Utility of neuroleptic blood levels in the treatment of acute psychosis

Twenty-two acutely psychotic patients were treated with a flexible dose of haloperidol in a 5-week study. The neuroleptic blood levels of all patients were measured; however, for 10 of the patients, the treating physician remained blind to the drug blood level. The Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions (CGI) scale were administered at study entry and once a week by a blind rater. No clinical differences were seen between the two groups at any time point. However, blood levels within an operative therapeutic range of 10-20 ng/ml were seen at the same rate in both groups of patients. These data do not contradict other findings which suggest a correlation between clinical outcome and blood level but rather suggest that responsible clinicians using clinical signs can maintain the 'average patient' within the range of therapeutic blood levels, even without the laboratory monitoring of such levels.