Treating Impulsivity, Irritability, and Aggression of Antisocial Personality Disorder with Quetiapine

Abstract

There are few effective treatments of antisocial personality disorder (APD). Preliminary work suggests that the atypical antipsychotic quetiapine can decrease irritability, impulsivity, and aggressiveness. Data were collected from 4 patients with APD who were referred to a maximum-security inpatient psychiatric facility for pretrial evaluation and were treated with quetiapine. Quetiapine was effective in these patients as was indicated by a decrease in symptoms such as impulsivity, hostility, aggressiveness, irritability, and rage reactions. Typical dosage was 600 to 800 mg per day. Patients attributed their willingness to comply with quetiapine treatment to both the effectiveness of the drug and its favorable adverse-event profile. Quetiapine was successfully combined with mood stabilizers, particularly gabapentin, in patients with prominent affective instability. Quetiapine has demonstrated efficacy in aggression, impulsivity, and irritability and has proved to be an effective medication in these patients with APD. In addition, its favorable adverse-event profile makes patients willing to comply.

Pharmacotherapy of personality disorders: what we know and what we have to search for

“…A small case series is available to suggest the efficacy of quetiapine treatment (600-800 mg/day) in reducing hostility, impulsivity, aggression, and rage reactions in four antisocial personality disorder inpatients in a maximum security services [133]. In another case series of 7 patients with ASPD and high psychopathic traits a low dose of clozapine led to improvement in all symptom domains, in particular aggression, violence, impulsive-behavioural dyscontrol, and anger [134].…”

Drug treatment for personality disorders

“…There have also been encouraging open studies with clozapine, olanzapine and quetiapine (Frankenburg & Zanarini, 1993;Benedetti et al, 1998;Zullino et al, 2002;Walker et al, 2003) that suggest better compliance as well as efficacy with the atypical antipsychotics than with the typical ones. Olanzapine is currently being tested in Advances in Psychiatric Treatment (2004), vol.…”

Quetiapine Dosage Across Diagnostic Categories

“…Preliminary works suggest interest of quetiapine in monotherapy or augmentation strategy for a wide range of other psychiatric disorders such as antisocial personality disorder (600-800 mg/day) [11], borderline personality disorders (175-400 mg/day) in one study [12] and at higher dosage in a recent one (400-800 mg/day, with average daily dosage: 540 mg/day) [13], resistant depression (mean dosage: 166.67 ± 211.69 mg/day) [14], post traumatic stress disorders [15] (mean dosage: 216 mg/day), resistant obsessive compulsive disorders (quetiapine dosages titrated upward to 300 mg/day, mean dose: 215 ± 124 mg/day) [16]. Controversial data, for example, on the lack of efficacy of quetiapine at dosage lower than 150 mg/day highlights the importance of a precise determination of the potentially effective dosage [17].…”