Maudsley's guidelines

ANTIPSYCHOTIC DRUGS

General introduction

Classification of antipsychotics The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Ed...

Choosing an antipsychotic 2 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 very low...

Relative efficacy Schizophrenia and related psychoses CHAPTER 1 Antipsychotics are effective in b...

References Schizophrenia and related psychoses CHAPTER 1 References Zohar J, et al. Neuroscience...

General principles of prescribing Schizophrenia and related psychoses CHAPTER 1 General principle...

Antipsychotics – minimum effective doses 8 The Maudsley® Prescribing Guidelines in Psychiatry CHA...

References Schizophrenia and related psychoses CHAPTER 1 References Dudley K, et al. Chlorpromaz...

Quick reference for licensed maximum doses Schizophrenia and related psychoses CHAPTER 1 Quick re...

Clinical effectiveness

Adverse effects

Summary 106 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Penfluridol weekly Backg...

References Schizophrenia and related psychoses CHAPTER 1 In practice, penfluridol is usually star...

Electroconvulsive therapy and psychosis

Treatment-refractory schizophrenia 108 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER...

Adverse effects

Summary Schizophrenia and related psychoses CHAPTER 1 maintained their symptomatic improvement or...

References 110 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Grover S,...

Omega-3 fatty acid (fish oils) in schizophrenia

References Schizophrenia and related psychoses CHAPTER 1 References Electronic Medicines Compend...

Treatment

Prevention Schizophrenia and related psychoses CHAPTER 1 Omega-­3 fatty acid (fish oils) in schiz...

Overall

Summary recommendations – fish oils (PUFAs)

References 112 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 reduction in transiti...

Alternative routes of administration Schizophrenia and related psychoses CHAPTER 1 Alternative ro...

Inhaled

Intranasal 116 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Inhaled Loxapine is t...

Intravenous

Sublingual

Equivalent doses 14 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Equivalent doses...

Buccal

Transdermal Schizophrenia and related psychoses CHAPTER 1 ­haloperidol had a shorter time to peak...

Rectal

References 118 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Rectal Chlorpromazine...

Stopping antipsychotics

Withdrawal effects of antipsychotics Schizophrenia and related psychoses CHAPTER 1 Stopping antip...

Neurobiology of withdrawal 120 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Neuro...

Pattern of tapering Schizophrenia and related psychoses CHAPTER 1 Pattern of tapering Positron em...

Tapering in practice 122 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Exponential...

When to attempt discontinuation Schizophrenia and related psychoses CHAPTER 1 When to attempt dis...

References 16 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Foster P. ...

References 124 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Leucht S,...

ANTIPSYCHOTIC ADVERSE EFFECTS

Extrapyramidal symptoms 126 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ANTIPSYC...

References Schizophrenia and related psychoses CHAPTER 1 References Owens DGC. A Guide to the Ex...

Akathisia Schizophrenia and related psychoses CHAPTER 1 Akathisia Akathisia is a fairly common ad...

References Schizophrenia and related psychoses CHAPTER 1 Notes ■ ■Akathisia can be difficult to d...

Treatment of tardive dyskinesia

Treatment – first steps Schizophrenia and related psychoses CHAPTER 1 Treatment of tardive dyskin...

Treatment – additional agents

Treatment – other possible options 136 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER...

High-dose antipsychotic medication: prescribing and monitoring

References Schizophrenia and related psychoses CHAPTER 1 Table 1.30  Other options for the treatm...

Antipsychotic-induced weight gain Schizophrenia and related psychoses CHAPTER 1 Antipsychotic-­in...

Time course

Dose–response 142 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Time course Antips...

References Schizophrenia and related psychoses CHAPTER 1 References Barton BB, et al. Update on ...

Treatment of antipsychotic-induced weight gain

Monitoring

Treatment and prevention 144 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Treatme...

References Schizophrenia and related psychoses CHAPTER 1 References Pillinger T, et al. Comparat...

Neuroleptic malignant syndrome 150 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 N...

Efficacy Schizophrenia and related psychoses CHAPTER 1 High-­dose antipsychotic medication: presc...

References Schizophrenia and related psychoses CHAPTER 1 Risk factors for developing NMS include ...

Catatonia 154 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Catatonia Catatonia is...

References 158 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Rogers JP...

ECG changes – QT prolongation

Introduction

QT prolongation Schizophrenia and related psychoses CHAPTER 1 ECG changes – QT prolongation Intro...

Other ECG changes

Quantifying risk 162 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ■ ■There is som...

Other risk factors 164 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Aripiprazole ...

ECG monitoring

Adverse effects 18 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 A small number of...

Metabolic inhibition Schizophrenia and related psychoses CHAPTER 1 Table 1.37  Non-­psychotropics...

Other cardiovascular risk factors

Summary

References 166 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Other cardiovascular ...

Effects of antipsychotic medications on plasma lipids

Effect of antipsychotic medications on lipids

Olanzapine Schizophrenia and related psychoses CHAPTER 1 Effects of antipsychotic medications on ...

Clozapine

Screening and monitoring

Clinical management of dyslipidaemia 170 The Maudsley® Prescribing Guidelines in Psychiatry CHAPT...

Recommendations

Summary of monitoring

References Schizophrenia and related psychoses CHAPTER 1 recommended by NICE for secondary preven...

Diabetes and impaired glucose tolerance

Schizophrenia

Antipsychotic medications

First-generation antipsychotic medications

Second-generation antipsychotic medications 174 The Maudsley® Prescribing Guidelines in Psychiatr...

Predicting antipsychotic-related diabetes

Monitoring 176 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ­glucose homeostasis....

Treatment of antipsychotic-related diabetes

Prescribing high-dose antipsychotic medication Schizophrenia and related psychoses CHAPTER 1 ■ ■T...

Summary: antipsychotic medications – risk of diabetes and impaired glucose tolerance Schizophreni...

References 178 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Schimmelb...

Blood pressure changes with antipsychotics

Orthostatic hypotension 182 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Blood pr...

Hypertension Schizophrenia and related psychoses CHAPTER 1 Antipsychotics with a high affinity fo...

References 184 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 dopamine receptor ant...

Antipsychotic-associated hyponatraemia 186 The Maudsley® Prescribing Guidelines in Psychiatry CHA...

