Plasma Levels as Predictors of Clinical Response and Violent Behavior

  • Jerome A. Yesavage


Steady state serum levels have been found to be useful measurements when selecting dosage for medications. This has worked well with such drugs as digoxin, aminophylline, and phenytoin sodium, but work with neuroleptics has been less successful. A number of problems hamper research in this field. Certain medications show extremely low serum levels; problems occur with enzyme induction and multiple metabolites; and the assays are technically complex. Many studies have used flexible dose schedules which can obscure therapeutic results when additional medication is added to the regimens of nonresponsive patients or doses are reduced because of side effects. Finally, the most difficult obstacle to overcome is obtaining steady state levels in short-term acute care clinical settings where rapid patient turnover and brief hospitalization are the rule.


Brief Psychiatric Rate Scale Physical Assault Brief Psychiatric Rate Scale Score Fluorescence Spectrophotometry Total Brief Psychiatric Rate Scale Score 
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  1. 1.
    S. S. Chang, H. Dekirmenjian, A. Walcynski, et al., Clinical pharmacological studies of antipsychotics. Read before a meeting of the Society of Biological Psychiatry, Atlanta, May, 1978.Google Scholar
  2. 2.
    J. A. Yesavage, J. Becker, P.D. Werner, et al., Serum level monitoring of thiothixene in schizophrenia: acute single- dose levels at fixed doses, Am. J. Psychiatr. 139:2 (1982).Google Scholar
  3. 3.
    L. Jacobsson, L. Von Knorring, B. Mattsson, et al., Penfluridol and thiothixene: dosage, plasma level and changes in psychopathology. Int. Pharmacopsychiatry 11:206 (1976).PubMedGoogle Scholar
  4. 4.
    L. Jacobsson, L. Von Knorring, B. Mattsson, et al., Controlled trial of penfluridol and thiothixene in the maintenance treatment of chronic schizophrenic syndromes, Acta. Psychiatr. Scand. 54:113 (1976).PubMedCrossRefGoogle Scholar
  5. 5.
    T. Mjorndal and L. Oreland, Determination of thiothixenes in plasma at therapeutic concentrations, Acta. Pharmacol. Toxicol. (Copenh) 29:295 (1971).CrossRefGoogle Scholar
  6. 6.
    J. A. Yesavage, C. A. Holman, R. Cohn and L. Lombrozo, Correlation of initial thiothixene serum levels and clinical response. Comparison of fluorometric, gas chromatographic, and RBC assays, Arch. Gen. Psychiatr. 40:301 (1983).PubMedCrossRefGoogle Scholar
  7. 7.
    S. P. Roose, S. Bone, C. Haidorfer, D. L. Dunne and R. R. Fieve, Lithium treatment in older patients, Am. J. Psychiatr. 136:843 (1979).PubMedGoogle Scholar
  8. 8.
    R. Braithwaite, S. Montgomery, and S. Dawling, Depression and tricyclic antidepressant levels, in “Drugs and the “Elderly,” J. Crooks and I.H. Stevens, eds., University Park Press, Baltimore (1979).Google Scholar
  9. 9.
    J. A. Yesavage, Inpatient violence and the schizophrenic patient: an inverse correlation between danger-related events and neuroleptic levels, Biol. Psychiatr. 17 (no. 11):1331 (1982).Google Scholar
  10. 10.
    D. Student and J. R. Lion, Methodological Issues in Psycho-pharmacological Research in Violent Individuals, International Society for Research on Aggression, National Institutes of Medicine.Google Scholar
  11. 11.
    J. A. Yesavage, P. D. Werner, J. M. T. Becker, C. A. Holman and M. J. Mills, Inpatient evaluation of aggression in psychiatric patients, J. Nervous Ment. Pis. 169:299 (1981).CrossRefGoogle Scholar
  12. 12.
    J. A. Yesavage, Correlates of dangerous behavior by schizophrenics in hospital (unpublished data, 1983)Google Scholar

Copyright information

© Springer Science+Business Media New York 1985

Authors and Affiliations

  • Jerome A. Yesavage
    • 1
  1. 1.Stanford University Medical SchoolStanfordUSA

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