35 - References

References

Prescribing psychotropics CHAPTER 14 Table 14.6  (Continued ) Antipsychotic generic name and formulation Licensed site(s) of administration Lorazepam Solution for injection Intramuscular administration. Can be administered into the gluteal, deltoid or frontal thigh area according to the manufacturer.35 A 1:1 dilution of Ativan injection with normal saline or Sterile Water for Injection BP is recommended in order to facilitate intramuscular administration and absorption.18 Olanzapine Powder for solution for injection Inject slowly, deep into the muscle mass. The exact site of administration is not specified and choice of muscle site should be a clinical decision according to the manufacturer.36 Not to be used intravenously* or subcutaneously. Use the solution immediately within 1 hour of reconstitution.37 *Intravenous use has been reported38,39 but is off-­licence/label. Promethazine hydrochloride Solution for injection By deep intramuscular injection into a large muscle.40 Can be administered into the thigh, upper arm or gluteal region. Ensure muscle mass is sufficient for the volume being injected.6 Other intramuscular injections Clotiapine 40mg/4mL injection (available in Argentina, Belgium, Israel, Italy, Luxembourg, South Africa, Spain, Switzerland and Taiwan41) By intramuscular injection.41 No other information available. Clozapine intramuscular injection 25mg/mL (unlicensed)42,43 Only for deep intramuscular administration into the gluteal muscle. 25mg IM clozapine = 50mg oral. The maximum volume that can be injected into each site is 4mL (100mg). For doses greater than 100mg daily, the dose may be divided and administered into two sites. (Injection sites should be rotated as per usual IM practice.) Administration into the lateral thigh and deltoid muscles has been used in one case series.42 FGA, first-­generation antipsychotic; ISM, in situ microparticles; SC, subcutaneous; SGA, second-­generation antipsychotic; SPC, summary of product characteristics. References

1. Purgato M, et al. Bromperidol decanoate (depot) for schizophrenia. Cochrane Database Syst Rev 2012; 11:CD001719.
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3. Eumedica. Medical Information Department – written communication, 2020.
4. Janssen UK. Guidance on the Administration to Adults of Oil-Based Depot and Other Long-­Acting Intramuscular Antipsychotic Injections, 7th edn. 2022 (last accessed August 2024); https://www.hpft.nhs.uk/media/6180/guidance-­on-­im-­administration-­of-­oil-­based-­depots-­and-­ other-­long-­acting-­antipsychotic-­injections-­7th-­edition.pdf.
5. Lundbeck Ltd. Summary of product characteristics. Depixol 20mg/ml solution for injection (flupentixol decanoate). 2021 (last accessed August 2024); https://www.medicines.org.uk/emc/product/995/smpc.
6. Sanofi. Medical Information Department – verbal and written communication, 2017.
7. Glazer WM, et  al. Injection site leakage of depot neuroleptics: intramuscular versus subcutaneous injection. J Clin Psychiatry 1987; 48:237–239.
8. Spanarello S, et al. The pharmacokinetics of long-­acting antipsychotic medications. Curr Clin Pharmacol 2014; 9:310–317.
9. Abhijnhan A, et al. Depot fluspirilene for schizophrenia. Cochrane Database Syst Rev 2007; 2007:CD001718.
10. iMedikament.de. IMAP. 2024 (last accessed August 2024); https://imedikament.de/imap.

958 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 14 11. Essential Pharma Ltd. Medical Information Department – written communication, 2024. 12. Essential Pharma Ltd (Malta). Summary of product characteristics. HALDOL Decanoate (haloperidol decanoate) 100mg/ml solution for injection. 2023 (last checked August 2024); https://www.medicines.org.uk/emc/product/15246/smpc#gref. 13. Janssen. Medical Information Department – verbal and written communication, 2024. 14. McEvoy JP, et al. Effectiveness of paliperidone palmitate vs haloperidol decanoate for maintenance treatment of schizophrenia: a randomized clinical trial. JAMA 2014; 311:1978–1987. 15. Quraishi S, et al. Depot perphenazine decanoate and enanthate for schizophrenia. Cochrane Database Syst Rev 2000; 2:CD001717. 16. Laakeinfo.fi. PERATSIN DECANOATE solution for injection 108mg/ml (perphenazine decanoate). 2023 (last accessed August 2024); https://laakeinfo.fi/Medicine.aspx?m=2333. 17. Starmark JE, et  al. Abscesses following prolonged intramuscular administration of perphenazine enantate. Acta Psychiatr Scand 1980; 62:154–157. 18. myHealthbox 2012-­2024. Summary of Product Characteristics. 2024 (last accessed August 2024); https://myhealthbox.eu/en/. 19. Lundbeck Ltd. Summary of product characteristics. Clopixol 200mg/ml solution for injection (zuclopenthixol decanoate). 2022 (last accessed August 2024); https://www.medicines.org.uk/emc/product/6414/smpc. 20. Otsuka Pharmaceuticals (UK) Ltd. Summary of product characteristics. Abilify Maintena 300mg powder and solvent for prolonged-­release suspension for injection in pre-­filled syringe (aripiprazole). 2024 (last accessed August 2024); https://www.medicines.org.uk/emc/ product/12955/smpc%202022. 21. Alkermes Inc. Highlights of prescribing information. ARISTADA® (aripiprazole lauroxil) extended-­release injectable suspension for intramuscular use. 2018 (last accessed August 2024); https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/207533s013lbl.pdf. 22. Alkermes Inc. Highlights of prescribing information. ARISTADA INITIO® (aripiprazole lauroxil) extended-­release injectable suspension, for intramuscular use. 2023; https://www.aristada.com/downloadables/ARISTADA-­INITIO-­PI.pdf. 23. Eli Lily and Company Ltd. Summary of product characteristics. Zypadhera (olanzapine pamoate monohydrate) 210mg powder and solvent for prolonged release suspension for injection. 2023 (last assessed August 2024); https://www.medicines.org.uk/emc/product/6429/smpc. 24. Janssen-­Cilag Ltd. Summary of product characteristics. Xeplion (paliperidone) 25mg, 50mg, 75mg, 100mg, and 150mg prolonged-­release suspension for injection. 2023 (last accessed May 2024); https://www.medicines.org.uk/emc/product/7652/smpc. 25. Janssen-­Cilag Ltd. Summary of product characteristics. TREVICTA 175mg, 263mg, 350mg, 525mg prolonged release suspension for injection. 2023 (last accessed August 2024); https://www.medicines.org.uk/emc/medicine/32050. 26. Janssen-­Cilag Ltd. Summary of product characteristics. Byannli 700mg prolonged-­release suspension for injection in pre-­filled syringe (paliperidone). 2023 (last accessed August 2024); https://www.medicines.org.uk/emc/product/13307/smpc. 27. Janssen-­Cilag Ltd. Summary of product characteristics. RISPERDAL CONSTA 25mg powder and solvent for prolonged-­release suspension for intramuscular injection (risperidone). 2022 (last assessed August 2024); https://www.medicines.org.uk/emc/medicine/9939. 28. ROVI Biotech Ltd. Summary of product characteristics. Okedi (risperidone) 100mg powder and solvent for prolonged-­release suspension for injection pre-­filled syringes. 2023 (last accessed August 2024); https://www.medicines.org.uk/emc/product/13778/smpc. 29. Shandong Luye Pharmaceutical Co Ltd. Highlights of prescribing information. RYKINDO® (risperidone) for extended-­release injectable suspension for intramuscular use. 2023 (last checked June 2024); https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/212849s000lbl.pdf. 30. Indivior UK Ltd. Highlights of prescribing information. PERSERIS (risperidone) for extended-­release injectable suspension, for subcutaneous use. 2018 (last accessed September 2024); https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210655s000lbl.pdf. 31. Teva Neuroscience Inc. Highlights of prescribing information. UZEDY (risperidone) extended-­release injectable suspension for subcutaneous use. 2024 (last checked June 2024); https://www.uzedy.com/globalassets/uzedy/prescribing-­information.pdf. 32. Otsuka Pharmaceutical (UK) Ltd. Summary of product characteristics. Abilify 7.5mg/ml solution for injection (intramuscular) (aripiprazole). 2023 (last accessed August 2024); https://www.medicines.org.uk/emc/product/6239/smpc. 33. ADVANZ Pharma. Summary of product characteristics. Haloperidol injection BP 5mg/ml. 2024 (last accessed August 2024); https://www. medicines.org.uk/emc/product/514. 34. Concordia International. Medical Information Department – verbal and written communication, 2017. 35. Macure Pharma UK Ltd. Medical Information Department – written communication, 2024. 36. Lilly UK. Medical Information Department – verbal and written communication, 2017. 37. Eramol (UK) Ltd. Summary of product characteristics. Xyquila 10mg powder for solution for injection (olanzapine). 2023 (last accessed August 2024); https://www.medicines.org.uk/emc/product/15138/smpc. 38. Wang M, et al. A retrospective comparison of the effectiveness and safety of intravenous olanzapine versus intravenous haloperidol for agitation in adult intensive care unit patients. J Intensive Care Med 2022; 37:222–230. 39. Khorassani F, et  al. Intravenous olanzapine for the management of agitation: review of the literature. Ann Pharmacother 2019; 53:853–859. 40. Sanofi. Medical Information Department – written communication, 2024. 41. Carpenter S, et al. Clotiapine for acute psychotic illnesses. Cochrane Database Syst Rev 2004; 4:CD002304. 42. Henry R, et al. Evaluation of the effectiveness and acceptability of intramuscular clozapine injection: illustrative case series. BJPsych Bull 2020; 44:239–243. 43. Casetta C, et al. A retrospective study of intramuscular clozapine prescription for treatment initiation and maintenance in treatment-­resistant psychosis. Br J Psychiatry 2020; 217:506–513.

The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M. Taylor, Thomas R. E. Barnes and Allan H. Young. © 2025 David M. Taylor. Published 2025 by John Wiley & Sons Ltd. Note: Page numbers in bold indicate tables and in italics indicate figures, where they fall outside the text range. 5a-­reductase inhibitors, psychiatric adverse effects  971 5HT see 5-­hydroxytryptamine 22q11.2 deletion syndrome (22q11.2DS)  820–­823 clinical features and risks  820 general prescribing principles  821 managing psychiatric disorders  821–­822 Abilify MyCite, adherence monitoring aid  933 Abnormal Involuntary Movement Scale  127 acamprosate, preventing relapse after alcohol detoxification  489–­490 ACE see angiotensin-­converting enzyme acetaldehyde, metabolism of alcohol  895 acetaminophen see paracetamol acetylcholinesterase inhibitors (AChE-­Is) Alzheimer’s disease  630, 632–­636, 642, 649 dementia with Lewy bodies  648 management of behavioural and psychological symptoms of dementia  671 mechanism of action  630, 631 mild cognitive impairment  648 older patients and dementia  654–­658, 659, 689 other dementias  647, 648, 649 rare dementias associated with neurological conditions  649 use in Parkinson’s disease  842 vascular dementia  647 activated partial thromboplastin time, psychotropic agent effects  965 activation adverse effects, depression in children and adolescents  571 Acuphase see zuclopenthixol acetate acute behavioural disturbance use of term  543 see also drug-­induced excited states acutely disturbed/violent behaviour  62–­73 oral/inhaled treatment  62 parenteral treatment  62–­65 practical measures  65 zuclopenthixol acetate  66–­67 acute mania, treatments  310–­315 AD see Alzheimer’s disease adapted Naranjo adverse drug reaction scale  972, 973 addiction  477–­560 see also alcohol dependence; dependence syndrome; drugs of misuse; illicit drugs; new psychoactive substances; nicotine dependence; opioid dependence; smoking; substance misuse and dependence ADH see alcohol dehydrogenase ADHD see attention deficit hyperactivity disorder adherence  927–­936 antipsychotics  30, 928–­929, 933–­934 assessing  929, 930 clinician-­patient relationship  939 definitions and terminology  927 enhancing medication adherence  931–­934 factors affecting  929 impacts of non-­adherence  928–­929 intervention  932 intervention research of poor quality  931 lithium  284 monitoring and assessing attitudes  931 object relations  939 rates and degrees  927–­928 relational aspects  939–­944 relational factors influencing clinicians  939 relational factors influencing patients  940 restarting medications after period of non-­compliance  937–­938 strategies  931 administration of medicines alternative routes  115–­118 covertly in food and drink, older people  629, 694–­699 covertly in food and drink for older people  629, 694–­699 site of intramuscular injections  954–­957 adolescents bulimia nervosa/binge eating disorder  794 see also children and adolescents adrenergic a2 agonists, tics and Tourette’s syndrome  615 ADRs see adverse drug reactions aducanumab, Alzheimer’s disease treatment  646 adverse drug reactions adapted Naranjo adverse drug reaction scale  972, 973 Naranjo scale  972, 973 adverse drug reactions (ADRs) anticholinergic effects of antipsychotics  43–­44 antipsychotics in menopausal women  859–­860 Index

