Mean Chlorpromazine Equivalent Dose Research Articles

Baseline Antipsychotic Dose and Transition to Psychosis in Individuals at Clinical High Risk: A Systematic Review and Meta-Analysis.

Emerging meta-analytical evidence indicates that baseline exposure to antipsychotics is associated with an increased risk of transitioning to psychosis in individuals at clinical high-risk for psychosis (CHR-P) and that such effect is not a result of pretest risk enrichment. However, to maximize its translational utility for prognostic stratification in clinical practice, testing for the potential presence of a dose-response association is crucial. To test whether the negative prognostic effect of baseline antipsychotic exposure in individuals at CHR-P follows a dose-effect pattern, as indicated by mean chlorpromazine equivalent doses (CPZ-ED). MEDLINE and Cochrane Library, performed up to August 31, 2023, searching for English-language studies on individuals at CHR-P reporting data on exposure to antipsychotics at baseline and detailed information on dosage by transition status. Studies that provided information on antipsychotic exposure at baseline and included detailed dosage data categorized by transition status. Eligible studies were identified following PRISMA guidelines and evaluated independently by 2 reviewers with the Newcastle-Ottawa Scale for assessing the quality of nonrandomized studies in meta-analyses. The primary outcome was transition to psychosis in individuals at CHR-P who were receiving antipsychotic treatment at baseline, measured by baseline mean CPZ-ED in individuals at CHR-P who transitioned to psychosis compared to those who did not. Eight studies were included in the systematic review and meta-analysis. Among 290 individuals at CHR-P (mean [SD] age, 19.4 [2.6] years) who were exposed to antipsychotics at baseline and remained in contact up to the completion of the study, 66 converted to psychosis and 224 did not. The mean CPZ-ED ranged 60 to 395 mg/d in those who converted and 13 to 224 mg/d in those who did not. Those who converted to psychosis had higher CPZ-ED than those who did not in both the common-effects model (Hedges g, 0.41; 95% CI, 0.12-0.70; z, 2.78; P = .005) and in the random-effects model (Hedges g, 0.41; 95% CI, 0.15-0.67; z, 3.69; P = .008; τ2, 0.0). There was no relevant heterogeneity (Cochran Q, 3.99; df, 7; P = .78; I2, 0.0%; 95% CI, 0.0-68.0). The radial plot indicated a good fit of the model. In individuals at CHR-P who were exposed to antipsychotics at baseline, those receiving higher antipsychotic doses demonstrated an increased likelihood of transitioning to psychosis. This meta-analytic evidence of putative dose-effect association confirms that baseline antipsychotic exposure and the corresponding dosage carry salient prognostic information that could improve current CHR-P criteria-based risk stratification at inception.

Association Between Sexual Dysfunction and Dose of Atypical Antipsychotics: Essential to Learn the Basics.

There is paucity of data on sexual dysfunction associated with atypical antipsychotics in Indian population. We estimated the prevalence of sexual dysfunction and assessed dose dependency, if any, in patients on monotherapy of atypical antipsychotics. This cross-sectional study analyzed the data from patients with F20 to F29 (International Classification of Diseases 10th Revision, ICD-10) receiving monotherapy of risperidone (group1), olanzapine (group2), or quetiapine (group3) for at least 4weeks. The sexual function of participants was assessed using Arizona sexual experiences (ASEX) scale. Chlorpromazine (CPZ) equivalent dose and doses in terms of dose years were calculated. Kruskal-Wallis test, Mann-Whitney U-test, and Pearson correlation were used for analysis. Of the 154 subjects, 65.58% were males, with 44%, 48%, and 8% receiving risperidone, olanzapine, and quetiapine, respectively. The mean duration of treatment was 20.9weeks. Lower ASEX scores were reported with quetiapine. The differences in mean ASEX scores between groups1 and 2 were statistically significant for sex drive (P=.016), sexual arousal (P=.025), and overall score (P=.037). Sexual dysfunction was more frequent with risperidone (48.5%) than with olanzapine (28.4%) and quetiapine (0%). In group1, the duration of therapy positively correlated with the mean scores of sexual desire (P=.003) and arousal (P=.033), but this was not the case for group2 (receiving olanzapine). The mean CPZ equivalent doses were comparable between the groups (P=.064); those receiving <200mg CPZ dose equivalents showed greater sexual impairment. We conclude that the occurrence of atypical antipsychotic-induced sexual dysfunction is not dose dependent. Olanzapine has a better safety profile in terms of sexual dysfunction, whereas the data reflecting the experience with quetiapine are insufficient.

