Quetiapine Discontinuation Syndrome

American Journal of Psychiatry (Impact Factor: 12.3). 06/2005; 162(5):1020. DOI: 10.1176/appi.ajp.162.5.1020
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Available from: Jeffrey P Staab
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    • "The psychological dependence to quetiapine, which in the reported cases involved the subjective craving for this drug leading to behaviours such as falsifying symptoms to obtain medication, has to our knowledge not been reported in the literature for other antipsychotic medications. A previous case report has suggested that medications which antagonise D2 and H1 systems may help attenuate the symptoms of quetiapine withdrawal in persons for whom a gradual taper is not sufficient (Kim & Staab, 2005). Quetiapine may have beneficial effects in a number of 'off-label' conditions. "
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    ABSTRACT: Quetiapine is an antipsychotic drug whose effect appears to be mediated through antagonist activity at the dopamine and serotonin receptors. While Quetiapine is not currently classified as a controlled substance, there have been a growing number of reports of the drug being abused both in American prisons and in general community settings. These accounts have included reports of both intranasal and intravenous uses. In this paper we report two cases of prisoners deliberately feigning psychotic symptoms for the purposes of obtaining quetiapine. In both cases there appears to be some evidence of psychological dependence and of a discontinuation syndrome when the medication was ceased. Our report adds support to the possibility that quetiapine has clinically relevant reinforcing properties with potential for producing both dependence and withdrawal symptoms and as such it should be re-evaluated as a drug with addictive potential and abuse risk.
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    ABSTRACT: New generation antipsychotic (NGA) drugs introduced to the US market after clozapine (aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone) are frequently used in individuals with intellectual disabilities (ID). However, there is very limited research to fully establish evidence-based or personalized medicine approaches for their use in this population. These guidelines take a pragmatic approach to establishing frameworks for their use by utilizing the prescribing information and reviewing the available literature on other relevant neuropsychiatric disorders. In the absence of expert consensus guidance and well-controlled comparison trials, we present a set of guidelines to inform initiation, dosing and monitoring of use in adults. Further, in these guidelines we provide practical information on drug-drug interactions and adverse drug reactions, and a brief review of discontinuation syndromes, potential for abuse, use during pregnancy and cost considerations. We also provide drug utilization review forms for each NGA to facilitate implementation of these guidelines, these guidelines provide a practical and necessary resource for practitioners treating psychiatric disorders and challenging behaviors in adult individuals with ID.
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