Medication Trial Summaries
| Pt. | Involuntary Medication Trials | Restored? |
|---|---|---|
| 1 | Ten weeks of treatment with quetiapine with dose gradually increased from 100 mg twice daily to 350 mg twice daily had no impact on underlying delusional ideation; no concomitant psychotropic medication. | No |
| 2 | Three weeks of oral perphenazine 8mg twice daily resulted in significant improvement in mental status; phenylzine 30 mg twice daily was continued during the entire evaluation, which had been prescribed by his community provider to treat a single past episode of depression successfully. | Yes |
| 3 | Three months of haloperidol decanoate 100 mg every 28 days resulted in gradual but marked diminution of paranoid ideation; concomitant medication was benztropine 0.5 mg twice daily prescribed for extrapyramidal side effects, as well as diphenhydramine 75 mg at bedtime for insominia. | Yes |
| 4 | Three weeks of risperidone 4 mg daily resulted in marked reduction of delusional ideation; no concomitant psychotropic medication; the risperidone was inadvertently discontinued after he was returned to a local jail for further legal proceedings; he relapsed and was then returned to FMC Butner, where he agreed to resume taking risperidone 4 mg daily on a voluntary basis; within four weeks the examiners opined that he was again competent to stand trial. | Yes |
| 5 | Three months of treatment with haloperidol decanoate 150 mg every 28 days resulted in gradual but significant reduction in delusional ideation; no concomitant psychotropic medication; he returned to FMC Butner two years later for a second round of competency assessment and treatment for charges of violation of supervised release; examiners described his treatment response as similar to the preceding one, finding him competent to stand trial following four months of involuntary treatment with haloperidol decanoate 150 mg every 28 days. | Yes |
| 6 | Two months of treatment with fluphenazine decanoate 12.5 mg every 14 day had minimal or no benefit; his delusions responded within three weeks of increasing the dose of fluphenazine decanoate to 25 mg every two weeks; concomitant psychotropic medication included benztropine 1 mg twice daily for extrapyramidal side effects and fluoxetine 20 mg daily for new-onset depressive symptoms. | Yes |
| During his lengthy period of pretrial detention, he relapsed due to medication noncompliance in a local jail facility; two years later he was returned to FMC Butner for a second round of involuntary treatment; his delusional ideation responded to two weeks of oral haloperidol 5 mg followed by two weeks of treatment with haloperidol decanoate 100 mg every 28 days; he was also prescribed benztropine 1 mg in the morning and 2 mg at bedtime and diphenhydramine 50 mg four times daily, as needed, for extrapyramidal side effects. | ||
| Three years later he relapsed into psychosis with delusions and more prominent hallucinations while serving his lengthy sentence of incarceration at FMC Butner, which was attributed to medication noncompliance; his psychosis persisted at low levels following involuntary treatment with haloperidol decanoate 100 mg every 28 days but resolved within three weeks of dose increase to 150 mg every 28 days; at this time, he was prescribed doxepin 100 mg daily for new-onset depressive symptoms; three weeks later he sustained anoxic encephalopathy following a near-lethal suicide attempt by hanging. | ||
| 7 | Three months of fluphenazine decanoate 25 mg every 14 days resulted in partial reduction in delusional ideation, with initial opinion of restoration of competency; concomitant medication was benztropine 1 mg three times daily as needed for extrapyramidal side effects; he was returned to FMC Butner for additional involuntary treatment several months later after he refused fluphenazine at local jail; he remained delusional despite treatment with olanzapine 7.5 mg to 10 mg daily for two months; examiners opined he was nonrestorable to competency, in part due to prediction he would again stop taking psychotropic medication after leaving FMC Butner. | No |
| 8 | Six weeks of haloperidol decanoate 25 mg every 28 days resulted in significant diminution of paranoid ideation; no concomitant psychotropic medication. | Yes |
| 9 | One month of treatment with haloperidol decanoate 100 mg every 28 days was discontinued due to side effects of urinary retention, muscle stiffness, and drooling; most of his delusional ideation gradually resolved following three months of treatment with risperidone 2 mg twice daily; concomitant medication was trihexyphenidyl 5 mg three times daily for extrapyramidal side effects and diphenhydramine 75 mg at bedtime for insomnia. | Yes |
| 10 | Three months of haloperidol decanoate 75 mg every 28 days resulted in gradual but significant diminution of delusional ideation; no concomitant psychotropic medication. | Yes |
