Severe irritability in a critically ill preterm infant: a case of delirium at the neonatal intensive care unit / Grave irritabilidade em prematuro criticamente doente: um caso de delirium na unidade de terapia intensiva neonatal

ABSTRACT Delirium is a common disorder in intensive care units, being associated with greater morbidity and mortality. However, in neonatal intensive care units, delirium is rarely diagnosed, due to the low familiarity of the neonatologist with the subject and the difficulties in the applicability of diagnostic questionnaires. This case report aimed to assess the presence of this disorder in this group of patients and identify the difficulties encountered in the diagnosis and treatment. We report the case of a premature newborn with necrotizing enterocolitis during hospitalization and underwent three surgical approaches. The newborn exhibited intense irritability, having received high doses of fentanyl, dexmedetomidine, clonidine, ketamine, phenytoin, and methadone, without the control of the symptoms. A diagnosis of delirium was then made and treatment with quetiapine was started, with a complete reversal of the symptoms. This is the first case reported in Brazil and the first describing the withdrawal of the quetiapine.

RESUMO Delirium é uma síndrome comum em unidades de terapia intensiva, associando-se a maiores morbidade e mortalidade. No entanto, nas unidades de terapia intensiva neonatal, ele raramente é diagnosticado em razão da baixa familiaridade do neonatologista com a suspeita diagnóstica e das dificuldades na aplicabilidade dos questionários diagnósticos. Este relato de caso tem como objetivos mostrar que delirium está presente nesse grupo de pacientes e apontar as dificuldades encontradas no seu diagnóstico e tratamento. Relatamos o caso de um recém-nascido prematuro com enterocolite necrosante, submetido a três abordagens cirúrgicas. O recém-nascido apresentou intensa irritabilidade, tendo recebido altas doses de fentanil, dexmedetomidina, clonidina, cetamina, fenitoína e metadona, sem controle dos sintomas. Em seguida, foi feita a hipótese diagnóstica de delirium e iniciado tratamento com quetiapina, com reversão completa dos sintomas. Este é o primeiro caso notificado no Brasil e o primeiro que descreve a suspensão da quetiapina.

Effect of the association of amantadine and quetiapine in the treatment of rem sleep behavior disorder: case report / Efeito da associação de amantadina e quetiapina no tratamento do distúrbio do comportamento do sono rem: relato de caso / Efecto de la asociación de amantadina y quetiapina en el tratamiento del trastorno del comportamiento del sueño rem: reporte de un caso

The aim was to report the case of a patient with REM sleep behavior disorder, unresponsive to standard treatment and with complete control of the condition after association of amantadine. Female patient, 45 years old, with systemic arterial hypertension and hypothyroidism, referred to neurological care, reporting frequent episodes of nocturnal agitation in the first hours of sleep, with walking and vocalization, waking up easily if called. She complains of drowsiness and anxiety, secondary to the impact of the RBD on her personal life. She mentions previous attempts at drug treatment with benzodiazepines (Bromazepam and Clonazepam), Zolpidem and Trazodone, all without clinical improvement, with Quetiapine being introduced at a low dose (not yet tried) 25mg, with a therapeutic target of 50mg with partial improvement only with 25mg. When trying 50mg, presenting a worsening of the picture. In a new follow-up, therapy with Amantadine 50 mg/day associated with Quetiapine 25 mg/day was started. The patient returned reporting a significant improvement in the condition, less frequent episodes associated with reduced nocturnal movement. After adaptation of the combined therapy, with adjustments in the dose of Amantadine, an increase of 50mg every 14 days up to 200 mg/day, with the possibility of using quetiapine 50mg (balance between the drugs), the patient evolved stable, with a great improvement in the quality of life and absence of new episodes of the sleep disorder.

