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.