Quetiapine use in a patient with chronic schizophrenia and severe parkinsonism

A 52-year-old patient with treatment-resistant paranoid schizophrenia developed severe parkinsonian features after more than 20 years of antipsychotic drug therapy. The role of this therapy was thought to have been a contributing factor to the patient's clinical presentation, although Parkinson's disease could not be ruled out. Originally, parkinsonian symptoms developed acutely and progressed to hand tremor, sialorrhea, upper body rigidity, masked facies, striatal hand, bradykinesia, and a severe, unsteady, shuffling gait. Tremor and rigidity were the only parkinsonian symptoms that responded to anticholinergic therapy. After converting from a first- to a second-generation antipsychotic drug, the patient maintained psychiatric stability, with some improvement in motor functioning-most notably decreased upper body rigidity. Our findings are consistent with the literature on quetiapine therapy in patients with Parkinson's disease in terms of adequately controlling psychosis without worsening motor symptoms. The difference, however, was that in most cases reported, psychotic features were the result of dopamine-enhancing treatments and not schizophrenia.