The Maudsley Prescribing Guidelines in Psychiatry

David M. Taylor BSc, MSc, PhD, FFRPS, FRPharmS, is Director of Pharmacy and Pathology at the Maudsley Hospital and Professor of Psychopharmacology at King's College, London. Thomas R. E. Barnes, MBBS, MD, FRCPsych, DSc, is Emeritus Professor of Clinical Psychiatry at Imperial College London and joint-head of the Prescribing Observatory for Mental Health at the Royal College of Psychiatrists' Centre for Quality Improvement. Allan H. Young, MB, ChB, MPhil, PhD, FRCPC, FRCPsych, is Chair of Mood Disorders and is Director of the Centre for Affective Disorders in the Department of Psychological Medicine in the Institute of Psychiatry at King's College London, UK.

Preface x Acknowledgements xii Notes on using The Maudsley Prescribing Guidelines in Psychiatry xiii List of abbreviations xv Part 1 Drug treatment of major psychiatric conditions 1 Chapter 1 Schizophrenia and related psychoses 3 ANTIPSYCHOTIC DRUGS 3 General introduction 3 General principles of prescribing 8 Minimum effective doses 9 Licensed maximum doses 12 Equivalent doses 14 High?dose antipsychotics: prescribing and monitoring 16 Combined antipsychotics 20 Antipsychotic prophylaxis 25 Negative symptoms 31 Monitoring 36 Relative adverse effects - a rough guide 39 Treatment algorithms for schizophrenia 40 First?generation antipsychotics - place in therapy 44 NICE guidelines for the treatment of schizophrenia 46 Antipsychotic response - to increase the dose, to switch, to add or just wait - what is the right move? 49 Acutely disturbed or violent behaviour 54 Antipsychotic depots/long?acting injections (LAIs) 66 Depot/LAI antipsychotics - pharmacokinetics 71 Management of patients on long?term depots/LAIs 73 Aripiprazole long?acting injection 75 Olanzapine long?acting injection 77 Paliperidone palmitate long?acting injection 79 Risperidone long?acting injection 82 Electroconvulsive therapy and psychosis 86 Omega?3 fatty acid (fish oils) in schizophrenia 88 ANTIPSYCHOTIC ADVERSE EFFECTS 90 Extrapyramidal symptoms 90 Akathisia 94 Weight gain 97 Treatment of antipsychotic?induced weight gain 99 Neuroleptic malignant syndrome 104 Catatonia 107 ECG changes - QT prolongation 112 Effect of antipsychotic medications on plasma lipids 119 Diabetes and impaired glucose tolerance 123 Blood pressure changes 130 Hyponatraemia 134 Hyperprolactinaemia 137 Sexual dysfunction 141 Pneumonia 148 Switching antipsychotics 150 Venous thromboembolism 153 REFRACTORY SCHIZOPHRENIA AND CLOZAPINE 156 Clozapine initiation schedule 156 Optimising clozapine treatment 158 Alternatives to clozapine 162 Re?starting clozapine after a break in treatment 169 Initiation of clozapine for community?based patients 170 CLOZAPINE ADVERSE EFFECTS 175 Clozapine: common adverse effects 175 Clozapine: uncommon or unusual adverse effects 179 Clozapine: serious haematological and cardiovascular adverse effects 184 Clozapine?induced hypersalivation 189 Clozapine?induced gastrointestinal hypomotility (CIGH) 193 Clozapine, neutropenia and lithium 197 Clozapine and chemotherapy 202 Chapter 2 Bipolar disorder 205 Lithium 205 Valproate 214 Carbamazepine 221 Antipsychotic drugs in bipolar disorder 226 Antipsychotic long?acting injections in bipolar disorder 229 Physical monitoring for people with bipolar disorder 232 Treatment of acute mania or hypomania 235 Rapid?cycling bipolar disorder 241 Bipolar depression 243 Prophylaxis in bipolar disorder 250 Chapter 3 Depression and anxiety disorders 255 Depression: introduction 255 Basic principles of prescribing in depression 255 Official guidance on the treatment of depression 256 Antidepressants: general overview 257 Recognised minimum effective doses of antidepressants 262 Drug treatment of depression 264 Treatment of refractory depression: first choice 267 Treatment of refractory depression: second choice 271 Treatment of refractory depression: other reported treatments 274 Psychotic depression 278 Electroconvulsive therapy and psychotropic drugs 281 Stimulants in depression 285 Post?stroke depression 290 Treatment of depression in the elderly 293 Antidepressants: alternative routes of administration 298 Antidepressant prophylaxis 306 Antidepressant discontinuation symptoms 310 Antidepressants: swapping and stopping 314 Drug interactions with antidepressants 321 Cardiac effects of antidepressants 325 Antidepressant?induced arrhythmia 329 Antidepressant?induced hyponatraemia 333 Antidepressants and hyperprolactinaemia 337 Antidepressants and