Rapid dose titration of quetiapine for the treatment of acute schizophrenia
and acute mania: a case series
Frank-Gerald B Pajonk*,
Anne K Schwertner,
Marko Alexander Seelig
Department of Psychiatry and Psychotherapy, The Saarland University
Hospitals, Hamburg, Germany.
* To whom correspondence should be addressed.
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Abstract |
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To quickly reduce symptoms and to optimize long-term outcome, patients with an
acute episode of schizophrenia or mania require prompt treatment intervention. The
atypical antipsychotic quetiapine ('Seroquel') has been approved for the treatment of
schizophrenia and manic episodes associated with bipolar disorder. For patients with
acute symptoms such as aggression or agitation, higher doses of quetiapine than the
recommended initiation schedule are often required. This report presents the
tolerability findings from rapid initiation with high-dose quetiapine for eight patients
who were consecutively admitted with acute symptoms of schizophrenia (n = 5) or mania (n
= 3). The results from this case series show that quetiapine treatment could be safely
titrated at a more rapid rate and to doses greater than that described in the current
prescribing information. For most patients, rapid dose escalation was well tolerated; no
serious side effects were observed and vital clinical parameters were unchanged; one
patient experienced transient somnolence. In conclusion, these results suggest that
rapid dose escalation of quetiapine could be a useful treatment approach for acutely ill
patients with schizophrenia and bipolar mania in order to improve acute symptoms and
support the need for randomized controlled trials. However, dose adjustments should be
considered with respect to each patient's individual level of tolerability.
Key Words:
schizophrenia, mania, acute symptoms, quetiapine, high dose, tolerability
