- Email: [email protected]
Quetiapine treatment in early psychosis: no evidence of cataracts
Schizophrenia Research 71 (2004) 511 – 512 www.elsevier.com/locate/schres
Letter to the Editor Quetiapine treatment in early psychosis: no evidence of cataracts
Dear editors: A recent exchange of letters to the editor (Laties, 2001; Valibhai et al., 2001) regarding a possible association of quetiapine treatment with cataract development has prompted us to report on our own experience using quetiapine with a group of young people with a first episode of psychotic illness. Valibhai et al. (2001) described a single case of a man with a 20-year history of antipsychotic treatment who developed lenticular changes 15 months after quetiapine was added with risperidone. A poster presentation reporting lens opacities in 15 out of 150,000 patients taking quetiapine was also cited, although it was noted that (a) the majority of these patients had other risk factors for cataracts (advanced age, diabetes, smoking, or hypertension), (b) not all had baseline examinations, (c) some had pre-existing cataracts, and (d) the prevalence is lower than the general population. Laties (2001) in response to Valibhai, cautioned that the lens changes described in the single case were atypical and pointed out that long-term therapy with other antipsychotic agents may have contributed. We report on a group of 37 Caucasian patients (mean age 23 F 5.6, 31 men and 6 women) with a first episode of psychosis treated with quetiapine as the only antipsychotic in an open label 2-year protocol with a 3-year extension phase. Thirteen of the patient had no prior exposure to antipsychotic medication. The others had a mean of 10 weeks (S.D. = 8.3) of prior exposure. The individual daily dose of quetia-
0920-9964/$ - see front matter D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2004.02.010
pine ranged from 150 to 800 mg/day with a mean, over the course of the protocol, between 500 and 600 mg/day. None of the patients had significant medical disease. One-third of the patients were smokers. Slit lamp eye examinations were conducted at baseline and at 6-month intervals for the first 2 years, and yearly thereafter. Of the 37 patients assessed at baseline, slit eye exams were available for 26 patients at 6 months, 22 patients at 12 months, 18 patients at 18 months, 16 patients at 2 years, 8 patients at 3 years and 2 patients after 4 years of treatment. The mean duration of exposure to quetiapine at the time of the last available slit eye exam was 22.4 months (S.D. = 12.9). The baseline examinations revealed a variety of minor ocular abnormalities. None of the patient had cataracts. Over the course of the study, no significant ocular changes were noted for any of the patients. To our knowledge, this is the first report examining ocular lens integrity in young people treated with quetiapine. These results do not support a relationship between quetiapine treatment and cataract formation (Stip and Boisjoly, 1999; Shahxad et al., 2002). References Laties, A., 2001. Quetiapine and cataracts. Letter to the editor. The American Journal of Psychiatry 159 (2), 322. Shahxad, S., Suleman, M.I., Shahab, H., Mazour, I., Jaur, A., Rudzinskiy, P., Lippmann, S., 2002. Cataract occurrence with antipsychotic drugs. Psychosomatics 43 (5), 354 – 359 (Sep. – Oct.). Stip, E., Boisjoly, H., 1999. Quetiapine: are we overreacting in our concern about cataracts (The Beagle Effect)? Letter to the editor. Canadian Journal of Psychiatry 44 (5), 503. Valibhai, F., Phan, N., Still, D., True, J., 2001. Cataracts and quetiapine. Letter to the editor. The American Journal of Psychiatry 158 (6), 966.
512
Letter to the Editor
David Whitehorn * Janet Gallant Hazel Woodley Qing Rui Heather Milliken Lili Kopala Department of Psychiatry, Dalhousie University and the Nova Scotia Early Psychosis Program, Capital District Mental Health Program, 300 Pleasant Street, Dartmouth, Halifax, Nova Scotia, Canada B2Y 3Z9 E-mail address: [email protected] 9 January 2004 * Corresponding author. Tel.: +1-902-464-3457, Voice mail pager: +1-902-458-1319.
Letter to the Editor Quetiapine treatment in early psychosis: no evidence of cataracts
Dear editors: A recent exchange of letters to the editor (Laties, 2001; Valibhai et al., 2001) regarding a possible association of quetiapine treatment with cataract development has prompted us to report on our own experience using quetiapine with a group of young people with a first episode of psychotic illness. Valibhai et al. (2001) described a single case of a man with a 20-year history of antipsychotic treatment who developed lenticular changes 15 months after quetiapine was added with risperidone. A poster presentation reporting lens opacities in 15 out of 150,000 patients taking quetiapine was also cited, although it was noted that (a) the majority of these patients had other risk factors for cataracts (advanced age, diabetes, smoking, or hypertension), (b) not all had baseline examinations, (c) some had pre-existing cataracts, and (d) the prevalence is lower than the general population. Laties (2001) in response to Valibhai, cautioned that the lens changes described in the single case were atypical and pointed out that long-term therapy with other antipsychotic agents may have contributed. We report on a group of 37 Caucasian patients (mean age 23 F 5.6, 31 men and 6 women) with a first episode of psychosis treated with quetiapine as the only antipsychotic in an open label 2-year protocol with a 3-year extension phase. Thirteen of the patient had no prior exposure to antipsychotic medication. The others had a mean of 10 weeks (S.D. = 8.3) of prior exposure. The individual daily dose of quetia-
0920-9964/$ - see front matter D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2004.02.010
pine ranged from 150 to 800 mg/day with a mean, over the course of the protocol, between 500 and 600 mg/day. None of the patients had significant medical disease. One-third of the patients were smokers. Slit lamp eye examinations were conducted at baseline and at 6-month intervals for the first 2 years, and yearly thereafter. Of the 37 patients assessed at baseline, slit eye exams were available for 26 patients at 6 months, 22 patients at 12 months, 18 patients at 18 months, 16 patients at 2 years, 8 patients at 3 years and 2 patients after 4 years of treatment. The mean duration of exposure to quetiapine at the time of the last available slit eye exam was 22.4 months (S.D. = 12.9). The baseline examinations revealed a variety of minor ocular abnormalities. None of the patient had cataracts. Over the course of the study, no significant ocular changes were noted for any of the patients. To our knowledge, this is the first report examining ocular lens integrity in young people treated with quetiapine. These results do not support a relationship between quetiapine treatment and cataract formation (Stip and Boisjoly, 1999; Shahxad et al., 2002). References Laties, A., 2001. Quetiapine and cataracts. Letter to the editor. The American Journal of Psychiatry 159 (2), 322. Shahxad, S., Suleman, M.I., Shahab, H., Mazour, I., Jaur, A., Rudzinskiy, P., Lippmann, S., 2002. Cataract occurrence with antipsychotic drugs. Psychosomatics 43 (5), 354 – 359 (Sep. – Oct.). Stip, E., Boisjoly, H., 1999. Quetiapine: are we overreacting in our concern about cataracts (The Beagle Effect)? Letter to the editor. Canadian Journal of Psychiatry 44 (5), 503. Valibhai, F., Phan, N., Still, D., True, J., 2001. Cataracts and quetiapine. Letter to the editor. The American Journal of Psychiatry 158 (6), 966.
512
Letter to the Editor
David Whitehorn * Janet Gallant Hazel Woodley Qing Rui Heather Milliken Lili Kopala Department of Psychiatry, Dalhousie University and the Nova Scotia Early Psychosis Program, Capital District Mental Health Program, 300 Pleasant Street, Dartmouth, Halifax, Nova Scotia, Canada B2Y 3Z9 E-mail address: [email protected] 9 January 2004 * Corresponding author. Tel.: +1-902-464-3457, Voice mail pager: +1-902-458-1319.