A Systematic Approach to Pharmacotherapy in Patients With Neuroleptic-Resistant Psychoses

The presence or absence of neuroleptic-induced pseudoparkinsonism, the presence or absence of akathisia, and plasma levels of haloperidol are used to distinguish five types of haloperidol-resistant psychotic patients. The five types are patients receiving an inadequate dose, those whose inadequate dose cannot be increased due to the presence of akathisia, those in whom neuroleptic activity at the dopamine type 2 receptors in the brain is inhibited, those receiving a bioavailable but clinically ineffective dose, and those receiving an excessive dose. Management strategies are proposed for each type of patient and include guidelines for adjusting doses of haloperidol, switching to different neuroleptics, and introducing nonneuroleptic somatic therapies.