Patterns of antipsychotic prescriptions in patients with schizophrenia in China: A national survey.

To investigate the patterns and correlates of antipsychotic prescriptions among recently discharged inpatients with schizophrenia in China. The study included discharged patients from 41 tertiary psychiatric hospitals in 29 provinces between March 19-30, 2019. A total of 1032 inpatients with schizophrenia were included. Socio-demographic and clinical data were retrieved from medical records upon discharge. Patients received a total of 13 unique antipsychotic medications, which included 9 s-generation antipsychotics (SGAs) and 4 first-generation antipsychotics (FGAs). The utilization rates of SGAs and FGAs were 98.8 % and 6.1 % respectively. The three most commonly antipsychotic medications were risperidone (35.1 %), olanzapine (31.3 %), and clozapine (24.6 %). The mean chlorpromazine equivalent dose was 452.12 ± 230.74 mg/day. The utilization rate of mood stabilizers was 18.9 %, 8.8 % for antidepressants, 20.3 % for sleep improvers, and 9.9 % for anticholinergics. More than two fifths patients (43.1 %) received two or more antipsychotic medications. Predictors of antipsychotic polypharmacy included younger age, residing in Central or West China, a longer duration of illness, a history of prior hospitalizations, and having agitated behavior during the hospitalization. Antipsychotic polypharmacy in China is common on inpatients settings. The proportion of antipsychotic polypharmacy in China is higher than in many other countries, despite limited data to support the efficacy of many combinations. Clozapine remains one of most commonly prescribed antipsychotics in China, either as a monotherapy or combination therapy.

F95. ASSESSING MANIC SYMPTOMS IN PATIENTS WITH SCHIZOPHRENIA USING THE YOUNG MANIA RATING SCALE

BackgroundVan Os and Kapur have proposed that the discrete categorical dichotomy of schizophrenia versus bipolar disorder be changed to a dimensional conceptualization. It is also known that manic symptoms can contribute to the clinical course and prognosis of schizophrenia. Hence, a domain for mania has been included in the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). However, the psychometric properties of the Young Mania Rating Scale (YMRS) have been little studied in subjects with schizophrenia.MethodsOne hundred and sixty-six inpatients with schizophrenia (diagnosed with DSM-5,2 age ≥ 18 years and ≤ 65 years, and length of hospital stay ≥ 2 weeks) were enrolled from two mental hospitals in Korea. The Institutional Review Board approved the study protocol, and informed consent was given by all study subjects before the start of the study. The Korean version of the YMRS was used to evaluate the severity of manic symptoms. In addition, the domain for mania in the CRDPSS was used to evaluate presence or absence of manic symptoms (0–1, absence; 2–4, presence).ResultsThe average age and age-at-onset of the subjects were 46.5 (SD = 11.2) and 25.2 (SD = 13.2) years, respectively. Half were men (51.5%), and most were unmarried (79.1%), religiously affiliated (61.5%) and educated below high school graduate level (73.0%). The mean chlorpromazine equivalent dose of prescribed antipsychotics was 921.1 (SD = 952.0) mg. The mean total score on the YMRS was 7.3 (SD = 6.9) and the mean item scores were: 0.2 (SD = 0.4) for elevated mood, 0.1 (SD = 0.4) for increased motor activity, 0.1 (SD = 0.4) for sexual interest, 0.1 (SD = 0.4) for sleep, 0.4 (SD = 0.8) for irritability, 0.6 (SD = 1.2) for speech, 0.8 (SD = 1.1) for language, 2.0 (SD = 3.3) for content, 0.2 (SD = 0.7) for aggressive behavior, 1.0 (SD = 1.0) for appearance, and 1.8 (SD = 1.7) for insight. The Cronbach α for the 11 YMRS items was 0.66, which is considered an acceptable level of internal consistency. Moreover, only 4% (n = 7) of the 166 subjects had manic symptoms as assessed by the mania domain in the CRDPSS. A receiver operating characteristic curve (ROC) showed that the optimal cut-off score distinguishing schizophrenia patients with and without manic symptoms was 10 with a sensitivity of 88.3% and specificity of 75.6% (area under curve = 0.803, P = 0.012).DiscussionSince a 10 point total score on the YMRS represents a mild level of Clinical Global Impression (CGI) severity of mania, we may conclude that our threshold on the YMRS for identifying manic symptoms in patients with schizophrenia is reasonable. Hence it may be useful to investigate the evaluation of manic symptoms in patients with schizophrenia from the perspective of deconstructing psychoses.

