Efficacy of Low Adjunctive Quetiapine Administration in Control of Hypomanic State in Bipolar Affective Disorder Captured by EEG

Abstract

Aim: According to current biopsychiatric models, hypomania is associated with subvigil patterns in EEG, suggesting a significant impact of instable vigilance dynamics to bipolar disorders. Quetiapine as a well-accepted treatment option in bipolar disorders has been suggested to modify vigilance regulation by its high affinity to 5HT1A receptors at raphe nucleus, so even a low dose administration of quetiapine might be quite efficient to guide the recovery of the presumed instable vigilance dynamic in hypomanic state of bipolar disorder. Methods:We report a patient with a bipolar disorder, who experienced a hypomanic state under an established drug treatment with valproic acid and olanzapine. For evaluation of therapeutic response to low dose quetiapine, structured clinical interview and discrete EEG analysis of initial and follow up recordings were administered.Results: Administration of a low dose of 50 mg quetiapine per night as an adjunctive treatment to prescribed psychopharmacologic drug formulation was followed not only by the intended improvement of sleep comfort, but also by a complete control of hypomanic state. Clinical improvement was accompanied with a restoring of initially EEG recorded patterns of impaired vigilance regulation. Conclusion:Our report emphasizes the advantage of stratifying presumed effectiveness of quetiapine already at low dose administration in controlling exacerbated bipolar disorders by combined clinical and neurophysiological approaches as suggested by EEG, in particular due to specific stabilizing mechanisms at the cerebral vigilance regulation system.