changes in sIL-2R levels during treatment were inversely correlated with changes in positive symptoms (r=-0.524; p=0.009). That is, increases in sIL-2R levels were associated with reductions in positive symptoms.. These data show that quetiapine elevates, like clozapine, sIL-2R levels in schizophrenia. Furthermore, the results suggest that sIL-2R alterations in schizophrenia rely on complex interplays between antipsychotics and the positive symptoms of the disorder. Future randomized controlled trials involving larger samples of schizophrenia patients are warranted to determine whether changes in plasma sIL-2R are quetiapine-related.

Topics: Adult; Affective Symptoms; Antipsychotic Agents; Comorbidity; Cytokines; Dibenzothiazepines; Female; Humans; Interleukin-6; Male; Psychiatric Status Rating Scales; Quetiapine Fumarate; Receptors, Interleukin-1; Receptors, Interleukin-2; Schizophrenia; Substance-Related Disorders; Young Adult

Quetiapine is a new-generation antipsychotic medication approved in the treatment of schizophrenia, bipolar disorder, and related disorders. There are reports about the abuse and possible dependence of quetiapine. We present the first case of definite quetiapine dependence. This is a 37-year-old male who applied to the addiction unit because he could not control quetiapine use. He had a history of alcohol and benzodiazepine dependence as well as cannabis abuse. He reported to have a rush on quetiapine and suffered from its withdrawal when he tried to wean off the medication. This case and similar other suggest that while quetiapine may be beneficial in the treatment of some patients with addictive disorders, we should be cautious when using quetiapine to treat patients with drug or alcohol dependence.

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Humans; Male; Quetiapine Fumarate; Substance Withdrawal Syndrome; Substance-Related Disorders

Atypical antipsychotic agents constitute one therapeutic approach for bipolar disorder. Since disease course and outcome are variable, further studies are needed to complement limited data supportive of clinical decisions at treatment initiation.. This 12-month, prospective, observational study investigated factors associated with symptomatic remission (total YMRS score < or =12) and full clinical recovery (sustained reduction in CGI-BP-S overall score) in bipolar disorder during treatment with atypical antipsychotics (predominantly olanzapine, risperidone and quetiapine; alone or in combination with a psychotropic such as lithium or valproate) in actual clinical practice.. Amongst 872 enrolled and eligible patients, rates of symptomatic remission and full clinical recovery at 12 months were 93.0 and 78.5%, respectively. Of the baseline factors significantly (P< or =0.05) associated with symptomatic remission, the following categories were positively associated with a higher chance of symptomatic remission: Caucasian ethnicity; higher CGI-BP-S scores; family-dependent living; a previous manic episode; 1, 2 or > or =5 social activities; no work impairment; and being neither satisfied nor dissatisfied with life. Outpatient treatment and historically longer periods of mania were significantly positively associated with full clinical recovery.. While clinical status may also be associated with longer-term remission and recovery, factors relating to social functioning and quality of life are easily assessed and potentially modifiable. Such knowledge may aid physicians' clinical decisions regarding patients with bipolar mania treated with atypical antipsychotics.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Ethnicity; Female; Humans; Lithium Carbonate; Male; Observation; Olanzapine; Personality Disorders; Prospective Studies; Quetiapine Fumarate; Remission Induction; Risperidone; Severity of Illness Index; Substance-Related Disorders; Valproic Acid

This study analyzed and defined specific factors that account for attrition in clinical research for patients with bipolar and substance-related disorders.. Data were analyzed from two completed studies: an open-label trial of lamotrigine in patients with bipolar disorder (BPD) and cocaine-related disorder, and a placebo-controlled trial of quetiapine in patients with BPD and alcohol-related disorders. Correlations and Independent sample t-tests were performed to assess the impact of baseline characteristics including on length of study participation. Significance was set at the p=0.05 level.. In the lamotrigine-treated patients, the presence of an amphetamine-related disorder, in addition to cocaine-related disorders, was associated with a shorter time in the study. In the quetiapine-treated patients higher scores on the Addiction Severity Index Legal subscale were associated with shorter length in the study. The presence of panic disorder was associated with shorter time in both studies.. Although the data were taken from the two largest clinical trials, to date, in patients with BPD and substance-related disorders, the sample sizes were relatively modest. In addition, the baseline assessments were somewhat different in the two studies limiting our ability to make conclusions on differences between patients with BPD and cocaine use versus alcohol use.. This study adds to an emerging literature on the significance of panic disorder in patients with BPD.

