Antipsychotic dosing: found in translation

Abstract

In the field of schizophrenia research, as in other areas of psychiatry, there is a sense of frustration that greater advances have not been made over the years, calling into question existing research strategies. Arguably, many purported gains claimed by research have been "lost in translation," resulting in limited impact on diagnosis and treatment in the clinical setting. There are exceptions; for example, we would argue that different lines of preclinical and clinical research have substantially altered how we look at antipsychotic dosing. While this story remains a work in progress, advances "found in translation" have played an important role. Detailing these changes, the present paper speaks to a body of evidence that has already shifted clinical practice and raises questions that may further alter the manner in which antipsychotics have been administered over the last 6 decades.

Fig. 1

Preinjection dopamine D₂ occupancy levels in 7 patients taking long-acting injectable risperidone, with the injection interval doubled from the recommended 2 to 4 weeks. Only 3 patients had D₂ levels above the threshold recommended to optimize clinical response, although none showed clinical deterioration. All had been on monthly injections for at least 4 months.

Fig. 2

Total Brief Psychiatric Rating Scale (BPRS) scores for extended dosing (n = 14) and treatment as usual (TAU; n = 12) in participants completing the 6-month trial.

Fig. 3

Vacuous chewing movements (VCMs) in rats exposed to continuous (pump) or intermittent (subcutaneous [SC]) administration of haloperidol (HAL) or vehicle (VEH).