This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Ross J. Baldessarini, MD; Bruce M. Cohen, MD, PhD; Martin H. Teicher, MD, PhD

Arch Gen Psychiatry. 1988;45(1):79-91.

Abstract
• The clinical use of antipsychotic agents may be enhanced by considering their dose-effect characteristics. In particular, assessment of immediate and later follow-up treatment of psychotic patients (1) indicates that moderate doses are adequate for most patients, (2) fails to support the utility of unusually high doses, and (3) even suggests the existence of a biphasic relationship of antipsychotic efficacy to dose of neuroleptics and possibly to plasma concentrations of the drugs as well. Trends toward lesser overall clinical benefits of high doses may reflect untoward extrapyramidal or other central nervous system effects leading to behavioral and cognitive symptoms. Thus, moderate doses of neuroleptics appear, on average, to be about as effective as, and probably safer than, the larger doses that have been popular in the United State in recent years.

Author Affiliations
From the Department of Psychiatry and the Neuroscience Program, Harvard Medical School, and the Department of Psychiatry, Massachusetts General Hospital, Boston; and the Department of Psychiatry and the Mailman Research Center, McLean Hospital, Belmont, Mass.

Footnotes
Accepted for publication Nov 12, 1986.

Reprint requests to Mailman Research Center, McLean Hospital, 115 Mill St, Belmont, MA 02178 (Dr Baldessarini).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Historical perspective on antipsychotic long-acting injections
Johnson
Br. J. Psychiatry 2009;195:S7-S12.
ABSTRACT | FULL TEXT  

Cognitive-behavioural therapy for severe mental disorders: back to the future?
Scott
Br. J. Psychiatry 2008;192:401-403.
ABSTRACT | FULL TEXT  

What CATIE Did: Some Thoughts on Implications Deep and Wide
Owens
Psychiatr. Serv. 2008;59:530-533.
ABSTRACT | FULL TEXT  

How CATIE brought us back to Kansas: a critical re-evaluation of the concept of atypical antipsychotics and their place in the treatment of schizophrenia
Owens
Adv. Psychiatr. Treat. 2008;14:17-28.
ABSTRACT | FULL TEXT  

Can't Get Enough of That Dopamine
Cohen and Carlezon
Am. J. Psychiatry 2007;164:543-546.
FULL TEXT  

New antipsychotic agents are much awaited.
Chakraborti
BMJ 2006;332:1511-1511.
FULL TEXT  

Establishing a dose-response relationship for oral risperidone in relapsed schizophrenia
Ezewuzie and Taylor
J Psychopharmacol 2006;20:86-90.
ABSTRACT  

Rational pharmacotherapy in early psychosis
REMINGTON
Br. J. Psychiatry 2005;187:s77-s84.
ABSTRACT | FULL TEXT  

Why aren't depot antipsychotics prescribed more often and what can be done about it?
Patel and David
Adv. Psychiatr. Treat. 2005;11:203-211.
ABSTRACT | FULL TEXT  

Construct Validity of the Animal Latent Inhibition Model of Selective Attention Deficits in Schizophrenia
Lubow
Schizophr Bull 2005;31:139-153.
ABSTRACT | FULL TEXT  

Use of Electronic Medical Record Data for Quality Improvement in Schizophrenia Treatment
Owen et al.
J. Am. Med. Inform. Assoc. 2004;11:351-357.
ABSTRACT | FULL TEXT  

Long-Term K+ Channel-Mediated Dampening of Dopamine Neuron Excitability by the Antipsychotic Drug Haloperidol
Hahn et al.
J. Neurosci. 2003;23:10859-10866.
ABSTRACT | FULL TEXT  

Recent Developments in Pharmacotherapy for the Acutely Psychotic Patient
Daniel
J Am Psychiatr Nurses Assoc 2002;8:S40-S47.
 

Inpatient Antipsychotic Drug Use in 1998, 1993, and 1989
Centorrino et al.
Am. J. Psychiatry 2002;159:1932-1935.
ABSTRACT | FULL TEXT  

A 23-Year-Old Man With Schizophrenia
Goff
JAMA 2002;287:3249-3257.
FULL TEXT  

Prevention of Relapse in Schizophrenia
Curtin et al.
NEJM 2002;346:1412-1413.
FULL TEXT  

Clinical Experience and Prescribing Practices
Fleishman
Psychiatr. Serv. 2002;53:631-632.
FULL TEXT  

Interaction of Dopamine D1 and NMDA Receptors Mediates Acute Clozapine Potentiation of Glutamate EPSPs in Rat Prefrontal Cortex
Chen and Yang
J. Neurophysiol. 2002;87:2324-2336.
ABSTRACT | FULL TEXT  

A Double-blind, Placebo-Controlled Dose-Response Comparison of Intramuscular Olanzapine and Haloperidol in the Treatment of Acute Agitation in Schizophrenia
Breier et al.
Arch Gen Psychiatry 2002;59:441-448.
ABSTRACT | FULL TEXT  

Delays in Adopting Evidence-Based Dosages of Conventional Antipsychotics
Valenstein et al.
Psychiatr. Serv. 2001;52:1242-1244.
ABSTRACT | FULL TEXT  

Determining the optimal dose of haloperidol in first-episode psychosis
Oosthuizen et al.
J Psychopharmacol 2001;15:251-255.
ABSTRACT  

High dose neuroleptics -- who gives them and why?
Wilkie et al.
Psychiatr. Bull. 2001;25:179-183.
ABSTRACT | FULL TEXT  

The differential effects of chlorpromazine and haloperidol on latent inhibition in healthy volunteers
McCartan et al.
J Psychopharmacol 2001;15:96-104.
ABSTRACT  