976 Index adverse drug reactions (ADRs) (cont’d) biochemical effects of psychotropics  959, 960–­965 discussion with patients  941 haematological effects of psychotropics  959, 965–­966 increased incidence and severity in older people  627–­628 non-­psychotropics with psychiatric effects  969–­974 psychiatric adverse effects of non-­psychotropic drugs  969–­974 psychiatric effects of antiseizure medications  812–­813 psychotropic sensitivity in people with learning difficulties  825 see also extrapyramidal side effects AF see atrial fibrillation age effects changes in pharmacodynamics  627–­628 depression in children and adolescents  570 see also children and adolescents; older people aggressive behaviours Huntington’s disease  832 paradoxical/disinhibitory drug reactions, benzodiazepines  471–­473 valproate treatment  290 agitation and irritability, Huntington’s disease  832, 833 agomelatine in overdose  913 smokers  892 agonist replacement therapy, limited evidence for stimulant use disorder  532 agranulocytosis  245, 251, 267–­268, 275–­276, 959, 966 akathisia  43, 44, 127, 128, 131–­134 alanine aminotransferase (ALT)  960 albumin hepatic impairment  753, 754 psychotropic agent effects  960 alcohol dehydrogenase (ADH)  895, 896 alcohol dependence  479–­497 in children and adolescents  493 clinical assessment  479–­480 mild  480, 485 moderate  480, 485 in older people  493 pharmacologically assisted withdrawal  482–­487 in pregnancy  492–­493 preventing relapse after detoxification  489–­492 severe  480, 486 Wernicke’s encephalopathy/thiamine deficiency  487–­488 withdrawal  480–­489 alcohol detoxification benzodiazepines  484–­486 carbamazepine  487 community or in-­patient  482 fixed dose treatment regimen  485–­486 pharmacologically assisted withdrawal  482–­487 preventing relapse  489–­492 symptom-­triggered treatment regimen  486 alcohol use amnesia  898 ataxia  898 bariatric surgery effects  855 disulfiram reaction  490 driving impairment  922 electrolyte disturbances  898 health guidance  479 metabolism of  895 pharmacodynamic interactions  897–­899 pharmacokinetic interactions  895–­897 psychotropic drug combination  895–­899 sedation  897 alcohol use disorder (AUD) comorbid mental health disorders  494–­496 see also alcohol dependence Alcohol Use Disorders Identification Test (AUDIT)  480, 482 alcohol withdrawal  480–­489 benzodiazepines  484–­487 common interventions  484 community detoxification  482 delirium tremens  480, 481, 482, 486 mild  480, 484 pharmacologically assisted/ detoxification  482–­487 seizures  480, 481 severe  481, 484 severity assessment  480, 483 treating somatic symptoms  488–­489 treatment interventions  484 aldehyde dehydrogenase  895, 896 alkaline phosphatase in blood, psychotropic agent effects  960 allopurinol  226 α2A-­adrenoceptor agonists, see also guanfacine alpha blockers, older patients with urinary retention, drug safety  658 alpha-­lipoic acid, for antipsychotic-­induced weight gain  145 ALT see alanine aminotransferase alternative therapies Alzheimer’s disease management  641, 643–­645 inclusion on MHA forms T2 and T3  950 see also complementary therapies; natural remedies Alzheimer’s disease (AD) atrial fibrillation patients  847 cognitive enhancers  630–­641 adverse effects  635–­637 combination treatment  634 dosing and formulations  633–­634 drug interactions  637–­640 drug tolerability  634–­635 efficacy  632 mechanism of action  630 switching drugs  632–­633 differentiating from vascular dementia  647 management with alternative substances  641, 643–­645 NICE guidelines  642 novel antibody treatments  646–­647 amantadine for antipsychotic-­induced weight gain  145 for fatigue in multiple sclerosis  837 for tardive dyskinesia  136 ambivalence about medication, clinicians understanding patients  940–­941 amfebutamone see bupropion amfetamines attention deficit hyperactivity disorder in adults  798–­800 breastfeeding mothers  747 depression  388 in pregnancy  727 stimulant use disorder  533–­534 see also methamphetamine use disorder amino acids, for tardive dyskinesia  137 amisulpride  3, 4 clozapine augmentation  221 efficacy  3 in overdose  915 plasma level monitoring  869–­870 target range  868 use in patients with hepatic impairment  754, 756, 761 amitriptyline antidepressant  337 for clozapine-­induced hypersalivation  258, 259 post-­stroke pain treatment  393 in pregnancy  720 serotonin reuptake inhibition  404 ammonia in blood, psychotropic agent effects  960 amnesia, alcohol effects  898 amylase in blood, psychotropic agent effects  961 AN see anorexia nervosa Anafranil see clomipramine analgesics headache after ECT  384 managing behavioural and psychological symptoms of dementia  668 opioid avoidance for patients on naltrexone  490, 518 opioid substitution treatment combination  518–­519

safety in older patients/dementia  660–­661 see also non-­steroidal anti-­inflammatory drugs; opioids; paracetamol angiotensin-­converting enzyme (ACE) inhibitors, lithium interaction  284–­285 angiotensin II receptor antagonists, lithium interaction  285 anhedonia, stimulant use detoxification  535 ANI see asymptomatic neurocognitive impairment anorexia nervosa (AN)  792–­794 antidepressants  793 co-­morbid conditions  792, 794 monitoring when on oral electrolyte supplementation  794 NICE guidelines  795 psychological symptom treatment  793 relapse prevention  794 treating physical aspects  793–­794 weight restoration  792 Antabuse see disulfiram antiamyloid therapy, Alzheimer’s disease treatment  646–­647 antibiotics psychiatric adverse effects  969 safety in older patients/dementia  662 anticholinergic adverse effects of antipsychotics  43–­44 anticholinergic burden, cognitive impairment  642 anticoagulants, safety/use in older patients/ dementia  662 anticonvulsants benzodiazepine properties  484 borderline personality disorder  789 people with learning difficulties  827 use in alcohol withdrawal management  480, 481 see also antiseizure medications anti-­dementia drugs  630–­649 use in renal impairment  778 see also cognitive enhancers antidepressants adverse effects, relative and absolute risks  444–­445 with alcohol  899 anorexia nervosa  793 antipsychotic augmentation  35 with antipsychotics for psychotic depression  362 anxiety spectrum disorders  340 arrhythmia induction  411–­415 atrial fibrillation patients  846 bariatric surgery patients  850 bipolar depression  321 bleeding risks  432–­439 borderline personality disorder  789 breastfeeding mothers  735, 736, 737–­740 bulimia nervosa/binge eating disorder  794–­795 cardiac effects  406–­408, 409–­415 choice  338–­339 co-­prescribed with warfarin leading to non-­GI bleeding risk  433 diabetes mellitus  423–­425 dosing  626 increasing if insufficient response  345, 346 driving impairment  922 drug interactions  401–­405 pharmacodynamic effects  402, 404–­405 pharmacokinetic effects  401–­402, 403 duration of treatment  340 effectiveness  337 electroconvulsive therapy combination  384 Fatal Toxicity Index  412 glucose homeostasis effects  423–­425 hyperbolic tapering  366, 376, 379, 382 hyperprolactinaemia  420–­422 hyponatraemia induction  416–­419 ketamine  357 managing behavioural and psychological symptoms of dementia  672–­673 managing treatment-­resistant depression  348–­356, 357 minimum effective doses  342, 366 natural  440–­443 next-­steps if no response  340 onset of action  338 in overdose  913–­915 overview  337–­341 perioperative bleeding risks with non-­SSRI antidepressants  437 pharmacodynamic drug interactions  402, 404–­405 pharmacokinetic drug interactions  401–­402, 403 post-­stroke prophylaxis  393 practical application of tapering  380–­381 in pregnancy  719–­722 prolactin effects  420 prophylaxis  393, 397–­400 relapse risk of discontinuation after medium/long term use  398–­399 relative adverse effects  338–­339, 412 risks to people with epilepsy  815 St John’s wort  440–­443 sexual dysfunction  426–­431 smokers  893 stopping  378 sudden cardiac death  411, 412 suicidality  339 suicide risks in children and adolescents  570–­571 swapping and stopping guide  368–­371 switching  345, 366–­372 tapering  366, 376, 378–­382 Index target ranges  874 use in older people with depression  688–­693 use in patients with hepatic impairment  753, 757–­758, 761 use in patients with renal impairment  772–­775 use in stimulant use disorder  535 antidepressant withdrawal at risk patients  375 avoidance  375–­376 clinical relevance  375 incidence and severity of symptoms  373–­374 signs and symptoms  373–­376 stopping  378 switching  366–­367 time course  374 treatment  376 troubleshooting during tapering  381 antiemetics, safety in older patients/ dementia  658–­659 antihistamines driving impairment  923 safety in older patients/dementia  661, 674 antihypertensives, safety/use in older patients/dementia  661 anti-­inflammatory drugs, Alzheimer’s disease management  644–­645 antimalarials psychiatric adverse effects  969 QT prolongation  165 antiparkinsonian treatments, psychiatric adverse effects  970 antipsychotic depot, see also long-­acting injectable antipsychotics Antipsychotic Non-­Neurological Side-­Effects Rating Scale  4 antipsychotics adherence to treatment  30, 928–­929, 933–­934 administration of  115–­118 buccal  117 inhalation  115, 116 intranasal  115, 116–­117 intravenous  117 rectal  116, 118 sublingual  115, 117 transdermal  116 adverse effects  1, 2, 3–­4, 23–­24, 30, 43–­44, 126–­213 acute kidney injury risk  769 agranulocytosis  245, 251, 267–­268 akathisia  43, 44, 127, 128, 131–­134, 207 atrial fibrillation risk  846 blood pressure changes  182–­185 cardiomyopathy  254 cardiovascular adverse effects  253–­257 colitis  245

