Sleepwalking in four patients treated with quetiapine.

Sleepwalking (SW), also known as somnambulism, is characterized by episodes of complex motor behavior initiated during sleep, including rising from bed and walking about. It tends to occur between the ages of 4 and 8 and is likely to dissipate in adolescence. It occurs in 2-14% of children and 1.6-2.4% of adults (Remulla & Guilleminault 2004). SW occurs during the first third of the night, during non REM stages 3 and 4 of sleep. Throughout the various episodes, the individual has reduced alertness and responsiveness, a blank stare, and unresponsiveness to communication with others or to efforts to be awakened by others. On awakening, the individual has limited recall for those events of the episode and may be confused for a short period of time (American Psychiatric Association 2000). Most behaviors during SW are routine and of low complexity. However, also complex and dangerous behaviors, including screaming, running, and physical aggression, may occur (Bassetti et al. 2000). The disorder runs in families and does have a strong genetic basis, although the mode of inheritance is still unknown (American Psychiatric Association 2000). SW induced by medication has been reported for hypnotics (zolpidem, (Mendelson 1994, Harazin & Berigan 1999, Yanes Baonza et al. 2003, Sharma & Dewan 2005, Yang et al. 2005), zolpidem in combination with valproic acid (Sattar et al. 2003)), antipsychotics (perphenazine (Huapaya 1979), olanzapine (Kolivakis et al. 2001, Chiu et al. 2008), quetiapine (Hafeez & Kalinowski 2007, Seeman, 2010)), lithium (Landry & Montplaisir 1998), lithium in combination with neuroleptics (Charney et al. 1979, Glassman et al. 1986), antidepressants (amitriptyline (Huapaya 1979), bupropion (Khazaal et al. 2003, Oulis et al. 2010), mirtazapine (Yeh et al. 2009), paroxetine (Kawashima & Yamada 2003), reboxetine (Künzel et al. 2004)), benzodiazepines (Lauerma 1991), diphenhydramine (Huapaya 1979), methaqualone (Huapaya 1979) and topiramate (Varkey & Varkey 2003). Since SW occurs out of slow wave sleep, the increase in slow wave sleep induced by lithium and certain neuroleptics, e.g. clozapine and olanzapine (Salin-Pascual et al. 1999, Sharpley et al. 2000, Cohrs 2008), may represent a favoring neurophysiological mechanism (Charney et al. 1979). As far as we know, (PUBMED, June 2012), SW associated with quetiapine treatment has solely been reported by Hafeez & Kalinowski (2007) in 2 patients, one affected by schizoaffective disorder and one by pervasive developmental disorder (both patients were also affected by attention-deficit/hyperactivity disorder (ADHD)) as well as by Seeman (2011) in 1 patient, affected by schizophrenia. Hereafter, you will be told of four patients who presented SW during treatment with quetiapine, for the first time in their life.