Antipsychotic dosing strategies in acute schizophrenia

Determining the optimal dose of antipsychotic for an acute schizophrenic episode has been an elusive goal. Empirical dose adjustment with conventional neuroleptics has generally led to excessive drug exposure, in part due to the lag time between initiation of therapy and response and in part due to the indefinite nature of the response. Data from dose- and plasma concentration-response studies and from imaging studies have provided some guidance. In particular, newer antipsychotic drugs such as risperidone and sertindole have been evaluated in multiple fixed-dose designs to determine the optimal dose or dose range. To devise an overall treatment strategy for an acute psychotic episode, we reviewed and incorporated data from a number of controlled studies.