978 Index antipsychotics (cont’d) constipation  241, 263–­266 delirium  245 diabetes and impaired glucose tolerance  174–­181, 207 dyslipidaemia  207 dystonia  127, 128 ECG changes (QTc prolongation)  161–­168, 207 eosinophilia  245 extrapyramidal symptoms  126–­130, 207 gastrointestinal hypomotility  241, 263–­266 gastrointestinal necrosis  245 haematological adverse effects  251–­252 heat stroke  245 hepatic failure/enzyme abnormalities  245 hyperglycaemia  186 hyperlipidaemia  186 hyperprolactinaemia  190–­194, 196, 207 hypersalivation  241, 258–­262 hypertension  183–­184 hyponatraemia  186–­189 hypothermia  245 interstitial lung disease  245 interstitial nephritis  245 knee-­buckling  245 myocarditis  253–­254, 255 neuroleptic malignant syndrome  150–­153 neutropenia  267–­272 ocular effects  245 orthostatic hypotension  182–­183, 207 in overdose  913–­915 pancreatitis  246 parotid gland swelling  246 pericardial effusion  246 pericarditis  246 plasma lipids  169–­173 pneumonia  204–­206 polyserositis  246 pseudoparkinsonism  127–­128 QTc prolongation  161–­168, 207 renal injury risk  769 sedation  207 sexual dysfunction  195–­203, 207 skin reactions  246 stuttering  246 tardive dyskinesia  120, 127, 128, 135–­140, 208 thrombocytopenia  246 thromboembolism  211–­213, 246, 253 venous thromboembolism  211–­213, 253 weight gain  141–­149, 208 with alcohol  895–­899 antidepressant augmentation  35 with antidepressants for psychotic depression  362 augmentation of  58–­59 bariatric surgery patients  851–­852 bipolar disorder  300–­304, 305–­307, 310, 311 depression  301, 319 first generation  300 mania  300, 301, 302 second generation  300–­302 specific drugs  301–­302 borderline personality disorder  788 breastfeeding mothers  736, 741–­743 with caffeine  903 children and adolescents  590, 598, 606, 615–­616, 623, 626 choosing  2–­3 classification of  1–­2 clozapine augmentation  221 combinations of  7, 22–­25, 58–­59 discontinuation of  7, 28, 29, 30–­31, 119–­125 pattern of tapering  121–­122 reduction of olanzapine  121, 122 tapering in practice  122 when to attempt discontinuation  123 driving impairment  922 equivalent doses  14–­15 first-­generation adverse effects  3–­4, 49 classification  2 diabetes, antipsychotic-­related  174 equivalent doses  14 long-­acting injectable antipsychotics  75, 76 maximum doses  11, 12 minimum effective doses  8 nomenclature  49 penfluridol  106–­107 relative efficacy  3 role of older antipsychotics  49–­50 treatment algorithm  46 treatment of negative symptoms  35 hepatic impairment  754–­756, 761 high-­dose  55–­56 adverse effects  18, 76 efficacy  17–­18 prescribing and monitoring  17–­19 recommendations  19 Huntington’s chorea  831 increased free plasma levels in hepatic impairment  753–­754 long-­term treatment  8–­84 managing behavioural and psychological symptoms of dementia  668 maximum doses  11–­12 menopausal women  858, 859, 860 minimum effective doses  8 monitoring  40–­41 monotherapy poor response to  22 switching to  59 mortality risks in dementia patients  669 neurobiology of withdrawal  120 oestrogen interactions  858, 859, 860 optimal dosage  55 options for menopausal women  860 in overdose  915–­916 people with 22q11.2 deletion syndrome  822 people with epilepsy, risks  816 people with learning difficulties  826 plasma level variations  56–­57 polypharmacy  22–­25, 59, 95, 226 adverse effects  23–­24 long-­term treatment  22–­23 poor response to antipsychotic monotherapy  22 poor tolerability  207–­210 in pregnancy  715–­718 first-­generation  715–­716 neurodevelopment effects  717–­718 second-­generation  716–­717 preventing sudden cessation by non-­compliance  933 principles of prescribing  7 prophylaxis  28–­33 alternative views  31 discontinuation of  30–­31 dose for  30 reducing  28 relative adverse effects  43–­44 relative efficacy  3–­4 renal impairment  769–­771 response assessment  7 second-­generation  49, 50 adverse effects  3–­4 classification  2 diabetes, antipsychotic-­related  174–­176 equivalent doses  14, 15 long-­acting injectable antipsychotics  4, 75 maximum doses  11, 12 minimum effective doses  8 neuroleptic malignant syndrome association  151 optimal dosage  55 relative efficacy  3 treatment algorithm  46 treatment of negative symptoms  35 smokers  892–­893 stopping  7, 28, 30–­31, 90, 119–­125 hyperbolic reduction schedule  121, 122 pattern of tapering  121–­122 reduction of olanzapine  121, 122 tapering in practice  122 when to attempt discontinuation  123 withdrawal effects  119–­120, 123 suppositories  118 switching medication  57–­58, 207–­210 target ranges  868–­873, 873–­874 teratogenic potential  715–­717

topiramate  221, 228 use in patients with hepatic impairment  754–­756, 761 use patients with in renal impairment  769–­771 withdrawal effects  119–­120, 123 see also individual drug names antiretroviral therapy (ART) adverse psychiatric effects  808–­809 human immunodeficiency virus treatment  804 interactions with psychotropic drugs  804, 807–­808 pharmacokinetic interactions with other drugs  545 antiseizure medications  882 driving impairment  922 interactions with psychotropic drugs  813–­814 managing behavioural and psychological symptoms of dementia  673 psychiatric side-­effects (adverse and beneficial)  812–­813 use in alcohol dependence treatment  492 see also anticonvulsants; valproate antispasmodics, safety in older patients/ dementia  659 anxiety children and adolescents with autism spectrum disorder  610 comorbid alcohol use disorder  495 drug treatment in anorexia nervosa  793 Huntington’s disease  832, 833 menopausal women  858 in pregnancy  726–­727 anxiety spectrum disorders  446–­475 atrial fibrillation patients  847 benzodiazepines  446, 460 caffeine effects  905 children and adolescents  582–­586 after prescribing  584–­585 before prescribing  582–­583 clinical guidance  582 diagnostic issues  582 dosages  585 what to prescribe  583–­584 cognitive behavioural therapy  447, 448, 449 multiple sclerosis  836 NICE guidelines  448–­449 and nicotine  909 people living with human immunodeficiency virus  805–­806 pre-­school children  586 psychological approaches  448 specific drugs used  449–­455 SSRIs/SNRIs  446–­447 see also generalised anxiety disorder; obsessive-­compulsive disorder; panic disorder; post-­traumatic stress disorder; social phobia anxiolytic effect, benzodiazepines  460 anxiolytics driving impairment  922 use in renal impairment  776–­777 see also benzodiazepines apathy, Huntington’s disease  832, 833 apgar scores, medications in pregnancy  720, 723, 724 aripiprazole  8, 11, 15, 24, 43 for antipsychotic-­induced weight gain  145 Aristada  12, 88 bipolar disorders  301, 305, 306, 316 borderline personality disorder  788 cardiac safety of  164 clozapine augmentation  221 effects on impulse control disorders  560 hyperprolactinaemia  191 long-­acting injections  85–­89 bipolar disorder  305, 306 brands  88 delayed doses  86, 87 doses and frequencies  77, 85, 86, 87 switching to  86 in overdose  915 pharmacokinetics  81 plasma level monitoring  870 pneumonia association  204–­205 in pregnancy  717, 718 QTc prolongation  164 rapid-­cycling bipolar affective disorder  316 target range  868 weight restoration in anorexia nervosa  792 Aristada (aripiprazole lauroxil)  12, 88 arrhythmia cardiovascular risk factors  166 clozapine  240 flumazenil  70 induction by antidepressants  411–­415 physiological risk factors  164 psychotropic drug risks  845 ART see antiretroviral therapy ascites, risk in hepatic impairment  753, 754 ASD see autism spectrum disorder asenapine bipolar disorder  301 psychosis  8, 11, 12, 15, 43 sublingual  62, 117 aspartate aminotransferase (AST), psychotropic agent effects  961 aspirin, valproate interactions  292 assessing adherence  929, 930 AST see aspartate aminotransferase asymptomatic neurocognitive impairment (ANI), HIV related  806 ataxia, alcohol effects  898 atomoxetine, attention deficit hyperactivity disorder in adults  799, 801 atrial fibrillation (AF)  845–­848 Index psychiatric conditions increasing risk  846, 847 psychotropic drug prescription  845–­847 treatment  845 types  845 atropine  258, 259, 489, 660 attachment style of patients affecting relationship with clinician  941 attention deficit hyperactivity disorder (ADHD) in adults  798–­802 diagnosis  798 NICE guidelines  800 non-­stimulant medication  798, 799, psychostimulants  798, 799, 800 amfetamines  533 borderline personality disorder relationship  789 caffeine effects  905 children with 22q11.2 deletion syndrome  821 children and adolescents  562, 563, 574, 597–­604 bipolar disorder/bipolar affective disorder relationship  574 diagnostic issues  597 inattention, overactivity and impulsiveness symptoms in autism spectrum disorder  607–­608 melatonin use for insomnia  620–­621 prescribing guidelines  597–­598, 599–­602 drug use in renal impairment  778 medication risks in people with epilepsy  816–­817 and nicotine  909 in pregnancy  727 stimulant use disorder  533 atypical eating disorders  795 atypical/typical antipsychotic classification  1–­2 AUD see alcohol use disorder AUDIT see Alcohol Use Disorders Identification Test autism spectrum disorder (ASD) children and adolescents  605–­613, 620–­621 inattention, overactivity and impulsiveness symptoms  607–­608 melatonin use for insomnia  620–­621 pharmacological treatment of co-­ occurring disorders and problem behaviours  607–­610 pharmacological treatment of core symptoms  605–­606 restricted repetitive behaviours and interests  606 social and communication impairment  606 psychotropic drugs used  826–­827

980 Index baclofen, preventing relapse after alcohol detoxification  492 BALANCE study, bipolar disorder  290, 326 bariatric surgery  849–­856 drug pharmacokinetic alterations  849 general recommendations for psychotropic prescribing  854 lithium in perioperative phases  853 medication formulation considerations  849 mental health after surgery  855 psychiatric illness risk  849 Barnes Akathisia Rating Scale  127 basophils, psychotropic agent effects  965 Bazett’s correction formula  162 BDD see body dysmorphic disorder BED see binge eating disorder behavioural changes, benzodiazepine induced disinhibition  471–­473 behavioural disturbance see acutely disturbed/violent behaviour; aggressive behaviours; drug-­induced excited states behavioural and psychological symptoms of dementia (BPSD)  667–­679 non-­drug management measures  667–­668 pharmacological measures  668–­679 beneficial psychiatric effects, antiseizure medications  812–­813 benign ethnic neutropenia (BEN)  268, 269, benperidol  43 benzhexol (trihexyphenidyl), clozapine-­ induced hypersalivation  259 benzodiazepinea, breastfeeding  746 benzodiazepine dependence  464, 540–­542 dose reduction recommendations  540 novel illicit drugs  540 overuse of prescribed medication  540 polysubstance use  541, 542 withdrawal management  466–­469, 540–­542 benzodiazepines  64–­65 adverse effects  461–­462 adverse effects of long-­term use  464, 465 alcohol withdrawal treatment  484–­487 anxiolytic effect  460 breastfeeding mothers  746 with caffeine  903 for catatonia  154–­155 concentration in normal dosing and UK legal limit  923 dependence/withdrawal/ discontinuation  464–­465, 540–­542 diazepam equivalent doses  466, 467 direct taper or switch to diazepam  466 disinhibition  471–­473 driving impairment  922 drug interactions  462 fixed dose regimen for alcohol withdrawal  485–­486 hypnotic effect  460 long-­term use effects  464–­465 mania treatment in bipolar disorder  310, 311–­312 for neuroleptic malignant syndrome  151 not recommended for managing behavioural and psychological symptoms of dementia  671–­672 in overdose  917 pregnancy  541 process before tapering  468 psychiatric disorder treatment  460–­463 reduction schedules  469 sedatives in hepatic impairment  761 smokers  892 stopping  466 symptom-­triggered regimen for alcohol withdrawal  485, 486–­487 tapering  466 tapering patterns  467 tapering process  468 for tardive dyskinesia  136 troubleshooting during tapering process  468–­469 use in anxiety spectrum disorders  446 use in children and adolescents with autism spectrum disorder  609 use in depression  461 use in pregnancy  726 use in psychosis  461 withdrawal management  466–­469, 540–­542 symptoms  465 benztropine, clozapine-­induced hypersalivation  259 beta agonists, safety in older patients/ dementia/Parkinsons  659 betahistine, for antipsychotic-­induced weight gain  145 bethanechol, for constipation treatment  265 bicarbonate in blood, psychotropic agent effects  961 bilirubin in blood, psychotropic agent effects  961 binge eating disorder (BED)  794–­795 comorbid depression  795 NICE guidelines  795 biochemical effects of psychotropics  959, 960–­965 bipolar disorder/bipolar affective disorder  279–­334 antipsychotic drugs  300–­304, 311 long-­acting injections  305–­307 atrial fibrillation patients  846 carbamazepine  295–­299 children and adolescents  573–­579 after prescribing  574 attention deficit hyperactivity disorder relationship  574 before prescribing  573 clinical guidance  573–­574 depression treatments  577 first-­line treatments  577 mania treatments  575–­576, 577 specific issues  574–­575 what to prescribe  573, 575–­577 comorbid alcohol use disorder  495 depression  319–­325 antipsychotics  301, 302 lithium  280 meta-­analysis of drug studies  319 valproate  290 disruptive mood dysregulation disorder relationship  574 lithium  279–­288 maintenance treatment  280 prophylaxis  326, 327, 328 stopping/withdrawal effects  331–­332 tapering  332–­333 mania acute/hypomania  310–­315 antipsychotic treatments  300, 301, 302, 311 benzodiazepines  310, 311–­312 lithium treatment  279–­280 treatment strategies  310 valproate treatment  289–­290 multiple sclerosis  836 other treatments  574–­575 people living with human immunodeficiency virus  805 physical monitoring  283, 291, 297, 308–­309 postpartum psychosis risk  715 in pregnancy  722, 725–­726 prophylaxis  326–­330 antipsychotics  301, 302 carbamazepine  295–­296 lithium  326, 327, 328 valproate  290 rapid cycling type  290, 316–­318 relapse after stopping medication  332 stopping lithium and other mood stabilisers  331–­334 tapering lithium  332–­333 valproate  289–­294 bleeding gastrointestinal irritant drugs  753 SSRI effects  393–­394, 404, 409, 432–­439 warfarin interactions with SSRIs  846 see also platelets blonanserin  8, 12, 15, 43, 227 blood-­brain barrier, increased permeability with old age  628 blood clotting antipsychotics risk of pathological clotting  212 see also bleeding; platelets blood count, antipsychotic medication monitoring  40