Topics: Adult; Alcohol-Related Disorders; Amphetamine-Related Disorders; Anticonvulsants; Antipsychotic Agents; Bipolar Disorder; Clinical Trials as Topic; Cocaine-Related Disorders; Comorbidity; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Female; Humans; Lamotrigine; Male; Panic Disorder; Patient Dropouts; Psychiatric Status Rating Scales; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Severity of Illness Index; Substance-Related Disorders; Time Factors; Triazines

Topics: Adult; Antipsychotic Agents; Borderline Personality Disorder; Dibenzothiazepines; Female; Humans; Male; Quetiapine Fumarate; Substance-Related Disorders

Topics: Antipsychotic Agents; Bipolar Disorder; Clonazepam; Dibenzothiazepines; Female; Humans; Hypnotics and Sedatives; Middle Aged; Pyridines; Quetiapine Fumarate; Self Medication; Substance-Related Disorders; Zolpidem

Topics: Affect; Antipsychotic Agents; Bipolar Disorder; Central Nervous System Stimulants; Comorbidity; Dibenzothiazepines; Humans; Psychiatric Status Rating Scales; Quetiapine Fumarate; Risperidone; Self Medication; Substance-Related Disorders

Topics: Acid-Base Imbalance; Alkalosis, Respiratory; Dibenzothiazepines; Humans; Male; Middle Aged; Quetiapine Fumarate; Substance-Related Disorders; Suicide, Attempted

Sleep disturbances are a common finding in the clinical practice of addictions. Clinical management of insomnia is known to influence the prognosis of the addiction and the success of the detoxication process itself (Peles, Schreiber, and Adelson, 2006; Pace-Schott, Stickgold, Muzur, Wigren, Ward, et al., 2005; Bootzin and Stevens, 2005; Maher, 2004). Thus the relevance of controlling sleep disturbances from the very beginning of the detoxification process. However, managing this situation is often not easy for the clinician. The classical option of using sedating-hypnotic drugs to treat insomnia in polydrug users presents objections: the tolerance associated to high doses of benzodiacepines chronic abuse in many drug addicts obliges the clinician to use high doses of hypnotics, both in acute detoxification and the following de-habituation, with the associated resulting risk of dependence and undesirable side effects (excessive sedation, nocturnal enuresis, ataxia, etc).

Topics: Antipsychotic Agents; Dibenzothiazepines; Humans; Quetiapine Fumarate; Retrospective Studies; Sleep Wake Disorders; Spain; Substance-Related Disorders

Disturbances in the endogenous cannabinoid (ECB) system in schizophrenia may contribute to their enhanced sensitivity to psychoactive substances, and the beneficial effects of second-generation antipsychotics for substance abuse in schizophrenia may involve modulatory effects on ECB. To verify these two assumptions, 29 patients (24 completers) with schizophrenia and substance use disorders (SUD) were treated with quetiapine for 12 weeks, and peripheral ECB levels were measured, using high-performance liquid chromatography/mass spectrometry, in patients (weeks 0, 6 and 12) and 17 healthy volunteers. Baseline anandamide levels were significantly higher in patients, relative to controls. This result is consistent with studies describing ECB dysfunctions in schizophrenia. SUD parameters improved during treatment, but no changes in ECB occurred over time. Improvements in substance abuse were probably not mediated by modulatory effects of quetiapine on ECB. Lastly, baseline anandamide predicted endpoint SUD scores (alcohol/ cannabis). Anandamide is a potential target for medications aimed at relieving SUD in schizophrenia.

Topics: Adult; Analysis of Variance; Antipsychotic Agents; Arachidonic Acids; Cannabinoid Receptor Modulators; Chromatography, High Pressure Liquid; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Endocannabinoids; Female; Humans; Linear Models; Male; Mass Spectrometry; Middle Aged; Polyunsaturated Alkamides; Psychiatric Status Rating Scales; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology; Substance-Related Disorders

Topics: Alcoholism; Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Benzodiazepines; Bromazepam; Depression; Dibenzothiazepines; Hospitalization; Humans; Life Change Events; Male; Middle Aged; Quetiapine Fumarate; Self Administration; Substance-Related Disorders

Topics: Adult; Antipsychotic Agents; Cocaine-Related Disorders; Dibenzothiazepines; Drug Combinations; Drug Synergism; Humans; Male; Quetiapine Fumarate; Substance Abuse, Intravenous; Substance-Related Disorders

