The Maudsleyยฎ
Prescribing Guidelines in Psychiatry
Contents
Preface
Acknowledgments
Notes on using The Maudsleyยฎ Prescribing Guidelines in Psychiatry
List of abbreviations
Part 1 Drug treatment of major psychiatric conditions
Chapter 1 Schizophrenia and related psychoses
ANTIPSYCHOTIC DRUGS
General introduction
Antipsychotics โ general principles of prescribing
Antipsychotics โ minimum effective doses
Antipsychotics โ quick reference for licensed maximum doses
Antipsychotics โ equivalent doses
High-dose antipsychotics: prescribing and monitoring
Combined antipsychotics (antipsychotic polypharmacy)
Antipsychotic prophylaxis
Negative symptoms
Monitoring
Relative adverse effects โ a rough guide
Treatment algorithms for schizophrenia
First-generation antipsychotics โ place in therapy
NICE guidelines for the treatment of schizophrenia
Antipsychotic response โ to increase the dose, to switch, to add or just wait โ what is the right move?
Acutely disturbed or violent behaviour
Antipsychotic depots/long-acting injections (LAIs)
Depot/LAI antipsychotics โ pharmacokinetics
Management of patients on long-term depots/LAIs
Aripiprazole long-acting injection
Olanzapine long-acting injection
Paliperidone palmitate long-acting injection
Risperidone long-acting injection
Risperidone subcutaneous long-acting injection
Newer long-acting injectable antipsychotic preparations
Penfluridol weekly
Electroconvulsive therapy and psychosis
Omega-3 fatty acid (fish oils) in schizophrenia
Stopping antipsychotics
ANTIPSYCHOTIC ADVERSE EFFECTS
Extrapyramidal symptoms
Akathisia
Treatment of tardive dyskinesia
Antipsychotic-induced weight gain
Treatment of antipsychotic-induced weight gain
Neuroleptic malignant syndrome
Catatonia
ECG changes โ QT prolongation
Effect of antipsychotic medications on plasma lipids
Diabetes and impaired glucose tolerance
Blood pressure changes with antipsychotics
Hyponatraemia in psychosis
Hyperprolactinaemia
Sexual dysfunction
Pneumonia
Switching antipsychotics
Venous thromboembolism
REFRACTORY SCHIZOPHRENIA AND CLOZAPINE
Clozapine initiation schedule
Intramuscular clozapine
Optimising clozapine treatment
Alternatives to clozapine
Re-starting clozapine after a break in treatment
Guidelines for the initiation of clozapine for patients based in the community
CLOZAPINE ADVERSE EFFECTS
Clozapine: common adverse effects
Clozapine: uncommon or unusual adverse effects
Clozapine: serious haematological and cardiovascular adverse effects
Clozapine-induced hypersalivation
Clozapine-induced gastrointestinal hypomotility (CIGH)
Clozapine, neutropenia and lithium
Clozapine and chemotherapy
Clozapine-genetic testing for clozapine treatment
Chapter
2 Bipolar disorder
Lithium
Valproate
Carbamazepine
Antipsychotics in bipolar disorder
Antipsychotic long-acting injections in bipolar disorder
Physical monitoring for people with bipolar disorder
Treatment of acute mania or hypomania
Rapid cycling bipolar affective disorder
Bipolar depression
Prophylaxis in bipolar disorder
Stopping lithium and mood stabilisers
Chapter 3 Depression and anxiety disorders
Introduction to Depression
Official guidance on the treatment of depression
Antidepressants โ general overview
Recognised minimum effective doses of antidepressants
Drug treatment of depression
Management of treatment-resistant depression โ first choice
Management of treatment-resistant depression โ second choice
Treatment-resistant depression โ other reported treatments
Ketamine
Psychotic depression
Switching antidepressants
Antidepressant withdrawal symptoms
Stopping antidepressants
Electroconvulsive therapy (ECT) and psychotropic drugs
Psychostimulants in depression
Post-stroke depression
Antidepressants โ alternative routes of administration
Antidepressant prophylaxis
Drug interactions with antidepressants
Cardiac effects of antidepressants โ summary
Antidepressant-induced arrhythmia
Antidepressant-induced hyponatraemia