blood lipids, antipsychotic medication monitoring  40 blood pressure changes  182–­185 antipsychotic medication monitoring  41 hypertension  41, 183–­184, 241 orthostatic hypotension  182–­183, 207 blood tests biochemical effects of psychotropics  959, 960–­965 haematological effects of psychotropics  959, 965–­966 blood transfusion in surgery, SSRI risks  436–­437 BN see bulimia nervosa body dysmorphic disorder (BDD)  587–­592 children and adolescents  587–­594 NICE guidelines  588–­589 psychological therapies  447, 587 SSRIs/SNRIs  447, 588 treatment duration and follow-­up  591 treatment initiation  589 treatment-­refractory cases  590 bone loss, anorexia nervosa risk  794 bone marrow suppression, antiretrovirals  807 bone mineral density (BMD), reduction by antiretrovirals  807 borderline personality disorder (BPD)  787–­791 antidepressants  789 antipsychotics  788 botulinum toxin  790 co-­morbid mental health conditions  787, 788 crisis management  790 drug treatment evidence  788–­790 ketamine  790 lack of evidence for drug treatments  787–­788 mood stabilisers and anticonvulsants  789 omega-­3 fatty acids  790 opioid antagonists  789 sedatives, short term use recommended  788 botulinum toxin borderline personality disorder  790 clozapine-­related hypersalivation  259 tardive dyskinesia  137 BPD see borderline personality disorder BPSD see behavioural and psychological symptoms of dementia bradykinesia  35 see also pseudoparkinsonism breast enlargement  196 breastfeeding antidepressants  735, 737–­740 antipsychotics  736, 741–­743 general prescribing principles  734–­735, 736 measuring infant exposure to drugs  734 mood stabilisers  736, 744–­745 not permitted with lithium use  736 stimulants  747 use of psychotropic medications  734–­747 bremelanotide use in patients with hepatic impairment  761 use in patients with renal impairment  778 brexanolone, in overdose  913 brexpiprazole  8, 12, 15, 43, 915 British Association for Psychopharmacology catatonia  156 dementia recommendations  649 bronchodilators, safety in older patients/ dementia  659–­660 buccal administration, antipsychotics  117 bulimia nervosa (BN)  794–­795 comorbid depression  795 NICE guidelines  795 buprenorphine analgesia for patients on opioid substitution treatment  519 blocking other opioids  506, 507, 519 cautions  513 conventional induction  508–­509 intoxication  513 liver function effects  513 low-­dose induction  509 methadone comparison  503 opioid substitution treatment  501, 503, 506–­514 overdose  513 prolonged-­release injection/ Buvidal  509–­510 timecourse of withdrawal symptoms  501 transferring back to methadone  512–­513 transition from methadone  510–­512 treatment methods and doses  508, 509 withdrawal  501, 516–­517 buprenorphine with naloxone (Suboxone)  513 bupropion (amfebutamone)  145, 259 adverse effects  527 attention deficit hyperactivity disorder in adults  799, 801 borderline personality disorder  789 clinical effectiveness  527 contraindicated in anorexia nervosa  794 nicotine addiction  527, 529 not recommended in bulimia nervosa/ binge eating disorder  795 in overdose  914 in pregnancy  721, 722 preparations and doses  527, 529 buspirone, in overdose  917 butyrophenones, in overdose  915 caffeine  901–­907 anxiety disorders  905 attention deficit hyperactivity disorder  905 Index dose and psychotropic effects of  902–­903, 902 drink types  901 energy drinks  901, 904 general effects of  902 interactions  903 intoxication  903–­904 mood disorders  905 pharmacokinetics  902–­903 schizophrenia  904 withdrawal effects  902 calcium antagonists, for tardive dyskinesia  137 calcium in blood, psychotropic agent effects  961 calcium levels, long-­term lithium use  282 cannabis/cannabinoids  36, 546, 550, 558, capacity and consent assessment in older people  694 covert administration of medicines in food and drink  629, 694–­699 learning difficulties  824–­825 Mental Health Act  629, 694–­698, 950, 951 right not to take medication  931 carbamazepine  295–­299 adverse effects  296–­297 bipolar disorder  295–­299, 310, 311 depression  295 discontinuation  297, 298 drug interactions  297–­298 formulations  295 indications  295–­296, 298 lithium interactions  286 mania  295 mechanism of action  295 in overdose  916 plasma levels  296 prescribing  298 pre-­treatment tests and monitoring  297, 298 prophylaxis  295–­296 smokers  892 target range  868 teratogenicity  297, 714, 723–­724 carbohydrate-­deficient transferrin (CDT), psychotropic agent effects  961 cardiac arrhythmia, atrial fibrillation  845–­848 cardiac death  161, 166 cardiac drugs, safety/use in older patients  662 cardiac effects antidepressants  406–­408, 409, 411–­412 drug-­induced excited states  543, 544 torsades de pointes/QT interval prolongation risk with methadone  506 cardiac malformation in infants, maternal mental health problems and lithium  723

982 Index cardiomyopathy  254 cardiovascular agents, psychiatric adverse effects  970 cardiovascular disease  169 cardiovascular effects, antiretrovirals  807 cardiovascular mortality  176 cardiovascular risks, acetylcholinesterase inhibitors in Alzheimer’s disease  637 care homes and environments, learning difficulties  825 cariprazine  8, 11, 15, 43 bipolar disorder  301, 321 in overdose  915 catatonia  154–­160 algorithm for treatment of catatonic stupor  157 associated psychiatric and medical conditions  154 ECT treatment  155 in schizophrenia  155 sub-­types  154 treatment  154–­156, 158 CATIE study  58 CBT see cognitive behavioural therapy CDT see carbohydrate-­deficient transferrin cerebrolysin, Alzheimer’s disease management  643–­644 cerebrovascular disease see vascular dementia cerebrovascular events anticoagulants reducing risks  662 antipsychotic risks  212, 669 see also stroke checklist for prescribing clinician factor  942–­943 patient/clinician relationship  943 patient factor  942 checklists, adherence assessment  931 chemotherapeutic agents, psychiatric adverse effects  971 chemotherapy, clozapine contraindicated  273–­274 child neurodevelopment, antipsychotic exposure during pregnancy  717–­718 children, 22q11.2 deletion syndrome  821 children and adolescents  561–­626 alcohol misuse  493 antipsychotics use  568, 573, 580, 590, 606, 615–­616 augmentation of other drug treatments  590 first-­generation antipsychotics  580, 615 rapid tranquillisation  623 second-­generation antipsychotics  568, 573, 580, 590, 608, 615–­616, 623 anxiety, with autism spectrum disorder  610 anxiety disorders  582–­586 chlorpromazine  1, 8, 11, 14, 28, 43, 118 chlorprothixene, possible teratogen  716 chocolate, Alzheimer’s disease management  644 cholesterol  169, 170, 962 cholinesterase inhibitors see acetylcholinesterase inhibitors chorea, Huntington’s disease  830, 831 chronic kidney disease (CKD), psychiatric disorders  769 Chronic Kidney Disease Epidemiology Collaboration (CKD-­EPI) formula, glomerular filtration rate estimation  766 cigarette smoking see smoking CIGH see clozapine-­induced GI hypomotility cimetidine, psychiatric adverse effects  971 citalopram as antidepressant  337, 338 binge eating disorder  794 switching antidepressants  366 use in patients with hepatic impairment  761 CK see plasma creatine kinase CKD see chronic kidney disease CKD-­EPI see Chronic Kidney Disease Epidemiology Collaboration Clinical Institute Withdrawal Assessment of Alcohol Scale -­ Revised (CIWA-­Ar)  482, 483, 484, 485, 486, 537 Clinical Opiate Withdrawal Scale (COWS)  501, 502 clinician-­patient relationship attachment style of patients  941 collaboration enhancing medication adherence  931 importance to outcomes  939 prescribing influences  943 clinicians responsibilities with ‘off-­label’ prescribing  945 seeking support  943 training in compliance therapy and adherence  933–­934 clomipramine (Anafranil) in pregnancy  719 serotonin reuptake inhibition  404 clonazepam, concentration in normal dosing and UK legal limit  923 clonidine, clozapine-­induced hypersalivation  259 clotiapine  8, 15, 957 clotting factor synthesis reduction, hepatic impairment  753 clozapine  214–­277 adverse effects  239, 241–­277 agranulocytosis  245, 251, 267–­268 cardiomyopathy  254 cardiovascular adverse effects  240, 253–­257 approved psychotropic medications  563–­564 attention deficit hyperactivity disorder  597–­604 medication continuing into adulthood  799 symptoms  562, 563, 574, 607–­608 autism spectrum disorder  605–­613, 620–­621 bipolar disorder  573–­579 body dysmorphic disorder  587–­594 bulimia nervosa/binge eating disorder  794 cognitive behavioural therapy  566–­567, 574, 587, 590, 595 depression  566–­572 with autism spectrum disorder  610 irritability (aggression, self-­injurious behaviour, and severe disruptive behaviours) in autism spectrum disorder  608 lack of engagement with psychological therapies  587 lithium plasma levels  281 melatonin use for sleep disturbance/ insomnia  575, 609–­610, 620–­622 obsessive compulsive disorder  587–­594 with autism spectrum disorder  610 optimising lithium treatment for prophylaxis in bipolar disorder  327 post-­traumatic stress disorder  595–­596 pre-­school children, anxiety disorders  586 prescribing principles  561–­565 psychosis  580–­581 psychotropic drug starting doses  626 rapid tranquillisation  623–­625 relative infant dose  734 restricted repetitive behaviours and interests, autism spectrum disorder  606 selective serotonin reuptake inhibitors  566–­567, 583–­584, 585, 588 sleep disturbance in autism spectrum disorder  609–­610 social and communication impairment, autism spectrum disorder  606 SSRI use  566–­567, 583–­584, 585, 588 suicidal ideation risk with SSRIs  588 symptom rating scales  573 tics and Tourette’s syndrome  614–­619 adrenergic a2 agonists  615 antipsychotics  615–­616 use of adult treatments  562 depression  568–­569 mania  574 obsessive compulsive disorder  592 chlordiazepoxide, alcohol withdrawal treatment  485–­486 chloride in blood, psychotropic agent effects  962