References 188 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References de Leon J...

Hyperprolactinaemia 190 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Hyperprolact...

Contraindications

References 20 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Royal Coll...

Management

Summary of management Schizophrenia and related psychoses CHAPTER 1 Contraindications Prolactin-­...

References Schizophrenia and related psychoses CHAPTER 1 References Suzuki Y, et al. Differences...

Sexual dysfunction and antipsychotics

The human sexual response

Effects of psychosis Schizophrenia and related psychoses CHAPTER 1 Sexual dysfunction and antipsy...

Effects of antipsychotic drugs 196 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 P...

Treatment of sexual dysfunction 198 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ...

References 200 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 The evidence base sup...

Pneumonia

Combined antipsychotics (antipsychotic polypharmacy)

Background 204 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Pneumonia Background ...

Mechanisms

Summary Schizophrenia and related psychoses CHAPTER 1 ■ ■Assume that the use of all antipsychotic...

References 206 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Dzahini O...

Switching antipsychotics Schizophrenia and related psychoses CHAPTER 1 Switching antipsychotics T...

References 208 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Lumateperone and pima...

Venous thromboembolism

Evidence of an association Schizophrenia and related psychoses CHAPTER 1 Venous thromboembolism E...

Mechanisms

Outcomes 212 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Mechanisms Several mech...

Poor response to antipsychotic monotherapy

Summary

Practice points

References Schizophrenia and related psychoses CHAPTER 1 Summary Antipsychotics are almost certai...

REFRACTORY SCHIZOPHRENIA AND CLOZaPINE

Clozapine initiation schedules

Clozapine dosing regimen 214 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Table 1...

Faster titrations Schizophrenia and related psychoses CHAPTER 1 Alternatively, an attempt can be ...

References 218 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Male smoker – target ...

Intramuscular clozapine

References Schizophrenia and related psychoses CHAPTER 1 Intramuscular clozapine Intramuscular cl...

Long-term antipsychotic treatment 22 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1...

Optimising clozapine treatment

Using clozapine alone

Clozapine augmentation 220 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Optimisin...

References 222 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Other options include...

Alternatives to clozapine 226 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Altern...

Summary of alternatives to clozapine Schizophrenia and related psychoses CHAPTER 1 Summary of alt...

References 230 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Millgate ...

Restarting clozapine after a break in treatment 234 The Maudsley® Prescribing Guidelines in Psych...

References Schizophrenia and related psychoses CHAPTER 1 References John AP, et al. Rates and re...

Initiation of clozapine in the community

Adverse effects Schizophrenia and related psychoses CHAPTER 1 monotherapy.24 Although the interpr...

Relative contraindications to community initiation

Essential criteria for suitability for community initiation

Initial work-up 236 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Initiation of cl...

Mandatory blood monitoring and registration

Dosing Schizophrenia and related psychoses CHAPTER 1 ■ ■Echocardiogram if clinically indicated. ■...

Adverse effects

Recommended additional monitoring

Switching from other antipsychotics Schizophrenia and related psychoses CHAPTER 1 Adverse effects...

Serious cardiac adverse effects

References 240 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Serious cardiac adver...

The use of combined antipsychotic medications in clinical practice

CLOZAPINE ADVERSE EFFECTS

Clozapine: common adverse effects Schizophrenia and related psychoses CHAPTER 1 CLOZAPINE ADVERSE...

References Schizophrenia and related psychoses CHAPTER 1 References Palmer SE, et  al. Life-­thr...

Clozapine: uncommon or unusual adverse effects Schizophrenia and related psychoses CHAPTER 1 Cloz...

References Schizophrenia and related psychoses CHAPTER 1 References Thompson A, et al. Late onse...

Clozapine: serious haematological adverse effects

Agranulocytosis

Summary Schizophrenia and related psychoses CHAPTER 1 Clozapine: serious haematological adverse e...

References 252 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Vermeulen...

Clozapine: serious cardiovascular adverse effects

Conclusion

Thromboembolism

Myocarditis Schizophrenia and related psychoses CHAPTER 1 Clozapine: serious cardiovascular adver...

Cardiomyopathy 254 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 4 days until a da...

References 256 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Paciullo ...

Clozapine-induced hypersalivation 258 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER ...

References 260 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Man WH, e...

Clozapine-induced gastrointestinal hypomotility Schizophrenia and related psychoses CHAPTER 1 Clo...

Prevention and simple management of CIGH

Management of suspected acute CIGH 264 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER...

Clozapine rechallenge following severe constipation

Summary 24 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Given the association bet...

Key message

References Schizophrenia and related psychoses CHAPTER 1 Clozapine rechallenge following severe c...

Clozapine, neutropenia and lithium

Mild neutropenia

Severe neutropenia or agranulocytosis Schizophrenia and related psychoses CHAPTER 1 Clozapine, ne...

Benign ethnic neutropenia 268 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Risk f...

Concurrent medications

Management options

Lithium Schizophrenia and related psychoses CHAPTER 1 Concurrent medications Different classes of...

Granulocyte colony-stimulating factor 270 The Maudsley® Prescribing Guidelines in Psychiatry CHAP...

References Schizophrenia and related psychoses CHAPTER 1 ■ ■Combined antipsychotic medications ar...

References Schizophrenia and related psychoses CHAPTER 1 G-­CSF in the face of a low or declining...

Clozapine and chemotherapy

Summary Schizophrenia and related psychoses CHAPTER 1 Clozapine and chemotherapy The use of cloza...

References 274 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ■ ■The likelihood of ...

Genetic testing for clozapine treatment

Response

Agranulocytosis Schizophrenia and related psychoses CHAPTER 1 Genetic testing for clozapine treat...

Benign ethnic neutropenia

Metabolism 276 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 HLA-­B59:01 Presence ...

Other adverse effects

Antipsychotic prophylaxis

References Schizophrenia and related psychoses CHAPTER 1 NFIB rs28379954 T>C CT carriers have muc...

First episode of psychosis 28 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Antips...

Multi-episode schizophrenia

Summary Schizophrenia and related psychoses CHAPTER 1 a first admission for schizophrenia, clozap...

Adherence to antipsychotic treatment

Dose for prophylaxis

How and when to stop55 30 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 A large me...

