High dose neuroleptics

Sir: Wilkie et al's (Psychiatric Bulletin, May 2001, 25, 179-183) study of high dose neuroleptics was timely and informative. However, it is surprising to note that they consider haloperidol 10 mg to be equivalent to chlorpromazine 100 mg. It is generally regarded that 2 mg of haloperidol is equivalent to 100 mg of chlorpromazine (King, 1995). Moreover, the highest recommended dose of haloperidol in schizophrenia is 30 mg (British Medical Association & Royal Pharmaceutical Society of Great Britain, 2001) and not 200 mg as the authors suggest. It is well known that doses of haloperidol higher than 12 mg do not produce any additional clinical benefits while causing increasing side-effects. The findings of the present study suggest that high dose neuroleptic prescribing is not based on sound pharmacological principles. Despite the high profile of pharmacological treatments in psychiatry, psychopharmacology does not appear to have a similar status in the psychiatric trainee's curriculum. I hope that the newfound Psychopharmacology Special Interest Group of the College will rectify this anomaly.