A Case of Sustained Remission of Refractory Schizophrenia with High-Dose Haloperidol Complicated by Parkinsonism and Transient Hepatic Enzyme Elevation
Location
Philadelphia, PA
Start Date
17-4-2026 1:30 PM
End Date
17-4-2026 2:30 PM
Description
Treatment-resistant schizophrenia remains one of psychiatry’s most challenging clinical problems, affecting an estimated 20–30% of patients who fail to respond adequately to standard antipsychotic therapy. High-dose haloperidol has been explored as a salvage strategy in this population, yet its use in contemporary practice is rare given the significant risk of dose-dependent adverse effects. We present a case of a 37-year-old male with chronic, refractory schizophrenia marked by persistent auditory hallucinations, paranoid delusions, and disorganized thought who had failed multiple prior antipsychotic regimens. Following a comprehensive medication review, oral haloperidol was initiated and progressively titrated to 100 mg/day—a supratherapeutic dose that far exceeds the standard recommended range of 3–7.5 mg/day but aligns with historical protocols for treatment-resistant illness. The patient was subsequently monitored on a monthly basis for clinical response, neurological status, and metabolic parameters via routine laboratory studies.
Over the ensuing nine months, the patient achieved and maintained complete remission of all targeted positive symptoms. Neurological examination revealed mild bradykinesia and rigidity consistent with drug-induced parkinsonism, though no dyskinesias were observed, and the patient reported significant sedation. Laboratory monitoring demonstrated a transient, asymptomatic elevation in serum alkaline phosphatase that resolved following a subsequent dose reduction. No features of neuroleptic malignant syndrome or other severe toxicity emerged throughout the observation period.
The extrapyramidal findings in this case are a predictable consequence of high-degree D2 receptor blockade at supratherapeutic doses and are consistent with the known dose-dependent adverse effect profile of first-generation antipsychotics. The transient hepatic enzyme elevation, while less frequently reported, has precedent in the literature and highlights the importance of extending metabolic surveillance beyond standard neurological monitoring when employing this strategy. Taken together, this case illustrates that high-dose haloperidol can confer durable and clinically meaningful remission in carefully selected patients with refractory schizophrenia. Its use demands rigorous patient selection, thorough informed consent, and vigilant ongoing monitoring of both neurological and laboratory parameters to mitigate its substantial adverse effect burden.
Level of Evidence: V
Embargo Period
5-25-2026
A Case of Sustained Remission of Refractory Schizophrenia with High-Dose Haloperidol Complicated by Parkinsonism and Transient Hepatic Enzyme Elevation
Philadelphia, PA
Treatment-resistant schizophrenia remains one of psychiatry’s most challenging clinical problems, affecting an estimated 20–30% of patients who fail to respond adequately to standard antipsychotic therapy. High-dose haloperidol has been explored as a salvage strategy in this population, yet its use in contemporary practice is rare given the significant risk of dose-dependent adverse effects. We present a case of a 37-year-old male with chronic, refractory schizophrenia marked by persistent auditory hallucinations, paranoid delusions, and disorganized thought who had failed multiple prior antipsychotic regimens. Following a comprehensive medication review, oral haloperidol was initiated and progressively titrated to 100 mg/day—a supratherapeutic dose that far exceeds the standard recommended range of 3–7.5 mg/day but aligns with historical protocols for treatment-resistant illness. The patient was subsequently monitored on a monthly basis for clinical response, neurological status, and metabolic parameters via routine laboratory studies.
Over the ensuing nine months, the patient achieved and maintained complete remission of all targeted positive symptoms. Neurological examination revealed mild bradykinesia and rigidity consistent with drug-induced parkinsonism, though no dyskinesias were observed, and the patient reported significant sedation. Laboratory monitoring demonstrated a transient, asymptomatic elevation in serum alkaline phosphatase that resolved following a subsequent dose reduction. No features of neuroleptic malignant syndrome or other severe toxicity emerged throughout the observation period.
The extrapyramidal findings in this case are a predictable consequence of high-degree D2 receptor blockade at supratherapeutic doses and are consistent with the known dose-dependent adverse effect profile of first-generation antipsychotics. The transient hepatic enzyme elevation, while less frequently reported, has precedent in the literature and highlights the importance of extending metabolic surveillance beyond standard neurological monitoring when employing this strategy. Taken together, this case illustrates that high-dose haloperidol can confer durable and clinically meaningful remission in carefully selected patients with refractory schizophrenia. Its use demands rigorous patient selection, thorough informed consent, and vigilant ongoing monitoring of both neurological and laboratory parameters to mitigate its substantial adverse effect burden.
Level of Evidence: V