Higher than recommended dosages of antipsychotics in male patients with schizophrenia are associated with increased depression but no major neurocognitive side effects: Results of a cross-sectional pilot naturalistic study.

ABSTRACT

INTRODUCTION: The current small pilot naturalistic cross-sectional study assesses whether higher dosages of antipsychotics are related to a satisfactory outcome concerning symptoms of schizophrenia but also to a worse outcome in terms of adverse events and neurocognitive function. MATERIAL AND METHODS: 41 male stabilized hospitalized schizophrenic patients were assessed by PANSS, Calgary Depression Rating Scale, UKU and Simpson-Angus Scale and a battery of neurocognitive tests. Medication and dosage was prescribed according to clinical judgement of the therapist. RESULTS: Clinical variables and adverse events did not differ between patients in the recommended vs high dosage groups. Higher dosage correlated with depressive symptoms but there was no correlation with neurocognitive measures except for impaired concentration. DISCUSSION: Results suggest that it is possible to achieve a good clinical response in refractory patients by exceeding recommended antipsychotic dosages at the price of depression and possible mild isolated concentration deficits but not other neurocognitive or extrapyramidal adverse events. Currently clinicians prefer first-generation antipsychotics when high dosages are prescribed, but considering the more favorable adverse effects profile of newer agents, it is important to study higher dosages of these agents and to test whether they should be preferably given when high dosages are necessary.