colitis  245 common adverse effects  241–­242 constipation  241, 263–­266, 882 delirium  245 eosinophilia  245 gastrointestinal hypomotility  263–­266 gastrointestinal necrosis  245 haematological adverse effects  251–­252 heat stroke  245 hepatic failure/enzyme abnormalities  245 hypersalivation  241, 258–­262 hypertension association  184, 241 hypothermia  245 interstitial nephritis  245 knee-­buckling  245 myocarditis  253–­254, 255 neutropenia  267–­272 nocturnal enuresis  242 ocular effects  245 pancreatitis  246 parotid gland swelling  246 pericardial effusion  246 pericarditis  246 pneumonia  242 pneumonia association  204, 205 polyserositis  246 sedation  242 seizures  242 skin reactions  246 stuttering  246 tachycardia  184, 234, 242, 253, 255 thrombocytopenia  246 thromboembolism  246, 253 uncommon adverse effects  245–­246 venous thromboembolism  253 weight gain  242 augmentation of treatment  220–­222 bipolar disorder  301–­302 borderline personality disorder  788 with caffeine  903 chemotherapy contraindication  273–­274 clozapine/norclozapine ratio  871 combined medications  24 community initiation  236–­240 adverse effects  239 dosing  237, 238 essential criteria for  236 initial work-­up  236–­237 mandatory blood monitoring and registration  237 recommended additional monitoring  239 relative contraindications  236 serious cardiac adverse effects  240 switching from other antipsychotics  239 titration schedules  238 delay/underuse of  57 dosing  214–­218, 237, 238 ECT augmentation  108–­109 EEG test  41 efficacy  3–­4 efficacy for negative symptoms  35 genetic testing for treatment  275–­277 agranulocytosis  275–­276 benign ethnic neutropenia  276 glucose tolerance impairment association  174–­175 hyponatraemia treatment  187 initiation schedules  214–­218 interruptions in treatment  234–­235 intramuscular clozapine  219 lithium use with  269–­270, 271 maximum dose  11 ‘off-­label’ prescribing  947 in overdose  915 people with 22q11.2 deletion syndrome  822 people living with human immunodeficiency virus and treatment-­resistant schizophrenia  804 plasma level monitoring  870–­871, 881–­882 plasma lipids, effect on  170 possible risks in pregnancy  717 prescribing of  7 relative efficacy  3 restarting after a break in treatment  234–­235 site of administration of intramuscular injections  957 smokers  892 smokers/non-­smokers, dosing regimens  216–­218 switching from other antipsychotics  239 target range  868 titration schedules  214–­215, 216–­218, 238 treatment optimisation  220–­225 treatment-­resistant schizophrenia  214–­233 alternatives to clozapine  226–­233 dosing regimen  214–­218 faster titrations  215 intramuscular clozapine  219 treatment optimisation  220–­225 clozapine-­induced GI hypomotility (CIGH)  263–­266, 882 clozapine rechallenge following severe constipation  265 management of suspected acute CIGH  264 prevention and simple management  264 risk factors  263 clozapine-­related life-­threatening agranulocytosis (CRLTA)  251 cocaine, stimulant use disorder  533 Cochrane review acute behavioural disturbance  63 benzodiazepines  64–­65 Index catatonia treatment  155 long-­acting injectable antipsychotics  74 smoking cessation  909 Cockroft and Gault equation, creatinine clearance calculation  766, 767 COCP see combined oral contraceptive pill cognitive behavioural therapy (CBT) anxiety spectrum disorders  447, 448, 449 benzodiazepine withdrawal  541, 542 children and adolescents  566–­567, 574, 587, 590, 595 psychosis  929 cognitive decline, anticholinergic drugs  654, 658 cognitive disturbances and decline, Huntington’s disease  834 cognitive enhancers adverse effects  631, 635–­637 Alzheimer’s disease  630–­641 combination treatment  634 discontinuation  640–­641 dose tolerability  634–­635 dosing and formulations  633–­634 drug interactions  637–­640 efficacy  632 managing behavioural and psychological symptoms of dementia  671 mechanism of action  630, 631 switching drugs  632–­633 see also acetylcholinesterase inhibitors; memantine cognitive impairment anticholinergic burden  642 multiple sclerosis  837 people living with human immunodeficiency virus  806 see also Alzheimer’s disease; dementia; mild cognitive impairment; vascular dementia collaboration between the patient and the prescriber, enhancing medication adherence  931 combination nicotine replacement therapy  524, 529–­530 combination therapies bipolar depression  319, 322 prophylaxis in bipolar disorder  327, 328 psychotic depression  362, 364 combined oral contraceptive pill (COCP), premenstrual syndrome  474–­475 communication, patient factor in prescribing  942 communication with patients, adherence relationship  933–­934 community detoxification, alcohol withdrawal  482 Community Treatment Order (CTO), Mental Health Act  953 complementary therapies, Parkinson’s disease  842

984 Index compliance use of term  927 see also adherence ‘compliance therapy’  933 compulsion, dependence syndrome  477–­478 concurrent illnesses, drug interactions in older people  627 consent see capacity and consent constipation causing drugs, avoid in hepatic impairment  754 constipation, clozapine-­induced  263–­266, clozapine rechallenge following severe constipation  265 prevention and management  241, 264 risk factors  263 controlled drugs psychostimulants used for attention deficit hyperactivity disorder in adults  798, 799 see also illicit drugs corticosteroids agents, psychiatric adverse effects  971 countertherapeutic use of medication  942 countertransference, clinicians  939, 942 covert administration of medicines in food and drink, older people  629, 694–­699 COVID-­19 pandemic  268 valproate preventative effects  290 COWS see Clinical Opiate Withdrawal Scale COX-­2 inhibitors, lithium interactions  285–­286 CrCl see creatinine clearance C-­reactive protein in blood, psychotropic agent effects  961 creatine kinase, psychotropic agent effects  962 creatine kinase (CK) elevations, antiretrovirals  807 creatinine in blood, psychotropic agent effects  962 creatinine clearance (CrCl), renal function assessment  766, 767 creatinine phosphokinase, antipsychotic medication monitoring  41 CRLTA see clozapine-­related life-­threatening agranulocytosis Crocus sativus (saffron), Alzheimer’s disease management  643 cross-­tapering, switching antidepressants  366 CTO see Community Treatment Order cultural beliefs, influencing adherence  940 CYP see cytochrome function cyproheptadine, ‘off-­label’ prescribing  947 cytisine adverse effects  526 clinical effectiveness for smoking cessation  526 nicotine addiction  526, 529 preparations and doses  526, 529 cytochrome (CYP) function  883–­891 alcohol and substrates for enzymes  896, 897, 898 antidepressant interactions with enzymes  339, 401, 401–­402, 403 caffeine metabolism/clearance  903 enzyme phenotype frequency by ancestry  889–­890 genetics  888–­891 nicotine/smoking effects  903, 910 environmental lithium effects  279 Huntington’s disease  834 inappropriate sexual behaviour  680–­687 Lewy bodies  630, 642, 648, 649, 842 management of behavioural and psychological symptoms of dementia  667–­679 mild cognitive impairment/pre-­clinical dementia  648 other kinds  648–­649 Parkinson’s disease  842 people living with human immunodeficiency virus  806 safer prescribing  654–­666 vascular  647 dementia with Lewy bodies (DLB)  630, 642, 648, 649, 842 dependence definition/diagnosis  477–­478 see also addiction; substance misuse and dependence dependence syndrome, definition  477–­478 depot antipsychotic medications  4, 29, 74–­80, 95 comparison of types  76 doses and frequencies  77–­78 improving adherence and outcomes  4, 29, 928–­929, 932–­933 pharmacokinetics  81 prescribing advice  75–­76 reduction of  123 restarting after period of non-­compliance  937 schizophrenia  29, 53 site of administration of intramuscular injections  954–­957 depression  335–­445 atrial fibrillation patients  846 basic prescribing principles  335–­336 children and adolescents  566–­572 acute phase  569–­570 after prescribing  569–­570 with autism spectrum disorder  610 before prescribing  567 clinical guidance  566–­571 diagnostic issues  566 discontinuation phase  570 maintenance phase  570 specific issues  570 what to prescribe  567–­569 chronic kidney disease  769 comorbid alcohol use disorder  494 comorbid with eating disorders  794, 795 diabetes mellitus association  423 drug treatment summary chart  344, 345–­347 Huntington’s disease  832, 833 ketamine as treatment  351, 357–­361 lithium DAI see Drug Attitude Inventory DAOAs see direct-­acting oral anticoagulants daridorexant in overdose  917 use in patients with hepatic impairment  761 use in patients with renal impairment  777 database studies, antidepressant associated hyponatraemia  416, 417 DBM see dibenzoylmethane DBS see deep brain stimulation DBT see dialectical behaviour therapy decision making, relational aspects  939–­943 deep brain stimulation (DBS)  137, 227, 230, 592 delirium  245 analgesics causing  660 antibiotics association  662, 663 anticholinergic drug effects  654, 658 antipsychotics used to manage  117, 118 benzodiazepine reactions similar to  471 caffeine at high doses  902 clozapine adverse effects  245 constipation effects in dementia patients  658 ECT/lithium effects  384, 385 excited delirium see drug-­induced excited states gamma-­butyrolactone withdrawal  534, 537 GHB/GBL withdrawal  534, 537 haloperidol treating in older people  706 hyperthermia and drug-­induced excited states  543 opioid effects  660 people living with human immunodeficiency virus  806 post-­injection delirium sedation syndrome  76, 77, 91 delirium tremens, severe alcohol withdrawal  480, 481, 482, 486 demeclocycline  187, 188 dementia  630–­653 Alzheimer’s disease  630–­647 antipsychotic prescriptions  119 drug recommendations and drugs to avoid  663–­664

augmentation of antidepressants in unipolar depression  280 prophylaxis of unipolar depression  281 managing behavioural and psychological symptoms of dementia  672–­673 menopausal women  858 multiple sclerosis  835 natural remedies St John’s wort  440–­443 taken without doctor’s knowledge  442 NICE guidelines  336 nicotine effects  909 older people  688–­693 Parkinson’s disease  840 people living with human immunodeficiency virus  804–­805 post stroke  393–­396 in pregnancy  719–­726 psychostimulants  388–­392 psychotic symptoms  362–­365 St John’s wort  440–­443 sexual dysfunction  426 stimulant use association  535 treatment resistant  348–­356 use of benzodiazepines  461 see also antidepressants; bipolar disorder designer drugs see new psychoactive substances; synthetic cannabinoids detoxification opioid substitution treatment  500 see also alcohol detoxification deutetrabenazine hepatic impairment  761 renal impairment  778 for tardive dyskinesia  136 dexamfetamine, attention deficit hyperactivity disorder in adults  798, 800 dextromethorphan, in overdose  914 DHA see docosahexanoic acid diabetes mellitus antidepressants  423–­425 antipsychotic-­related  174–­181 comorbid depression  423 see also glucose homeostasis dialectical behaviour therapy (DBT), borderline personality disorder  787 diazepam  68 with alcohol  898 benzodiazepine withdrawal  540, 541 concentration in normal dosing and UK legal limit  923 switching from benzodiazepines  466 diazepam equivalent doses, benzodiazepines  466, 467 dibenzoylmethane (DBM), Alzheimer’s disease management  645 DiGeorge syndrome (22q11.2 deletion syndrome)  820–­823 diphenhdyramine, clozapine-­induced hypersalivation  259 direct-­acting oral anticoagulants (DOACs) atrial fibrillation patients  845, 846 citalopram/escitalopram not affecting  394 possible SSRI interactions  394 renal function assessment  766 discontinuation symptoms when switching antidepressants  366–­367 see also withdrawal discontinuation syndrome, donepezil  632 disinhibition benzodiazepines  471–­473 clinical implications  472 incident rates  471 mechanism  472 risk factors  471–­472 subjective reports  472 see also paradoxical/disinhibitory/ aggressive drug reactions disruptive mood dysregulation disorder (DMDD), bipolar disorder relationship  574 distribution of drugs, changes with old age  628 disulfiram (Antabuse), preventing relapse after alcohol detoxification  491–­492 diuretics, lithium interaction  285 diversion and misuse of prescribed drugs opioids  503, 512, 513, 514 stimulants for ADHD in adults  798, 799 DLB see dementia with Lewy bodies DOACs see direct-­acting oral anticoagulants docosahexanoic acid (DHA) see omega-­3 fatty acids doctor see clinician donanemab, Alzheimer’s disease treatment  646 donepezil Alzheimer’s disease treatment  630–­637, 638, 640, 642 for tardive dyskinesia  137 dopamine and norepinephrine-­reuptake inhibitors see bupropion dopaminergic agents and dopamine partial agonists, possible effects on impulse control disorders  560 dosage reduction see tapering dose-­related adverse drug effects, increased in hepatic impairment  753 Driver and Vehicle Licensing Agency (DVLA), UK  923–­924 driving and psychotropic medicines  921–­926 duty of driver  923 duty of prescriber  924 effects of mental illness  921 medication-­induced sedation  923 Index psychotropic drug groups causing impairments  922 UK General Medical Council guidelines for prescribers  924 UK law  921–­923 driving restrictions, people with epilepsy  817 dronabinol, weight restoration in anorexia nervosa  792 droperidol  64, 65 drug administration see administration of medicines Drug Attitude Inventory (DAI)  931 drug half-­life  866 see also pharmacokinetics drug-­induced excited states  543–­544 hyperthermia risk  543, 544 identification  543 illicit drugs  543–­544 illicit and misused drugs  543–­544 management  543–­544 outcomes  544 pathophysiology  543 restraint risks  543 drug-­induced parkinsonism see pseudoparkinsonism drug interactions acetylcholinesterase inhibitors  637–­638, 638–­639 alternative treatments used by menopausal women  858 antidepressants  339, 401–­405 pharmacodynamic interactions  402, 404–­405 pharmacokinetic interactions  401–­402 atrial fibrillation patients  847 carbamazepine  297–­298 changes with old age  627, 628–­629 illicit drugs with prescribed psychotropic drugs  545, 546–­548 lithium  284–­286, 286 ACE inhibitors  284–­285 sodium levels  284–­285 memantine  637–­638, 640 post stroke depression  393 valproate  292 drugs of misuse summary  549–­553 see also diversion and misuse of prescribed drugs; illicit drugs; substance misuse and dependence dual diagnosis, substance misuse with mental illness  477 dual reuptake inhibitors adverse effects relative to other antidepressants  338 see also duloxetine; venlafaxine duloxetine borderline personality disorder  789 in overdose  914 in pregnancy  721 smokers  892

