Is quetiapine suitable for treatment of acute schizophrenia with catatonic stupor? A case series of 39 patients

Abstract

Bunta Yoshimura,1,2 Tomoya Hirota,3 Manabu Takaki,2 Yoshiki Kishi,11Department of Psychiatry, Okayama Psychiatric Medical Center, 2Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; 3Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USAPurpose: We aimed to determine which antipsychotic is most effective for the treatment of acute schizophrenia with catatonic stupor.Patients and methods: Data were obtained from the medical records of 450 patients with the diagnosis of schizophrenia, who had received acute psychiatric inpatient treatment between January 2008 and December 2010 at our hospital. Among them, 39 patients (8.7%) met the definition of catatonic stupor during hospitalization. The diagnoses of schizophrenia in all 39 patients were reconfirmed during the maintenance phase. We retrospectively reviewed the medical records of these 39 patients to investigate which antipsychotics were chosen for treatment during the period from admission to recovery from catatonia, at the time of discharge, and 12 and 30 months after discharge.Results: As compared to other antipsychotics, it was found out that use of quetiapine had better outcomes and hence was used more often. A total of 61.5% of patients were on quetiapine at the time of recovery from catatonia and 51.3% of patients were on quetiapine at the time of discharge as compared to only 17.9% of patients on quetiapine on admission. However, at 12 and 30 months after discharge, the rates had decreased to 38.4% and 25.6%. Similarly, of 29 patients who were not administered electroconvulsive therapy, quetiapine was used at significantly higher rates at the time of recovery from catatonia (48.3%) than at the time of admission (17.2%). All 39 patients had received an antipsychotic as the first-line treatment and some antipsychotics might have contributed to the development of catatonia.Conclusion: This study suggests that quetiapine is a promising agent for the treatment of schizophrenia with catatonic stupor during the acute phase.Keywords: catatonia, electroconvulsive therapy, quetiapine, schizophrenia, stupor