Abstract
Quetiapine has been trialled in the treatment of borderline personality disorder with promising results, although robust randomized controlled trials are still required to support their safe use despite second-generation antipsychotics being touted as having a more favourable tolerability profile [1–3].
Reported herein is the case of a 46-year-old woman with a diagnosis of borderline personality disorder, low average intelligence and no prior history of obsessive–compulsive symptoms (OCS) who developed OCS (Yale Brown Obsessive–ompulsive Scale score = 28) within 2 weeks of commencing quetiapine (up to 300 mg day−1). She was concomitantly on treatment with mirtazipine, which she continues to date without any side-effects. The obsessive violent imagery, thoughts of contamination and showering compulsions satisfied DSM-IV criteria for a diagnosis of obsessive–ompulsive disorder (OCD) [4]. Symptoms resolved within 1 week of discontinuing the quetiapine. This patient retrospectively reported similar symptoms during a 3 month trial of olanzapine earlier in the course of treatment that similarly resolved with the cessation of olanzapine.
A review of the literature indicated few reports of quetiapine-related exacerbation of OCS, while this has been more extensively reported with other atypical agents [5]. A series of five cases reported the de novo induction of OCS in patients with pre-existing bipolar disorder and schizophrenia [6]. There are no reports of quetiapine-induced OCS in the absence of an DSM-IV Axis 1 diagnosis or in patients with borderline personality disorder.
This presents an interesting dilemma given that augmentation with quetiapine has been recommended for treatmentrefractory OCD with good results [7]. Psychiatrists need to be aware of these uncommon side-effects of quetiapine that are rarely acknowledged in common sources of drug information, and as the off-label uses of quetiapine become more commonly advocated [8].