Alternative views Schizophrenia and related psychoses CHAPTER 1 at least 3 weeks for oral antipsy...

References 32 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Karson C, ...

Negative symptoms

Pharmacological treatment of negative symptoms 34 The Maudsley® Prescribing Guidelines in Psychia...

Summary and recommendations 36 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 RCTs ...

References Schizophrenia and related psychoses CHAPTER 1 References Messinger JW, et al. Avoliti...

Monitoring 40 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Monitoring Table 1.6 s...

References 42 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References National I...

Relative adverse effects – a rough guide Schizophrenia and related psychoses CHAPTER 1 Relative a...

Treatment algorithms for schizophrenia

First-episode schizophrenia Schizophrenia and related psychoses CHAPTER 1 Either: Agree the choic...

Relapse or acute exacerbation of schizophrenia 46 The Maudsley® Prescribing Guidelines in Psychia...

Relapse or acute exacerbation of schizophrenia Schizophrenia and related psychoses CHAPTER 1 Rela...

References 48 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Robinson D...

First-generation antipsychotics – place in therapy

Nomenclature

Role of older antipsychotics Schizophrenia and related psychoses CHAPTER 1 First-­generation anti...

References 50 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 alternative to SGAs wh...

NICE guidelines for the treatment of schizophrenia1

NICE guidelines – a summary 52 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 NICE ...

References 54 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 allow the use of long-...

Antipsychotic response – to increase the dose, to switch, to add or just wait – what is the right...

Optimal dosage

High dosage Schizophrenia and related psychoses CHAPTER 1 Antipsychotic response – to increase th...

Plasma level variations 56 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ­network ...

Treatment options for schizophrenia that is poorly responsive to standard antipsychotic treatment...

Summary Schizophrenia and related psychoses CHAPTER 1 When treatment fails ■ ■If the dose of anti...

References 60 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Samara MT,...

Acutely disturbed or violent behaviour

Oral/inhaled treatment

Parenteral treatment 62 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Acutely dist...

Practical measures Schizophrenia and related psychoses CHAPTER 1 positive or negative effects and...

Zuclopenthixol acetate 66 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Zuclopenth...

References Schizophrenia and related psychoses CHAPTER 1 References Patel MX, et al. Joint BAP N...

Antipsychotic depots/long-acting injections 74 The Maudsley® Prescribing Guidelines in Psychiatry...

Advice on prescribing LAIs Schizophrenia and related psychoses CHAPTER 1 understanding of these f...

Differences between LAIs 76 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ■ ■Adjus...

References Schizophrenia and related psychoses CHAPTER 1 References Tiihonen J, et al. Real-­wor...

Depot antipsychotics – summary of pharmacokinetics Schizophrenia and related psychoses CHAPTER 1 ...

References 82 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Mallikaarj...

Management of patients on long-term treatment with long-acting injectable antipsychotic medicatio...

References 84 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ■ ■Discontinuation of ...

Aripiprazole long-acting injection

Aripiprazole 1-monthly

One-injection start

Two-injection start Schizophrenia and related psychoses CHAPTER 1 Aripiprazole long-­acting injec...

Aripiprazole 2-monthly8,9 Schizophrenia and related psychoses CHAPTER 1 Aripiprazole 2-­monthly8,...

Other LAI aripiprazole brands 88 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Oth...

References Schizophrenia and related psychoses CHAPTER 1 References Shirley M, et al. Aripiprazo...

Olanzapine long-acting injection

Switching

Stopping 90 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Olanzapine long-­acting ...

Post-injection delirium sedation syndrome Schizophrenia and related psychoses CHAPTER 1 Post-­inj...

References 92 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Heres S, e...

Paliperidone palmitate long-acting injection

Paliperidone long-acting injection 1-monthly Schizophrenia and related psychoses CHAPTER 1 Palipe...

Paliperidone long-acting injection 3-monthly Schizophrenia and related psychoses CHAPTER 1 Palipe...

Paliperidone LAI 6-monthly (PP6M) 96 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1...

References Schizophrenia and related psychoses CHAPTER 1 Dose adjustments should not be needed bu...

Risperidone long-acting injection

Risperidone intramuscular long-acting injections Schizophrenia and related psychoses CHAPTER 1 Ri...

Risperidone subcutaneous long-acting injections Schizophrenia and related psychoses CHAPTER 1 Ris...

References 104 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Knox ED, ...

Penfluridol weekly

Background

Lithium

Mechanism of action

Clinical indications The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David...

Lithium and suicide

Plasma levels Bipolar disorder CHAPTER 2 Prophylaxis of unipolar depression Lithium is significan...

Formulations

Adverse effects

Lithium toxicity 282 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Formulations Th...

Pre-treatment tests

On-treatment monitoring12,58

Discontinuation Bipolar disorder CHAPTER 2 Above 2mmol/L, increased disorientation and seizures u...

Interactions with other drugs70–72 284 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER...

References 286 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 fenbufen, fenoprofen,...

Valproate

Mechanism of action1

Formulations

Indications Bipolar disorder CHAPTER 2 Valproate Mechanism of action1 Valproate is a simple branc...

Plasma levels 290 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 less effective but...

Adverse effects

Pre-treatment tests

On-treatment monitoring

Discontinuation Bipolar disorder CHAPTER 2 Adverse effects Valproate can cause both gastric irrit...

Use in women of child-bearing age

Interactions with other drugs 292 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Us...

References Bipolar disorder CHAPTER 2 References Rosenberg G. The mechanisms of action of valpro...

Carbamazepine

Mechanism of action1

Formulations

Indications Bipolar disorder CHAPTER 2 Carbamazepine Mechanism of action1 Carbamazepine blocks vo...

Plasma levels

Adverse effects1 296 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 considered to b...

Pre-treatment tests

On-treatment monitoring

Discontinuation

Use in women of child-bearing age

Interactions with other drugs41–44 Bipolar disorder CHAPTER 2 and a specificity approaching 100% ...

References 298 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 resulting in treatmen...

Antipsychotic drugs in bipolar disorder

First-generation antipsychotics

Second-generation antipsychotics 300 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2...

Specific antipsychotics Bipolar disorder CHAPTER 2 Bipolar depression In acute treatment of bipol...

