Akathisia as a side effect of antipsychotic treatment with quetiapine in a patient with Parkinson's disease.

Due to its low profile for extrapyramidal side-effects, quetiapine has become an alternative to clozapine in the treatment of dopamimetic psychosis in patients with Parkinson's disease (PD). We describe the case of a patient with PD who developed severe akathisia, a common complication with classical antipsychotics, with quetiapine.     

国产奎硫平合并舒必利治疗难治性精神分裂症

目的:了解舒必利合并国产奎硫平(启维)治疗难治性精神分裂症的疗效和安全性。方法:26例符合CCMD-Ⅲ精神分裂症诊断标准且临床判断属于难治性病人,予舒必利合并奎硫平治疗,疗程8周,分别在治疗前及治疗后进行阳性与阴性症状量表(PANSS)和不良反应状量表(TESS)评定。结果:合并治疗8周后总有效率65.3%。PANSS阳性、阴性及一般精神病理评分于治疗前后均有显著差异(P<0.01)。TESS总分治疗前后无显著差异(P>0.05)。副反应主要为肌张力增高、失眠、体重增加、静坐不能。结论:对于舒必利治疗反应不佳的难治性精神分裂症病人合并奎硫平治疗仍可取得较好的临床效果,安全性较高,耐受性及依从性好,可作为临床治疗难治性病人的方法之一。     

Clinical experience of quetiapine in 24 elderly patients with delirium

Background: A recent study reported that patients with delirium responded well to the administration of atypical antipsychotic agents. In the present study we administered quetiapine to patients with delirium and obtained good results. Methods: This study included 24 patients (10 men, 14 women), referred to the psychiatry department during admission to other hospital departments, who were diagnosed as having delirium according to the diagnostic and statistical manual of mental disorders (4th edition) (DSM‐IV) between April 2001 and September 2002. The mean age of the patients was 76.5 years (men 71.0 years; women 80.5 years). An initial dose of quetiapine was established at 25–50 mg/day. Depending on the symptoms, the dose and frequency were increased as required. According to Trzepacz's delirium rating scale (DRS), the treatment response was evaluated prior to the administration of quetiapine and 1, 3, 5 and 7 days after administration began. Results: Prior to the administration of quetiapine, the mean DRS score was 18.1. The mean scores were 12.2, 10.8, 9.7 and 8.9 after 1, 3, 5 and 7 days of quetiapine administration, respectively. These values were significantly lower than the value before administration (P < 0.001). Seven days after the administration of quetiapine commenced, the total DRS score was lower than the cutoff point (12) in 20 patients (83.3%). In 18 patients (75.0%), delirium was clinically relieved. Doses ranged from 25 mg/day to 125 mg/day, with a mean dose of 54.7 mg/day. With respect to the administration method, the majority of patients (i.e. 13 patients) received quetiapine once per day (after dinner). Somnolence was observed in three patients as a side‐effect of quetiapine administration. However, this side‐effect improved after 1–2 days, without decreasing the dose. Conclusions: Quetiapine may be useful for controlling delirium and concerning side‐effects and extrapyramidal symptoms were not recorded in the present study. Thus, it is appropriate to trial quetiapine in the treatment of delirium.     

Treatment of essential blepharospasm with quetiapine.

A 69-year-old male with blepharospasm unresponsive to several medications who was successfully treated with quetiapine is described. His symptoms were largely alleviated by low doses, but he experienced sedation, which permitted him to take the medication at bedtime only.     

国产奎硫平与氯氮平治疗慢性精神分裂症的随机对照研究

目的比较氯氮平与国产奎硫平(奎的平)治疗慢性精神分裂症的疗效及安全性。方法将83例慢性精神分裂症患者随机分为奎的平组(42例)和氯氮平(41例),两药治疗量均为200~600mg/d,疗程为12周。疗效指标包括阳性和阴性症状量表(PANSS)、简明精神病评定量表(BPRS);不良反应指标为治疗时出现的不良反应量表(TESS)及有关实验室检查。结果治疗结束时,两组PANSS和BPRS评分较入组时均有显著减低(P<0.01);PANSS减分率:奎的平组为(63.4±24.7)%,氯氮平组为(64.7±23.1)%;临床总有效率:奎的平组为68.1%,氯氮平组为69.6%;两组疗效差异无显著性。奎的平组的不良反应较氯氮平少,其中活动减少、便秘、流涎、头晕、体位性低血压的发生率显著少于氯氮平组(P<0.01或0.05)。结论国产奎的平治疗慢性精神分裂症的疗效与氯氮平相似,某些不良反应较氯氮平轻而少;是一种相对安全、有效的抗精神病药,对慢性精神分裂症患者的康复及防止衰退均有积极的意义。     

