Neuroleptic-refractory patients and their drug plasma levels

The clinical, pharmacological and technical aspects of estimations of plasma concentrations of neuroleptics are discussed in the context of the treatment of the neuroleptic-refractory schizophrenic patient. A flow diagramme is suggested for the clinical analysis of schizophrenic patients who do not respond to medication. It is concluded that, in spite of the sizeable amount of research carried out in this area, no evidence is yet available that drug plasma level concentrations correlate adequately with clinical response; hence no therapeutic window has yet emerged. The reasons for this failure are mentioned. Hence it might be premature for the ordinary mental hospital to develop costly laboratory facilities to cater for this experimental advance.