Quetiapine Addiction in an Adolescent.

[Author Affiliation]Venkata Kolli. 1 Department of Psychiatry, Creighton University, Omaha, Nebraska.Hind Mary. 2 Creighton Psychiatry Residency Program, Creighton University, Omaha, Nebraska.Blanca Garcia-Delgar. 3 Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Barbara J. Coffey. 3 Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Address correspondence to: Barbara J. Coffey, MD, MS, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, E-mail: Barbara.coffey@mssm.eduChief Complaint and Presenting ProblemF. was a 16-year-old adolescent boy with attention-deficit/hyperactivity disorder (ADHD) and opiate and cannabis use disorders with a recent history of escalating recreational quetiapine use. He was admitted to the hospital after ingestion of 400 mg quetiapine and 2 mg alprazolam at school with the intention of getting high. He was referred to the Child and Adolescent Psychiatry consultation service for disposition and management.History of Present IllnessF.'s parents reported that he was diagnosed with ADHD as a child, consistent with his early history of hyperactivity, short attention span, and fidgetiness. He reportedly made careless mistakes, had trouble playing quietly, and trouble taking turns. He recalled becoming bored easily, especially in school, and he disliked mental activity that required sustained effort. In addition, parents reported that F. had a history of lying, rule and curfew breaking, and shoplifting; a past diagnosis of conduct disorder had also been made.In this context, F. reported that his first opiate use was at the age of 9 years when he ingested a family member's medication; his regular substance use began at the age of 13 years. F. reported that he started smoking tobacco when he was 13 and was smoking around 20 cigarettes a day by the time of this evaluation. He also started smoking marijuana at age 13; he reported a history of smoking 2 g of marijuana at least once a week in the past, but none over recent months. In addition he experimented with inhalants briefly when he was 13; he started using Triple C (containing dextromethorphan, acetaminophen, and pseudoephedrine) when he was 13, and ingested up to two to three bottles at a time at a frequency of two to three times a week. When he was 14, he experimented with oral methamphetamines and methylene-dioxy-meth-amphetamine, and also started using benzodiazepines, such as clonazepam, and would occasionally use opiates. F. reported that he drank alcohol occasionally. He denied ever using intravenous drugs. There was no history of abusing any other analgesic drugs.Most recently F. reported that he was started on 50 mg quetiapine to initiate sleep a few months before admission. He reported that he experienced a "buzz" from this medication, and described this experience as similar to what he experienced with opiate ingestion. He claimed that he resisted the temptation to increase the dose of this medication for 2 months after its initiation. He subsequently increased the dose to 100 mg and reported that he liked the feeling. He reported that when he requested a dose increase from his family physician, the dose was increased to 300 mg once daily; he then gradually increased his quetiapine to 400 mg three times a day over a period of 3 months. He also procured quetiapine from friends and reported that he sometimes provided sexual favors to a middle-aged woman in exchange for quetiapine.F. reportedly felt dysphoric and craved on days when he was unable to obtain quetiapine, or when he would attempt to reduce his use. He reported that he experienced palpitations on 400 mg three times a day, but continued taking the medication. Since his first use, quetiapine quickly became his primary drug of abuse. …