This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Web of Science (7) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Pajonk, F.-G. B. Articles by Seelig, M. A. Search for Related Content PubMed PubMed Citation Articles by Pajonk, F.-G. B. Articles by Seelig, M. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Bipolar Disorder Schizophrenia Social Bookmarking                         What's this?

Rapid dose titration of quetiapine for the treatment of acute schizophrenia and acute mania: a case series

Department of Psychiatry and Psychotherapy, The Saarland University Hospitals, Hamburg, Germany, frank.pajonk{at}uniklinik-saarland.de

Anne K. Schwertner

Department of Psychiatry and Psychotherapy, The Saarland University Hospitals, Hamburg, Germany

Marko Alexander Seelig

Department of Psychiatry and Psychotherapy, The Saarland University Hospitals, Hamburg, Germany

To quickly reduce symptoms and to optimize long-term outcome, patients with an acute episode of schizophrenia or mania require prompt treatment intervention. The atypical antipsychotic quetiapine (‘Seroquel’) has been approved for the treatment of schizophrenia and manic episodes associated with bipolar disorder. For patients with acute symptoms such as aggression or agitation, higher doses of quetiapine than the recommended initiation schedule are often required. This report presents the tolerability findings from rapid initiation with high-dose quetiapine for eight patients who were consecutively admitted with acute symptoms of schizophrenia (n 5) or mania (n 3). The results from this case series show that quetiapine treatment could be safely titrated at a more rapid rate and to doses greater than that described in the current prescribing information. For most patients, rapid dose escalation was well tolerated; no serious side effects were observed and vital clinical parameters were unchanged; one patient experienced transient somnolence. In conclusion, these results suggest that rapid dose escalation of quetiapine could be a useful treatment approach for acutely ill patients with schizophrenia and bipolar mania in order to improve acute symptoms and support the need for randomized controlled trials. However, dose adjustments should be considered with respect to each patient’s individual level of tolerability.

Key Words: schizophrenia • mania • acute symptoms • quetiapine • high dose • tolerability

