Psychotic exacerbation with haloperidol

A case illustrating the worsening of a patient's schizophrenic symptoms following haloperidol dosage increases in presented. This case is remarkable in that few cases of psychotic exacerbation with haloperidol dosage increases have been reported in the world literature. The possibility exists that, like certain tricyclic antidepressants, neuroleptic medication may possess a "therapeutic window,". The concept of a therapeutic window and its relationship to the phenomenon of psychotic exacerbation is reviewed. In evaluating this condition, the clinician should consider other causes of psychotic exacerbation, such as akathisia and anticholinergic psychosis.