title: Paradoxical severe agitation induced by add-on high-doses quetiapine in schizo-affective disorder.
abstract: We report the case of a 35-year-old patient suffering from schizo-affective disorder since the age of 19 years, treated by a combination of first-generation antipsychotics, zuclopenthixol (100 mg/day) and lithium (1200 mg/day) (serum lithium=0.85 mEq/l). This patient had no associated personality disorder (particularly no antisocial disorder) and no substance abuse disorder. Within the 48 h following the gradual introduction of quetiapine (up to 600 mg/day), the patient presented severe agitation without an environmental explanation, contrasting with the absence of a history of aggressiveness or personality disorder. The diagnoses of manic shift and akathisia were dismissed. The withdrawal and the gradual reintroduction of quetiapine 2 weeks later, which led to another severe agitation, enabled us to attribute the agitation specifically to quetiapine.
authors.affiliation: Université Paris Est-Créteil, Pôle de Psychiatrie du Groupe des Hôpitaux Universitaires de Mondor, INSERM U955, Eq Psychiatrie Génétique, Fondation FondaMental Fondation de Coopération Scientifique en Soins, F-94000 Créteil, France. Electronic address: guillaume.fond@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Fond
authors.affiliation: CHU Montpellier, Département Universitaire de Psychiatrie Adulte, Hôpital La Colombière, INSERM 1061, Université Montpellier 1, F-34000 Montpellier, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: MacGregor
authors.affiliation: CHU Montpellier, Département Universitaire de Psychiatrie Adulte, Hôpital La Colombière, INSERM 1061, Université Montpellier 1, F-34000 Montpellier, France.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ducasse
authors.affiliation: CHU Montpellier, Département Universitaire de Psychiatrie Adulte, Hôpital La Colombière, INSERM 1061, Université Montpellier 1, F-34000 Montpellier, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Brittner
mesh_terms: D000328:Adult; D000374:Aggression / Q000187:drug effects; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D004409:Dyskinesia, Drug-Induced; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D000069348:Quetiapine Fumarate
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate
keywords: Aggressiveness; Agitation; Drug interaction; Quetiapine; Schizo-affective disorder