Introduction:Quetiapine fumarate is an atypical antipsychotic approved for the treatment of schizophrenia, major depressive disorder, and bipolar disorder. Due to the sedative effects observed at low doses, prescribers use quetiapine to aid patients with sleep disturbances. Current evidence has established that quetiapine can cause negative changes in metabolic parameters, but it is unknown if these consequences also occur at low doses. Due to the use of quetiapine for sleep, the purpose of this study is to identify if metabolic effects are also a risk with the use of low-dose quetiapine.Methods:Eligible subjects were identified through the Veterans Affairs electronic medical records as having an active prescription for quetiapine from June 30, 2012, through September 1, 2013. Subjects were then evaluated using inclusion and exclusion criteria for determination of study entrance. Descriptive statistics and t tests were utilized to identify clinical and statistical differences in outcomes.Results:A total of 403 subjects were included in the final analysis. The average dose of quetiapine was 116.8 mg and average duration of therapy was 44 months. Increases were observed in systolic blood pressure (+1.95 mmHg; P = .036), diastolic blood pressure (+1.97 mmHg; P = .001), body mass index (+0.52; P = .001), weight (+1.88 kg; P = .002), and fasting blood glucose (+6.71 mg/dL; P = .002). Conversely, a decrease in total cholesterol (−10.06 mg/dL; P < .001) was recognized.Discussion:As a result of the findings, there may be negative metabolic consequences with the use of low-dose quetiapine. Routine prescribing of low doses for sleep as a first-line medication should be avoided.

Allopurinol was observed to decrease the number and rate of aggressive events in patients refractory to other treatments.

Background:Long-acting injectable antipsychotics (LAIAs) have been developed to decrease medication nonadherence. LAIAs are usually given biweekly or monthly, with the exception of new 3-month and 6-week formulations. There has been no known evaluation regarding whether the frequency of LAIA formulation affects adherence. The purpose of this study is to evaluate whether there is a difference in adherence between LAIAs administered biweekly or monthly.Methods:Eligible participants were identified from the Louis Stokes Cleveland VA electronic medical record as having an active prescription for a LAIA between September 1, 2009, and September 1, 2014. Participants were then evaluated using inclusion and exclusion criteria to determine study entrance. Medication possession ratios (MPRs) were calculated for each participant to determine adherence for comparison of objectives. Descriptive statistics and t tests were used to identify significant differences between groups.Results:There were 128 participants enrolled based on eligibility criteria. There were no differences in MPRs for biweekly versus monthly administered LAIAs (0.98 versus 0.97, respectively; P = .691). No differences in adherence were observed between first- and second-generation LAIAs (0.98 versus 0.98, respectively; P = .975), or for risperidone LAI versus paliperidone palmitate (0.97 versus 0.99, respectively; P = .269). Hospitalizations were observed to decrease by 61% after LAIA initiation (P = .021).Discussion:Based on the findings of this retrospective cohort review, there was no difference in adherence in patients prescribed biweekly versus monthly injected LAIAs. Patient preference and response, safety, tolerability, cost, and availability of follow-up appointments should be other factors to take into consideration for agent selection.

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