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.     

奎硫平治疗强迫症的辅助作用

目的：探讨奎硫平辅助治疗强迫症的临床疗效和安全性。方法：对48例强迫症患者,在服用原抗抑郁药的基础上随机分为奎硫平组和安慰剂组,分别给予合用奎硫平和安慰剂。疗程12周。采用Yale-Brown强迫症量表（Y-BOCS）和治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：奎硫平组Y-BOCS评分治疗后有显著下降,安慰剂组则无差异;治疗后Y-BOCS评分以奎硫平组显著较低。两组TESS评分相仿。结论：抗抑郁药合用奎硫平治疗强迫症有一定辅助作用。     

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.     

奎硫平与氯丙嗪治疗精神分裂症的多中心随机双盲对照试验

目的：评价富马酸奎硫平治疗精神分裂症的疗效和安全性，并与经典抗精神病药氯丙嗪对照。方法：本研究采用多中心、随机平行、双盲双模拟对照试验方法。共入组符合研究方案的病例237例，奎硫平组119例，氯丙嗪组118例。两组药物剂量均为每天300—750mg。结果：两组的主要疗效指标阳性和阴性症状量表(PANSS)、简明精神病量表(BPRS)评分在治疗结束时与基线比较均有显著下降(P＜0．01)；根据PANSS减分率评定临床总有效率，奎硫平组的有效率为61．61％，氯丙嗪组的有效率为64．81％，两组之间无显著性差异；奎硫平组的药物不良反应发生率为44．54％，氯丙嗪组的发生率是76．27％。其中以震颤、肌紧张和静坐不能等明显少于对照组；实验室检查两组均无严重异常。结论：富马酸奎硫平是一种新的安全有效的抗精神病药物。     

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.