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Long-term high-dose neuroleptic treatment: who gets it and why?
M I Krakowski1, M Kunz, P Czobor
1Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962.
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.