国产与进口喹硫平治疗精神分裂症的疗效比较

目的:评价国产与进口喹硫平治疗精神分裂症的临床疗效及安全性.方法:随机选择本院门诊及住院精神分裂症患者76例,分为试验组38例和对照组38例,分别口服国产及进口喹硫平150～600 mg·d-1,疗程8周.结果:试验组痊愈率为65.8%,有效率为89.5%;对照组痊愈率为68.4%,有效率86.8%,两组疗效差异无显著性(P>0.05).两组的不良反应均轻微,安全性好,常见的不良反应有失眠、激越、嗜睡、头疼、心动过速、体位性低血压和体重增加.结论:国产喹硫平对精神分裂症的疗效肯定,使用安全性和耐受性好,与进口喹硫平疗效相当.     

半富马酸喹硫平的合成研究

2-氨基二苯硫醚和三光气反应得到的2-异氰酸基二苯硫醚在多聚磷酸中闭环后,经氯代、与哌嗪缩合得到11-哌嗪-1-基二苯并[b,f][1,4]硫氮杂革,由2-(2-氯乙氧基)乙醇进行哌嗪N4-位烷基化反应后与富马酸成盐,制得抗精神病药半富马酸喹硫平,总收率63.4%(以2-氨基二苯硫醚计).     

Effectiveness of quetiapine for the management of aggressive psychosis in the emergency psychiatric setting: a naturalistic uncontrolled trial

Objective

Traditionally, conventional antipsychotics, often administered intramuscularly, are used to reduce hostility and aggression in the emergency setting. This study investigated the efficacy of quetiapine, an oral atypical antipsychotic, in managing aggressive psychosis.

Methods

Adult hospitalized patients (n=36) with an Overt Aggression Scale (OAS) total score ≥1 and a Brief Psychiatric Rating Scale-derived Psychosis Index score ≥6 received 100–800 mg/day flexibly dosed quetiapine and were monitored daily for a maximum of 5 days. The OAS total score and Physical Aggression Against Others subscale score were primary efficacy assessments. Tolerability was assessed with the Udvalg for Kliniske Undersogelser Side Effects Rating Scale.

Results

An 83% decrease in the OAS Physical Aggression Against Others subscale score occurred from Day 1 (baseline) to Day 2, which was generally maintained to Day 5; a 39% reduction in OAS total score was observed by Day 2. The OAS total score decreased from a mean baseline of 3.3 to 1.5 at Day 5, a significant decrease for Days 2–4 (P?<?0.01) and of borderline significance on Day 5 (P=0.059). Adverse events were mostly mild to moderate with concentration difficulties and somnolence the most common.

Conclusion

These results from an uncontrolled trial suggest that quetiapine may be helpful for some aggressive patients in the emergency setting.     

Quetiapine Attenuates Glial Activation and Proinflammatory Cytokines in APP/PS1 Transgenic Mice via Inhibition of Nuclear Factor-κB Pathway

Background:

In Alzheimer’s disease, growing evidence has shown that uncontrolled glial activation and neuroinflammation may contribute independently to neurodegeneration. Antiinflammatory strategies might provide benefits for this devastating disease. The aims of the present study are to address the issue of whether glial activation and proinflammatory cytokine increases could be modulated by quetiapine in vivo and in vitro and to explore the underlying mechanism.

Methods:

Four-month–old amyloid precursor protein (APP) and presenilin 1 (PS1) transgenic and nontransgenic mice were treated with quetiapine (5mg/kg/d) in drinking water for 8 months. Animal behaviors, total Aβ levels, and glial activation were evaluated by behavioral tests, enzyme-linked immunosorbent assay, immunohistochemistry, and Western blot accordingly. Inflammatory cytokines and the nuclear factor kappa B pathway were analyzed in vivo and in vitro.

Results:

Quetiapine improves behavioral performance, marginally affects total Aβ₄₀ and Aβ₄₂ levels, attenuates glial activation, and reduces proinflammatory cytokines in APP/PS1 mice. Quetiapine suppresses Aβ_1-42-induced activation of primary microglia by decresing proinflammatory cytokines. Quetiapine inhibits the activation of nuclear factor kappa B p65 pathway in both transgenic mice and primary microglia stimulated by Aβ_1–42.

Conclusions:

The antiinflammatory effects of quetiapine in Alzheimer’s disease may be involved in the nuclear factor kappa B pathway. Quetiapine may be an efficacious and promising treatment for Alzheimer’s disease targeting on neuroinflammation.