O objetivo foi relatar o caso de uma paciente com transtorno comportamental do sono REM, sem resposta ao tratamento padrão e com completo controle do quadro após associação de amantadina. Paciente do sexo feminino, 45 anos, com hipertensão arterial sistêmica e hipotireoidismo, encaminhada a atendimento neurológico relatando episódios frequentes de agitação noturna nas primeiras horas de sono, com deambulo e vocalização, despertava facilmente se chamada. Queixa-se de sonolência e ansiedade, secundárias ao impacto do TCSREM em sua vida pessoal. Menciona tentativas prévias de tratamento medicamentoso com benzodiazepínicos (Bromazepam e Clonazepam), Zolpidem e Trazodona, todos sem melhora clínica, sendo introduzido Quetiapina em dose baixa (ainda não tentado) 25mg, com alvo terapêutico de 50mg com melhora parcial apenas com 25mg. Ao tentar 50mg, apresentando piora do quadro. Em novo retorno, iniciou-se terapia com Amantadina 50 mg/dia associada a Quetiapina 25 mg/dia. A paciente retornou referindo melhora significativa do quadro, episódios em menor frequência associados a redução na movimentação noturna. Após adaptação da terapia combinada, com ajustes da dose de Amantadina, aumento de 50mg a cada 14 dias até 200 mg/dia, sendo possível o uso da quetiapina 50mg (equilíbrio entre os fármacos) a paciente evoluiu estável, com grande melhora da qualidade de vida e ausência de novos episódios do distúrbio de sono.

El objetivo fue reportar el caso de un paciente con trastorno de conducta del sueño REM, que no responde al tratamiento estándar y con un control completo de la condición después de la asociación de amantadina. Paciente femenina, de 45 años de edad, con hipertensión arterial sistémica e hipotiroidismo, referida a atención neurológica, reportando episodios frecuentes de agitación nocturna en las primeras horas de sueño, con marcha y vocalización, despertándose fácilmente si se le llama. Se queja de somnolencia y ansiedad, secundarias al impacto de la RBD en su vida personal. Menciona intentos previos de tratamiento farmacológico con benzodiazepinas (Bromazepam y Clonazepam), Zolpidem y Trazodona, todos sin mejoría clínica, con la introducción de quetiapina a una dosis baja (aún no probada) de 25mg, con un objetivo terapéutico de 50mg con mejoría parcial solo con 25mg. Al intentar 50mg, presentando un empeoramiento de la imagen. En un nuevo seguimiento se inició tratamiento con 50 mg/día de amantadina asociado a 25 mg/día de quetiapina. El paciente retornó reportando una mejoría significativa en la condición, episodios menos frecuentes asociados a reducción del movimiento nocturno. Después de la adaptación de la terapia combinada, con ajustes en la dosis de Amantadina, un aumento de 50mg cada 14 días hasta 200 mg/día, con la posibilidad de utilizar quetiapina 50mg (equilibrio entre los fármacos), el paciente evolucionó estable, con una gran mejoría en la calidad de vida y ausencia de nuevos episodios del trastorno del sueño.

Tromboembolismo pulmonar como posible reacción adversa a Quetiapina Reporte de caso / Pulmonary thromboembolism as a possible adverse reaction to Quetiapine Case report

Resumen Algunos estudios sugieren que existe una relación entre el uso de antipsicóticos y el riesgo de tromboembolismo venoso (TEV) y embolia pulmonar (EP). Sin embargo, los resultados siguen sin ser concluyentes. Se trata del caso de un Masculino de 23 años con antecedentes de Esquizofrenia y Depresión tratado quetiapina 800 mg, el cual es encontrado muerto en la cama de un hotel. En la necropsia sin lesiones traumáticas visibles, hallazgos histológicos de tromboembolismo pulmonar masivo con infartos pulmonares secundarios. Laboratorio de Toxicología detectó la presencia de quetiapina, no se detectó alcohol o drogas de abusos. Mediante el Algoritmo De Karch & Lasagna Modificado el tromboembolismo pulmonar fue una reacción adversa con una probabilidad de relación causal posible. Se han informado muchos casos de muerte súbita causada por EP con la exposición a antipsicóticos, pero la relación de su uso y el riesgo de TEV y EP sigue siendo controvertida.

