Haloperidol long-term treatment with

Beasley CM Jr, Deliva MA, Tamura RN, et al. Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol. Br J Psychiatry 1999 174 23-30. 

No formal, prospective, long-term efficacy or safety studies of either typical or atypical antipsychotics in children and adolescents with schizophrenia have been conducted (166, 167). However, reports of the long-term treatment of children and adolescents with conduct disorder (181, 182), autism (183), and Tourette s disorder (184) with either haloperidol or thioridazine suggest that the tolerability of these medications in children and adolescents is comparable with that in adults. 

Tollefson GD, Beasley CM Jr, Tamura RN Blind, controlled long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haloperidol. Am J Psychiatry 154 1248-1254, 1997... 

In this context, Lilly (474) reported a meta-analysis of three controlled studies of patients with TD who were treated with olanzapine. These authors found an 11-fold decrease in TD on olanzapine versus haloperidol based on the AIMS scale. There were a few patients who developed TD in the first 6 weeks of olanzapine, but this could have been from previous drug exposure, now not suppressed by the neuroleptic. Interestingly, there were no new cases (0/375) of TD developing in patients on long-term olanzapine treatment, whereas there were three of 83 cases on haloperidol. It is very difficult to arrive at definitive evidence about TD because most patients have received previous neuroleptic therapy and because TD-like symptoms occur spontaneously, providing an alternative explanation. It is clear that it is difficult to prove that olanzapine causes TD but equally difficult to prove that it does not. The 11-fold decreased incidence, however, is strong evidence that at least it produces much less TD. 

Kane JM, Carson WH, Saha AR, Saha AR, McQuade RD, Ingenito GG, Zumbroff DL, Ali MW (2002) Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder. J Clin Psychiat 63 763-71 Kasper S, Lerman MN, McQuade RD, Saha A, Carson WH, Ali M, Archibald D, Ingenito G, Marcus R, Pigott T (2003). Efficacy and safety of aripiprazole vs. haloperidol for long-term maintenance treatment following acute relapse of schizophrenia. Int J Neuropsychopharmacol 6 325-37... 

Tollefson, G. D., Beasley, C. M., Jr., Tamura, R. N., Tran, P. V., Potvin, J. H. 1997, Blind, controlled, long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haloperidol, Am.J.Psychiatry, vol. 154, no. 9, pp. 1248-1254. 

Maintenance with injections of the decanoate ester of fluphenazine or haloperidol every 2—4 weeks, or with long-acting risperidone microspheres every 2—3 weeks, can be very effective. However, an expectation of superiority of long-acting injected antipsychotics is not well supported by available studies, most of which involve randomization of patients who already are largely cooperative with long-term oral treatment. 

Antipsychotic drugs commonly have been used empirically to manage manic and psychotic illness in bipolar disorder patients. Indeed, standard neuroleptics are a mainstay of the treatment of acute mania (only chlorpromazine is FDA-approved for this indication, although haloperidol has also been widely used) and for manic episodes that break through prophylactic treatment with LF or an anticonvulsant. However, the older antipsychotics are not used routinely for long-term prophylactic treatment in bipolar disorder because their effectiveness is untested, some may worsen depression, and the risk of tardive dyskinesia in these syndromes may be higher than in schizophrenia. 

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