Effectiveness of quetiapine for the management of aggressive psychosis in the emergency psychiatric setting: a naturalistic uncontrolled trial

Objective: Traditionally, conventional antipsychotics, often administered intramuscularly, are used to reduce hostility and aggression in the emergency setting. This study investigated the efficacy of quetiapine, an oral atypical antipsychotic, in managing aggressive psychosis. Methods: Adult hospitalized patients ( n = 36) with an Overt Aggression Scale (OAS) total score >= 1 and a Brief Psychiatric Rating Scale-derived Psychosis Index score >= 6 received 100 - 800 mg/day flexibly dosed quetiapine and were monitored daily for a maximum of 5 days. The OAS total score and Physical Aggression Against Others subscale score were primary efficacy assessments. Tolerability was assessed with the Udvalg for Kliniske Undersogelser Side Effects Rating Scale. Results: An 83% decrease in the OAS Physical Aggression Against Others subscale score occurred from Day 1 ( baseline) to Day 2, which was generally maintained to Day 5; a 39% reduction in OAS total score was observed by Day 2. The OAS total score decreased from a mean baseline of 3.3 to 1.5 at Day 5, a significant decrease for Days 2 - 4 (P< 0.01) and of borderline significance on Day 5 ( P = 0.059). Adverse events were mostly mild to moderate with concentration difficulties and somnolence the most common. Conclusion: These results from an uncontrolled trial suggest that quetiapine may be helpful for some aggressive patients in the emergency setting.