Long-term high-dose neuroleptic treatment: who gets it and why?
OBJECTIVE
High doses of neuroleptic medication are still administered to many patients, although many studies have shown the effectiveness of low-dose strategies. The purposes of the study were to determine whether and in what ways high-dose patients differed from patients on regular dosages and whether the higher dosages were more effective.


METHODS
In a case-control study at two large state hospitals, 38 high-dose patients were compared with 29 regular-dose patients.


RESULTS
The high-dose patients had a persistent course of illness, with severe chronic symptoms resulting in hospitalizations of much longer duration than those of the regular-dose patients. The high-dose patients evidenced more regressed functioning and were more violent. To control these behaviors, clinicians increased neuroleptic dosages.


CONCLUSIONS
The high-dose patients represented a subgroup of chronic regressed and violent patients. Clinicians prescribed high dosages and continued to use them despite a lack of clear evidence that such treatment is effective.
Krakowski
M I
MI
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962.
Kunz
M
M
Czobor
P
P
Volavka
J
J
D000341:Affective Disorders, Psychotic / Q000188:drug therapy / Q000523:psychology; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects; D006778:Hospitals, Psychiatric / Q000592:standards* / Q000706:statistics & numerical data; D006783:Hospitals, State / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D012043:Regression, Psychology; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome; D014754:Violence; D000092864:Suicide Prevention
D014150:Antipsychotic Agents; D006220:Haloperidol