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To the Editor: We have 2 concerns about the study by Dr Rosenheck and colleagues.¹ First, the average dosages of olanzapine (14.1 mg/d) and haloperidol (13.6 mg/d) do not reflect similar levels of dopamine D₂ receptor occupancy in each treatment group: about 75% for olanzapine and about 90% for haloperidol.² Although the dosages that the authors used are common in practice, they do not reflect optimal dosing for haloperidol. Given the relationship between dopaminergic neurotransmission and extrapyramidal symptoms and aspects of cognitive and motor functioning,³ differences in dopamine D₂ receptor occupancy could partially explain the small advantages found in favor of olanzapine.

Second, all patients assigned to haloperidol received prophylactic benztropine mesylate, which may negatively modify the expression of tardive dyskinesia⁴ and may have a negative influence on cognitive functioning.

Comparing olanzapine with optimally dosed haloperidol might shift the balance even more in favor of haloperidol. Such lower doses of . . . [Full Text of this Article]

Lieuwe de Haan, MD, PhD
Academic Medical Centre
Amsterdam, the Netherlands

Nico van Beveren, MD
Erasmus University Medical Centre
Rotterdam, the Netherlands

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