986 Index duty of managers of hospitals to give information to detained patients, S132 of the Mental Health Act dyslipidaemia  169 clinical management  170–­171 switching antipsychotics  207 dystonia extrapyramidal effects  127, 128 Huntington’s disease  830, 831 see also pseudoparkinsonism early-­onset schizophrenia spectrum (EOSS) disorder  580 eating disorders  792–­797 anorexia nervosa  792–­794 atypical/eating disorders not otherwise specified  795 bulimia nervosa/binge eating disorder  794–­795 comorbid depression  794, 795 NICE guidelines  795 Ebstein’s anomaly (cardiac malformation), lithium in pregnancy  723, 725 ECG changes, antiretrovirals  807 ECT see electroconvulsive therapy efavirenz, psychiatric adverse reactions  808 eGFR see estimated glomerular filtration rate eicosapentaenoic acid (EPA) see omega-­3 fatty acids elderly people atrial fibrillation  845–­848 genitourinary symptoms of menopause  861 optimising lithium treatment for prophylaxis in bipolar disorder  327 electrocardiogram (ECG) monitoring antipsychotic medication users  41, 165 methadone users with QT prolongation risk factors  506 see also QTc prolongation electroconvulsive therapy (ECT)  108–­110, 227 adverse effects  109 for catatonia  155 children and adolescents  568, 569 drug resistant depression treatment  351 managing behavioural and psychological symptoms of dementia  675 in pregnancy  722 psychotic depression treatment  363 psychotropic drug combination  384–­386 S58a of the Mental Health Act  952–­953 for treatment-­resistant schizophrenia  108–­109 electrolytes alcohol effects  898 anorexia nervosa  793–­794 antipsychotic medication monitoring  40 see also sodium levels electronic nicotine vaping devices see nicotine vaping devices embolic events, SSRIs decreasing risk  433 emergency situations, rapid tranquilisation  68–­69 energy drinks, caffeine content  901, 904 environmental lithium, high levels inversely related to suicide and dementia at a population level  279 eosinophilia  245 eosinophils, psychotropic agent effects  965 EOSS see early-­onset schizophrenia spectrum disorder EPA see eicosapentaenoic acid epilepsy  811–­819 learning difficulties comorbidity  825 psychiatric comorbidities  811–­812 see also people with epilepsy EPSEs see extrapyramidal side effects EPS (extrapyramidal symptoms) see extrapyramidal side effects erectile dysfunction  199, 200 erythrocyte sedimentation rate, psychotropic agent effects  966 escitalopram smokers  893 use in patients with hepatic impairment  761 esketamine, enantiomer of ketamine  357 esketamine (intranasal) treatment resistant depression  336, 351, 357, 359 see also ketamine Espranor orodispersible buprenorphine brand  507, 508 estimated glomerular filtration rate (eGFR), renal impairment assessment  766 ethanol see alcohol excited delirium use of term  543 see also drug-­induced excited states excretion of drugs, changes with old age  628 excretory capacity of the kidney, estimation in renal impairment assessment  766 expectations of treatment, placebo and nocebo effects  941 extended release (ER) preparations intramuscular injections  955, 956 memantine for older adults  633 extended release preparations, see also long-­acting injectable antipsychotics; modified-­release preparations; prolonged release injections; slow-­release oral morphine extrapyramidal side effects (EPSEs)  1–­2, 3, 126–­130 amisulpride  869 children  623 features of most common symptoms  127–­128 first generation antipsychotics  580 high-­dose antipsychotics  56 methamphetamine use plus antipsychotics  534 patient sensitivity  75 people with learning difficulties  825 people living with human immunodeficiency virus  804, 806 smoking alleviating symptoms  909 switching antipsychotics  207 treatment  128 see also pseudoparkinsonism family, improving medication adherence  932, 933 fasting plasma glucose (FPG) test  176, 177 Fatal Toxicity Index (FTI), antidepressants  412 fatigue multiple sclerosis  837 psychostimulants to reduce in depression  388, 389 fentanyl dependence, buprenorphine low-­dose induction  509 ferritin in blood, psychotropic agent effects  962 FGAs see first-­generation antipsychotics financial incentives, improving adherence  933 first-­generation antipsychotics (FGAs) adverse effects  3–­4, 49 bipolar disorder  300 children and adolescents  580 classification of  2 equivalent doses  14 impaired glucose tolerance and diabetes  174 long-­acting injectable antipsychotics  75, 76 maximum doses  11, 12 minimum effective doses  8 nomenclature  49 penfluridol  106–­107 people with learning difficulties  826 in pregnancy  715–­716 relative efficacy  3 role of older antipsychotics  49–­50 site of administration of intramuscular injections  954–­955 treatment algorithm  46 treatment of negative symptoms  35 fish oils dyslipidaemia treatment  171 mild/moderate depressions in older adults  689 schizophrenia treatment/ prevention  111–­114 for tardive dyskinesia  137 see also omega-­3 fatty acids fixed-­dose regimens, benzodiazepines for alcohol withdrawal management  485

fluid restriction, hyponatraemia treatment  187, 188 flumazenil, guidelines for use of  70 flunitrazepam, concentration in normal dosing and UK legal limit  923 fluoxetine bipolar depression  322 borderline personality disorder  789 bulimia nervosa  794 children and adolescents autism spectrum disorder  610 depression/bipolar disorder  566–­568, 569, 570–­571, 574 ‘off-­label’ prescribing  947 in pregnancy  720 suicidality in children and adolescents  566, 570–­571, 588, 610 flupentixol bipolar disorder  305, 306 borderline personality disorder  789 long-­acting injection doses and frequencies  77 pharmacokinetics  81 fluphenazine, smokers  893 fluvoxamine for antipsychotic-­induced weight gain  145 smokers  893 for tardive dyskinesia  137 folic acid, Alzheimer’s disease management  643 forms T2 and T3, Mental Health Act  950 forms T4/T5/T6, Mental Health Act  952–­953 formulations of drugs impaired absorption following bariatric surgery  849 problems with tablets when tapering  382 FPG see fasting plasma glucose test FRAMES principles (feedback, responsibility, advice, menu, empathy, self-­efficacy), NICE public health guidance on harmful drinking  479 frontotemporal dementias  648–­649 FTI see Fatal Toxicity Index full blood count, antipsychotic medication monitoring  40 galantamine Alzheimer’s disease  630–­636, 639, 642 mild cognitive impairment  636 gambling disorder  560 gamma-­aminobutyric acid A (GABA-­A)  897 gamma-­butyrolactone (GBL; pro-­drug of GHB)  537–­539 see also gamma-­hydroxybutyrate and gamma-­butyrolactone gamma-­glutamyl transferase (GGT), psychotropic agent effects  963 gamma-­hydroxybutyrate (GHB) and gamma-­butyrolactone dependence  537–­539 planned elective withdrawal  538–­539 unplanned withdrawal  538 withdrawal management  537–­539 withdrawal syndrome  534, 537 GASS see Glasgow Antipsychotic Side-­effect Scale gastro-­esophageal reflux disease (GERD) 22q11.2 deletion syndrome  820 clozapine  241 gastrointestinal bleeding, SSRI risks  433–­434 gastrointestinal disorders, drug safety in older patients/dementia  658–­659 gastrointestinal disturbances, antiretrovirals  807 gastrointestinal hypomotility, clozapine-­induced  263–­266 gastrointestinal irritant drugs, increased risk of bleeding in hepatic impairment  753 gastrointestinal necrosis  245 GBL see gamma-­butyrolactone G-­CSF see granulocyte-­colony stimulating factor generalised anxiety disorder (GAD) NICE guidelines  448 pregabalin  447–­448 specific drugs used  449–­450 SSRIs/SNRIs  446 valproate treatment  290 generalised seizures, severe alcohol withdrawal  480, 481 General Medical Council, UK, guidelines for prescribers, medical conditions and safe driving  924 genetics of cytochrome function  888–­891 genetic testing, for clozapine treatment  275–­277 genitourinary symptoms of menopause (GSM)  857, 861, 862 gestational diabetes, antipsychotics risk  716–­717 GFR see glomerular filtration rate GGT see gamma-­glutamyl transferase GHB see gamma-­hydroxybutyrate Ginkgo biloba  136, 222, 227, 641, 643 G see gamma-­hydroxybutyrate and gamma-­butyrolactone GABA-­A see gamma-­aminobutyric acid A gabapentin borderline personality disorder  789 tardive dyskinesia  137 use in patients with hepatic impairment  761 gabapentinoids (GABA analogues), addiction/physical dependence and withdrawal  464, 465, 469 GAD see generalised anxiety disorder galactorrhoea  196 Index ginseng, Alzheimer’s disease management  643 Glasgow Antipsychotic Side-­effect Scale (GASS)  4 glomerular filtration rate (GFR), estimation for renal impairment assessment  766 glucocorticoid receptor blocking, psychotic depression treatment  364 glucose in blood, psychotropic agent effects  963 glucose homeostasis antidepressant effects  423–­425 SSRIs improving control  423 see also diabetes mellitus glucose tolerance impairment, antipsychotic-­ related  174–­181, 207 glutamate, role in cognitive function/ dementia  630, 631, 672 glycated haemoglobin (HbA1c)  53, 175, 176, 177, 424, 432, 963 glycopyrrolate, clozapine-­induced hypersalivation  259 gonadotrophin-­releasing hormone agonists, medical menopause induction test  475 granulocyte-­colony stimulating factor (G-­CSF)  270–­271 GSM see genitourinary symptoms of menopause guanfacine attention deficit hyperactivity disorder in adults  799, 801 clozapine-­induced hypersalivation  259 gynaecological and obstetric haemorrhage, SSRI risks  435–­436 H2 see histamine-­2 HAD see HIV-­associated dementia haematological effects of psychotropics  959, 965–­966 haemodialysis, depression treatment  769 haemoglobin, psychotropic agent effects  966 half-­life of drugs  866 see also pharmacokinetics haloperidol  8, 11, 14, 43, 49, 50 acute behavioural disturbance  62, 63, 65 clozapine augmentation  221 intravenous administration  117 long-­acting injections, doses and frequencies  77 pharmacokinetics  81 possible teratogen  716 smokers  893 haloperidol decanoate  11, 14 Hamilton Depression Rating Scale (HAM-­D), drug effect assessment  337, 345 HAND see HIV-­associated neurocognitive disorders HbA1c see glycated haemoglobin