Antipsychotic Dosing Patterns for Schizophrenia in Three Treatment Settings
Remington et al.
Psychiatr. Serv. 2001;52:96-98.
ABSTRACT | FULL TEXT  

Low dose typical antipsychotics - a brief evaluation
Taylor
Psychiatr. Bull. 2000;24:465-468.
FULL TEXT  

Double-Blind Study of Clozapine Dose Response in Chronic Schizophrenia
Simpson et al.
Am. J. Psychiatry 1999;156:1744-1750.
ABSTRACT | FULL TEXT  

Induction of NF-kappa B Activity during Haloperidol-Induced Oxidative Toxicity in Clonal Hippocampal Cells: Suppression of NF-kappa B and Neuroprotection by Antioxidants
Post et al.
J. Neurosci. 1998;18:8236-8246.
ABSTRACT | FULL TEXT  

Review: chlorpromazine reduces relapse but increases adverse events in schizophrenia
Barnes
Evid. Based Ment. Health 1998;1:83-83.
FULL TEXT  

Psychopharmacological Treatment of Schizophrenia: What Social Workers Need to Know
Bentley
Research on Social Work Practice 1998;8:384-405.
ABSTRACT  

Medication Removal and Research in Psychotic Disorders
Baldessarini et al.
Arch Gen Psychiatry 1998;55:281-283.
FULL TEXT  

Clozapine and Haloperidol Modulate N-Methyl-D-aspartate- and Non-N-Methyl-D-aspartate Receptor-Mediated Neurotransmission in Rat Prefrontal Cortical Neurons In Vitro
Arvanov et al.
J. Pharmacol. Exp. Ther. 1997;283:226-234.
ABSTRACT | FULL TEXT  

Clinical Risk Following Abrupt and Gradual Withdrawal of Maintenance Neuroleptic Treatment
Viguera et al.
Arch Gen Psychiatry 1997;54:49-55.
ABSTRACT  

The drug treatment of patients with schizophrenia
DTB 1995;33:81-86.
ABSTRACT | FULL TEXT  

Plasma Haloperidol Levels and Clinical Effects in Schizophrenia and Schizoaffective Disorder
Volavka et al.
Arch Gen Psychiatry 1995;52:837-845.
ABSTRACT  

Risk of Tardive Dyskinesia in Older Patients: A Prospective Longitudinal Study of 266 Outpatients
Jeste et al.
Arch Gen Psychiatry 1995;52:756-765.
ABSTRACT  

Neuroleptic Withdrawal in Schizophrenic Patients
Baldessarini et al.
Arch Gen Psychiatry 1995;52:189-192.
ABSTRACT  

The effects of remoxipride and chlorpromazine on eye movements and psychomotor performance in healthy volunteers
King et al.
J Psychopharmacol 1995;9:143-149.
ABSTRACT  

Effects of Limiting Medicaid Drug-Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia
Soumerai et al.
NEJM 1994;331:650-655.
ABSTRACT | FULL TEXT  

Lower-Dose Therapy With Traditional Neuroleptics in Chronically Hospitalized Schizophrenic Patients
Smith
Arch Gen Psychiatry 1994;51:427-429.
ABSTRACT  

Progress in Psychiatry- First of Two Parts
Michels and Marzuk
NEJM 1993;329:552-560.
FULL TEXT  

Clinical and Biologic Response to Clozapine in Patients With Schizophrenia: Crossover Comparison With Fluphenazine
Pickar et al.
Arch Gen Psychiatry 1992;49:345-353.
ABSTRACT  

Haloperidol Blood Levels and Clinical Effects
Volavka et al.
Arch Gen Psychiatry 1992;49:354-361.
ABSTRACT  

Acute Extrapyramidal Syndromes in Neuroleptic-Treated Elders: A Pilot Study
Ganzini et al.
J Geriatr Psychiatry Neurol 1991;4:222-225.
ABSTRACT  

Optimal Dose of Neuroleptic in Acute Schizophrenia: A Controlled Study of the Neuroleptic Threshold and Higher Haloperidol Dose
McEvoy et al.
Arch Gen Psychiatry 1991;48:739-745.
ABSTRACT  

Dosage of Haloperidol for Schizophrenia
Rifkin et al.
Arch Gen Psychiatry 1991;48:166-170.
ABSTRACT  

A Controlled Dose Comparison of Haloperidol in Newly Admitted Schizophrenic Patients
Van Putten et al.
Arch Gen Psychiatry 1990;47:754-758.
ABSTRACT  

Fluphenazine Dose, Clinical Response, and Extrapyramidal Symptoms During Acute Treatment
Levinson et al.
Arch Gen Psychiatry 1990;47:761-768.
ABSTRACT  

Risk Factors for Neuroleptic Malignant Syndrome: A Case-Control Study
Keck et al.
Arch Gen Psychiatry 1989;46:914-918.
ABSTRACT  

Antidepressants in 'Depressed' Schizophrenic Inpatients: A Controlled Trial
Kramer et al.
Arch Gen Psychiatry 1989;46:922-928.
ABSTRACT  

Psychiatry
Glass and Freedman
JAMA 1989;261:2883-2885.
ABSTRACT  

Dopamine Receptor Occupancy and Plasma Haloperidol Levels
Wolkin et al.
Arch Gen Psychiatry 1989;46:482-483.
ABSTRACT  

Atypical Neuroleptics, Dose-Response Relationships, and Treatment-Resistant Psychosis
Cohen et al.
Arch Gen Psychiatry 1989;46:381-383.
ABSTRACT  

Who Should Receive Clozapine?
Marder and Van Putten
Arch Gen Psychiatry 1988;45:865-867.
ABSTRACT