Abstract Some studies suggest a relationship between antipsychotic use and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, the results remain inconclusive. This is the case of a 23-year-old male with a history of schizophrenia and depression treated with quetiapine 800 mg, who was found dead in a hotel bed. At necropsy with no visible traumatic lesions, histological findings of massive pulmonary thromboembolism with secondary pulmonary infarcts. Toxicology laboratory detected the presence of quetiapine, no alcohol or drugs of abuse were detected. Using the Modified Karch & Lasagna Algorithm, pulmonary thromboembolism was an adverse reaction with a probable causal relationship. Many cases of sudden death caused by PE have been reported with exposure to antipsychotics, but the relationship of their use and the risk of VTE and PE remains controversial.

Acute respiratory distress syndrome caused by quetiapine poisoning: a case report / 中华劳动卫生职业病杂志

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.

Efficacy of maintenance electroconvulsive therapy combined with quetiapine treatment for manic episode of bipolar disorder / 中国基层医药

Objective:To investigate the efficacy of maintenance electroconvulsive therapy (MECT) combined with quetiapine treatment for manic episodes of bipolar disorder.Methods:A total of 103 patients with manic episodes of bipolar disorder received treatment in Kangci Hospital of Jiaxing from January 2019 to August 2020 and were included in this study. They were randomly divided into observation ( n = 46) and control groups ( n = 57). The observation group was given MECT combined with quetiapine treatment and the control group was treated with magnesium valproate sustained-release tablets combined with quetiapine. All patients received 4 weeks of treatment. Clinical efficacy, total hospital cost, drug cost during hospitalization, drug proportion, adverse reactions, and scores of the Bech-Rafaelsdn Mania Rating Scale and the Wisconsin Card Sorting Test pre- and post-treatment were compared between the two groups. Results:After 4 weeks of treatment, total response rate was significantly higher in the observation group than in the control group [76.09% (35/46) vs. 56.14% (32/57), χ2 = 4.45, P < 0.05]. In the observation group, total hospital cost, drug cost during hospitalization, and drug proportion were (16074.52 ± 1019.81) yuan, (1374.52 ± 619.81) yuan, and 8.70% respectively, which were not significantly different from those in the control group [(15618.14 ± 1550.34) yuan, (1261.14 ± 750.34) yuan, 10.53%, t = 1.71, 0.82, χ2 = 0.09, all P > 0.05]. After 4 weeks of treatment, Bech-Rafaelsdn Mania Rating score was significantly lower in the observation group than in the control group [(7.36 ± 3.04) points vs. (10.23 ± 2.37) points, t = 5.38, P < 0.001]. The number of wrong responses and the number of perseverative errors in the Wisconsin Card Sorting Test in the observation group were (40.45 ± 3.61) counts and (9.56 ± 1.39) counts, respectively, which were significantly lower than those in the control group [(48.59 ± 4.51) counts, (12.08 ± 1.25) counts, t = 10.17, 9.56, both P < 0.001]. The number of perseverative errors in the Wisconsin Card Sorting Test was significantly higher in the observation group than in the control group [(33.85 ± 2.50) counts vs. (29.71 ± 2.14) counts, t = 8.90, P < 0.001]. There was no significant difference in total incidence of adverse reactions between observation and control groups (21.74% vs. 22.81%, χ2 = 0.01, P > 0.05). Conclusion:MECT combined with quetiapine treatment is highly effective on the manic episodes of bipolar disorder. The combined therapy is worthy of clinical application.