A Study of the Impact of Cannabis on Doses of Discharge Antipsychotic Medication in Individuals with Schizophrenia or Schizoaffective Disorder.

Patients with schizophrenia or schizoaffective disorder have a high prevalence of comorbid cannabis use disorder (CUD). CUD has been associated with poorer outcomes in patients. We compared doses of antipsychotic medications at the time of discharge from hospital among inpatients with schizophrenia or schizoaffective disorder with or without concurrent cannabis use. We reviewed the medical records of patients (N=8157) with schizophrenia or schizoaffective disorder discharged from the hospital between 2008 and 2012. The patients were divided into two groups; those with urine drug tests positive for cannabis and those negative for cannabis. Doses of antipsychotic medications were converted to chlorpromazine equivalents. Bivariate analyses were done with Student's t test for continuous variables and χ 2 test for categorical variables. Linear regression was carried out to adjust for potential confounders. Unadjusted analysis revealed that the cannabis positive group was discharged on lower doses of antipsychotic medication compared with the cannabis negative group (geometric mean chlorpromazine equivalent doses 431.22±2.20 vs 485.18±2.21; P<0.001). However, the difference in geometric mean chlorpromazine equivalent doses between the two groups was no longer significant after adjusting for sex, age, race, and length of stay (geometric mean difference 0.99; 95% CI 0.92-1.10). Though limited by lack of information on duration, amount and severity of cannabis use, as well as inability to control for other non-antipsychotic medications, our study suggests that cannabis use did not significantly impact on doses of antipsychotics required during the periods of acute exacerbation in patients with schizophrenia or schizoaffective disorder.

Using the Young Mania Rating Scale for Identifying Manic Symptoms in Patients with Schizophrenia.

Dear Editor: Van Os and Kapur1 have proposed that the discrete categorical dichotomy of schizophrenia versus bipolar disorder should be changed to a dimensional conceptualization. It is also known that manic symptoms can contribute to the clinical course and prognosis of schizophrenia. Hence, a domain for mania has been included in the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).2,3 However, the psychometric properties of the Young Mania Rating Scale (YMRS) have little been studied in subjects with schizophrenia. As described elsewhere,4 166 inpatients with schizophrenia (diagnosed with DSM-5,2 age ≥18 years and ≤65 years, and length of hospital stay ≥2 weeks) were enrolled from two mental hospitals in Korea. The Institutional Review Board of Yong-In Mental Hospital (receipt number: 2013-49) approved the study protocol, and informed consent was given by all study subjects before the start of the study. The Korean version of the YMRS was used to evaluate the severity of manic symptoms,5 and the domain for mania in the CRDPSS was used to evaluate presence or absence of manic symptoms (0–1, absence; 2–4, presence).3 The average age and age-at-onset of the subjects were 46.5 (SD=11.2) and 25.2 (SD=13.2) years, respectively. Half were men (51.5%), and most were unmarried (79.1%), religiously affiliated (61.5%) and educated below high school graduate level (73.0%). The mean chlorpromazine equivalent dose of prescribed antipsychotics was 921.1 (SD=952.0) mg. The mean total score on the YMRS was 7.3 (SD=6.9) and the mean item scores were: 0.2 (SD=0.4) for elevated mood, 0.1 (SD=0.4) for increased motor activity, 0.1 (SD=0.4) for sexual interest, 0.1 (SD=0.4) for sleep, 0.4 (SD=0.8) for irritability, 0.6 (SD=1.2) for speech, 0.8 (SD=1.1) for language, 2.0 (SD=3.3) for content, 0.2 (SD=0.7) for aggressive behavior, 1.0 (SD=1.0) for appearance, and 1.8 (SD=1.7) for insight. The Cronbach α for the 11 YMRS items was 0.66, which is considered as an acceptable level of internal consistency. Moreover, only 4% (n=7) of the 166 subjects had manic symptoms as assessed by the mania domain in the CRDPSS. As shown in Fig. 1, a receiver operating characteristic curve showed that the optimal cut-off score distinguishing schizophrenia patients with and without manic symptoms was 10 with a sensitivity of 88.3% and specificity of 75.6% (area under curve=0.803, p=0.012). Fig. 1 Receiver operating characteristic curve for total score on the Young Mania Rating Scale in schizophrenia patients with and without manic symptoms (cut-off=10, sensitivity=88.3%, specificity=75.6%) Since a 10 point total score on the YMRS represents a mild level of Clinical Global Impression severity of mania,6 we may conclude that our threshold on the YMRS for identifying manic symptoms in patients with schizophrenia is reasonable. Hence, it may be useful to evaluate manic symptoms in patients with schizophrenia from the perspective of deconstructing psychoses.