Topics: Adult; Antipsychotic Agents; Anxiety Disorders; Dibenzothiazepines; Humans; Male; Prisoners; Quetiapine Fumarate; Substance-Related Disorders; Treatment Refusal

A possible case of intranasal quetiapine misuse in a patient with schizoaffective disorder and substance abuse is presented. A 28-year-old Caucasian female with schizoaffective disorder (bipolar type), comorbid polysubstance abuse, tobacco dependence, and personality disorder was admitted to an inpatient psychiatric facility following a hit-and-run conviction. Medications on admission included quetiapine, benztropine, haloperidol, lorazepam, diphenhydramine, and trazodone. As-needed medication orders included benztropine and lorazepam. The patient was hospitalized in order to undergo rehabilitation and psychiatric stabilization. During the first four weeks of the patient's hospital stay, the nursing staff suspected her of "cheeking" or "palming" her quetiapine dose on several occasions. During this time she was also suspected of using cocaine and alcohol while away from the hospital. The patient demonstrated symptoms that are consistent with cocaine withdrawal, but the patient denied the use of cocaine. Aspirin tablets, quetiapine tablets, and white powder were found in her room. The patient stated that the white powder was aspirin. It was suspected that it also contained quetiapine, which the patient later admitted to crushing and snorting for its "calming" effects. Quetiapine was discontinued. There have been reports in the literature of oral and intranasal quetiapine abuse among prison inmates.. Possible intranasal quetiapine misuse was detected in a patient with schizoaffective disorder and a history of substance abuse. While antipsychotic medications are not typically thought of as drugs with an abuse potential, reports of the use and diversion of intranasal quetiapine among prison inmates, i.v. quetiapine abuse, and this case report indicate otherwise.

Topics: Administration, Intranasal; Adult; Antipsychotic Agents; Dibenzothiazepines; Female; Humans; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders; United States

To evaluate the direct medical cost of atypical antipsychotic therapy for schizophrenia among Hong Kong Chinese patients and to identify factors affecting the cost of treatment.. In this retrospective database analysis, patient data were retrieved from three Hong Kong public hospitals. Patients aged 2 18 years who received an initial prescription for olanzapine, risperidone, quetiapine or amisulpride between April 1 and September 30, 2003; and had an ICD-10-coded diagnosis of schizophrenia were included. Patient data were collected for a maximum duration of 1 year before and after treatment initiation. Primary outcome measures were the schizophrenia-related direct medical costs. Demographic and clinical factors were analyzed by multiple regression analysis to identify influential factors for the cost of atypical antipsychotic therapy.. A total of 325 patient records were reviewed and 82 patients were included in the analysis. Cost per patient per month for clinic visits (US$ 67 +/- 41 versus US$ 78 +/- 41), medications (US$ 8 +/- 12 versus US$ 97 +/- 83), and the total cost per patient per month (US$ 314 +/- 898 versus US$ 431 +/- 914) increased significantly after treatment initiation (US$ 1 = HK$ 7.8). Previous duration of hospitalization (RR = 1.00, 95% CI = 1.00 1.01), history of substance abuse (RR = 1.26, 95% CI = 1.05 1.52) and use of depot antipsychotics (RR = 1.22, 95% CI = 1.05 - 1.42) were associated with higher cost of atypical antipsychotic therapy.. The total direct medical cost increased significantly after initiation of atypical antipsychotic therapy in a cohort of Chinese patients with schizophrenia. History of drug abuse, use of depot antipsychotics and prior duration of hospitalization were positive predictors of cost of therapy.

Topics: Adult; Amisulpride; Antipsychotic Agents; Benzodiazepines; China; Cost of Illness; Cost-Benefit Analysis; Databases, Factual; Delayed-Action Preparations; Dibenzothiazepines; Female; Health Care Costs; Hong Kong; Hospitalization; Humans; Male; Medical Records; Middle Aged; Olanzapine; Quetiapine Fumarate; Regression Analysis; Retrospective Studies; Risperidone; Schizophrenia; Substance-Related Disorders; Sulpiride

Quetiapine is an atypical antipsychotic agent approved by the FDA for the treatment of schizophrenia, acute mania, and bipolar depression. Recently, reports of medication abuse, particularly intranasal and i.v. abuse, have been described. Three cases of oral misuse of quetiapine are presented and clinical implications are discussed. Clinicians should exercise caution when prescribing quetiapine to patients at risk for substance abuse.

