Prescribing Practices of Quetiapine for Insomnia at a Tertiary Care Inpatient Child and Adolescent Psychiatry Unit: A Continuous Quality Improvement Project.

OBJECTIVE To examine the prescribing practices of quetiapine for insomnia at a tertiary care child and adolescent psychiatric inpatient unit. METHOD A retrospective chart review was conducted on all admissions in 2013 involving night-time only prescription of quetiapine. We examined patient demographics, discharge diagnoses, physician's written indications for prescriptions, and maximum doses used. If used for insomnia only, we noted any documentation of past sedative trials, concurrent prescriptions of other sedative agents, whether quetiapine was started in hospital or continued as a part of a community regimen, and whether quetiapine was continued on discharge. RESULTS Of 720 admissions, 83 (11.5%) involved the prescription of night-time only quetiapine, and 47 of the 83 (57%) were for insomnia only. Of patients prescribed quetiapine for insomnia only, most common discharge diagnoses were anxiety disorder (35%), depressive disorder (27%), eating disorder (27%), and Cluster B/borderline personality traits/disorder (25%). Mean age was 15.4 years; mean maximum dose was 41.2 mg. Quetiapine was often started during admission (89.5%) and continued on discharge (66%). About 40% of these cases involved concurrent prescription of other sedative agents. Most patients (81%) had no documented history of prior sedative trials. CONCLUSIONS Quetiapine is used not infrequently for the management of insomnia in adolescents in tertiary mental health settings. We highlight the nuances associated with the prescription of quetiapine for the treatment of insomnia in the unique setting of the child and adolescent psychiatric inpatient unit, emphasizing the importance of weighing short-term use with potential long-term adverse consequences if continued in the community setting.