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Minerva Psichiatrica 2003 March;44(1):55-60

language: English

Severe tardive dyskinesia in a bipolar patient successfully treated with novel atypical antipsychotic agent quetiapine

La Pia S., Campana F., Franco F., Cetrangolo C., Paudice C.


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A 66-year-old patient with a bipolar affective disorder and a long history of neuroleptic use developed a severe form of tardive dyskinesia (TD). He was treated with the new atypical antipsychotic drug quetiapine, a dibenzothiazepine-derivative. Within 2 weeks of treatment with quetiapine, symptoms of TD, and in particular the troublesome dysphagia, improved substantially. Four weeks after starting treatment, the TD had almost completely resolved. Improvement of both involuntary movements and affective symptomatology continued during the follow-up. Like clozapine and other novel antipsychotics, quetiapine is active at multiple brain receptors and has a high ratio of serotonin 5-HT2-receptor binding to dopamine D2-receptor binding. Although the ultimate mechanism of TD remains unclear and not directly related to D2-receptor blockade, the transient and surmountable binding to D2 receptors shown by quetiapine and clozapine might account for the lesser propensity of both these drugs to induce TD and could also play a role in their efficacy in treating TD itself. Given its more favourable safety profile, quetiapine may be a useful alternative drug to clozapine, especially in some subgroups of patients, such as bipolar and elderly patients. This issue seems to need further large-scale controlled studies.

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