References Bipolar disorder CHAPTER 2 References ECNP. Neuroscience-­based nomenclature (NbN). 2...

Antipsychotic long-acting injections in bipolar disorder Bipolar disorder CHAPTER 2 Antipsychotic...

Conclusion 306 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 neither decreases nor...

References Bipolar disorder CHAPTER 2 References Keramatian K, et al. Long-­acting injectable se...

Physical monitoring for people with bipolar disorder1,2 Physical monitoring for people with bipol...

References Prolactin Children and adolescents only At start and if symptoms of raised prolactin d...

Treatment of acute mania or hypomania 310 The Maudsley® Prescribing Guidelines in Psychiatry CHAP...

References 312 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 References Cipriani ...

Rapid-cycling bipolar affective disorder 316 The Maudsley® Prescribing Guidelines in Psychiatry C...

References Bipolar disorder CHAPTER 2 References Miola A, et al. Prevalence and outcomes of rapi...

Bipolar depression

Meta-analysis in bipolar depression Bipolar disorder CHAPTER 2 Bipolar depression Bipolar depress...

Summary of drug choice

References 322 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Summary of drug choic...

Prophylaxis in bipolar disorder 326 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 ...

Optimising lithium treatment45

Combination treatment Bipolar disorder CHAPTER 2 risperidone LAI is well supported by RCTs39 and ...

References Bipolar disorder CHAPTER 2 References Malhi GS, et al. The 2020 Royal Australian and ...

Stopping lithium and mood stabilisers

Rationale for stopping

Withdrawal effects from lithium and other mood stabilisers Bipolar disorder CHAPTER 2 Stopping li...

Evidence for long-term treatment

Duration of tapering

Pattern of tapering 332 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Evidence for...

Practice guide to tapering

References Bipolar disorder CHAPTER 2 Practice guide to tapering ■ ■Patients should be told that ...

Introduction to depression The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition....

Official guidance on the treatment of depression: a summary of the NICE guidelines1

References 336 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Official guidance on ...

Antidepressants – general overview

Effectiveness Depression and anxiety disorders CHAPTER 3 Antidepressants – general overview Effec...

Onset of action

Choice of antidepressant and relative adverse effects 338 The Maudsley® Prescribing Guidelines in...

Drug interactions

Suicidality Depression and anxiety disorders CHAPTER 3 foods to cause hypertensive crisis and muc...

Duration of treatment

References 430 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References McCabe MP...

SSRIs and bleeding

Gastrointestinal bleeding Depression and anxiety disorders CHAPTER 3 Caution should be exercised ...

Intracranial/intracerebral haemorrhage

Gynaecological and obstetric haemorrhage Depression and anxiety disorders CHAPTER 3 One database ...

Abnormal vaginal bleeding

Postpartum haemorrhage 436 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 were thre...

Surgical and postoperative bleeding

Alternatives to SSRIs/SNRIs

Overall Depression and anxiety disorders CHAPTER 3 A review of 13 studies found an increased odds...

Next-step treatments

Summary

References 438 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 5. Jiang HY, et al. U...

St John’s wort

Evidence for St John’s wort in the treatment of depression 440 The Maudsley® Prescribing Guidelin...

Adverse effects

Drug interactions 442 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 People may reg...

References Depression and anxiety disorders CHAPTER 3 26. Nicolussi S, et al. Clinical relevance ...

Antidepressants: relative adverse effects – a rough guide 446 The Maudsley® Prescribing Guideline...

Anxiety spectrum disorders

Benzodiazepines

Use of antidepressants in anxiety spectrum disorders

SSRIs/SNRIs Depression and anxiety disorders CHAPTER 3 all drugs may be effective when standard d...

Pregabalin 448 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 overdose toxicity of ...

Psychological approaches Depression and anxiety disorders CHAPTER 3 OCD (where there is moderate ...

Summary of NICE guidelines for the treatment of GAD, panic disorder and OCD Depression and anxiet...

Panic disorder

GAD

OCD (where there is moderate or severe functional impairment)

References 456 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 19. Jakubovski E, et ...

Benzodiazepines in the treatment of psychiatric disorders

Anxiolytic effect

References 340 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Toxicity in overdose ...

Hypnotic effect Depression and anxiety disorders CHAPTER 3 Use in depression Benzodiazepines are ...

Use in depression

Use in psychosis 462 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Epidemiological...

Adverse effects

Drug interactions Depression and anxiety disorders CHAPTER 3 15. Roehrs T, et al. Drug-­related s...

References 464 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Benzodiazepines, z-­d...

Benzodiazepines, z-drugs and gabapentinoids: dependence, withdrawal effects and discontinuation 4...

Withdrawal symptoms Depression and anxiety disorders CHAPTER 3 patients with hepatic dysfunction,...

Stopping benzodiazepines

Dosage reduction (tapering)

Recognised minimum effective doses of antidepressants 342 The Maudsley® Prescribing Guidelines in...

Direct taper or switching to diazepam?

Pattern of tapering 468 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Practical ap...

Practical application of these principles Depression and anxiety disorders CHAPTER 3 with smaller...

Troubleshooting

Reduction schedules 470 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 11. Horowitz...

Tapering other drug classes

References Depression and anxiety disorders CHAPTER 3 Benzodiazepines and disinhibition Unexpecte...

Benzodiazepines and disinhibition

How common are disinhibitory reactions with benzodiazepines? 472 The Maudsley® Prescribing Guidel...

Who is at risk?

References Depression and anxiety disorders CHAPTER 3 References Furukawa TA, et al. Meta-­analy...

What is the mechanism? Depression and anxiety disorders CHAPTER 3 References Schieveld JNM, et a...

Subjective reports

Clinical implications 474 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Premenstru...

References Depression and anxiety disorders CHAPTER 3 If COCPs are ineffective, not tolerated, or...

Drug treatment of depression 344 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Dru...

Notes Depression and anxiety disorders CHAPTER 3 Notes ■ ■Tools such as the Montgomery–Asberg Dep...

References 346 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 in treatment (British...

Management of treatment-resistant depression – commonly used treatments 348 The Maudsley® Prescri...

References Depression and anxiety disorders CHAPTER 3 References Dunner DL, et al. Prospective, ...

Management of treatment-resistant depression – other well- supported treatments Depression and an...

