Data on the use of antipsychotics in acute psychiatric patients are based almost entirely on RCT trials with fixed or flexible dosing inside registered dosing intervals. Usually antipsychotic monotherapy is used in such trials. Real-life clinical experience might differ from such data and put in question recommendations and guidelines.

Inpatients admitted to PICU at University Psychiatric Hospital in Ljubljana during one month in 1999 and in 2006 were compared by clinical variables using CGI and GAS and by the use of antipsychotics. The doses of used antipsychotics were calculated into CPZ equivalents and compared with recommended as well as registered doses.

Results showed that samples for 1999 and 2006 did not differ in major demographic data. Clinical data however showed that 2006 patients were admitted more ill and discharged less ill (1 point average difference in CGI). The average doses of antipsychotics rose from 383 mg/day in 1999 to 689 mg/day in 2006. Although the atypical/typical ratio changed 5-fold during observed time, change in the observed doses is attributed to atypicals only. The doses of typical antipsychotics did not change comparing 1999 and 2006 sample.

The study was able to show important changes in the acute use of antipsychotics during the era of atypical or newer antipsychotics. Our results put in question some of the recommended dosing for antipsychotics in the acute psychiatric patients and confirm the practice of off-label use of antipsychotics regarding the dose in acute psychiatric states.