(FDA approved in bold)

• Schizophrenia
  
• Bipolar disorder (depression and acute mania)
  
• Major depressive disorder (adjunctive)
  
• Psychosis in patients with Parkinson’s disease (PD) or dementia with Lewy bodies (DLB)
  
• Obsessive-compulsive disorder
  
• Autism
  
• Alcoholism
  
• Tourette syndrome
  
• Insomnia
  
• Anxiety

• Blocks D2 receptor similar to other neuroleptics, but also blocks serotonin 2A receptors, which improves motor side effects and perhaps depression and cognitive problems
  
• May also affect serotonin 1A and other receptors, contributing to efficacy for cognitive and affective symptoms in some patients

• Psychosis – may be effective in days, more commonly takes weeks or months to determine best dose and achieve best clinical effect. Usually 4–6 weeks
  
• Insomnia – may be effective immediately

• Continue to use at lowest required dose. Most patients with schizophrenia see a reduction in psychosis with quetiapine (and other neuroleptics), but some patients, including many with PD and DLB, may improve more than 50%

• Increase dose
  
• In psychosis related to PD or DLB, reduce dose or eliminate offending medications, such as dopamine agonists or amantadine
  
• If not effective consider changing to clozapine. In PD and DLB, avoid long-term use of conventional antipsychotics
  
• Insomnia: if no sedation occurs despite adequate dosing, change to another agent

• Patients with affective disorders, such as bipolar disorder, may respond to mood stabilizing anticonvulsants, lithium, or benzodiazepines. In PD and DLB, cholinesterase inhibitors may improve symptoms (particularly in DLB).

• Prior to starting treatment and periodically during treatment, monitor weight, blood pressure, lipids, and fasting glucose due to risk of metabolic syndrome