title: A rational approach to employing high plasma levels of antipsychotics for violence associated with schizophrenia: case vignettes.
abstract: Forensic psychiatric settings contain a high prevalence of treatment-resistant violent schizophrenia patients. Clozapine therapy has the most robust data for the management of violence in patients with schizophrenia, but for those who cannot tolerate or refuse clozapine, high-dose antipsychotic treatment to high achieve high plasma levels remains a viable option despite limited evidence for efficacy in controlled trials. This article enumerates rational guidelines for employing high plasma level strategies, emphasizing the appropriate interpretation of, and reaction to high plasma antipsychotic levels in these treatment resistant patients, and the need to push treatment to the limits of tolerability or clinical response.
authors.affiliation: California Department of State Hospitals,Patton,California,USA;Mental Health Intensive Case Management,VA San Diego Healthcare System,San Diego,California,USA;University of California,San Diego,San Diego,California,USA;Loma Linda University,California,USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Meyer
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000097:blood; D016903:Drug Monitoring; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D017211:Treatment Failure; D014754:Violence / Q000517:prevention & control* / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol