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?

A Controlled Study of the Neuroleptic Threshold and Higher Haloperidol Dose

Joseph P. McEvoy, MD; Gerard E. Hogarty, MSW; Sandra Steingard, MD

Arch Gen Psychiatry. 1991;48(8):739-745.

Abstract
• After individual determination of neuroleptic threshold (NT) doses of haloperidol, 106 patients with schizophrenia or schizoaffective disorder (Research Diagnostic Criteria) were treated openly at such doses (mean, 3.7± 2.3 mg/d) for 2 weeks. Ten responding patients were discharged and unavailable for follow-up or refused subsequent randomization, and one nonresponding patient refused randomization. The remaining 95 responding or nonresponding patients were then randomly assigned, double-blind, to a dosage of haloperidol two to 10 times higher (mean, 11.6 ±4.7 mg/d) or to a continuing NT dosage (mean, 3.4±2.3 mg/d) for another 2 weeks. Of the 58 patients exposed only to NT dosages of haloperidol, 72% clinically recovered within the 5-week trial. Higher dosages given to 47 patients did not lead to greater improvement in measures of psychosis, but did produce slightly greater declines in measures of hostility. Higher dosages did regularly lead to significant increases in distressing extrapyramidal side effects.

Author Affiliations
From the Department of Psychiatry, Duke University Medical Center, John Umstead Hospital, Butner, NC (Dr McEvoy); and Department of Psychiatry, University of Pittsburgh (Pa), Western Psychiatric Institute and Clinic (Mr Hogarty and Dr Steingard).

Footnotes
Accepted for publication July 20, 1990.

Reprint requests to Department of Psychiatry, Duke University Medical Center, John Umstead Hospital, Butner, NC 27509 (Dr McEvoy).

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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effects of Second-Generation Antipsychotic Medication on Smooth Pursuit Performance in Antipsychotic-Naive Schizophrenia
Lencer et al.
Arch Gen Psychiatry 2008;65:1146-1154.
ABSTRACT | FULL TEXT  

A Preliminary Attempt to Personalize Risperidone Dosing Using Drug-Drug Interactions and Genetics: Part II
de Leon et al.
Psychosomatics 2008;49:347-361.
FULL TEXT  

Oculomotor and Neuropsychological Effects of Antipsychotic Treatment for Schizophrenia
Hill et al.
Schizophr Bull 2008;34:494-506.
ABSTRACT | FULL TEXT  

Has Research Informed Us on the Practical Drug Treatment of Schizophrenia?
Davis and Leucht
Schizophr Bull 2008;34:403-405.
FULL TEXT  

Insight and treatment attitude in schizophrenia: comparison of patients on depot and atypical antipsychotics
Mahadun and Marshall
Psychiatr. Bull. 2008;32:53-56.
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  

Efficacy and Tolerability of Olanzapine, Quetiapine, and Risperidone in the Treatment of Early Psychosis: A Randomized, Double-Blind 52-Week Comparison
McEvoy et al.
Am. J. Psychiatry 2007;164:1050-1060.
ABSTRACT | FULL TEXT  

Adverse effects of risperidone on spatial working memory in first-episode schizophrenia.
Reilly et al.
Arch Gen Psychiatry 2006;63:1189-1197.
ABSTRACT | FULL TEXT  

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

Risperidone and Haloperidol in First-Episode Psychosis: A Long-Term Randomized Trial
Schooler et al.
Am. J. Psychiatry 2005;162:947-953.
ABSTRACT | FULL TEXT  

Medication Adherence Among Psychotic Patients Before Admission to Inpatient Treatment
Rittmannsberger et al.
Psychiatr. Serv. 2004;55:174-179.
ABSTRACT | FULL TEXT  

Delayed Onset of Oculogyric Crisis and Torticollis with Intramuscular Haloperidol
Jhee et al.
The Annals of Pharmacotherapy 2003;37:1434-1437.
ABSTRACT | FULL TEXT  