988 Index HD see Huntington’s disease HDL see high-­density lipoprotein cholesterol heat stroke  245 hepatic CYP enzymes antidepressant interactions  401–­402, 403 see also cytochrome function hepatic damage clozapine induced  245 hepatitis B and C infection effects  545 toxicity assessment in new drugs  762 valproate induced  291 hepatic encephalopathy, from reduced drug metabolism in hepatic impairment  753, 754 hepatic impairment in patients  753–­767 antidepressants  753, 757–­758, 761 antipsychotics  754–­756, 761 lower starting doses recommended  753–­754 mood stabilisers  759, 761 sedatives  754, 760, 761 stimulants  760 hepatitis B and C infections, drug metabolism effects  545 hepatotoxicity assessment in new drugs  762 avoiding known drugs in hepatically impaired patients  754 herbal medicine see natural remedies high-­density lipoprotein (HDL) cholesterol  169 high-­dose antipsychotics  17 adverse effects  18 efficacy  17–­18 recommendations  19 highly protein-­bound drugs, increased toxicity in hepatic impairment  753–­754 hirudin, Alzheimer’s disease management  643 histamine-­2 (H2) antagonists, safety in older patients/dementia  662 HIV, see also human immunodeficiency virus; people living with human immunodeficiency virus HIV-­associated dementia (HAD)  806 HIV-­associated neurocognitive disorders (HAND)  806 HIV mania, secondary mania in people living with human immunodeficiency virus  805 hormonal treatments, premenstrual syndrome  474–­475 hormone replacement therapy (HRT)  861–­863 adverse effect management  863 depression/anxiety treatment for menopausal women  858 local treatments for GSM  861, 862 products and regimens  861, 862, 863 risks  861 starting treatment  863 versus raloxifene for psychosis treatment in menopausal women  860 hospital managers, duty to give information to detained patients under S132 of the Mental Health Act  952 HRT see hormone replacement therapy 5HT6 receptor antagonist, Alzheimer’s disease management  644 human immunodeficiency virus (HIV)  803–­810 treatment advances  804 see also people living with human immunodeficiency virus Huntington’s disease (HD)  830–­834 cognitive symptoms  834 general principles of pharmacological symptom management  830–­831 mental and behavioural symptoms  831–­833 motor symptoms  830–­831 huperzine A, Alzheimer’s disease management  643 hyperbolic tapering antidepressants  366, 376, 379, 382 benzodiazepine  467 lithium for bipolar disorder  333 hypercalcaemia, lithium  282 hypercholesterolaemia  170 hyperglycaemia  174, 186 hyperlipidaemia  170, 171, 186 hyperparathyroidism, lithium  282 hyperprolactinaemia  2, 24, 41, 50, 190–­194, 196 antidepressants  420–­422 contraindications  191 effects of antipsychotic medication on prolactin concentration  190 management  191, 192 switching antipsychotics  207 hypersalivation  258–­262 clozapine  241 oral anticholinergic agents, safety in older patients/dementia  660 treatment  258, 259–­260 hypersensitivity reactions, drug-­induced hepatic damage  762 hypertension  41, 183–­184, 241 hyperthermia, drug-­induced excited states  543, 544 hypertriglyceridemia  169, 171 hypnotic effect, benzodiazepines  460 hypnotics breastfeeding mothers  736, 746 driving impairment  922 in pregnancy  727 use in renal impairment  776–­777 hypoalbuminaemia, hepatic impairment  753, 754 hypoglycaemia  898 hypokalaemia, anorexia nervosa  793–­794 hypokinetic phase/rigidity, Huntington’s disease  830, 831 hypomania, treatments  310–­315 hyponatraemia  186–­189 antidepressants  416–­419 lithium retention and toxicity  286 other psychoactive prescribed drugs  418 and syndrome of inappropriate antidiuretic hormone  186, 188 treatment  187–­188 and water intoxication  186 hypo-­oestrogenic states, high prolactin levels in menopausal women  860 hypophosphataemia, anorexia nervosa  794 hypotension  41, 43, 44 clozapine  241 orthostatic  182–­183, 207 hypothermia  245 hypothyroidism, lithium risk  282 Hy’s rule, assessment of hepatotoxicity of new drugs  762 iatrogenic dependence, benzodiazepines/ z-­drugs/gabapentinoids  464, 540 idalopirdine (5HT6 receptor antagonist), Alzheimer’s disease management  644 ideational perseveration, Huntington’s disease  832 illicit drugs drug-­induced excited state  543–­544 drugs of misuse summary  549–­553 interactions with prescribed psychotropic drugs  545–­548, 546–­548 see also new psychoactive substances; substance misuse and dependence iloperidone  8, 12, 15, 43, 915 IM see intramuscular... immediate-­release (IR) preparations attention deficit hyperactivity disorder treatments  600, 620, 799, 800 medication doses for older adults  633, 700 modified release stimulant preparations preferred in adults  799 impulsive behaviour, disinhibitory drug reactions, benzodiazepines  471–­473 inappropriate sexual behaviour in older people  680–­687 incongruence of affect, multiple sclerosis  836 infant exposure relative infant dose  734 see also breastfeeding inhaled administration acutely disturbed/violent patients  62 antipsychotics  62, 115, 116 injectable diamorphine, prescribing guidelines for opioid dependency  514

injections site of administration of intramuscular injections  954–­958 see also long-­acting injectable antipsychotics in-­patient detoxification, alcohol withdrawal  482 INR see international normalised ratio in situ microparticle technology see risperidone ISM insomnia melatonin use in children and adolescents  575, 609–­610, 620–­622 menopausal women  858 people living with human immunodeficiency virus  805, 808, in pregnancy  726–­727 see also sleep disturbance integrase strand transfer inhibitors, psychiatric adverse reactions  809 intentional non-­adherence  932 interferons-­α and -­β, psychiatric adverse effects  971 international normalised ratio (INR), psychotropic agent effects  967 interstitial lung disease  245 interstitial nephritis  245 intracranial/intracerebral haemorrhage, SSRI risks  434–­435 intramuscular (IM) injections, acute behavioural disturbance  62–­66 intranasal antipsychotics  115, 116–­117 intranasal esketamine, treatment resistant depression  336, 351, 357, 359 intranasal ipratropium, clozapine-­induced hypersalivation  259 intranasal naloxone  499 involuntary movements, abnormal see tardive dyskinesia ipratropium nasal spray, clozapine-­induced hypersalivation  259 IR see immediate-­release preparations irritability (aggression, self-­injurious behaviour, and severe disruptive behaviours), children and adolescents with autism spectrum disorder  608 irritability and agitation, Huntington’s disease  832, 833 isotretinoin, psychiatric adverse effects  971 racemic mixture  357 route of administration  357–­358 treatment resistant depression  351, 357–­361 see also esketamine ketoacidosis, diabetic  174, 175 kidneys see chronic kidney disease; renal... knee-­buckling  245 lactate in blood, psychotropic agent effects  963 LAI see long-­acting injectable antipsychotics lamotrigine borderline personality disorder  789 clozapine augmentation  221 life-­threatening cutaneous reactions  937 in overdose  916 restarting after period of non-­ compliance  937, 938 target range  868 laxative misuse/abuse  792, 961, 962 laxatives  239, 241, 264–­265, 658, 882 LDL see low-­density lipoprotein cholesterol learning difficulties  824–­829 capacity and consent  824–­825 epilepsy comorbidity  825 general considerations  824 prescribing practice  824–­825 lecanemab, Alzheimer’s disease treatment  646 legal issues Mental Health Act England and Wales (1983)  949–­953 ‘off label’ prescribing  945–­946 UK drug-­driving law  921–­923 see also capacity and consent lemborexant managing sleep disturbance in dementia  674 in overdose  917 use in patients with hepatic impairment  761 leukopenia, psychotropic agent effects  966 levetiracetam, for tardive dyskinesia  137 Levodopa, hypokinetic rigidity in Huntington’s disease  831 levomepromazine  11, 43 Lewy body dementia  630, 642, 648, 649, LFTs see liver function tests libido  196, 199 linaclotide, for constipation treatment  265 lipids see plasma lipids lipoproteins in blood, psychotropic agent effects  963 liraglutide, for antipsychotic-­induced weight gain  145 lisdexamfetamine attention deficit hyperactivity disorder in adults  798–­800 borderline personality disorder  789 bulimia nervosa/binge eating disorder  795 KarXT (xanomeline-­trospium), Alzheimer’s disease management  645 ketamine  65, 68, 357–­361 anti-­suicidal effects  339 bipolar depression  321 borderline personality disorder  790 dosing recommendations  358 mechanism of antidepressant action  357 ‘off-­label’ prescribing  947 in overdose  914 psychotic depression treatment  363 Index lithium  279–­288 adherence/non-­compliance limiting effectiveness  284 adverse effects  282–­283 with alcohol  899 augmentation of antidepressants in unipolar depression  280 bariatric surgery patients  852, 853 bipolar disorder  279–­288 depression  280 mania  279–­280, 310, 311 stopping treatment  331–­334 suicide risk  281 borderline personality disorder  789 with caffeine  903 clinical indications  279–­281, 284 clozapine use with  269–­270, 271 depression treatment  280–­281 discontinuation  283–­284 driving impairment  922 drug interactions  283, 284–­286 environmental concentration inversely related to suicide and dementia at a population level  279 formulations  282 mania, acute treatment  279–­280, 310, 311 mechanism of action  279 on-­treatment monitoring  283, 284 optimising treatment for different ages  327 in overdose  916 patients on long-­term lithium  280 people with learning difficulties  people living with human immunodeficiency virus  805 plasma levels  281 postpartum  736 in pregnancy  723, 725 pre-­treatment tests  283 prophylaxis for unipolar depression  281, 399 renal effects  282, 285 renal function assessment  766 target range  868 teratogenicity  283 thyroid effects  282 toxicity  282–­283 use in patients with hepatic impairment  754, 759, 761 withdrawal effects  331–­332 liver function tests (LFTs) interpretation  753, 762 monitoring to access drug effects  41, 754, 762 see also hepatic damage lofepramine, in overdose  914 lofexidine, clozapine-­induced hypersalivation  259 lone atrial fibrillation  845

