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September 1988

Neuroleptic Plasma Level May Predict Response in Patients Who Meet a Criterion for Improvement

Author Affiliations

Department of Psychiatry Medical College of Pennsylvania Eastern Pennsylvania Psychiatric Institute 3200 Henry Ave Philadelphia, PA 19129
Nathan Kline Institute for Psychiatric Research Orangeburg, NY 10962 Department of Analytical Psychopharmacology New York State Psychiatric Institute Columbia University 722 W 168th St New York, NY 10032
Nathan Kline Research Institute
College of Pharmacy and Medicine University of Saskatchewan Saskatoon, S7NOWO Canada

Arch Gen Psychiatry. 1988;45(9):878-879. doi:10.1001/archpsyc.1988.01800330112018

To the Editor.—  We propose a novel approach to the analysis of neuroleptic plasma (or serum) level data in relation to clinical response.Across studies, neuroleptic levels have not consistently predicted clinical response.1 It has often been questioned whether this is partly due to inclusion of treatment-resistant subjects in studies. In the typical study, either a correlation is computed between plasma level and improvement ratings or groups of patients are categorized globally as "improvers" and "nonimprovers" and then are contrasted for plasma level. If a substantial number of nonresponsive patients have been included in a study, then a true relationship between plasma level and improvement in the rest of the patient sample might easily be missed. A number of methodological standards have evolved to address this problem, including the use of fixed and randomized doses (so that plasma levels of nonresponders will not be preferentially pushed higher, thereby

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