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Humans; Male; Middle Aged; Quetiapine Fumarate; Substance-Related Disorders

Anxiety disorders often coexist with substance use and complicate treatment by causing non-adherence and relapse. Optimal treatment generally involves the treatment of anxiety along with the treatment of substance abuse. Substance-abuse treatment generally involves individual and group therapy, sobriety maintenance interventions, structured living, and attending self-help groups such as Alcoholics Anonymous. Pharmacotherapy options for treating substance abuse are limited, but atypical antipsychotic medications have reportedly reduced substance abuse when used in patients with alcohol and drug problems. However, there are no reports of long-term benefits of these medications.. To assess long-term effects of adjunctive quetiapine on substance abuse in patients treated with quetiapine for severe anxiety symptoms.. In a previous paper, we reported that adjunctive treatment with quetiapine reduced symptoms of anxiety and cravings for alcohol and drugs when used in patients with anxiety disorders or with anxiety due to alcohol/drug dependence/abuse. In this study, we followed up with these patients one year later to assess their current symptoms, cravings and use of alcohol/drugs, and compared these to results of random breathalyzer and urine drug screening tests conducted as part of routine outpatient treatment of their substance abuse.. Six of nine patients continued to take adjunctive quetiapine over the previous 12-month period and reported complete sobriety (substantiated by their random breathalyzer and urine drug screens) and significant reduction in anxiety, depression, and cravings for alcohol and drugs.. Adjunctive quetiapine used for treatment of anxiety symptoms that may occur as part of different psychiatric disorders in patients with alcohol and drug problems might reduce cravings and substance use.

Topics: Adult; Antipsychotic Agents; Anxiety; Dibenzothiazepines; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Retrospective Studies; Substance-Related Disorders; Time Factors

Preliminary evidence suggests that clozapine relieves the craving for psychoactive substances in schizophrenia patients. Quetiapine shares crucial pharmacological properties with clozapine. Promising results have been described with quetiapine therapy in patients with psychosis and substance use disorder.. Based on Diagnostic and Statistical Manual of Mental Disorders - fourth edition (DSM-IV) criteria, patients were diagnosed with comorbid schizophrenia-spectrum and substance use disorders. Patients were switched to quetiapine for a 12-week open-label trial. Craving, quantities used, days of consumption, and severity of substance abuse were assessed every 3 weeks. Alcohol and Drug Use Scales were administered on baseline and end-point. Psychiatric symptoms, depressive symptoms, extrapyramidal symptoms, and cognition were also assessed at baseline, week 6 and week 12.. Twenty-four schizophrenia-spectrum patients were included in the last observation carried forward (LOCF) analyses, responding to one or more of the following substance use disorders: cannabis (15 patients), alcohol (10 patients), and other psychoactive substances (nine patients). Overall, severity of substance abuse improved during the study. Less weekly days were spent on drugs of abuse. A decrease in the weekly Canadian dollars spent on psychoactive substances was also observed. Cognition, psychiatric, depressive, and extrapyramidal symptoms also significantly improved (p < 0.05).. In this open-label, uncontrolled trial, significant improvements were noted in substance abuse, psychiatric symptoms, extrapyramidal symptoms, and cognition during quetiapine therapy. The study suffered from three main limitations: (1) the open-label design of the study; (2) the patients' poor compliance; and (3) the small sample size involved. Controlled studies on the use of quetiapine in dual diagnosis schizophrenia are warranted to confirm that the effects are drug-related.

Topics: Adult; Alcoholism; Cognition; Dibenzothiazepines; Female; Humans; Male; Marijuana Abuse; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology; Severity of Illness Index; Substance-Related Disorders

Topics: Administration, Intranasal; Antipsychotic Agents; California; Diagnosis, Differential; Dibenzothiazepines; Forensic Psychiatry; Humans; Malingering; Prisoners; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders

Excluding nicotine and caffeine dependence, almost 50% of individuals with schizophrenia also meet the criteria for substance abuse or dependence. Comorbid drug abuse presents complications to the effective treatment of these patients because they have increased psychotic symptoms and poorer treatment compliance.. This report describes thecase of a young man with schizophrenia and comorbid alcohol and cocaine abuse who was successfully treated with quetiapine. The patient was previously treated with olanzapine and developed priapism, which required emergency medical treatment.. The possible utility of atypical antipsychotics in the treatment of patients with schizophrenia and comorbid substance abuse needs to be confirmed in clinical trials.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Black or African American; Contraindications; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Humans; Male; Olanzapine; Pirenzepine; Priapism; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders