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Office of Mental Health



The PSYCKES Dose quality indicators identity individuals prescribed higher than recommended doses of psychotropic medications. The most effective and most tolerable dose of medication varies for any given individual. Pharmacokinetics (how the body processes the medication) and pharmacodynamics (how the medication affects the body and brain) both vary individually and with age. The Food and Drug Administration approval process includes determination of the lowest dose at which a medication is effective as well as the maximum dose likely to produce clinical improvement without serious or dangerous side effects. For most psychotropic medications, the effectiveness of a medication does not increase proportionally to increases in dose. Higher than recommended doses of psychotropics place the consumer at increased risk for adverse outcomes.

The Dose Reference Guide (214kb) provides:

  • brief definitions of each indicator within the Dose indicator set,
  • a summary of the scientific evidence regarding higher than recommended doses,
  • clinical recommendations for reducing higher than recommended doses of psychotropic medications, and
  • an annotated bibliography of key scientific articles.

Detailed information about the Dose indicators can be found in the Dose Technical Specifications (168kb).

For QI teams wishing to identify higher than recommended doses of psychotropic medication outside of the Medicaid population, chart review forms are available. The Psychotropic Medication Reference Table (386kb) provides information on the maximum doses used to calculate the Dose quality indicators. In adults, the recommended maximum doses were determined using the PORT guidelines for antipsychotics and the US Food and Drug Administration (FDA) for other drug classes. In youth, the maximum recommended doses were determined based on a hierarchy of sources including FDA recommendations.

OMH has developed several educational resources about psychotropic prescribing issues in dose, including:

Comments or questions about the information on this page can be directed to the PSYCKES Team.