Quetiapine in the treatment of psychotic adolescents: A case series of 23 patients with severe early onset psychosis

Abstract

Clinical efficacy, safety and tolerability of quetiapine in the treatment of 23 hospitalized psychotic adolescents were evaluated retrospectively. Twelve patients were changed to quetiapine from another antipsychotic medication during their hospital stay. In these patients, CGI-S improved from 4.75+/-0.87 to 2.92+/-0.67 (observation period 3.7+/-1.6 months). The most common adverse events were transient tachycardia and sedation. Mild EPS occurred only in one patient under quetiapine monotherapy. Transaminase increases more than threefold above norm were observed in two patients. fT4 values were slightly below the norm in 67% of the cases. In 11 patients, quetiapine was initiated using a rapid titration schedule with high dosages in the acute phase. Receiving a mean maximum daily dose of 927+/-300 mg, CGI-S improved from 6.00+/-0.63 to 3.18+/-1.25 (observation period 2.9+/-1.8 months). Severe adverse events did not occur. Besides applying lorazepam temporarily in nine of the 11 patients, antipsychotic co-medication was not necessary in this group. In line with other studies, quetiapine may be considered as an effective treatment for adolescents with a severe psychotic disorder showing a favourable side-effect profile. Our preliminary data suggest that a rapid initiation with high doses could be a promising approach in acute psychotic adolescents.

Rapid initiation of quetiapine well tolerated as compared with the conventional initiation regimen in patients with schizophrenia or schizoaffective disorders

“…A previous study of rapid dose titration with high doses of quetiapine for treating acute psychotic cases revealed that the most common adverse event was sedation. In another such study, however, only one patient experienced transient somnolence [17,18]. In the present study, the incidence of somnolence did not differ significantly between the two initiation schedules, but one patient in the rapid initiation group dropped out because of intolerable somnolence.…”

Quetiapine-Associated Hypothyroidism in Young Female Patients: A Report of Three Cases

“…Quetiapine has usually been a relatively safe antipsychotic without any serious side eff ects even in adolescents [3,5,10,11] . Notwithstanding, some warnings about the possibility of hypothyroidism have been presented [2,12] . The overall safety of quetiapine in children under the age of 18 years has not been established yet [1] and the role of quetiapine in metabolic problems (weight gain, dyslipidemia, and blood glucose abnormalities), tardive dyskinesia, and sudden cardiac death have been discussed [13] .…”

“…Quetiapine is usually well tolerated, severe side-eff ects are uncommon [5,10] . Sedation, postural hypotension, weight increase and increase in transaminases are the most important adverse eff ects [2] . A trend for a decrease in thyroxine (T 4 ) [2,11,12] , and in some cases also an increase in thyroid-stimulating hormone (TSH) have been reported [6,12] .…”

“…Sedation, postural hypotension, weight increase and increase in transaminases are the most important adverse eff ects [2] . A trend for a decrease in thyroxine (T 4 ) [2,11,12] , and in some cases also an increase in thyroid-stimulating hormone (TSH) have been reported [6,12] . According to the product monograph, quetiapine is associated with a dose-related decrease in total and free T 4 with the maximum reduction occurring during the fi rst 2 -4 weeks of treatment.…”

Quetiapine in Adolescents with Non-Affective Psychotic Disorders: An Open-Label Trial

“…In early reviews about the treatment of childhood-onset schizophrenia and psychotic disorders in general, the available studies already suggested the clinical eff ectiveness of quetiapine in these populations, but the authors [32,33] concluded that additional investigations are needed to confi rm these preliminary fi ndings. There are as yet no placebo-controlled studies, but in a recent double-blind 4-week comparison study, 200 mg / d quetiapine were compared with 400 mg / day quetiapine in drugna ï ve fi rst-episode psychosis patients, aged 15 -25 years and surprisingly, the 200 mg / day dose seemed to be more effi cacious with regard to early response rate [34] . 2 other recent open studies conclude that quetiapine at much larger doses may be an eff ective treatment in adolescents with a severe psychotic disorder (schizophrenia, acute schizophrenia-like disorder, schizoaffective disorder) [34,35] .…”