| 11 | Initial trial of haloperidol decanoate 150 mg was discontinued after a single injection due to severe akathisia; several-month trial of quetiapine at doses between 500 and 700 mg daily was ineffective, although the exact length of medication trial was not specified; three-week trial of olanzapine 10 mg daily followed by a few days of risperidone 2 mg daily were ineffective, which he refused to continue due to sedation and muscle aches or weakness; no concomitant psychotropic medication. | No |
| 12 | Four weeks of haloperidol decanoate 100 mg every 28 days resulted in significant reduction of delusional ideation; no concomitant psychotropic medication. | Yes |
| 13 | One month of perphenazine 40 mg daily was ineffective, as was an additional two month trial of perphenazine 56 mg daily; the delusional ideation responded to an additional two month trial of perphenazine 64 mg daily; no concomitant psychotropic medication; two years later, he voluntarily accepted treatment with haloperidol decanoate 50 mg every 28 days when he returned for presentence evaluation; with poor insight but no delusional ideation; he was also treated with benztropine 2 mg twice daily as needed. | Yes |
| 14 | Two months of haloperidol decanoate 150 mg every 28 days was ineffective and caused moderate akathisia; the dose of haloperidol decanoate was then lowered to 100 mg every 28 days; his delusional beliefs gradually resolved during the next three months of treatment; concomitant psychotropic medication was atenolol 50 mg daily for akathisia; doxepin 100 mg at bedtime for insomnia; and benztropine 1 mg twice daily as needed for extrapyramidal side effects. | Yes |
| 15 | Three to four weeks of treatment with risperidone 2 mg daily resulted in resolution of delusional ideation; concomitant psychotropic medication was lorazepam 1 mg as needed for severe agitation. | Yes |
| 16 | Six-week trial of olanzapine 20 mg at bedtime resulted in significant diminution of delusional ideation; concomitant psychotropic medication was doxepin 100 mg daily, which was prescribed for dysthymia before the olanzapine trial. | Yes |
| 17 | One month of olanzapine 10 mg daily was ineffective; his delusional beliefs gradually resolved during the next three months of treatment with same dose of olanzapine; concomitant medication was paroxetine 20 mg daily for new-onset depressive symptoms that emerged only after his delusional ideation waned; his anxiety symptoms were treated with clonazepam 0.5 mg in the morning and 1 mg at night for two to three weeks. | Yes |
| 18 | Two weeks of treatment with risperidone 4 mg daily and lithium 1200 mg daily resulted in significant reduction in paranoia, although low-level delusions persisted; no other psychotropic medication prescribed. | Yes |
| 19 | Three months of haloperidol decanoate 75 mg every 28 days resulted in slow improvement; concomitant psychotropic medication of benztropine 1 mg twice daily as needed for extrapyramidal side effects was never used by defendant; two years later he was returned to FMC Butner after relapsing following noncompliance with medication while on probation; involuntary treatment with haloperidol decanoate 100 mg every two weeks was initiated, but the evaluation period ended two weeks later with an inadequate medication trial and judge did not authorize additional period of treatment for competency restoration. | Yes |
| 20 | Three months of haloperidol decanoate 50 mg every 21 days resulted in partial reduction in delusional ideation; concomitant medication was benztropine 1 mg twice daily as needed for extrapyramidal side effects; a few months later, he was returned to FMC Butner for additional involuntary treatment after relapsing in jail due to noncompliance; a trial of risperidone 2 mg twice daily for three weeks resulted in partial remission of delusional ideation; his complaints of constipation from risperidone were treated with oral stool softener twice daily. | Yes |
| 21 | Two months of treatment with haloperidol decanoate 100 mg every 28 days was ineffective; the dose was increased to 150 mg every 28 days for the next three months, then increased again to 200 mg every 28 days for 1 month; serum haloperidol level collected at the end of the six-month period was lower than expected at 2.9 ng/mL; no concomitant psychotropic medication. | No |
| 22 | Two weeks of treatment with unspecified dose of oral fluphenazine followed by two weeks of treatment with fluphenazine decanoate 25 mg every two weeks resulted in moderate improvement in psychotic symptoms; no concomitant psychotropic medication; evaluators opined that his competency would be restored with an additional period of treatment, but the judge did not authorize any additional involuntary treatment. | No |