Antipsychotic Dosage at Hospital Discharge and Outcomes Among Persons With Schizophrenia
Sohler et al.
Psychiatr. Serv. 2003;54:1258-1263.
ABSTRACT | FULL TEXT  

Comparative Efficacy and Safety of Atypical and Conventional Antipsychotic Drugs in First-Episode Psychosis: A Randomized, Double-Blind Trial of Olanzapine Versus Haloperidol
Lieberman et al.
Am. J. Psychiatry 2003;160:1396-1404.
ABSTRACT | FULL TEXT  

Comparative Effectiveness of Antipsychotic Drugs
ADITYANJEE
Am. J. Psychiatry 2003;160:590-591.
FULL TEXT  

Subjective Experience and D2 Receptor Occupancy in Patients With Recent-Onset Schizophrenia Treated With Low-Dose Olanzapine or Haloperidol: A Randomized, Double-Blind Study
de Haan et al.
Am. J. Psychiatry 2003;160:303-309.
ABSTRACT | FULL TEXT  

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

Low dose typical antipsychotics -- a brief evaluationAuthor's reply
Oosthuizen et al.
Psychiatr. Bull. 2001;25:194-194.
FULL TEXT  

Antipsychotic Drugs: Importance of Dopamine Receptors for Mechanisms of Therapeutic Actions and Side Effects
Strange
Pharmacol. Rev. 2001;53:119-134.
ABSTRACT | FULL TEXT  

Conventional and Atypical Antipsychotics and the Evolving Standard of Care
Mossman and Lehrer
Psychiatr. Serv. 2000;51:1528-1535.
ABSTRACT | FULL TEXT  

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

Cognitive-behavioural techniques for general psychiatrists in the management of patients with psychoses
TURKINGTON and KINGDON
Br. J. Psychiatry 2000;177:101-106.
ABSTRACT | FULL TEXT  

First-Episode Psychosis in a Managed Care Setting: Clinical Management and Research
Jarskog et al.
Am. J. Psychiatry 2000;157:878-884.
FULL TEXT  

Relationship Between Dopamine D2 Occupancy, Clinical Response, and Side Effects: A Double-Blind PET Study of First-Episode Schizophrenia
Kapur et al.
Am. J. Psychiatry 2000;157:514-520.
ABSTRACT | FULL TEXT  

Chlorpromazine equivalents and percentage of British National Formulary maximum recommended dose in patients receiving high-dose antipsychotics
Yorston and Pinney
Psychiatr. Bull. 2000;24:130-132.
ABSTRACT | FULL TEXT  

Persistence of Haloperidol in Human Brain Tissue
Kornhuber et al.
Am. J. Psychiatry 1999;156:885-890.
ABSTRACT | FULL TEXT  

APA Practice Guideline for Schizophrenia: Risperidone Equivalents
REMINGTON et al.
Am. J. Psychiatry 1998;155:1301a-1302.
FULL TEXT  

5-HT2 and D2 Receptor Occupancy of Olanzapine in Schizophrenia: A PET Investigation
Kapur et al.
Am. J. Psychiatry 1998;155:921-928.
ABSTRACT | FULL TEXT  

Haloperidol Plasma Levels and Dose Optimization
Coryell et al.
Am. J. Psychiatry 1998;155:48-53.
ABSTRACT | FULL TEXT  

Olanzapine on Trial
Capehart and Holsinger
Am. J. Psychiatry 1998;155:152-152.
FULL TEXT  

Risperidone in the treatment of schizophrenia: a meta-analysis of randomized controlled trials
Fujian Song
J Psychopharmacol 1997;11:65-71.
ABSTRACT  

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

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

Early Detection of Neuroleptic-Induced Parkinsonism in Elderly Patients with Dementia
Sweet et al.
J Geriatr Psychiatry Neurol 1994;7:251-253.
ABSTRACT  

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