References 352 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References Marcanton...

Treatment-resistant depression – other reported treatments Depression and anxiety disorders CHAPT...

References 354 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References Gonçalves...

Ketamine

Background

Mechanism

Route of administration Depression and anxiety disorders CHAPTER 3 Ketamine Background Over the p...

Adverse effects 358 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 doses tested, in...

References 360 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References Berman RM...

Psychotic depression

Acute treatment 362 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Psychotic depres...

Ketamine formulations

ECT

Maintenance treatment Depression and anxiety disorders CHAPTER 3 Ketamine formulations Many of th...

Other treatments

Summary

References 364 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 for 4–6 months after ...

Switching antidepressants

General guidelines 366 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Switching ant...

References 372 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References Horowitz ...

Antidepressant withdrawal symptoms

Signs and symptoms

Incidence and severity Depression and anxiety disorders CHAPTER 3 Antidepressant withdrawal sympt...

Time course 374 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Time course The onse...

Clinical relevance14,15

Who is at risk?10,14–16,18

How to avoid14–16,18 Depression and anxiety disorders CHAPTER 3 Clinical relevance14,15 The sympt...

How to treat14–16,23

References 376 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 difficult to stop.13 ...

Stopping antidepressants

Rate of tapering 378 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Stopping antide...

Pattern of tapering Depression and anxiety disorders CHAPTER 3 Pattern of tapering Although reduc...

Practical application of tapering 380 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER ...

Troubleshooting Depression and anxiety disorders CHAPTER 3 A cautious initial rate of reduction i...

References 382 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Unfortunately, most c...

Electroconvulsive therapy and psychotropic drugs 384 The Maudsley® Prescribing Guidelines in Psyc...

References 386 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References Pluijms E...

Psychostimulants in depression 388 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 P...

References Depression and anxiety disorders CHAPTER 3 References Satel SL, et al. Stimulants in ...

Post-stroke depression

Prophylaxis of post-stroke depression

Treatment of post-stroke depression Depression and anxiety disorders CHAPTER 3 Post-­stroke depre...

References 394 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 with a heightened ris...

Antidepressant prophylaxis

After first episode

Recurrent depression Depression and anxiety disorders CHAPTER 3 Antidepressant prophylaxis After ...

Discontinuation of medium- and long-term antidepressants 398 The Maudsley® Prescribing Guidelines...

Dose for prophylaxis

References Depression and anxiety disorders CHAPTER 3 treatment or to have antidepressants slowly...

Drug interactions with antidepressants

Pharmacokinetic interactions Depression and anxiety disorders CHAPTER 3 Drug interactions with an...

Pharmacodynamic interactions 402 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Pha...

16. References Depression and anxiety disorders CHAPTER 3 (lumateperone and ziprasidone) and drug...

Cardiac effects of antidepressants – summary

References Depression and anxiety disorders CHAPTER 3 SSRIs are generally recommended in cardiac ...

Antidepressant-induced arrhythmia Depression and anxiety disorders CHAPTER 3 Antidepressant-­indu...

Use in at-risk patients

Relative cardiotoxicity 412 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Use in a...

Summary

References Depression and anxiety disorders CHAPTER 3 Summary ■ ■Tricyclics (but not lofepramine)...

Antidepressant-induced hyponatraemia

Which antidepressants?

Database studies 416 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Antidepressant-...

Monitoring1,27,28

Treatment28

Restarting treatment

Other prescribed drugs 418 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Treatment...

References Depression and anxiety disorders CHAPTER 3 10. Movig KL, et  al. Association between a...

Antidepressants and hyperprolactinaemia

References Depression and anxiety disorders CHAPTER 3 References Emiliano AB, et  al. From galac...

Antidepressants and diabetes mellitus

Depression and diabetes

Recommendations 424 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Recommendations ...

References Depression and anxiety disorders CHAPTER 3 12. Briscoe VJ, et al. Effects of a selecti...

Antidepressants and sexual dysfunction

Effects of depression 426 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Antidepres...

Effects of antidepressant drugs 428 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 ...

Post-SSRI sexual dysfunction

Introduction The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M. Tayl...

References 478 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 ■ ■evidence of tolera...

Alcohol dependence

Assessment and brief structured intervention Addictions and substance misuse CHAPTER 4 Alcohol de...

Alcohol withdrawal 480 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 The following...

Pharmacologically assisted withdrawal (alcohol detoxification) 482 The Maudsley® Prescribing Guid...

Wernicke’s encephalopathy Addictions and substance misuse CHAPTER 4 Carbamazepine is an alternati...

Relapse prevention Addictions and substance misuse CHAPTER 4 Relapse prevention There is no place...

Pregnancy and alcohol use 492 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Baclof...

Children and adolescents

Older adults

Concurrent alcohol and substance use disorders Addictions and substance misuse CHAPTER 4 ­healthc...

Comorbid mental health disorders in AUD 494 The Maudsley® Prescribing Guidelines in Psychiatry CH...

References 496 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 ­optimised11 and cloz...

Opioid dependence

Prescribing for opioid dependence

Treatment of opioid overdose 498 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Opi...

Opioid substitution treatment (OST) 500 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTE...

Methadone 504 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 In rare cases, patient...

Buprenorphine 506 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Methadone overdose...

Alternative oral opioid preparations

Injectable diamorphine 514 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Alternati...

Prescribing psychotropic medications in patients with opiate dependence Addictions and substance ...

Opioid detoxification and reduction regimens

Opioid withdrawal in a community setting 516 The Maudsley® Prescribing Guidelines in Psychiatry C...

Opioid withdrawal in a specialist addiction in-patient setting

Naltrexone in relapse prevention Addictions and substance misuse CHAPTER 4 Opioid withdrawal in a...

Pain control in patients on OST 518 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 ...

References 520 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 References Scott G, ...

Nicotine and smoking cessation

Nicotine replacement therapy (NRT) Addictions and substance misuse CHAPTER 4 Nicotine and smoking...

Varenicline 524 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Clinical effectivene...

Cytisine 526 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Preparations and dose P...

Bupropion

Electronic nicotine vaping devices and vaping Addictions and substance misuse CHAPTER 4 Bupropion...

Treatment algorithms 528 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 that do not...