Efficacy of quetiapine fumarate combined with lithium carbonate in the treatment of bipolar disorder in 30 patients / 中国基层医药

Objective:To investigate the efficacy of quetiapine fumarate combined with lithium carbonate in the treatment of bipolar disorder and its effect on cognitive function.Methods:Sixty patients with bipolar disorder, who received treatment in Zhuji Fifth People's Hospital from January 2017 to December 2019, were included in this study. They were randomly assigned to receive either lithium carbonate (control group, n = 30) or quetiapine fumarate combined with lithium carbonate treatment (combined treatment group, n = 30). All patients received 4 weeks of treatment. Manic and depressive symptoms pre- and post-treatment, clinical efficacy, cognitive function, and adverse reactions were compared between the two groups. Fasting venous blood was taken before and 4 weeks after treatment to measure superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), and glutathione peroxidase (GSH-Px) levels. Results:The scores of the Bech-Rafaelsdn Mania Rating Scale (BRMS) and the Hamilton Rating Scale for Depression (HAMD) in each group were significantly decreased after treatment compared with before treatment ( t = 10.39, 12.47, both P < 0.001). The score of the Mini-Mental State Examination in each group significantly increased after treatment compared with before treatment ( t = 8.36, 14.52, both P < 0.001). The scores of BRMS and HAMD post-treatment were significantly lower in the combined treatment group than in the control group ( t = 5.86, 5.54, both P < 0.001). The score of MMSE post-treatment was significantly higher in the combined treatment group than in the control group ( t = 2.40, P = 0.020). The response rate was significantly higher in the combined treatment group than in the control group ( Z = 2.16, P = 0.030). After treatment, serum MDA level significantly decreased in each group compared with before treatment ( t = 8.72, 15.47, both P < 0.001). After treatment, SOD, CAT and GSH-Px levels were significantly increased in each group compared with before treatment (SOD: tcontrol group = 2.84, P = 0.006, tcombined treatment group = 4.05, P < 0.001; CAT: tcontrol group = 5.20, P < 0.001, tcombined treatment group = 9.86, P < 0.001; GSH-Px: tcontrol group = 2.67, P = 0.010, tcombined treatment group = 3.71, P = 0.001). Serum MDA level post-treatment was significantly lower in the combined treatment group than in the control group ( t = 12.38, P < 0.001). Serum SOD and CAT levels post-treatment were significantly higher in the combined treatment group than in the control group ( tSOD = 2.24, P = 0.029; tCAT = 2.72, P = 0.009). There was no significant difference in the incidence of adverse reactions between the combined treatment and control groups [20.00% (6/30) vs. 16.67% (5/30), χ2 = 1.02, P = 0.907). Conclusion:Quetiapine fumarate combined with lithium carbonate can greatly improve clinical symptoms and cognitive function and reduce the over-activation of oxidative stress in patients with bipolar disorder. The combined therapy is of certain clinical application value.

Interview and treatment of a case with body dysmorphic disorder / 四川精神卫生

This paper reported a case of patient with body dysmorphic disorder in order to improve the clinical interview skills， diagnosis and treatment of clinicians in psychiatric department. The client was a 17-year-old unmarried male， came for psychological consultation because he was not satisfied with his appearance and had low self-esteem. After the changing of learning environment， the client showed excessive attention to his appearance along with low mood. The client was diagnosed with body dysmorphic disorder， and a biological-psychosocial comprehensive intervention was recommended. Sertraline combined with quetiapine was given as biotherapy to improve his mood and cognition. The psychotherapy included mindfulness-based stress reduction and cognitive behavioral therapy. These therapies helped the client learn to relax and correct cognitive biases. In terms of social resources， family members were encouraged to pay more attention to the client’s advantages， and schoolwork management on campus was strengthen. These methods promoted the development of client’s self-confidence.

Hiponatremia relacionada con el uso de quetiapina: reporte de caso clínico

La hiponatremia es la alteración electrolítica más frecuente en el anciano y puede ser asintomática o producir un espectro de síntomas, especialmente del sistema nervioso central, tales como alteración del estado de conciencia, letargia, cefalea, convulsiones y alteraciones en la marcha, los cuales son un motivo frecuente de consulta de esta población. Esta entidad tiene un alto impacto en la funcionalidad del paciente, pues requiere múltiples hospitalizaciones, e incluso en mortalidad. Su etiología es multifactorial; entre sus causas más comunes están la baja ingesta de sal, las enfermedades crónicas como la nefropatía y la insuficiencia cardiaca y el síndrome de secreción inadecuada de hormona antidiurética (SIADH), que a su vez se produce comúnmente por el uso crónico de determinados fármacos, como los antidepresivos, los diuréticos y los antipsicóticos, que son los más olvidados en el abordaje clínico. Se presenta en este caso clínico el abordaje diagnóstico de la hiponatremia y la importancia de la anamnesis como instrumento clave para detectar la etiología de esta entidad clínica.

