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Long-Term High-Dose Neuroleptic Treatment: Who Gets It and Why?
Michal Kunz; Pal Czobor; Menahem I. Krakowski; Jan Volavka
Psychiatric Services 1993; doi:
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This work was partly supported by grants R29MH45454 and RO1MH41772 from the National Institute of Mental Health. The authors thank Chito Evangelista, M.D.; Barry Helfer, chief of pharmacy at the Rockland Psychiatric Center; Joseph Lobaido, chief of pharmacy at the Manhattan Psychiatric Center; and the nursing staff and psychiatrists at both hospitals for help with data acquisition and for patient assessment.

Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962

Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962; New York University Medical Center in New York City

1993 by the American Psychiatric Association

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Abstract

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 was 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.

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