Influence de la résistance aux hallucinations auditives sur la dépression : étude au moyen du questionnaire révisé des croyances à propos des voix

Beliefs about voices and reactions to voices have been proposed as important variables influencing the course of depression in schizophrenia. Consequences of auditory hallucinations are different according to identity, goals, omnipotence, omniscience, and meanings attributed to voices by the client. Ten to 15 % of the general population experience auditory hallucinations during lifetime without any distress or need for medical care. In addition, neither frequency of voices, nor their topography, influence the emotional consequences of auditory hallucinations experiences, but the relationships to voices. The Revised Belief about Voices Questionnaire analyzes voices along 5 dimensions: malevolence, benevolence, omnipotence, resistance, and engagement. Malevolent voices are related to depression, whereas benevolent voices engender more positive emotions. Subjects usually engage with benevolent voices, and resist to malevolent voices. But resistance strategies are barely efficient and often backfire. Patients resisting to their voices consider them more malevolent and present with more depressive symptoms. This research aims at studying the influence of resistance to auditory hallucinations on depression in a group of patients suffering from schizophrenia and experiencing auditory hallucinations, using the Revised Beliefs About Voices Questionnaire (BAVQ-R). It also provides a study of the psychometrics properties of the French language version of the BAVQ-R. Thirty-eight patients suffering from paranoid schizophrenia, undifferentiated schizophrenia or schizoaffective disorder, have been tested with the French versions of the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Positive and Negative Syndrome Scale (PANSS), and the Calgary Depression Scale for Schizophrenia (CDSS). Each patient presented with auditory hallucinations during the week before evaluation, with a minimum score of 3 on P3 item of PANSS. Mean age was 39.39 years (SD 11.33); mean duration of symptoms was 13.92 years (SD 10.81), and patients' mean history of hospitalizations was 7.66 (SD 9.24). Each patient was receiving an antipsychotic medication at the time of evaluation, with a mean chlorpromazine equivalent dose of 806.69 mg/d (ET 539.51); 18.5 % of patients were receiving serotonin reuptake inhibitor, and 31.57 % once committed a suicide attempt. The French version of the BAVQ-R presents with a satisfying internal consistency (Cronbach's alpha=0.74). Similar to the original version, Malevolence and Resistance, and Benevolence and Engagement dimensions are strongly correlated (r=0.73, and r=0.90, P<0.05, respectively). The BAVQ-R scores correlate with the CDSS (r=0.40, P<0.05) and the PANSS General Psychopathology subscale scores (r=0.44, P<0.05), but not with the Positive and Negative subscales. (r=0.17, and r=0.13, P>0.05, respectively). Correlations and forced entry multiple regressions analyses show that Resistance and Malevolence are both strongly correlated to depression, but Resistance is the only dimension that influences depression. Moreover, clients presenting with depressive symptoms resist more to their auditory hallucinations. Finally, emotional resistance, in comparison to behavioral resistance, is responsible for depression in people suffering from auditory hallucinations. Emotional resistance to auditory hallucinations constitutes the most important variable influencing depression in schizophrenia comparing to what the voices say or are supposed to know, their malevolence or benevolence. Demonstration of the influence of resistance to voices on depression would help the development of new therapeutic practices.

