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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)
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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 

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