References 530 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 References National ...

Stimulant use disorder (SUD)

Overview of treatment 532 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Stimulant ...

Cocaine

Amfetamines Addictions and substance misuse CHAPTER 4 There is a small developing evidence base f...

Polysubstance abuse

Psychosis associated with stimulant drugs 534 The Maudsley® Prescribing Guidelines in Psychiatry ...

Stimulant-associated depression

References Addictions and substance misuse CHAPTER 4 ­cannot be co-­administered. Haloperidol sho...

GHB and GBL dependence

The withdrawal syndrome1,2

Withdrawal management Addictions and substance misuse CHAPTER 4 GHB and GBL dependence Gamma-­hyd...

References Addictions and substance misuse CHAPTER 4 References Kamal RM, et al. Pharmacological...

Benzodiazepine misuse

Withdrawal management 540 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Benzodiaze...

Polysubstance use

Pregnancy and benzodiazepine misuse

Summary Addictions and substance misuse CHAPTER 4 Polysubstance use Illicit benzodiazepines are o...

References 542 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 ■ ■Benzodiazepine mis...

Drug-induced excited state

Pathophysiology

Identification

Management Addictions and substance misuse CHAPTER 4 Drug-­induced excited state A drug-­induced ...

Outcomes

References 544 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 heat generation and c...

Interactions between illicit drugs and prescribed psychotropic drugs Addictions and substance mis...

References 548 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 References Zapelini ...

Drugs of misuse – a summary Addictions and substance misuse CHAPTER 4 Drugs of misuse – a summary...

References Addictions and substance misuse CHAPTER 4 References Couchman L, et al. Amisulpride a...

Substance misuse in pregnancy 554 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Su...

References Addictions and substance misuse CHAPTER 4 References UK Health Security Agency. UK Te...

Gambling disorder

References 560 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Gambling disorder At ...

Principles of prescribing practice in childhood and adolescence The Maudsley® Prescribing Guideli...

References Prescribing in children and adolescents CHAPTER 5 References Gerlach M, et al. Psychi...

Depression in children and adolescents

Diagnostic issues

Clinical guidance 566 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 Depression in ...

Prescribing for depression in children and adolescents Prescribing in children and adolescents CH...

After prescribing Prescribing in children and adolescents CHAPTER 5 are approved for use in adult...

Specific issues 570 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 ■ ■If none of th...

References Prescribing in children and adolescents CHAPTER 5 likely to outweigh these risks in mo...

Bipolar disorder in children and adolescents

Clinical guidance Prescribing in children and adolescents CHAPTER 5 Bipolar disorder in children ...

Other treatments 574 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 After prescribi...

References 578 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 References Colom F, ...

Psychosis in children and adolescents 580 The Maudsley® Prescribing Guidelines in Psychiatry CHAP...

References Prescribing in children and adolescents CHAPTER 5 References Pina-­Camacho L, et al. ...

Anxiety disorders in children and adolescents

Diagnostic issues

Clinical guidance

Prescribing for anxiety disorders in children and adolescents 582 The Maudsley® Prescribing Guide...

References 586 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 Pre-school children T...

Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) in children and adolescents

Drug treatment in obsessive compulsive disorder (OCD)

Drug treatment in body dysmorphic disorder (BDD) Prescribing in children and adolescents CHAPTER ...

Prescribing SSRIs in children

NICE guidelines for the assessment and treatment of OCD and BDD 588 The Maudsley® Prescribing Gui...

Initiation of treatment with medication Prescribing in children and adolescents CHAPTER 5 Initiat...

Treatment-refractory OCD and BDD in children 590 The Maudsley® Prescribing Guidelines in Psychiat...

Duration of treatment and long-term follow-up Prescribing in children and adolescents CHAPTER 5 D...

References 592 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 References Bandelow ...

Post-traumatic stress disorder (PTSD) in children and adolescents Prescribing in children and ado...

References

Diagnostic issues

Clinical guidance Prescribing in children and adolescents CHAPTER 5 Post-­traumatic stress disord...

Attention deficit hyperactivity disorder (ADHD) in children and adolescents Prescribing in childr...

References Prescribing in children and adolescents CHAPTER 5 References National Institute for H...

Autism spectrum disorder (ASD) in children and adolescents

Pharmacological treatment of core ASD symptoms Prescribing in children and adolescents CHAPTER 5 ...

Pharmacological treatment of co-occurring disorders and problem behaviours in ASD Prescribing in ...

References Prescribing in children and adolescents CHAPTER 5 References Lai MC, et  al. Prevalen...

Tics and Tourette’s syndrome in children and adolescents

Detection and treatment of comorbidity

Education and behavioural treatments

Pharmacological treatments 614 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 Tics ...

Adrenergic 2 agonists

Antipsychotics Prescribing in children and adolescents CHAPTER 5 these more helpful compared with...

Other drugs 616 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 placebo group. Surpr...

References 618 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 References Murphy TK...

Melatonin in the treatment of insomnia in children and adolescents

Efficacy 620 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 Melatonin in the treatm...

Adverse effects

Dose Prescribing in children and adolescents CHAPTER 5 Adverse effects Many of the children who h...

References 622 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 References Gringras ...

Rapid tranquillisation (RT) in children and adolescents Prescribing in children and adolescents C...

References Prescribing in children and adolescents CHAPTER 5 References Kendrick JG, et al. Phar...

Doses of commonly used psychotropic drugs in children and adolescents

References 626 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 Doses of commonly use...

General principles in prescribing in older adults

General principles The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M...

Drug interactions 628 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 and diuretics)...

Administering medicines in foodstuffs13–16

References Prescribing in older people CHAPTER 6 Changes in the way these drugs are handled in ol...

Dementia

Alzheimer’s disease (AD) 630 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 Dementi...

Vascular dementia (VaD) Prescribing in older people CHAPTER 6 24.0% and 31.4% of treated individu...

Dementia with Lewy bodies (DLB)

Mild cognitive impairment (MCI)

Other dementias 648 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 Dementia with Le...

Summary of clinical practice guidance for use of anti-dementia drugs Prescribing in older people ...

References 650 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 References National ...

Safer prescribing for physical conditions in dementia

Anticholinergic drugs 654 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 Safer pres...