Excessive dosing and polypharmacy of antipsychotics caused by pro re nata in agitated patients with schizophrenia

It has been recommended that for patients with schizophrenia, antipsychotics should be prescribed simply, using an optimal dose. However, pro re nata (p.r.n., meaning to use on an as-needed basis) antipsychotics may increase the risk of excessive dosing (defined as mean chlorpromazine-equivalent doses above 1000 mg) and polypharmacy (combination use of different antipsychotics). This study aimed to investigate the increased risk caused by p.r.n. antipsychotics. The subjects included 413 patients with schizophrenia from 17 acute psychiatric wards in nine hospitals. Over a 24-h period on a survey day, data on regular medication and the use of p.r.n. were collected. The analysis focused on p.r.n. antipsychotics in agitated patients. We used McNemar's test to evaluate differences in the proportions of patients prescribed antipsychotics with excessive dosing or polypharmacy before (i.e., regular medication only) and after prescribed p.r.n. antipsychotics were added to regular medication (i.e., regular medication plus p.r.n. antipsychotics). Of 413 patients, 312 (75.5%) were prescribed p.r.n. for agitated status. Of those, 281 (90.1%) were prescribed p.r.n. antipsychotics. The total doses were significantly higher and more compounded in case patients prescribed p.r.n. antipsychotics than in those who were not. Seventeen patients (4.1%) were actually administered p.r.n. antipsychotics. Their total medication, including p.r.n. on the current day, represented excessive dosing or polypharmacy of antipsychotics. The use of p.r.n. antipsychotics may cause hidden excessive dosing and polypharmacy. Our results indicate the importance of careful monitoring of p.r.n. antipsychotics to agitated patients with schizophrenia.

P-673 - Deaths at a psychiatric hospital: causes, risk factors and forensic responsibilities

Every death at a psychiatric hospital raises questions about its cause and the forensic responsibilities it engages. - To assess the rate of deaths posing forensic problems at a psychiatric hospital. - To determine the patients’ victimological profile. - To identify the causes and risk factors of these deaths. We conducted a retrospective and descriptive study based on the forensic autopsies and the medical files of patients who died during their stay at AlRazi psychiatric hospital between January 2000 and December 2010. During the study period, 115 deaths were recorded. We studied the deaths of 33 autopsied patients (28.69% of all deaths). Patients are predominantly male (60%), aged 43 on average, mostly smokers (66%), with a low socioeconomic level (61%) and a medical history (40%) primarily of hypertension and diabetes. 40% of our casualties are schizophrenic, mostly of the paranoid form (60%). Antipsychotics are the most prescribed drugs (87.5%). High doses are used (mean chlorpromazine equivalent dose: 1237 mg/day). Most deaths occurred at night, during weekends. 21% died within the first 24 hours of their hospital stay. A cause for death was identified in ¾ of cases. 75.75% are sudden deaths mainly due to respiratory (40%), or cardiovascular causes (20%). Accidental deaths (18.18% of all deaths) include choking (50%), thermal burns (33.4%) and iatrogenic causes (16.6%). Suicides account for 6% of all deaths. Reducing the incidence of deaths posing forensic problems at psychiatric hospitals is an important goal to achieve through careful identification of risk factors.

Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study

BackgroundSurveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level.MethodsData from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines.ResultsIn 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA.ConclusionOur national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.

A comparative study of sexual dysfunction involving risperidone, quetiapine, and olanzapine.

Background:With the advent of newer antipsychotic drugs, side effects such as sexual dysfunction have been a major contributor toward treatment compliance. There are only a few studies that have compared different atypical antipsychotic agents regarding sexual dysfunction. We have not come across any data in this area on Indian population.Aims:To determine and compare the frequency of sexual dysfunction associated with risperidone, olanzapine, and quetiapine, among patients with clinically stable schizophrenia.Settings and Design:It is a cross-sectional hospital-based study. The subjects were recruited for the study by the purposive sampling technique.Materials and Methods:The total sample size was 102, consisting of 25 each in the quetiapine and risperidone groups, 22 in the olanzapine group, and 30 healthy volunteers. A Brief Psychiatric Rating Scale and Sexual Functioning Questionnaire (SFQ) were administered. The Kruskal Wallis test was used to compare the variables in the demographic data and the mean chlorpromazine equivalent doses of the study groups. To analyze the sexual dysfunction, the mean scores on all the domains of sexual functioning in SFQ were compared across the study groups using the Chi square test, for proportions.Results and Conclusion:Twenty-three percent of the healthy volunteers had some impairment in one or more domains of sexual functioning. For the medication groups this was 96, 88, and 90%, respectively for risperidone, quetiapine, and olanzapine. However, there was statistically no significant difference across the study groups although it was relatively less with quetiapine.

