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Determining the efficacy and tolerance of quetiapine extended release for the management of psychosis and accompanying acute behavioral disturbance in adult acute psychiatry

Stuart J. Lee, BA, DPsych

Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University, Melbourne, Victoria, Australia

Fiona Foley, BSc, BHSc

Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University, Melbourne, Victoria, Australia

Erica Hannagan, BSc, RN

Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University, Melbourne, Victoria, Australia

Jayashri Kulkarni, MBBS, MPM, FRANZCP, PhD

Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University, Melbourne, Victoria, Australia

Peter Bosanac, MBBS, MMed (Psychiatry), MD, FRANZCP

Department of Psychiatry, St. Vincent’s Health and The University of Melbourne, Fitzroy, South Australia, Australia

David J. Castle, MBBS, MSc, MD, FRCP, FRANZCP

Department of Psychiatry, St. Vincent’s Health and The University of Melbourne, Fitzroy, South Australia, Australia

Yitzchak Hollander, BSc, MD, FRCP(C), FRANZCP

Department of Psychiatry, Alfred Health and Monash University, Melbourne, Victoria, Australia

BACKGROUND: This study was conducted to explore the efficacy and tolerability of quetiapine extended release (XR) to treat psychosis and accompanying acute behavioral disturbance in hospitalized psychiatric patients.

METHODS: Patients with psychosis who displayed aggression were administered quetiapine XR (day 1 mean dose: 293.3 mg). Symptoms and side effects were assessed prospectively over an 8-day period. Symptoms were measured by the Overt Aggression Scale and Brief Psychiatric Rating Scale (BPRS), and side effects were measured using the Simpson-Angus Scale and Barnes Akathisia Rating Scale.

RESULTS: Fifteen of 16 consenting patients completed the study. Aggression was significantly reduced by day 3. Psychopathology also was significantly reduced, with the greatest improvement in BPRS Thinking Disturbance subscale scores. No significant increase in movement side effects was seen by day 8. Seven participants were administered a concomitant sedating antipsychotic on an as-needed basis, particularly in the first 4 days of treatment; these participants displayed much greater aggression—but not psychopathology—at day 1, and it took longer for their aggression and psychopathology to improve compared with patients treated with quetiapine XR as the sole antipsychotic.

CONCLUSIONs: Further research is needed before definitive recommendations can be made. However, current findings provide tentative support for quetiapine XR as a safe and effective medication for treating concurrent psychosis and behavioral disturbance, particularly in less severely aggressive patients.

KEYWORDS: acute inpatient psychiatry, quetiapine extended release, aggression, psychosis, prospective observational study

ANNALS OF CLINICAL PSYCHIATRY 2012;24(4):271-278

CORRESPONDENCE: Stuart J. Lee, BA, DPsych, Monash Alfred Psychiatry Research Centre, The Alfred Hospital, PO Box 315, Prahran, Victoria 3181 Australia E-MAIL: s.lee@alfred.org.au
Annals of Clinical Psychiatry ©2012 Frontline Medical Communications.

 
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