Safety of physical health medication prescribed in dementia 658 The Maudsley® Prescribing Guideli...

References 664 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 References Sink KM, ...

Management of behavioural and psychological symptoms of dementia (BPSD)

Non-drug measures Prescribing in older people CHAPTER 6 Management of behavioural and psychologic...

Pharmacological measures 668 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 review ...

Electroconvulsive therapy (ECT)

Summary Prescribing in older people CHAPTER 6 Pimavanserin (inverse agonist and antagonist at 5HT...

References 676 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 References National ...

Management of inappropriate sexual behaviour in older adults 680 The Maudsley® Prescribing Guidel...

Management Prescribing in older people CHAPTER 6 have been recommended as the first line of pharm...

References Prescribing in older people CHAPTER 6 References Sarangi A, et  al. Treatment and man...

Depression in older adults 688 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 Depre...

References 692 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 References Katona C,...

Covert administration of medicines within food and drink

Assessment of mental capacity4,6,7

Guidance on covert administration 694 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER ...

Summary of process 696 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 6 When consider...

References Prescribing in older people CHAPTER 6 References Wikipedia. Covert medication. 2023; ...

A guide to medication doses of commonly used psychotropics in older adults, [1] / National Instit...

References Prescribing in older people CHAPTER 6 Drug Specific indication/ additional notes Start...

Drug choice in pregnancy The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. D...

Psychosis during pregnancy and postpartum Prescribing in pregnancy and breastfeeding CHAPTER 7 Ps...

Depression during pregnancy and postpartum54–56 Prescribing in pregnancy and breastfeeding CHAPTE...

Bipolar illness during pregnancy and postpartum 722 The Maudsley® Prescribing Guidelines in Psych...

Anxiety and insomnia during pregnancy and postpartum 726 The Maudsley® Prescribing Guidelines in ...

Attention deficit hyperactivity disorder (ADHD) in pregnancy

References Prescribing in pregnancy and breastfeeding CHAPTER 7 ■ ■Hypnotic benzodiazepine recept...

Drug choice in breastfeeding

Infant exposure

General principles of prescribing psychotropics in breastfeeding 734 The Maudsley® Prescribing Gu...

Antidepressants in breastfeeding Prescribing in pregnancy and breastfeeding CHAPTER 7 ■ ■Where a ...

Antipsychotics in breastfeeding

Mood stabilisers in breastfeeding

Hypnotics in breastfeeding 736 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 7 Antip...

Stimulants in breastfeeding

References Prescribing in pregnancy and breastfeeding CHAPTER 7 Stimulants in breastfeeding Table...

Hepatic impairment

General principles of prescribing in hepatic impairment The Maudsley® Prescribing Guidelines in P...

Antipsychotics in hepatic impairment2 754 The Maudsley® Prescribing Guidelines in Psychiatry CHAP...

Antidepressants in hepatic impairment2 Prescribing in hepatic and renal impairment CHAPTER 8 Anti...

Mood stabilisers in hepatic impairment6,7,80 Prescribing in hepatic and renal impairment CHAPTER ...

Stimulants in hepatic impairment6,7,82

Sedatives in hepatic impairment 760 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 8 ...

Other psychotropics in hepatic impairment

Summary of recommended psychotropics in hepatic impairment Prescribing in hepatic and renal impai...

Drug-induced hepatic damage 762 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 8 Drug...

References Prescribing in hepatic and renal impairment CHAPTER 8 References Slim M, et al. Hepat...

Renal impairment

General principles of prescribing in renal impairment 766 The Maudsley® Prescribing Guidelines in...

Stage of renal impairment Prescribing in hepatic and renal impairment CHAPTER 8 Stage of renal im...

Notes 768 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 8 Notes ■ ■Monitor decline i...

Summary of recommended psychotropics in renal impairment Prescribing in hepatic and renal impairm...

References 780 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 8 References National ...

Borderline personality disorder (BPD) The Maudsley® Prescribing Guidelines in Psychiatry, Fifteen...

Drug treatments of BPD 788 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 9 In 2009 t...

Management of crisis 790 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 9 Ketamine A ...

References Drug treatment of other psychiatric conditions CHAPTER 9 References Winsper C, et al....

Eating disorders

Anorexia nervosa (AN) 792 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 9 Eating dis...

Bulimia nervosa (BN) and binge eating disorder (BED) 794 The Maudsley® Prescribing Guidelines in ...

Other atypical eating disorders Drug treatment of other psychiatric conditions CHAPTER 9 reboxeti...

References 796 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 9 References Martínez-...

Attention deficit hyperactivity disorder (ADHD) in adults 798 The Maudsley® Prescribing Guideline...

References Drug treatment of other psychiatric conditions CHAPTER 9 References Raman SR, et al. ...

Prescribing in human immunodeficiency virus (HIV) The Maudsley® Prescribing Guidelines in Psychia...

HIV treatment advances and mental health

Psychotic illness

Depression 804 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Although most psycho...

Bipolar affective disorder

Secondary mania (‘HIV mania’)

Anxiety disorders Drug treatment of psychiatric symptoms in the context of other conditions CHAPT...

HIV-associated neurocognitive disorders (HAND)

Delirium

Substance use disorders 806 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 SSRIs b...

Interactions between antiretroviral drugs and psychotropics Drug treatment of psychiatric symptom...

Adverse psychiatric effects of antiretroviral drugs 808 The Maudsley® Prescribing Guidelines in P...

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 A...

Epilepsy

Psychiatric comorbidities in epilepsy Drug treatment of psychiatric symptoms in the context of ot...

Psychiatric side effects of antiseizure medications 812 The Maudsley® Prescribing Guidelines in P...

Interactions of antiseizure medications22 Drug treatment of psychiatric symptoms in the context o...

Psychotropics and the risk of seizures in people with epilepsy 814 The Maudsley® Prescribing Guid...

Epilepsy and driving

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 E...

22q11.2 deletion syndrome

Clinical features 820 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 22q11.2 delet...

Psychiatric disorders in people with 22q11.2DS Drug treatment of psychiatric symptoms in the cont...

References 822 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 References Boot E, ...

Learning disabilities

General considerations1

Key practice areas 824 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Learning dis...

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 R...

Huntington’s disease

Motor symptoms 830 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Huntington’s dis...