Sex-Dependent Hippocampal Volume Reductions in Schizophrenia Relate to Episodic Memory Deficits

Sex-Dependent Hippocampal Volume Reductions in Schizophrenia Relate to Episodic Memory Deficits

Hidden high-dose antipsychotic prescribing: effects of p.r.n. doses

Aims and methodThe Royal College of Psychiatrists' Consensus Statement on “The use of high-dose antipsychotic medication’ suggests only fully qualified psychiatrists (MRCPsych) should recommend the prescribing of high-dose antipsychotic treatment. We observed changes in anti-psychotic prescribing in two surveys of psychiatric in-patients conducted eight and 32 months after publication of the Consensus Statement.ResultsOverall mean chlorpromazine equivalent doses of antipsychotic drugs reduced between the surveys. When p.r.n. (as required) prescribing (usually done by junior doctors) is included, mean potential doses and numbers of patients who might receive ‘high-doses' increases substantially, although the reduction between surveys in total mean dose and proportion of patients on high-dose antipsychotic medication is preserved, and the actual use of p.r.n. medication was low (4–5% of p.r.n. prescriptions).Clinical implicationsWe recommend the development of local guidelines for junior staff concerning antipsychotic drug prescribing, regular monitoring of p.r.n. medication by consultants, and pharmacists' involvement in reviews of patients prescribed high-dose antipsychotic medication.

Behavior Disorders in Persons With Mental Retardation Receiving Antipsychotic Medication

The behavior disorders of mentally retarded individuals receiving antipsychotic medication and the relationship between behavior disorders and the daily dose of drug were investigated. Of 355 residents of residential facilities in Wakayama Prefecture, Japan (age range, 7–64 years), the problem behaviors of 54 subjects receiving antipsychotic drugs were compared to those of 52 subjects receiving anticonvulsants and of 202 subjects without any medication at all, using the Japanese version of the Aberrant Behavior Checklist (ABC-J). All five subscale scores of the ABC-J were significantly higher for the antipsychotic group than for those of the other groups, whereas only the Irritability subscale was prominent in the subjects receiving anticonvulsants. The mean chlorpromazine equivalent dose was higher in the subjects with severe/profound disability than in those with mild/moderate disability and correlated with the Hyperactivity subscale scores. The problem behaviors of individuals with mental retardation prescribed antipsychotic drugs were more severe than those without medication; more severe disability and higher Hyperactivity scores were associated with dose of antipsychotic drugs.

Fluphenazine decanoate: a clinical problem?

The authors compared the medical records of 20 randomly selected schizophrenic patients who were receiving fluphenazine decanoate with the records of 20 other randomly selected schizophrenic patients who were receiving oral medications only. The fluphenazine decanoate group had a significantly higher mean chlorpromazine equivalent dose (2010 +/- 836) than the oral medication group (373 +/- 384). The two groups did not, however, differ on any of the other variables studied. The findings, in addition to reports in the literature, suggest that the use of fluphenazine decanoate may come at the inadvertent cost of a significantly higher dose of antipsychotic medications in a subgroup of patients.

Dissimilar dosing with high-potency and low-potency neuroleptics.

The authors studied high-potency versus low-potency neuroleptic dosing practices for 110 Boston-area psychiatric inpatients and compared the findings with the dosing practices reported in surveys of nearly 16,000 Veterans Administration patients. Mean chlorpromazine equivalent doses for the most common agents correlated strongly in both samples. Although frequencies of lower doses of both types of agents were similar, doses of potent drugs above the daily equivalent of 1 g of chlorpromazine accounted for more than 40% of prescriptions. The mean chlorpromazine-equivalent dose of popular potent agents (haloperidol or fluphenazine) was 3.54 times as high as that of popular low-potency agents (chlorpromazine or thioridazine). Potent agents are commonly used in mania and schizophrenia, often in relatively high doses, which may carry an excess of risk over unproven added benefit.