Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-15T15:59:14.839Z Has data issue: false hasContentIssue false
  • English
  • Français

A rational approach to employing high plasma levels of antipsychotics for violence associated with schizophrenia: case vignettes

Published online by Cambridge University Press:  27 May 2014

Jonathan M. Meyer
Jonathan M. Meyer*
Affiliation:
California Department of State Hospitals, Patton, California, USA; Mental Health Intensive Case Management, VA San Diego Healthcare System, San Diego, California, USA; University of California, San Diego, San Diego, California, USA; Loma Linda University, California, USA
*
*Address for correspondence: Jonathan M. Meyer, 3350 La Jolla Village Drive (116-A), San Diego, CA 92161, USA. (Email: jmmeyer@ucsd.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Forensic psychiatric settings contain a high prevalence of treatment-resistant violent schizophrenia patients. Clozapine therapy has the most robust data for the management of violence in patients with schizophrenia, but for those who cannot tolerate or refuse clozapine, high-dose antipsychotic treatment to high achieve high plasma levels remains a viable option despite limited evidence for efficacy in controlled trials. This article enumerates rational guidelines for employing high plasma level strategies, emphasizing the appropriate interpretation of, and reaction to high plasma antipsychotic levels in these treatment resistant patients, and the need to push treatment to the limits of tolerability or clinical response.