Hyponatraemia is the most common electrolyte disturbance in the elderly. It can be asymptomatic or produce a spectrum of symptoms, particularly in the central nervous system, such as altered state of consciousness, lethargy, headache, seizures and gait disturbances, all of which are a common reason for consultation in this population. This condition has a high impact on the functionality of the patient given the need formultiple hospital stays, as well as on mortality. Its aetiology ismultifactorial and its most common causes include low salt intake, chronic diseases such as kidney disease and heart failure, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is commonly caused by the chronic use of certain drugs, such as antidepressants, diuretics and antipsychotics, which are the most forgotten in clinical practice. The following clinical case presents the diagnostic approach of hyponatraemia and the importance of the medical history as a key tool to detect the aetiology of this clinical entity.

High Doses of Drugs Extensively Metabolized by CYP3A4 Were Needed to Reach Therapeutic Concentrations in Two Patients Taking Inducers / Dos pacientes que tomaban inductores necesitaron dosis altas de medicamentos metabolizados en gran medida por el CYP3A4 para alcanzar concentraciones terapéuticas

ABSTRACT Introduction: In the last 20 years of clinical practice, the senior author has identified these 2 rare cases in which the patients needed extremely high doses of drugs metabolized by CYP3A4 to reach and maintain serum therapeutic concentrations. Methods: The high metabolic ability of these 2 patients was demonstrated by the low concentration-to-dose ratios (C/D ratios) of several drugs metabolized by CYP3A4. Results: Case 1 was characterized by a history of high carbamazepine doses (up to 2,000 mg/day) and needed 170 mg/day of diazepam in 2 days to cooperate with dental cleaning. The high activity of the CYP3A4 isoenzyme was manifested by fast metabolism for quetiapine and diazepam, which took more than 1 year to normalize after the inducer, phenytoin, was stopped. Case 2 was also very sensitive to CYP3A4 inducers as indicated by very low C/D ratios for carbamazepine, risperidone and paliperidone. The carbamazepine (2,800 mg/day) and risperidone (20 mg/day) dosages for this second patient are the highest doses ever seen for these drugs by the senior author. Risperidone induction appeared to last for many months and metabolism was definitively normal 3 years after stopping carbamazepine. On the other hand, olanzapine C/D ratios were normal for induction. Conclusions: The literature has never described similar cases of very high doses of drugs metabolized by CYP3A4. We speculate that these 2 patients may have unusual genetic profiles at the nuclear receptor levels; these receptors regulate induction of drugs.

RESUMEN Introducción: Durante sus últimos 20 años de práctica, el último autor ha identificado estos 2 infrecuentes casos que necesitaban dosis extremadamente altas de medicaciones metabolizadas por el CYP3A4 para alcanzar y mantener concentraciones séricas terapéuticas. Métodos: La gran capacidad metabólica de estos 2 pacientes se demostró por los bajos cocientes entre concentración y dosis (C/D) de varias medicaciones metabolizadas por el CYP3A4. Resultados: El caso 1 se caracterizaba por una historia de altas dosis de carbamazepina (1.500 mg/día) y la necesidad de tomar 170 mg de diazepam en 2 días para facilitar una limpieza dental. La gran actividad de la isoenzima CYP3A4 se manifestó por una gran capacidad metabólica de quetiapina y diazepam, cuya normalización tardó más de 1 año tras la toma de un inductor, fenitoína. El caso 2 tambien era muy sensible a la inducción, lo cual se demuestra por los bajos cocientes C/D de carbamazepina, risperidona y paliperidona. Las dosis de carbamazepina (2.800 mg/día) y risperidona (20 mg/día) de este segundo paciente son las más altas nunca vistas por el último autor. La inducción de risperidona duró muchos meses y su metabolismo era normal 3 años después de interrumpir la carbamazepina. El cociente C/D de olanzapina era normal para la inducción. Conclusiones: Nunca se habían descrito casos similares de dosis tan altas de medicaciones metabolizadas por el CYP3A4. Se especula con que estos pacientes podrían tener unos perfiles genéticos inusuales en los receptores nucleares que regulan la inducción de medicamentos.

