Quetiapine is a psychotropic drug. Excessive use of quetiapine may lead to drowsiness, blurred vision, respiratory depression, hypotension and extrapyramidal reactions. Acute respiratory distress syndrome (ARDS) is rare due to overdose of quetiapine. On 14 February 2020, a patients with coma, respiratory arrest and hypotension due to overdose of quetiapine were admitted to our hospital. After receiving mechanical ventilation、plasma adsorption and anti-inflammatory treatment, the patient's consciousness turned clear, the machine was successfully removed and extubated, and the patient's condition was improved and discharged from hospital. We analyzed the clinical data of the patient with quetiapine poisoning, and discussed the clinical symptoms and chest CT characteristics of ARDS caused by quetiapine poisoning, in order to improve the understanding of quetiapine poisoning and improve the success rate of rescue.
Antipsychotic Agents ; Dibenzothiazepines ; Drug Overdose/therapy* ; Humans ; Quetiapine Fumarate/therapeutic use* ; Respiratory Distress Syndrome

Acute Disease ; Antipsychotic Agents ; adverse effects ; Drug Synergism ; Humans ; Pancreatitis ; chemically induced ; Quetiapine Fumarate ; adverse effects

The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018) with other recently published guidelines for treating bipolar disorder. We reviewed a total of five recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2018 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy for mania. However, the KMAP-BP 2018 did not prefer monotherapy with MS or AAP for psychotic mania. Quetiapine, olanzapine and aripiprazole were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Most guidelines advocated newer AAPs as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs (such as asenapine, cariprazine, paliperidone, lurasidine, long-acting injectable risperidone and aripiprazole once monthly) became prominent. KMAP-BP 2018 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2018, predominantly in the treatment of psychotic mania and severe depression. Further studies were needed to address several issues identified in our review.
Aripiprazole ; Bipolar Disorder ; Depression ; Drug Therapy ; Lithium ; Paliperidone Palmitate ; Prescriptions ; Quetiapine Fumarate ; Risperidone ; Valproic Acid

A woman in her twenties with schizophrenia developed immediate-onset mania after taking oral aripiprazole and receiving aripiprazole long-acting injection (ALAI). The dosage of aripiprazole was rapidly increased due to inadequate stimulating effect of low-dosage aripiprazole, but her manic symptomatology worsened. Clinicians should therefore carefully monitor for the induction of mania by oral aripiprazole and ALAI. Her manic symptomatology improved after adding 20 mg of blonanserin, 3 mg of risperidone, and 300 mg of quetiapine.
Aripiprazole ; Bipolar Disorder ; Female ; Humans ; Quetiapine Fumarate ; Risperidone ; Schizophrenia

No abstract available.
Quetiapine Fumarate ; Stroke

OBJECTIVE: Treatment for panic disorder (PD) have evolved, although there is still a strong unmet need for more effective and tolerable options. The present study summarizes and discusses recent evidence regarding the pharmacological and neuromodulatory treatment of PD. METHODS: MEDLINE, Cochrane Library, PsycINFO and Thomson Reuters’s Web of Science were searched for clinical trials published between 2010 and 2018. We included all prospective experimental studies including randomized controlled trials (RCT) and other clinical trials with more than 10 patients. RESULTS: Only 11 articles met the inclusion criteria, including 4 RCT, 3 open clinical trials and 5 comparative clinical trials. RCT demonstrated efficacy of transcranial magnetic stimulation (TMS) in only one of two trials. Neither pindolol nor d-fenfluramine were effective in blocking flumazenil-induced panic attacks. Augmentation with quetiapine was not superior to placebo. Open trials indicated that escitalopram, vortioxetine and TMS may be effective. Comparative trials did not demonstrate superiority from any drug, but confirmed tranylcypromine, paroxetine, clonazepam and alprazolam as effective options. CONCLUSION: The current study confirmed the efficacy of tranylcypromine, paroxetine, clonazepam, alprazolam and escitalopram. Vortioxetine and TMS, with duration of 4 or more weeks, also seems to be effective. Quetiapine, pindolol and d-fenfluramine were not considered effective compounds.
Alprazolam ; Citalopram ; Clonazepam ; Humans ; Panic Disorder ; Panic ; Paroxetine ; Pindolol ; Prospective Studies ; Quetiapine Fumarate ; Transcranial Magnetic Stimulation ; Tranylcypromine

