Quetiapine Induced Acute Dystonia in a Patient with History of Severe Head Injury
Robert G. Bota1,2 and Joanne W. Witkowski1,3,4
1Staff Psychiatrist Kaiser Permanente, Corona, CA. 2Assistant Clinical Professor of Psychiatry, University of Missouri Kansas City, 3Chief Psychiatry Kaiser Permanente, Riverside, CA. 4Assistant Clinical Professor of Psychiatry, University of California, Riverside and University of California, Irvine.
Abstract
A patient with a history of severe head injury 10 years ago regained ability to walk after years of being bound to a wheelchair. During the last psychiatric hospitalization, quetiapine was increased to therapeutic dose using a normal titration. As a result the patient developed dystonia of multiple muscle groups requiring 4 days of hospitalization for remittance of symptoms. In this paper, we take a close look at the literature concerning extrapiramidal symptoms (EPS) in this context, and we suggest that in patients with a history of head injury, it is warranted to consider a slower titration of antipsychotic medications, including ones that are considered having a lower risk of EPS such as quetiapine.
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