Determination of Lamotrigine, Olanzapine and Quetiapine in Human Plasma by Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry and Its Application in Therapeutic Drug Monitoring / 中国药学杂志

OBJECTIVE: To establish a highly sensitive and selective ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for simultaneous determination of the concentrations of lamotrigine, olanzapine and quetiapine in human plasma to provide guidance for clinical drug use. METHODS: The plasma samples were precipitated by methanol, voriconazole was used as internal standard, and then gradiently eluted by ACQUITY UPLC BEH C18 column (2.1 mm×50 mm, 1.7 μm) using mobile phase consisting of 0.1% formic acid solution and methanol. Multiple reaction monitoring (MRM) was conducted in ion detection mode using positive electrospray ionization source. RESULTS: The linear ranges of the calibration curves for lamotrigine, olanzapine and quetiapine in human plasma were 0.5-20 μg•mL-1, 2-200 and 10-1 000 ng•mL-1, respectively. The method had good matrix effect, extraction recovery, accuracy, precision and stability, and was successfully applied to analyze plasma samples of 45 patients. CONCLUSION: The UPLC-MS/MS method for determination of lamotrigine, olanzapine and quetiapine is proven to be a sensitive and reliable protocol for clinical therapeutic drug monitoring.

Quetiapine associated Central Serous Chorioretinopathy: Implicit role of serotonin and dopamine pathways

A 30-year-old insomniac, an off-label user of quetiapine, presented with blurring of central vision, eventually diagnosed as central serous chorioretinopathy. A potential association was suspected based on the drug's actions on the autonomic nervous system. He showed improvement on drug withdrawal; then he unwittingly resumed quetiapine and had a recurrence. Possible underlying mechanisms that include alteration in choroidal perfusion through serotonin and dopamine receptors are discussed. Although retinal vein occlusions and pigment epithelial detachment have been described with quetiapine, to the author's knowledge, this is the first case report of quetiapine-associated central serous chorioretinopathy.

Metabolic dysregulation in early onset psychiatric disorder before and after exposure to antipsychotic drugs

Antipsychotic Drugs (APDs) are being widely prescribed to treat various disorders, including schizophrenia and bipolar disorder; however, abnormal glucose metabolism and weight gain have been reported with Atypical Anti-Psychotic drugs (AAPDs) that can lead to insulin-resistance and type 2 diabetes mellitus. The study was designed to assess various biochemical parameters including insulin and blood sugar before and after exposure to APDs in order to exclude the involvement of psychiatric disorders and certain other factors in metabolic dysregulations. Fifty seven APDs-naïve patients with first episode psychosis were divided into six groups who received olanzapine, quetiapine, risperidone, aripiprazole, haloperidol or combination of olanzapine with escitalopram and haloperidol. The serum samples were taken before the intake of the first dose and then on follow-up. Decrease in the level of elevated insulin and glucose was observed post-treatment in some patients, while others were observed whose insulin and glucose levels increased post-treatment, yet some patients did not show any disturbance in the insulin and glucose levels. It is concluded that psychiatric disorders by itself, narcotics, cigarette smoking and use of oral snuff may be also be implicated in metabolic dysregulations. The effects of APDs on insulin and glucose in healthy volunteers might be different than in patients with psychiatric disorders.

Ischemic Stroke after Overdose of Oral Quetiapine

No abstract available.

