Efficacy of Dextromethorphan/Quinidine for Patients With Psychosis-Related Aggression

A Retrospective Case Series

Qi Liang Chen, Haley E. Calcagno, Mujeeb Shad

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Conclusions: These preliminary findings support dextromethorphan/quinidine as a potential alternative to conventional regimens for treating aggression and impulsive behavior in patients with psychotic disorder. These results should be interpreted cautiously, as extended, double-blinded, placebo-controlled studies with a larger sample size are needed to validate findings from this retrospective case series.

    Methods: The files of 4 inpatients with DSM-5-defined psychotic disorder and treatment-resistant aggression treated at the Oregon State Hospital (Salem, Oregon) between June and November of 2017 were retrospectively analyzed. The patients (age: mean ± SD = 59.8 ± 7.6) received open-label treatment with dextromethorphan/quinidine (final dose 20 mg/10 mg twice daily) for at least 12 weeks. Outcome was measured on the basis of patient self-report, treatment team evaluation, and physical examination by psychiatrists and primary care physicians.

    Background: Treatment-resistant aggressive behavior is a complex psychoneurological phenomenon with high health care and societal costs commonly observed in mental illnesses involving psychosis. Here, we report a preliminary evaluation of treatment with dextromethorphan/quinidine in 4 adult patients with significant history of psychosis-related aggression and impulsive behaviors.

    Results: Three of the 4 patients were considered responders to dextromethorphan/quinidine based on clinical impressions of reduction in aggression and impulsive behavior. The nonresponder, who had a history of multiple traumatic brain injuries, showed mild improvement in agitation but continued to display impulsive self-harm behavior despite treatment. Dextromethorphan/quinidine was generally well-tolerated. No metabolic, gastrointestinal, or cardiovascular side effects were observed.

    Original languageEnglish (US)
    JournalThe primary care companion for CNS disorders
    Volume20
    Issue number3
    DOIs
    StatePublished - Jun 28 2018

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    Dextromethorphan
    Quinidine
    Aggression
    Psychotic Disorders
    Impulsive Behavior
    Therapeutics
    Brain Concussion
    State Hospitals
    Primary Care Physicians
    Health Care Costs
    Sample Size
    Self Report
    Physical Examination
    Psychiatry
    Inpatients
    Placebos

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    Efficacy of Dextromethorphan/Quinidine for Patients With Psychosis-Related Aggression : A Retrospective Case Series. / Chen, Qi Liang; Calcagno, Haley E.; Shad, Mujeeb.

    In: The primary care companion for CNS disorders, Vol. 20, No. 3, 28.06.2018.

    Research output: Contribution to journalArticle

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    abstract = "Conclusions: These preliminary findings support dextromethorphan/quinidine as a potential alternative to conventional regimens for treating aggression and impulsive behavior in patients with psychotic disorder. These results should be interpreted cautiously, as extended, double-blinded, placebo-controlled studies with a larger sample size are needed to validate findings from this retrospective case series.Methods: The files of 4 inpatients with DSM-5-defined psychotic disorder and treatment-resistant aggression treated at the Oregon State Hospital (Salem, Oregon) between June and November of 2017 were retrospectively analyzed. The patients (age: mean ± SD = 59.8 ± 7.6) received open-label treatment with dextromethorphan/quinidine (final dose 20 mg/10 mg twice daily) for at least 12 weeks. Outcome was measured on the basis of patient self-report, treatment team evaluation, and physical examination by psychiatrists and primary care physicians.Background: Treatment-resistant aggressive behavior is a complex psychoneurological phenomenon with high health care and societal costs commonly observed in mental illnesses involving psychosis. Here, we report a preliminary evaluation of treatment with dextromethorphan/quinidine in 4 adult patients with significant history of psychosis-related aggression and impulsive behaviors.Results: Three of the 4 patients were considered responders to dextromethorphan/quinidine based on clinical impressions of reduction in aggression and impulsive behavior. The nonresponder, who had a history of multiple traumatic brain injuries, showed mild improvement in agitation but continued to display impulsive self-harm behavior despite treatment. Dextromethorphan/quinidine was generally well-tolerated. No metabolic, gastrointestinal, or cardiovascular side effects were observed.",
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