Objective This study was designed to investigate clinician rationales for prescribing higher than recommended dosages of antipsychotic medications in patients with schizophrenia. Methods Prescribers for all patients at two VA medical centers whose dosage exceeded PORT recommendations were interviewed. Results For 91/107 (85%) of patients, the prescriber responded that the current dosage should not be decreased. Positive symptoms were the most common target symptoms (94%), followed by negative symptoms (26%), anxiety (23%), and insomnia (13%). Conclusions In patients receiving higher than recommended dosages of antipsychotics, clinicians were frequently able to cite specific target symptoms.