A case series on drug induced hyponatremia: uncommon adverse effect of commonly used drugs

Older patients suffering from depression and psychosis have markedly increased since last decade. So, has the use of antidepressants and antipsychotics. The prevalence of hyponatremia due to these drugs is common in general as well as psychiatric practice. It may also lead to life threatening morbidity and mortality. Loss of renal function, polypharmacy, dementia and other conditions of advanced age can either exacerbate the severity of hyponatremia or mask its onset. In this case series, total four cases were reported of hyponatremia and drugs causing it were escitalopram, quetiapine, tianeptine and oxcarbazepine. Due to polypharmacy, a chance of hyponatremia was more in these patients. Patients received infusion of hypertonic saline with salt added diet to treat hyponatremia. Symptoms of hyponatremia were improved after the treatment. In all four cases, WHO and Naranjo’s causality assessment revealed ‘possible’ causal relationship with the prescribed drug. Prescribers should be aware of such adverse effect due to these drugs.

Quetiapine Induced Autoimmune Hemolytic Anemia in a Child Patient: A Case Report

Autoimmune hemolytic anemia is a disease characterized with destruction of erythrocytes as a result of antibody produce against patient's own erythrocytes and anemia. Autoimmune hemolytic anemia can be roughly stratified into two groups according to serological features and secondary causes including drugs induced hemolytic anemia. Drugs induced autoimmune hemolytic anemia is very rare in pediatric patients. Even though hematological side effects such as leucopenia, agranulocytosis, eosinophilia, thrombocytopenic purpura and aplastic anemia might occur due to psychotropic drug use; to the best of our knowledge there is no autoimmune hemolytic anemia case due to quetiapine, an atypical antipsychotics, in literature. We hereby describe the first child case of autoimmune hemolytic anemia during quetiapine treatment.We also are pointing out that one should keep in mind serious hematological side effects with atypical antipsychotic drug use with this case report.

Comparison of the efficacy of sertraline combined with risperidone or quetiapine in the treatment of schizophrenia / 中国基层医药

Objective To compare the efficacy of sertraline hydrochloride combined with risperidone or quetiapine in the treatment of schizophrenia.Methods Eighty-six patients with schizophrenia in Ningbo Psychiatric Hospital were selected and divided into observation group and control group according to the order of admission.The observation group was treated with sertraline hydrochloride combined with quetiapine , and the control group was treated with sertraline hydrochloride combined with risperidone.The clinical symptoms score,clinical efficacy and adverse reactions were compared between the two groups.Results Before treatment,the negative symptoms,positive symptoms,psychopa-thology,total score between the two groups had no statistically significant differences (all P＞0.05).After treatment, the negative symptoms ,positive symptoms,psychopathology and total scores of the observation group were (13.43 ± 1.27)points,(11.26 ±1.05)points,(13.54 ±1.84)points and(46.48 ±4.52)points,respectively,which were significantly lower than those of the control group[(16.87 ±1.98)points,(15.48 ±1.63)points,(18.35 ±2.04)points, (58.25 ±5.76)points](t＝9.590,14.272,11.481,10.541,all P＜0.05).The total effective rate of the observation group was significantly higher than that of the control group [93.02%(40/43) vs.67.44%(29/43)](χ2＝8.871, P＜0.05).There was no statistically significant difference between the two groups in the incidence rate of adverse reactions (P＞0.05).Conclusion Sertraline hydrochloride combined with quetiapine in the treatment of schizophrenia can improve the clinical symptoms of patients ,the clinical efficacy is good ,with mild adverse reactions.

Quetiapine Related Acute Paralytic Ileus in a Bipolar I Disorder Patient with Successful Low Dose Amisulpride Substitution: A Case Report

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.