Keywords

Antipsychotichigh-doseschizophreniaviolence
Type
Review Articles
Information
CNS Spectrums , Volume 19 , Issue 5 , October 2014 , pp. 432 - 438
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bollini, P, Andreani, A, Colombo, F, etal. High-dose neuroleptics: uncontrolled clinical practice confirms controlled clinical trials. Br J Psychiatry. 1984; 144(1): 25–27.CrossRefGoogle ScholarPubMed
2. Mackay, AVP. High-dose antipsychotic medication. Advances in Psychiatric Treatment. 1994; 1(1): 16–23.CrossRefGoogle Scholar
3. Krakowski, MI, Kunz, M, Czobor, P, Volavka, J. Long-term high-dose neuroleptic treatment: who gets it and why? Hosp Community Psychiatry. 1993; 44(7): 640–644.Google Scholar
4. Frogley, C, Taylor, D, Dickens, G, Picchioni, M. A systematic review of the evidence of clozapine's anti-aggressive effects. Int. J Neuropsychopharmacol.. 2012; 15(9): 1351–1371.CrossRefGoogle ScholarPubMed
5. Volavka, J, Czobor, P, Nolan, K, etal. Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. J Clin Psychopharmacol. 2004; 24(2): 225–228.Google Scholar
6. Royal College of Psychiatrists. Consensus Statement on High-Dose Antipsychotic Medication. Council Report CR138. London: Royal College of Psychiatrists; 2006.Google Scholar
7. Paton, C, Barnes, TR, Cavanagh, MR, Taylor, D, Lelliott, P; POMH-UK project team. High-dose and combination antipsychotic prescribing in acute adult wards in the UK: the challenges posed by p.r.n. prescribing. Br J Psychiatry. 2008; 192(6): 435–439.Google Scholar
8. Meyer, JM. Drug–drug interactions with antipsychotics. CNS Spectr. 2007; 12(suppl 21): 6–9.CrossRefGoogle ScholarPubMed
9. Kirchheiner, J, Schmidt, H, Tzvetkov, M, etal. Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplication. Pharmacogenomics J. 2007; 7(4): 257–265.CrossRefGoogle ScholarPubMed
10. Uchida, H, Takeuchi, H, Graff-Guerrero, A, etal. Predicting dopamine D2 receptor occupancy from plasma levels of antipsychotic drugs: a systematic review and pooled analysis. J Clin Psychopharmacol. 2011; 31(3): 318–325.CrossRefGoogle ScholarPubMed
11. Krakowski, MI, Czobor, P, Citrome, L, Bark, N, Cooper, TB. Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry. 2006; 63(6): 622–629.CrossRefGoogle ScholarPubMed
12. Krakowski, MI, Czobor, P, Nolan, KA. Atypical antipsychotics, neurocognitive deficits, and aggression in schizophrenic patients. J Clin Psychopharmacol. 2008; 28(5): 485–493.Google Scholar
13. Glick, ID, Balon, RJ, Ballon, J, Rovine, D. Teaching pearls from the lost art of psychopharmacology. J Psychiatr. Pract. 2009; 15(5): 423–426.Google Scholar
14. Simpson, GM, Kunz-Bartholini, E. Relationship of individual tolerance, behavior and phenothiazine produced extrapyramidal system disturbance. Dis Nerv Syst. 1968; 29(4): 269–274.Google Scholar
15. Merck under license to Forest Pharmaceuticals. Saphris [package insert]. St. Louis, MO: Forest Pharmaceuticals, Inc.; 2014.Google Scholar
16. Sunovion Pharmaceuticals, Inc. Latuda [package insert]. Marlborough, MA: Sunovion Pharmaceuticals, Inc.; 2013.Google Scholar
17. Haslemo, T, Olsen, K, Lunde, H, Molden, E. Valproic acid significantly lowers serum concentrations of olanzapine—an interaction effect comparable with smoking. Ther Drug Monit. 2012; 34(5): 512–517.CrossRefGoogle ScholarPubMed
18. Longo, LP, Salzman, C. Valproic acid effects on serum concentrations of clozapine and norclozapine. Am J Psychiatry. 1995; 152(4): 650.Google ScholarPubMed
19. Coryell, W, Miller, DD, Perry, PJ. Haloperidol plasma levels and dose optimization. Am J Psychiatry. 1998; 155(1): 48–53.CrossRefGoogle ScholarPubMed
20. Midha, KK, Hubbard, JW, Marder, SR, Marshall, BD, Van Putten, T. Impact of clinical pharmacokinetics on neuroleptic therapy in patients with schizophrenia. J Psychiatry Neurosci. 1994; 19(4): 254–264.Google ScholarPubMed
21. Perry, PJ, Lund, BC, Sanger, T, Beasley, C. Olanzapine plasma concentrations and clinical response: acute phase results of the North American Olanzapine Trial. J Clin Psychopharmacol. 2001; 21(1): 14–20.CrossRefGoogle ScholarPubMed
22. Gefvert, O, Eriksson, B, Persson, P, etal. Pharmacokinetics and D2 receptor occupancy of long-acting injectable risperidone (Risperdal Consta) in patients with schizophrenia. Int J Neuropsychopharmacol. 2005; 8(1): 27–36.CrossRefGoogle ScholarPubMed
23. Mamo, D, Kapur, S, Keshavan, M, etal. D2 receptor occupancy of olanzapine pamoate depot using positron emission tomography: an open-label study in patients with schizophrenia. Neuropsychopharmacology. 2008; 33(2): 298–304.Google Scholar
24. Seto, K, Dumontet, J, Ensom, MH. Risperidone in schizophrenia: is there a role for therapeutic drug monitoring? Ther Drug Monit. 2011; 33(3): 275–283.Google Scholar
25. Hiemke, C, Baumann, P, Bergemann, N, etal. AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: update 2011. Pharmacopsychiatry. 2011; 44(6): 195–235.Google ScholarPubMed
26. Salzman, C, Glick, ID, Keshavan, MS. The 7 sins of psychopharmacology. J Clin Psychopharmacol. 2010; 30(6): 653–655.CrossRefGoogle ScholarPubMed
27. Kelly, DL, Richardson, CM, Yu, Y, Conley, RR. Plasma concentrations of high-dose olanzapine in a double-blind crossover study. Hum Psychopharmacol. 2006; 21(6): 393–398.Google Scholar
28. Meyer, JM. Understanding depot antipsychotics: an illustrated guide to kinetics. CNS Spectr. 2013; 18(Suppl 1): 55–68.Google Scholar
29. Van Putten, T, Marder, SR, Mintz, J, Poland, RE. Haloperidol plasma levels and clinical response: a therapeutic window relationship. Am J Psychiatry. 1992; 149(4): 500–505.Google Scholar
30. Stauffer, V, Case, M, Kollack-Walker, S, etal. Trajectories of response to treatment with atypical antipsychotic medication in patients with schizophrenia pooled from 6 double-blind, randomized clinical trials. Schizophr Res. 2011; 130(1–3): 11–19.Google Scholar
31. Wei, FC, Jann, MW, Lin, HN, Piao-Chien, C, Chang, WH. A practical loading dose method for converting schizophrenic patients from oral to depot haloperidol therapy. J Clin Psychiatry. 1996; 57(7): 298–302.Google ScholarPubMed
32. Panagiotidis, G, Arthur, HW, Lindh, JD, Dahl, ML, Sjöqvist, F. Depot haloperidol treatment in outpatients with schizophrenia on monotherapy: impact of CYP2D6 polymorphism on pharmacokinetics and treatment outcome. Ther Drug Monit. 2007; 29(4): 417–422.Google Scholar
33. Kapur, S, Zipursky, R, Roy, P, etal. The relationship between D2 receptor occupancy and plasma levels on low dose oral haloperidol: a PET study. Psychopharmacology (Berl). 1997; 131(2): 148–152.Google Scholar
34. Ereshefsky, L, Mascarenas, CA. Comparison of the effects of different routes of antipsychotic administration on pharmacokinetics and pharmacodynamics. J. Clin. Psychiatry. 2003; 64(Suppl 16): 18–23.Google Scholar
35. Nyberg, S, Farde, L, Halldin, C, Dahl, ML, Bertilsson, L. D2 dopamine receptor occupancy during low-dose treatment with haloperidol decanoate. Am J Psychiatry. 1995; 152(2): 173–178.Google Scholar
36. Levinson, DF, Simpson, GM, Lo, ES, etal. Fluphenazine plasma levels, dosage, efficacy, and side effects. Am J Psychiatry. 1995; 152(5): 765–771.Google Scholar
37. Marder, SR, Midha, KK, Van Putten, T, etal. Plasma levels of fluphenazine in patients receiving fluphenazine decanoate: relationship to clinical response. Br J Psychiatry. 1991; 158(5): 658–665.CrossRefGoogle ScholarPubMed
38. Ikai, S, Remington, G, Suzuki, T, etal. A cross-sectional study of plasma risperidone levels with risperidone long-acting injectable: implications for dopamine D2 receptor occupancy during maintenance treatment in schizophrenia. J Clin Psychiatry. 2012; 73(8): 1147–1152.Google Scholar