Mental and behavioural symptoms Drug treatment of psychiatric symptoms in the context of other co...

Cognitive symptoms

References 834 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Cognitive symptoms C...

Multiple sclerosis

Depression Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 M...

Anxiety

Pseudobulbar affect

Bipolar disorder

Psychosis 836 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Anxiety Anxiety affec...

Cognitive impairment

Fatigue Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 ­pub...

References 838 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 References Marrie R...

Parkinson’s disease

Depression 840 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Parkinson’s disease ...

Psychosis Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 Ps...

Pimavanserin

Cholinesterase inhibitors

Other treatments 842 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Pimavanserin P...

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 R...

Atrial fibrillation Drug treatment of psychiatric symptoms in the context of other conditions CHA...

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 R...

Bariatric surgery

Pharmacokinetic changes following bariatric surgery

Medication formulations5,6 Drug treatment of psychiatric symptoms in the context of other conditi...

Antidepressants 850 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Antidepressants...

Antipsychotics Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER ...

Mood stabilisers 852 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Mood stabilise...

Lithium around the time of bariatric surgery

Other medicines Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER...

General recommendations

Psychotropics with a risk of weight gain after bariatric surgery 854 The Maudsley® Prescribing Gu...

Alcohol55,56

Wider considerations14,57

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 A...

Menopause

Diagnosis Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 Me...

Psychological symptoms of the menopause 858 The Maudsley® Prescribing Guidelines in Psychiatry CH...

Elderly care

Use of HRT Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 E...

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 S...

Plasma level monitoring of psychotropic drugs

First-order pharmacokinetics

Steady state The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M. Tayl...

Timing of sampling 866 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 to know when...

Interpretation of results

Target ranges Pharmacokinetics CHAPTER 11 Interpretation of results Is there a target range of pl...

Amisulpride Pharmacokinetics CHAPTER 11 Amisulpride Amisulpride plasma levels are closely related...

Aripiprazole

Clozapine 870 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 psychosis, studies su...

Olanzapine Pharmacokinetics CHAPTER 11 an individual’s clozapine plasma levels are common with a ...

Quetiapine 872 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 further therapeutic ...

Risperidone

Target ranges for other psychotropics Pharmacokinetics CHAPTER 11 Quetiapine has an established d...

References Pharmacokinetics CHAPTER 11 References Jakobsen MI, et  al. The significance of sampl...

Interpreting postmortem blood concentrations Pharmacokinetics CHAPTER 11 Interpreting postmortem ...

References 880 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 References Ferner R...

Acting on clozapine plasma concentration results Pharmacokinetics CHAPTER 11 Acting on clozapine ...

References 882 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 References Varma S,...

Psychotropic drugs and cytochrome (CYP) function Pharmacokinetics CHAPTER 11 Psychotropic drugs a...

Genetics of cytochrome function 888 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11...

References Pharmacokinetics CHAPTER 11 References Baldacci A, et al. Pharmacogenetic guidelines ...

Smoking and psychotropic drugs 892 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 ...

References 894 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 References Kroon LA...

Drug interactions with alcohol

Pharmacokinetic interactions1–4 Pharmacokinetics CHAPTER 11 Drug interactions with alcohol Drug i...

Pharmacodynamic interactions2–4 Pharmacokinetics CHAPTER 11 Interactions of uncertain aetiology i...

References Pharmacokinetics CHAPTER 11 References Zakhari S. Overview: how is alcohol metabolize...

Caffeine The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M. Taylor, ...

General effects of caffeine

Psychotropic effects of caffeine 902 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1...

Caffeine intoxication Other substances CHAPTER 12 ■ ■The potential effects of caffeine on the met...

Energy drinks

Effects of caffeine on different disorders 904 The Maudsley® Prescribing Guidelines in Psychiatry...

Summary Other substances CHAPTER 12 Mood disorders ■ ■Caffeine may elevate mood through increasin...

References 906 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 12 References Rihs M, ...

Nicotine

Psychotropic effects

Effects of nicotine on different disorders 908 The Maudsley® Prescribing Guidelines in Psychiatry...

Drug interactions

Smoking cessation and withdrawal symptoms

References 910 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 12 Movement disorders a...

Psychotropics in overdose The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. ...

References 918 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 13 References   1. Howl...

Driving and psychotropic medicines

Effects of mental illness

Psychiatric medicines, driving and UK law Psychotropic drugs in special conditions CHAPTER 13 Dri...

Other medicines

UK DVLA Psychotropic drugs in special conditions CHAPTER 13 In regards to methadone, doses of up ...

UK General Medical Council guidelines for prescribers66

References 924 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 13 Duty of the prescrib...

Working towards adherence

What is adherence?

How common is non-adherence? The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Editio...

Impact of non-adherence 928 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 14 For chr...

Factors affecting adherence7,28

Assessing adherence29,30 Prescribing psychotropics CHAPTER 14 hospital. The only difference is th...

Monitoring adherence and assessing attitudes to medication

Enhancing medication adherence Prescribing psychotropics CHAPTER 14 Monitoring adherence and asse...

Conclusion

References 934 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 14 to arise in cancer m...

Restarting psychotropic medications after a period of non-compliance Prescribing psychotropics CH...

References 938 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 14 length of time. The ...

Relational aspects of prescribing practice

Object relations

Memory

Treatment framework Prescribing psychotropics CHAPTER 14 Relational aspects of prescribing practi...

Factors that may influence the patient’s use of and adherence to medication 940 The Maudsley® Pre...

Summary – a checklist when prescribing 942 The Maudsley® Prescribing Guidelines in Psychiatry CHA...

References 944 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 14 References Olaisen ...

Prescribing drugs outside their licensed indications (‘off-label’ prescribing) Prescribing psycho...

Examples of acceptable use of drugs outside their licences/labels Prescribing psychotropics CHAPT...

References 948 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 14 References EMC. Sum...

The Mental Health Act in England and Wales Prescribing psychotropics CHAPTER 14 The Mental Health...

Completion of forms T2 and T3

Arranging and preparing for SOAD visits

Statutory consultees 950 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 14 If a patie...

What is consent?

What is capacity? Prescribing psychotropics CHAPTER 14 The Code of Practice 25.56 states: Statuto...