Influence of magnesium valproate and quetiapine separately combined with lithium carbonate on BRMS score,PANSS score and adverse effects of patients with manic episode of bipolar disorder in puberty / 中国基层医药

Objective To investigate the influence of magnesium valproate and quetiapine separately combined with lithium carbonate on BRMS scores,PANSS scores and adverse effects of patients with manic episode of bipolar disorder in puberty. Methods 100 patients with manic episode of bipolar disorder in puberty were chosen and randomly divided into two groups according to the digital table. Group A ( 50 children ) was given magnesium valproate,and group B (50 children) was given quetiapine on the basis of lithium carbonate. The clinical efficacy,the BRMS score,PANSS score and WCST score before and after treatment and the incidence of adverse effects of the two groups were compared. Results There was no significant difference in clinical efficacy between the two groups (94. 00% vs. 90. 00%),(χ2 =1. 31,P>0. 05). After treatment for 2 weeks,the BRMS score,PANSS score and WCST score of group B were significantly better than those of group A and before treatment(t=2. 45,3. 16;2. 71,3. 26,2. 79, 3. 36,all P<0. 05). 6 weeksafter treatment,there were no significant differences in the BRMS score,PANSS score and WCST score between the two groups(t=1. 20,1. 08,1. 19,all P<0. 05). There was no significant difference in the incidence rate of adverse effects between the two groups(χ2 =1. 49,P>0. 05). Conclusion Two kinds of bigeminy drug therapy in the treatment of patients with manic episode of bipolar disorder in puberty possess the clinical effects and safety,and quetiapine combined with lithium can help to shorten the onset time and higher the compliance degree.

Effect of quetiapine or olanzapine combined with sodium valproate on treatment of Uighur patients with bipolar disorder / 药物评价研究

Objective To explore the effect of quetiapine or olanzapine combined with sodium valproate on curative for Uighur patients with bipolar disorder.Methods Totally 100 Uighur patients with bipolar disorder were enrolled in The Fourth People's Hospital of Urumqi from June 2015 to June 2016,of which patients divided into two groups randomly,the patients of control group (n =50) accepted sodium valproate combined with olanzapine,and patients in observation group (n =50) were administered with sodium valproate combined with quetiapine.The patients taking medicine were reviewed at the hospital after 1,4,and 8 weeks,and the depression and manic state and severity of clinical efficacy with 17 HMDM score,BRMD score and GSI-IS score questionnaire were evaluated.Results Each score of questionnaire was significantly lower than that before treatment (P ＜ 0.05),all patients'clinical symptoms were relieved obviously,and symptoms tended to reduce or even disappeared with the extension of the course of treatment.Each score of questionnaire in observation group was lower than that in control group,bur difference has no statistical significance;Comparing the incidence of adverse reaction of two groups,the patients with dizziness and sleepiness in observation group were significantly decreased compared with observation group (P ＜ 0.05).Conclusions Quetiapine or olanzapine combined with sodium valproate for Uighur patients with bipolar disorder deserved popularization in clinic as the efficacious remission of depression and manic state.

Quetiapine Induced Cortisol Levels Decrease in One Patient and Related Literature Review / 中国药学杂志

OBJECTIVE: To evaluate the efficacy of quetiapine in reducing serum cortisol levels in patients with Cushing's syndrome. METHODS: The change of serum cortisol and ACTH levels in one patient with Cushing syndrome treated by quetiapine was introduced, the related literature was reviewed, and the mechanism of quetiapine for reducing cortisol levels was analyzed. RESULTS: One 44-year-old male patient with Cushing's syndrome took quetiapine 0.05 g for insomnia before bedtime.His cortisol level decreased from 34.73 to 5.68 μg·dL-1, and ACTH level decreased from 99.2 to 74.3 pg·mL-1. In the literature review, there were 7 reports of quetiapine-induced cortisol level decrease, all of the subjects were patients with mental illness or healthy subjects, and the serum cortisol levels were decreased at the magnitudes of 6.9-2.7 g·dL-1. CONCLUSION: Quetiapine can reduce cortisol levels of patients with mental illness and Cushing syndrome and healthy volunteers. As shown by literature searching through PubMed, EMbase and other databases, this case is the first report on quetiapine reducing serum cortisol levels of patients with Cushing's syndrome in the world.