References

• Arango C, Bobes J (2004) Managing acute exacerbations of schizophrenia: focus on quetiapine . Curr Med Res Opin 20: 619-626 [CrossRef][Medline] [Order article via Infotrieve]
• Arvanitis L A, Miller B G, the Seroquel Trial 13 Study Group (1997) Multiple fixed doses of ‘Seroquel’ (quetiapine) in patients with acute exacerbation of schizophrenia: a comparison with haloperidol and placebo . Biol Psychiatry 42: 233-246 [CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Ashim S, Warrington S, Anderson I M (2004) Management of diabetes mellitus occurring during treatment with olanzapine: report of six cases and clinical implications . J Psychopharmacol 18: 128-132 [Abstract/Free Full Text]
• Bobes J, Garcia-Portilla M P, Saiz P A, Bascaran M-T, Bousono M, Arango C (2002) High degree of tolerability for monotherapy with high doses of quetiapine: a case report . J Clin Psychiatry 63: 1048-1049 [Medline] [Order article via Infotrieve]
• Bowden C L, Grunze H, Mullen J, Brecher M, Paulsson B, Vågerö M, Svensson K (2004) An international, double-blind, randomized, placebo-controlled study of the efficacy and safety of quetiapine as monotherapy for mania associated with bipolar disorder . J Clin Psychiatry 66: 111-121
• Brecher M, Rak I W, Melvin K, Jones A M (2000) The long-term effect of quetiapine (Seroquel^TM) monotherapy on weight in patients with schizophrenia . Int J Psychiatry Clin Pract 4: 287-291
• Bressan R A, Jones H M, Pilowsky L S (2004) Atypical antipsychotic drugs and tardive dyskinesia: relevance of D2 receptor affinity . J Psychopharmacol 18: 124-127 [Abstract/Free Full Text]
• Calabrese J, Vieta E, Mullen J, Brecher M, Paulsson B, Jones M (2004) Quetiapine monotherapy for mania associated with bipolar disorder. Analysis of two international, double blind, randomised, placebo-controlled studies . Acta Psychiatr Scand (Submitted)
• Copolov D L, Link C G G, Kowalcyk B (2000) A multicentre, double-blind, randomized comparison of quetiapine (ICI 204,636, ‘Seroquel’) and haloperidol in schizophrenia . Psychol Med 30: 95-105 [CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Davis J M, Chen N (2004) Dose response and dose equivalence of antipsychotics . J Clin Psychopharmacol 24: 192-208 [CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Emsley R A, Buckley P, Jones M, Greenwood M R (2003) Differential effect of quetiapine on depressive symptoms in patients with partially responsive schizophrenia . J Psychopharmacol 17: 210-215 [Abstract/Free Full Text]
• Ganesan S, Levy M, Bilsker D (2003) Effectiveness of quetiapine treatment of aggressive psychosis in the emergency psychiatric setting: a naturalistic pilot study . Poster NR412 presented at the American Psychiatric Association 156th Annual Meeting, San Francisco, CA, USA, 17-22 May
• Goldstein J M, Zhong K X (2004) Tolerance to somnolence with quetiapine: preclinical mechanisms and clinical evidence . Poster 322 presented at the 157th Annual Meeting of the American Psychiatric Association, New York, USA, 1-6 May
• Hellewell J S E, Kalali A H, Langham S J, McKellar J, Awad A G (1999) Patient satisfaction and acceptability of long-term treatment with quetiapine . Int J Psychiatry Clin Pract 3: 105-113
• Kasper S, Müller-Spahn F (2000) Review of quetiapine and its clinical applications in schizophrenia . Expert Opin Pharmacother 1: 783-801 [CrossRef][Medline] [Order article via Infotrieve]
• Keks N, Tonso M, Tabone K, Thomas R, Tune P, D’Souza R, McHugh M (2003) Experience with atypical antipsychotics in an acute inpatient unit . International Congress on Schizophrenia Research, Colorado Springs, CO, USA, 29 March-2 April
• Kinon B J, Ahl J, Stauffer V L, Hill A L, Buckley P F (2004) Dose response and atypical antipsychotics in schizophrenia . CNS Drugs 18: 597-616 [CrossRef][Medline] [Order article via Infotrieve]
• Mishra A, Moore P B, Hobbs R (2004) Does quetiapine have mood altering properties? J Psychopharmacol 18: 281-284 [Abstract/Free Full Text]
• Mullen J, Jibson M D, Sweitzer D, for the QUEST Study Group (2001) A comparison of the relative safety, efficacy, and tolerability of quetiapine and risperidone in outpatients with schizophrenia and other psychotic disorders: the Quetiapine Experience with Safety and Tolerability (QUEST) study . Clin Ther 23: 1839-1854 [CrossRef][Medline] [Order article via Infotrieve]
• Nagy J (2003) Effectiveness of quetiapine up to 1600mg/day: short-term results with 14-month follow-up . Eur Neuropsychopharmacol 13(Suppl. 4): S340
• Sachs G, Chengappa K N R, Suppes T, Mullen J, Brecher M, Devine N A, Sweitzer D (2004) Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double-blind, placebo-controlled study . Bipolar Disord 6: 213-223 [CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Smith M A, McCoy R N, Hamer J, Brecher M, Goldstein J M (2003) Optimal titration for quetiapine: a pilot study . Poster NR568 presented at the 156th Annual Meeting of the American Psychiatric Association, San Francisco, CA, USA, 17-22 May
• Tandon R, Jibson M D (2003) Efficacy of newer generation antipsychotics in the treatment of schizophrenia . Psychoneuroendocrinology 28(Suppl. 1): 9-26
• Velligan D I, Newcomer J, Pultz J, Csernansky J, Hoff A L, Mahurin R, Miller A L (2002) Does cognitive function improve with quetiapine in comparison to haloperidol? Schizophr Res 53: 239-248 [CrossRef][Web of Science][Medline] [Order article via Infotrieve]

This version was published on January 1, 2006

Journal of Psychopharmacology, Vol. 20, No. 1, 119-124 (2006)
DOI: 10.1177/0269881105056665


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Web of Science (7) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Pajonk, F.-G. B. Articles by Seelig, M. A. Search for Related Content PubMed PubMed Citation Articles by Pajonk, F.-G. B. Articles by Seelig, M. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Bipolar Disorder Schizophrenia Social Bookmarking                         What's this?