High-Dose Neuroleptics: Uncontrolled Clinical Practice Confirms Controlled Clinical Trials

Abstract

The strategy of high-dose intramuscular haloperidol as routinely applied in a general hospital psychiatric ward to 74 successive patients, 33 of whom stayed only up to seven days, and a further 34 up to 15 days, led to a complete recovery in only six, and complete lack of change in 23. Adverse reactions were recorded in 42, severe enough to stop treatment in eight; there were three deaths. In view of this risk-benefit analysis, systematic application of this high dose strategy to get a more rapid turnover of patients is unjustified.

Antipsychotic drugs: is more worse? a meta-analysis of the published randomized control trials

“…Drug utilization studies using mean chlorpromazine equivalent doses showed that high doses are still frequently used (Baldessarini et al 1984;Bollini et al 1984;Magno Zito et al 1987;Holloway, 1988). One report indicated that the average dose administered has increased over the years (Reardon et al 1989).…”

“…The apparent lack of incremental benefit with increase in NL dose might have been caused by an increase in frequency and severity of adverse reactions that affect behaviour. It is well known in fact that some dose-dependent side effects of NL drugs, such as Parkinsonism, over-sedation and akathisia, could easily be confused with clinical manifestations of psychosis (Quitkin et al 1975;Bollini et al 1984). Accordingly, a patient with Parkinsonism or oversedation may be considered withdrawn or depressed, or one with akathisia may be seen as agitated.…”

“…Although most of the subsequent randomized control trials (RCTs) have not supported the greater advantage of high-dose regimens over conventional ones, high-dose regimens are still widely used in clinical practice (Baldessarini et al 1984;Bollini et al 1984;Magno Zito et al 1987;Holloway, 1988;Reardon et al 1989). Unfortunately, the level of exposure to and duration of treatment with NL drugs appear related to the prevalence of some types of adverse reactions, suggesting that many patients are exposed to unnecessarily high and potentially dangerous treatments.…”

High-dose antipsychotic medication

“…This compares to the work of Pilowsky et al (1992) who, in a study of rapid tranquillisation, found that serious side-effects were rare, even with intravenous use of high-dose antipsychotics. Other studies, however, have recorded a high incidence of adverse effects during rapid tran quillisation (Bollini et al 1984;Baidessarini et al 1988).…”

“…Reports have demonstrated the risk of severe side-effects, behavioural disturbance and perhaps sudden death related to higher drug dosage (Barnes & Bridges, 1980;Bollini et al, 1984;Baidessarini et al 1988;Mehtonen et al 1991). In response to this unease the Royal College of Psychiatrists convened a panel of experts to give an author itative opinion on the use of high doses (Thompson, 1994).…”