Quetiapine

證據等級: L5

預測適應症: 10 個

Quetiapine: From Psychiatric Disorders to Trichotillomania

One-Sentence Summary

Quetiapine is an atypical antipsychotic (D2/5-HT2A/H1/α1 receptor antagonist) internationally approved for schizophrenia, bipolar disorder, and adjunctive major depressive disorder. Among the ten TxGNN-predicted indications reviewed, Trichotillomania (hair-pulling disorder) is the only candidate supported by drug-specific evidence — 7 publications describing quetiapine use in this condition, though no clinical trials have been registered. The nine other top-ranked predictions (including the raw #1 hit, “retinal dystrophy with or without extraocular anomalies”) were reviewed and found to have no mechanistic plausibility and no drug-specific literature; they are flagged in the evidence pack itself as likely knowledge-graph embedding artifacts and are not carried forward in this report.

Quick Overview

Item	Content
Original Indication	Not registered in South Africa (0 SAHPRA licenses on file); internationally approved for schizophrenia, bipolar disorder, adjunctive MDD
Predicted New Indication	Trichotillomania
TxGNN Prediction Score	99.38%
Evidence Level	L4
South Africa Market Status	Not Marketed
Number of SAHPRA Registrations	0
Recommended Decision	Hold

Why is This Prediction Reasonable?

Quetiapine is a D2/5-HT2A/H1/α1 receptor antagonist. This receptor profile is the pharmacological basis for its established use in psychotic and mood disorders, and it is also the theoretical rationale proposed in the literature for modulating impulse-control circuitry (orbitofrontal–striatal–thalamic loop) implicated in trichotillomania and related obsessive-compulsive-spectrum conditions.

Trichotillomania sits in the same OCD-spectrum/impulse-control family that atypical antipsychotics have been explored for as adjunctive therapy, which is consistent with why this candidate — unlike the other nine TxGNN hits reviewed — has an identifiable clinical rationale and a body of case-level literature specifically naming quetiapine.

By contrast, the raw top-ranked TxGNN prediction (“retinal dystrophy with or without extraocular anomalies,” score 99.57%) and seven of the remaining eight candidates (congenital glycosylation disorder, hydranencephaly, 17p13.3 microdeletion syndrome, polymicrogyria syndromes, X-linked/syndromic myopias, Charcot-Marie-Tooth disease) are structural, chromosomal, or developmental disorders with no pharmacologically reversible target and no literature mentioning quetiapine at all — the retrieved “literature” for the #1 candidate is keyword-coincidence noise (orbital infections, diplopia, congenital ptosis) rather than actual evidence. These were excluded from this report as non-actionable model artifacts, per the evidence pack’s own rationale annotations.

Clinical Trial Evidence

Currently no related clinical trials registered.

Literature Evidence

PMID	Year	Type	Journal	Key Findings
38797877	2025	Review	International Journal of Dermatology	Large-scale review noting lack of consensus treatment guidelines for trichotillomania; pharmacological education gap among prescribers
17484394	2006	Review	The Journal of Practical Nursing	General treatment overview of trichotillomania
12405081	2002	Case Series/Overview	Psychiatry	Overview of trichotillomania pharmacotherapy; case of a 33-year-old woman with favorable clinical response to quetiapine
20833945	2010	Case Report	Psychosomatics	Case report and literature review of recurrent Rapunzel syndrome (trichobezoar) associated with trichotillomania
27840761	2016	Case Report	Case Reports in Psychiatry	Trichotillomania presenting as a manifestation of dementia; neural correlates and treatment poorly characterized
11212595	2001	Case Report	Journal of Psychiatry & Neuroscience	First reported case of quetiapine exacerbating obsessive-compulsive symptoms in a patient with comorbid OCD, trichotillomania, delusional disorder, and bipolar disorder — a cautionary counter-signal
19142421	2008	Case Report	Revista Brasileira de Psiquiatria	Case report of quetiapine used for treatment of trichotillomania

Note: evidence is exclusively case-report/case-series level (Tier 3), with one report (PMID 11212595) describing symptom exacerbation rather than benefit — the signal is mixed, not uniformly positive.

South Africa Market Information

No SAHPRA registration records are available in this evidence pack (0 licenses on file; market status: Not Marketed). Registration status for quetiapine generally in South Africa should be verified directly against the SAHPRA product register before any clinical use is considered for this indication.

Safety Considerations

Please refer to the SAHPRA-approved Professional Information (PI) for safety information. Report adverse drug reactions to SAHPRA.

A blocking data gap was identified: PI warnings/contraindications for this candidate could not be retrieved, which prevents a formal safety pre-assessment (S1 stage) from being completed.

Conclusion and Next Steps

Decision: Hold

Rationale:

Evidence for trichotillomania is limited to case reports/case series (L4) with no controlled trials, and includes at least one report of symptom worsening rather than improvement — the signal is directionally interesting but not yet actionable.
A blocking data gap (missing PI warnings/contraindications) prevents even a preliminary safety assessment from being completed.

To proceed, the following is needed:

Retrieve PI/label warnings and contraindications for quetiapine (currently blocking — DG001)
Confirm mechanism-of-action data from DrugBank to formally support the impulse-control rationale (DG002)
A prospective case series or pilot RCT in trichotillomania to resolve the mixed case-report signal (benefit vs. exacerbation)
Verify current SAHPRA registration status directly, since this evidence pack shows 0 licenses on file
Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.