Malingered psychotic symptoms and quetiapine abuse in a forensic setting

Abstract

Quetiapine is an antipsychotic drug whose effect appears to be mediated through antagonist activity at the dopamine and serotonin receptors. While Quetiapine is not currently classified as a controlled substance, there have been a growing number of reports of the drug being abused both in American prisons and in general community settings. These accounts have included reports of both intranasal and intravenous uses. In this paper we report two cases of prisoners deliberately feigning psychotic symptoms for the purposes of obtaining quetiapine. In both cases there appears to be some evidence of psychological dependence and of a discontinuation syndrome when the medication was ceased. Our report adds support to the possibility that quetiapine has clinically relevant reinforcing properties with potential for producing both dependence and withdrawal symptoms and as such it should be re-evaluated as a drug with addictive potential and abuse risk.

Keywords:

• forensic psychiatry
• malingering
• specialist substance misuse training
• psychotic symptoms