Antidepressants and hyperprolactinaemia
Antidepressants and diabetes mellitus
Antidepressants and sexual dysfunction
SSRIs and bleeding
St. Johnโs Wort
Antidepressants: relative adverse effects โ a rough guide
Anxiety spectrum disorders
Benzodiazepines in the treatment of psychiatric disorders
Benzodiazepines, z-drugs and gabapentinoids: dependence, detoxification and discontinuation
Benzodiazepines and disinhibition
Chapter 4 Addictions and substance misuse
Introduction
Alcohol dependence
Alcohol withdrawal delirium โ delirium tremens
Opioid dependence
Nicotine and smoking cessation
Pharmacological treatment of dependence on stimulants
GHB and GBL dependence
Benzodiazepine misuse
Synthetic cannabinoid receptor agonists (SCRAs)
Drug-induced acute behavioural disturbance (ABD) in acute admissions
Interactions between โstreet drugsโ and prescribed psychotropic drugs
Drugs of misuse โ a summary
Substance misuse in pregnancy
Part 2 Drug treatment of special patient groups
Chapter 5 Children and adolescents
Principles of prescribing practice in childhood and adolescence
Depression in children and adolescents
Bipolar illness in children and adolescents
Psychosis in children and adolescents
Anxiety disorders in children and adolescents
Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) in children and adolescents
Post-traumatic stress disorder in children and adolescents
Attention deficit hyperactivity disorder
Autism Spectrum Disorder
Tics and Tourette syndrome
Melatonin in the treatment of insomnia in children and adolescents
Rapid tranquillisation (RT) in children and adolescents
Doses of commonly used psychotropic drugs in children and adolescents
Chapter 6 Prescribing in older people
General principles
Dementia
Safer prescribing for physical conditions in dementia
Management of behavioural and psychological symptoms of dementia (BPSD)
A guide to medication doses of commonly used psychotropics in older adults
Covert administration of medicines within food and drink
Treatment of depression in older people
Chapter 7 Pregnancy and breastfeeding
Drug choice in pregnancy
What to include in discussions with pregnant women
Breastfeeding
Chapter 8 Hepatic and renal impairment
Hepatic impairment
Renal impairment
Part 3 Prescribing in specialist conditions
Chapter 9 Drug treatment of other psychiatric conditions
Borderline personality disorder (BPD)
Eating disorders
Delirium
Chapter 10 Drug treatment of psychiatric symptoms occurring in the
context of other disorders
General principles of prescribing in HIV
Epilepsy
22q11.2 deletion syndrome
Learning disabilities
Huntingtonโs disease โ pharmacological treatment
Multiple sclerosis
Parkinsonโs disease
Atrial fibrillation โ using psychotropics
Recommendations โ psychotropics in AF
Psychotropics in bariatric surgery
Prescribing in patients with psychiatric illness at the end of life
Part 4 Other aspects of psychotropic drug use
Chapter 11 Pharmacokinetics
Plasma level monitoring of psychotropic drugs
Interpreting postmortem blood concentrations
Acting on clozapine plasma concentration results
Psychotropics and cytochrome (CYP) function
Smoking and psychotropic drugs
Drug interactions with alcohol
Chapter 12 Other substances
Caffeine
Nicotine
Chapter 13 Psychotropic drugs in special conditions
Psychotropics in overdose
Driving and psychotropic medicines
Psychotropics and surgery
Chapter 14 Miscellany
Enhancing medication adherence
Re-starting psychotropic medications after a period of non-compliance
Biochemical and haematological effects of psychotropics
Summary of psychiatric side effects of non-psychotropics
Prescribing drugs outside their licensed indications (โoff-labelโ prescribing or unapproved use of approved drugs)
Examples of acceptable use of drugs outside their product licences/labels
The Mental Health Act in England and Wales
Site of administration of intramuscular injections
Intravenous formulations in psychiatry
Index
EULA