I agree wholeheartedly with the points raised by your C/L psych contact. Personally, I hesitate to use quetiapine just for insomnia (I think there are cleaner ways to get histamine blockade if that's the mechanism you're shooting for), but it is far from unusual especially if it can pull double-duty (e.g., as a mood stabilizer, antipsychotic, or antidepressant augment). Insofar as it's dosed for insomnia (usually 25-50 mg), its D2 affinity is negligible. It doesn't become a respectable antipsychotic until around 300 mg for most patients. And indeed, tardive dyskinesia to the extent that it occurs at all with quetiapine (probably the second-lowest chance after clozapine) would be very unusual to present with a limp, and not orofacial or upper extremity disturbances. When it does develop, it may transiently worsen after discontinuation of the neuroleptic, but should thereafter improve as the D2 receptors' sensitivity renormalizes.
And I'll just say as a psych hospital consultant myself, if quetiapine for insomnia constitutes malpractice, then half of the patients I see in the hospital should be contacting lawyers. Yes, it's "off-label." So is trazodone, at least for insomnia. Unless Dr. M. used a bombastic dose of the stuff or straight up lied about its side effect profile, it strikes me as very tough to carry a malpractice claim on an incidental (and very suspect) side effect alone. Glad to see the jury was of similar mind.
Geeze, another example of a fine upstanding plaintiff expert witness waxing “eloquently” against well-intentioned fellow professionals. How do these people sleep at night-perhaps a bit of quetiapine…
I agree wholeheartedly with the points raised by your C/L psych contact. Personally, I hesitate to use quetiapine just for insomnia (I think there are cleaner ways to get histamine blockade if that's the mechanism you're shooting for), but it is far from unusual especially if it can pull double-duty (e.g., as a mood stabilizer, antipsychotic, or antidepressant augment). Insofar as it's dosed for insomnia (usually 25-50 mg), its D2 affinity is negligible. It doesn't become a respectable antipsychotic until around 300 mg for most patients. And indeed, tardive dyskinesia to the extent that it occurs at all with quetiapine (probably the second-lowest chance after clozapine) would be very unusual to present with a limp, and not orofacial or upper extremity disturbances. When it does develop, it may transiently worsen after discontinuation of the neuroleptic, but should thereafter improve as the D2 receptors' sensitivity renormalizes.
And I'll just say as a psych hospital consultant myself, if quetiapine for insomnia constitutes malpractice, then half of the patients I see in the hospital should be contacting lawyers. Yes, it's "off-label." So is trazodone, at least for insomnia. Unless Dr. M. used a bombastic dose of the stuff or straight up lied about its side effect profile, it strikes me as very tough to carry a malpractice claim on an incidental (and very suspect) side effect alone. Glad to see the jury was of similar mind.
I agree with Dr.Skywalker. If the psychiatrist had lost this case, I would had to pull all my patients off of low-dose quetiapine for insomnia.
Geeze, another example of a fine upstanding plaintiff expert witness waxing “eloquently” against well-intentioned fellow professionals. How do these people sleep at night-perhaps a bit of quetiapine…
I agree with the psychiatrist as well. Just a heads up the Trazodone is misspelled.