Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T07:16:21.638Z Has data issue: false hasContentIssue false

Clinical use of High-Dose Neuroleptics

Published online by Cambridge University Press:  02 January 2018

Steven R. Hirsch
Affiliation:
Royal College of Psychiatrists
Thomas R. E. Barnes*
Affiliation:
Royal College of Psychiatrists
*
Department of Psychiatry, Charing Cross and Westminster Medical School, London W6 8RP

Abstract

There has been increasing public concern about the risks of high-dose antipsychotic (neuroleptic) treatment, arising in part from an, as yet unproven, association between high-dose treatment and death in a small minority of patients. The clinical issues related to the use of neuroleptics in doses exceeding the maximum recommended in the British National Formulary (BNF) were discussed at the Psychopharmacology Subcommittee. When, if ever, should the recommended doses be exceeded?

Type
Comment
Copyright
Copyright © The Royal College of Psychiatrists 

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.)

Footnotes

1.

The contents of this paper from the Psychopharmacology Subcommittee of the Royal College of Psychiatrists are the responsibility of the authors but are submitted only after being read and approved by the Subcommittee.

References

Baldessarini, R. J., Cohen, B. M. & Teicher, M. H. (1988) Significance of neuroleptic dose and plasma level in the pharmacological treatment of psychoses. Archives of General Psychiatry, 45, 7991.Google Scholar
Barnes, T. R. E. & Pantelis, C. (1992) Treatment-resistant schizophrenia. Schizophrenia Monitor, 2, 14.Google Scholar
Bollini, P., Andreani, A., Colombo, F., et al (1984) High dose neuroleptics: uncontrolled clinical practice confirms controlled clinical trials. British Journal of Psychiatry, 144, 2527.CrossRefGoogle ScholarPubMed
Brown, R. P. & Kocsis, J. H. (1984) Sudden death and antipsychotic drugs. Hospital and Community Psychiatry, 35, 486491.Google Scholar
Committee on Safety of Medicines (1990) Cardiotoxic effects of pimozide. Current Problems, 29.Google Scholar
Edwards, J. G. (1986) The untoward effects of antipsychotic drugs. In The Psychopharmacology and Treatment of Schizophrenia (eds P. B. Bradley & S. R. Hirsch), pp. 403441. Oxford: Oxford University Press.Google Scholar
Fulop, G., Phillips, R. A., Shapiro, A. K., et al (1987) ECG changes during haloperidol and pimozide treatment of Tourette's disorder. American Journal of Psychiatry, 144, 673675.Google ScholarPubMed
Henderson, R. A., Lane, S. & Henry, J. A. (1991) Life-threatening ventricular arrhythmia (Torsade de pointes) after haloperidol overdose. Human and Experimental Toxicology, 10, 5962.Google Scholar
Herrera, J. N., Sramek, J. J., Costa, J. F., et al (1988) High potency neuroleptics and violence in schizophrenia. Journal of Nervous and Mental Disease, 176, 558561.CrossRefGoogle Scholar
Kane, J. M. (1987) Treatment of schizophrenia. Schizophrenia Bulletin, 13, 133156.Google Scholar
Kane, J. M. Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789796.Google Scholar
Kiriike, N., Maeda, Y., Nishiwaki, S., et al (1987) Iatrogenic Torsade de pointes induced by thioridazine. Biological Psychiatry, 22, 99103.Google Scholar
Kriwisky, M., Perry, G. Y., Tarchitsky, D., et al (1990) Haloperidol-induced Torsades de pointes. Chest, 98, 482484.Google Scholar
Leestma, J. E. & Koenig, W. L. (1968) Sudden death and phenothiazines: a current controversy. Archives of General Psychiatry, 18, 137148.Google Scholar
Lipscomb, P. A. (1980) Cardiovascular side effects of phenothiazeines and tricyclic antidepressants: a review with precautionary measures. Postgraduate Medicine, 67, 189196.Google Scholar
Mehtonen, O. P., Aranko, K., Malkonen, L., et al (1991) A study of sudden death associated with the use of antipsychotic or antidepressant drugs. Acta Psychiatrica Scandinavica, 84, 5864.CrossRefGoogle ScholarPubMed
Neborsky, R., Janowsky, D., Munson, E., et al (1981) Rapid treatment of acute psychotic symptoms with high- and low-dose haloperidol. Archives of General Psychiatry, 38, 195199.Google Scholar
Palowski, L. S., Ring, H., Shine, P. J., et al (1992) Rapid tranquillisation. A survey of emergency prescribing in a general psychiatric hospital. British Journal of Psychiatry, 160, 831835.Google Scholar
Rifkin, A., Doddi, S., Karajgi, B., et al (1991) Dosage of haloperidol for schizophrenia. Archives of General Psychiatry, 48, 166170.Google Scholar
Simpson, G. M., Davis, J., Jefferson, J. W., et al (1987) Sudden deaths in psychiatric patients: the role of neuroleptic drugs. American Psychiatric Association Task Force Report, No. 27. Washington, DC: APA.Google Scholar
Solano, D. A., Sadow, T. & Ananth, J. (1989) Rapid tranquilization: a reevaluation. Neuropsychobiology, 22, 9096.Google Scholar
Van Putten, T., Marder, S. R. & Mintz, J. (1990) A controlled dose comparison of haloperidol in newly admitted schizophrenic patients. Archives of General Psychiatry, 47, 754758.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.