What are the next steps for a patient experiencing ongoing auditory hallucinations (AV hallucinations) while being treated with Seroquel (quetiapine)?

From the Guidelines

For a patient experiencing ongoing auditory hallucinations while on Seroquel (quetiapine), the next steps should include a comprehensive medication review and possible adjustment of the treatment plan, prioritizing the patient's morbidity, mortality, and quality of life as the primary outcome. The psychiatrist should first evaluate the current quetiapine dosage, as subtherapeutic doses may be insufficient to control psychotic symptoms. For psychosis, quetiapine doses typically range from 400-800 mg daily, and some patients require higher doses 1. If the patient is already on an adequate dose, adding a different antipsychotic medication might be beneficial, such as risperidone (2-6 mg daily) or olanzapine (10-20 mg daily) 1. Clozapine (starting at 12.5 mg and gradually increasing) could be considered for treatment-resistant cases, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1.

Some key points to consider in the treatment plan include:

• Assessing medication adherence and ruling out substance use that might exacerbate symptoms
• Evaluating for other medical causes of hallucinations
• Considering psychosocial interventions like cognitive behavioral therapy for psychosis (CBTp) to complement pharmacological treatment
• Regular follow-up appointments to monitor symptom changes and medication side effects
• Prioritizing the patient's physical health, including monitoring for potential side effects of antipsychotic medications, such as weight gain, diabetes, and hyperlipidemia 1

The goal of treatment is to reduce the patient's morbidity, mortality, and significant psychosocial and health consequences of schizophrenia, while also improving their quality of life 1. By taking a comprehensive and patient-centered approach, clinicians can help patients with schizophrenia achieve the best possible outcomes.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Next Steps for Patient with Ongoing Auditory Hallucinations

• The patient is currently being treated with Seroquel (quetiapine) and still experiencing auditory hallucinations (AV hallucinations), which suggests that the treatment may not be fully effective 2.
• One potential next step is to consider alternative antipsychotic medications, as some patients may respond better to different drugs 3.
• However, switching to another antipsychotic may not always be effective, and close monitoring of the patient's condition is necessary to determine the best course of action 3.
• Another approach is to consider non-pharmacological interventions, such as transcranial direct current stimulation (tDCS), which has shown promise in reducing auditory hallucinations in patients with schizophrenia 4.
• Relational-based therapies, such as Relating Therapy and Avatar Therapy/Virtual Reality assisted Therapy, have also shown positive effects in reducing auditory hallucinations and voice-related distress in patients with psychotic disorders 5.
• Further evaluation of the patient's condition and discussion with a healthcare professional are necessary to determine the most appropriate next steps for treatment.

Considerations for Treatment

• The patient's response to Seroquel (quetiapine) should be closely monitored, and adjustments to the treatment plan should be made as needed 2.
• The potential benefits and risks of alternative antipsychotic medications should be carefully considered, including the risk of hematologic toxicity 3.
• Non-pharmacological interventions, such as tDCS, may be considered as an adjunct to pharmacological treatment or as a alternative treatment option 4.
• Relational-based therapies may be a useful addition to the treatment plan, particularly for patients who are resistant to pharmacological interventions 5.