OBJECTIVES: The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder 2014 for rapid cycling.METHODS: The questionnaires, which were intended to survey experts for their opinions of medication used for rapid cycling, were completed by the review committee, which consisted of 84 Korean expert psychiatrists. We classified the responses into three categories. based on the lowest category in which the confidence interval fall (6.5≤ for first-line and 3.5≤ for high second-line treatment).RESULTS: The first-line treatment was the combination of a mood stabilizer and an atypical antipsychotic. This combination strategy was the treatment of choice for manic episodes. Additionally, a mood stabilizer with lamotrigine therapy and an atypical antipsychotic with lamotrigine combinations were the first-line treatments for the depressive phase. Atypical antipsychotic monotherapy, mood stabilizer monotherapy, the combination of two mood stabilizers, and the triple combination of mood stabilizers, atypical antipsychotics, and antidepressants were preferred as the next strategies. The first-line medications in all cases were valproate, quetiapine, olanzapine and aripiprazole. Lithium was the first-line medication in depressive and hypomanic episodes, and lamotrigine was the first-line medication for the treatment of the depressive phase.CONCLUSION: Compared to the surveys in 2014, the preference for atypical antipsychotics and lamotrigine have increased, and modalities used as a second-line treatment were more diverse.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Aripiprazole ; Bipolar Disorder ; Lithium ; Psychiatry ; Quetiapine Fumarate ; Valproic Acid

OBJECTIVES: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology.METHODS: According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey.RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred.CONCLUSION: Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.
Advisory Committees ; Aripiprazole ; Bipolar Disorder ; Buspirone ; Clozapine ; Drug Therapy ; Psychopharmacology ; Quetiapine Fumarate ; Thyroid Gland

OBJECTIVES: The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014: Children and Adolescents.METHODS: We performed the survey, using a questionnaire comprising 22 questions according to each situation, in children and adolescents with bipolar disorder.RESULTS: First-line pharmacotherapeutic strategies for manic episode in children with bipolar disorder were a combination of mood stabilizer (MS) and an atypical antipsychotics (AAP), monotherapy with an AAP, risperidone, and aripiprazole. Aripiprazole was selected as first-line medication for depressive episode in children with bipolar disorder, and aripiprazole, and risperidone were selected as first-line at high-risk children. First-line pharmacotherapeutic strategies for manic episode in adolescents were a combination of MS and an AAP, monotherapy with an AAP valproate, lithium, risperidone (Treatment of Choice, TOC), aripiprazole, and quetiapine. First-line pharmacotherapeutic strategies for depressive episode in adolescents, were a combination of an atypical antipsychotics and lamotrigine, valproate, aripiprazole (TOC), risperidone, and quetiapine. For depressive episodes in adolescents at high risk for bipolar disorder, valproate, aripiprazole (TOC), and risperidone were selected as first-line medication.CONCLUSION: We expect that the present KMAP-BP 2018-children and adolescents, is useful for clinicians to treat children and adolescents with bipolar disorder.
Adolescent ; Antipsychotic Agents ; Aripiprazole ; Bipolar Disorder ; Child ; Drug Therapy ; Humans ; Lithium ; Quetiapine Fumarate ; Risperidone ; Valproic Acid

The mechanism of medication-induced gastrointestinal hypomotility is primarily caused by muscarinic cholinergic antagonism. This effect may cause constipation and paralytic ileus, which may lead to fatal complications. A 51-year-old woman was admitted due to manic episode recurrence. She developed paralytic ileus under quetiapine use and treated successfully under low dose amisulpride use. The related mechanism, associated risk factors, and the rationale for medication switch are discussed.
Bipolar Disorder ; Cholinergic Antagonists ; Constipation ; Female ; Humans ; Intestinal Pseudo-Obstruction* ; Middle Aged ; Quetiapine Fumarate* ; Recurrence ; Risk Factors