990 Index long-­acting injectable (LAI) antipsychotics  4, 7, 23, 29, 74–­80 advice on prescribing  75–­76 aripiprazole  85–­89 for bipolar disorder  83–­84, 300, 301, 302, 305–­306, 326–­327 clozapine augmentation  221 differences between  76 doses and frequencies  77–­78 equivalent doses  14, 15 management of patients  83–­84 maximum doses  11, 12 for menopausal women  859 olanzapine  90–­92 paliperidone palmitate  93–­98 risperidone  94, 99–­105 test doses  75 long-­acting oral antipsychotics improving adherence  933 preventing sudden cessation  932–­933 restarting after period of non-­compliance  937 loop diuretics, lithium interaction  285 loperamides, safety in older patients/ dementia  658 lorazepam  68, 155 catatonia treatment  155 concentration in normal dosing and UK legal limit  923 rapid tranquillisation of children and adolescents  623 use in patients with hepatic impairment  761 low-­density lipoprotein (LDL) cholesterol  169 low-­dose aspirin co-­prescribed with SSRIs, GI bleeding risk  433, 434 loxapine  43, 893 lumateperone  8, 12, 15, 43, 208, 915 lung disease, interstitial  245 lurasidone  8, 11, 15, 43 bipolar depression  302 cardiac safety of  164 clozapine augmentation  221 in overdose  916 QTc prolongation  164 lymphocytes, psychotropic agent effects  966 MADRS see Montgomery-­Asberg Depression Rating Scale maintenance for drug dependence, opioid substitution treatment  500, 501–­504 maintenance phase, children and adolescents with depression  570 maintenance treatment bipolar disorder  326–­330 psychotic depression  363–­364 schizophrenia  29, 53 major depressive disorder (MDD)  335–­361 bipolar depression comparison  319 older people  688 see also depression malabsorptive surgical procedures, bariatric surgery  849 mania people living with human immunodeficiency virus  805 treatment in children and adolescents  575–­576 mania (bipolar disorder) antipsychotics  300, 301, 302, 311 benzodiazepines  310, 311–­312 carbamazepine  295 lithium treatment  279–­280 treatment options  310–­315 valproate treatment  289–­290 manic switch, depression in children and adolescents  571 MAOIs see monoamine oxidase inhibitors MARS see Medication Adherence Rating Scale MCI see mild cognitive impairment MDD see major depressive disorder MDRD see Modification of Diet in Renal Disease mean cell haemoglobin concentration, psychotropic agent effects  966 medical foods, Alzheimer’s disease management  644 medical menopause, assessing premenstrual syndrome/premenstrual dysphoric disorder  475 Medication Adherence Rating Scale (MARS)  931 medication-­taking aids  932 melatonin adverse effects, children and adolescents  621 for antipsychotic-­induced weight gain  146 children and adolescents  620, 621, 626 description  620 efficacy  620 managing behavioural and psychological symptoms of dementia  674 ‘off-­label’ prescribing  947 sleep disturbance/insomnia treatment, children and adolescents  575, 609–­610, 620–­622, 626 for tardive dyskinesia  137 melperone  15 memantine  222, 227 Alzheimer’s disease  630–­634, 636–­637, 640, 641 borderline personality disorder  789 immediate release versus extended release  633 managing behavioural and psychological symptoms of dementia  671 methods of action in AD treatment  630, 631 vascular dementia  647 memory, clinicians’ procedural memory and unconscious influences  939 menopause  857–­864 depression/anxiety  858 diagnosis  857 elderly care  861 genitourinary symptoms and treatments  857, 861, 862 hormone replacement therapy  861–­863 increased adiposity effects  859–­860 psychological symptoms  857, 858–­860 psychosis  858–­860 mental capacity see capacity and consent Mental Health Act (MHA), England and Wales (1983)  629, 682, 694–­698, 949–­953 mephedrone, misuse and dependence  533, 537, 543 metabolic abnormalities, antiretrovirals  808 metformin for antipsychotic-­induced weight gain  146 possible mood improvement in type II diabetes  424 methadone buprenorphine comparison  503 cautions  505–­506 general hospital settings  504, 505 hepatic/renal dysfunction  505 initiation of treatment  504 intoxication  505 opioid substitution treatment  501, 503–­506 in overdose  506, 917 psychiatric hospital settings  504–­505 titration schedules  504, 505 transferring back from buprenorphine  512–­513 transition to buprenorphine  510–­512 withdrawal  516 methamphetamine use disorder  533–­534 detoxification  534 psychotic symptoms  534–­535 methylphenidate attention deficit hyperactivity disorder in adults  798–­800 borderline personality disorder  789 driving impairment  922 people with learning difficulties  827 in pregnancy  727 psychotic depression treatment  364 metreleptin, weight restoration in anorexia nervosa  792 MHA see Mental Health Act (MHA) MI see myocardial infarction mianserin, in overdose  914 microdeletion syndrome, 22q11.2 deletion syndrome  820–­823

midazolam  64, 65 mild alcohol withdrawal  480 mild cognitive impairment (MCI), treatments  636, 643, 646, 648 mild neurocognitive disorder (MND), HIV related  806 mineral supplements anorexia nervosa  793 see also nutritional supplements minimum effective doses antidepressants  342, 366 antipsychotics  8 determining for patient  84 minocycline  226, 227 mirtazapine in overdose  914 in pregnancy  721–­722 smokers  893 weight restoration in anorexia nervosa  792 missed doses of psychotropic medication  937 MND see mild neurocognitive disorder moclobemide  914 modafinil for antipsychotic-­induced weight gain  146 depression  388 fatigue in multiple sclerosis  837 not recommended in pregnancy  727 in overdose  917 Modification of Diet in Renal Disease (MDRD) formula, glomerular filtration rate estimation  766 modified-­release (MR) preparations methylphenidate  600 stimulants for attention deficit hyperactivity disorder in adults  798, 799, 800 see also extended release preparations; slow-­release oral morphine molindone  12, 15 monoamine oxidase inhibitors (MAOIs) adverse effects, relative to other antidepressants  338 with alcohol  899 with caffeine  903 electroconvulsive therapy combination  385 glucose homeostasis  423, 424 hyponatraemia  416, 417, 418 interaction with tyramine-­containing foods  338–­339 not recommended for people living with human immunodeficiency virus  805 not recommended in pregnancy  722 in overdose  914 pharmacodynamic drug interactions  404–­405 serotonin syndrome  367 swapping and stopping antidepressants  368 monoclonal antibodies, Alzheimer’s disease treatment  646 monocytes, psychotropic agent effects  966 montelukast, psychiatric adverse effects  971 Montgomery-­Asberg Depression Rating Scale (MADRS), drug effect assessment  345 Montgomery vs Lanarkshire Health Board appeal case decision, ‘off-­label’ prescribing  945 mood disorders caffeine effects  905 see also bipolar disorder; depression mood elevation, psychostimulants use in depression  388 mood stabilisers adverse effects, rationale for reducing/ stopping  331 with alcohol  899 bariatric surgery patients  852 bipolar depression  319 bipolar disorder  279–­299, 310–­311 stopping treatment  331–­334 borderline personality disorder  789 breastfeeding mothers  736, 744–­745 combinations for rapid-­cycling bipolar affective disorder  316 managing behavioural and psychological symptoms of dementia  673 non-­antipsychotic agents for bipolar illness in pregnancy  723–­725 in overdose  916–­917 use in patients with hepatic impairment  759, 761 use in renal impairment  775–­776 withdrawal effects  331–­332 see also carbamazepine; lithium; valproate mood-­stabilising anticonvulsants, chronic kidney disease risk  769 mortality antipsychotic polypharmacy versus monotherapy  22, 23 antipsychotics versus other risk factors  166 cardiovascular with antipsychotics  18, 166, 176 diabetes-­related with antipsychotics  174 drug-­induced hyperthermia  544 neuroleptic malignant syndrome  151 motivation of patients adherence  929, 932, 933 readiness to change  940 movement disorders, and nicotine  910 MR see modified-­release MS see multiple sclerosis multiple sclerosis (MS)  835–­839 anxiety  836 bipolar disorder  836 cognitive impairment  837 depression  835 fatigue  837 Index pseudobulbar affect  836 psychosis  836–­837 multisubstance misuse see polysubstance abuse muscle rigidity see pseudoparkinsonism muscular spasm, uncontrolled see dystonia mutual aid and peer support, stimulant abstinence  532 myasthenia gravis, acetylcholinesterase inhibitors use in older patients/ dementia  660 myocardial function effects, drug-­induced excited states  543 myocardial infarction (MI), SSRI protective effects  433 myocarditis  253–­254, 255 myoclonus clozapine  241, 871 Huntington’s disease  831 lithium  269 nalmefene, alcohol dependence  490–­491 naloxone buprenorphine combination (Suboxone)  513 injection or internasal treatment  499 opioid overdose treatment  499 naltrexone for antipsychotic-­induced weight gain  146 borderline personality disorder  789 gambling disorder  560 ‘off-­label’ prescribing  947 people with learning difficulties  827 preventing relapse after alcohol detoxification  490 preventing relapse after opioid detoxification  517–­518 for tardive dyskinesia  137 NAPLS see North American Prodromal Longitudinal Studies Naranjo adverse drug reaction scale (adapted)  972, 973 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness  928 National Institute for Health and Care Excellence (NICE) guidelines anxiety spectrum disorders  448–­449 attention deficit hyperactivity disorder in adults  800 attention deficit hyperactivity disorder in children and adolescents  599 borderline personality disorder  788 dementia  642 depression  336 eating disorders  795 generalised anxiety disorder  448 hypercholesterolaemia  170 obsessive compulsive disorder  449 panic disorder  448 prophylaxis in bipolar disorder  327

992 Index National Institute for Health and Care Excellence (NICE) guidelines (cont’d) psychotic disorder monitoring  176 relapse prevention after alcohol detoxification  489, 490, 492 schizophrenia  2, 52–­54 National Poisons Information Service (NPIS)  538 natural remedies Alzheimer’s disease management  641, 643 drug interactions in menopausal women  858 Ginkgo biloba  136, 222, 227, 641, 643 non-­standardised preparations  440, 441 potential risks  442 St John’s wort  440–­443 taken without doctor’s knowledge  442 nausea, clozapine  241 NbN see Neuroscience-­based Nomenclature NE see norepinephrine negative predictive value (NPV)  275 neonatal problems first-­generation antipsychotics risk  716 tricyclic antidepressant withdrawal  720 nephritis, interstitial  245 nephrotoxic drugs, renal function assessment  766 Netherlands Clozapine Collaboration Group  267 NEURAPRO trial  111–­112 neurocognitive disorders HIV related  806 inappropriate sexual behaviour in older people  680–­687 see also dementia neurodevelopment, antipsychotic exposure during pregnancy  717–­718 neuroleptic malignant syndrome (NMS)  150–­153 catatonic stupor in  155, 156 renal impairment  769 restarting antipsychotics  150 risk factors  150, 151 signs and symptoms  150 treatment  150, 151 neurological conditions, rare dementias  649 neuromodulation stimulant use disorder  533 see also transcranial magnetic stimulation Neuroscience-­based Nomenclature (NbN)  2, 49 neurotoxicity, lithium  283 neutropenia agranulocytosis  267–­268 benign ethnic neutropenia  268, 269 clozapine-­related  251, 267–­272 granulocyte-­colony stimulating factor  270–­271 lithium  269–­270 neutrophils, psychotropic agent effects  966 new psychoactive substances (NPSs/designer drugs)  477, 540, 543, 544 NICE see National Institute for Health and Care Excellence nicotine  908–­911 attention deficit hyperactivity disorder  909 depression and anxiety  909 drug interactions  910 movement disorders  910 Parkinson’s disease  910 psychotropic effects  908 schizophrenia  908–­909 smoking cessation and withdrawal symptoms  910 see also smoking nicotine dependence  523–­531, 910 bupropion  527, 529 cytisine  526, 529 electronic vaping devices  527–­528, 530 nicotine replacement therapy  523–­524, treatment algorithms  528–­530 varenicline  524–­526 withdrawal symptoms  910 nicotine replacement therapy (NRT)  523–­524 adverse effects  524 clinical effectiveness  524 combination of formulations  524, 529–­530 preparations and doses  525, 529–­530 nicotine vaping devices (vaping)  527–­528, 530 adverse effects  528 clinical effectiveness  528 preparations and doses  528, 530 N-­methyl-­D-­aspartate (NMDA) receptor antagonists Alzheimer’s disease  630 see also ketamine NMS see neuroleptic malignant syndrome nocebo effects, patient expectations of treatment  941 nocturnal enuresis, management  242 non-­adherence impacts  928–­929 lithium  284 rates and degrees of adherence  927–­928 restarting psychotropic medications after period of non-­compliance  937–­938 non-­competitive N-­methyl-­D-­aspartate receptor antagonists  630 non-­compliance see non-­adherence non-­iatrogenic benzodiazepine dependence  540 non-­nucleoside reverse transcriptase inhibitors  808–­809 non-­steroidal anti-­inflammatory drugs (NSAIDs) Alzheimer’s disease management  644–­645 co-­prescribed with SSRIs, GI bleeding risk  433, 434 lithium interactions  285–­286 safety in older patients/dementia  660 norclozapine  871 norepinephrine (NE)-­modulating agents see viloxazine norepinephrine (NE)-­reuptake inhibitors see atomoxetine; bupropion North American Prodromal Longitudinal Studies (NAPLS)  112 NPIS see National Poisons Information Service NPSs see new psychoactive substances NPV see negative predictive value NRT see nicotine replacement therapy NSAIDs see non-­steroidal anti-­inflammatory drugs nucleoside reverse transcriptase inhibitors, psychiatric adverse reactions  808 nutritional supplements Alzheimer’s disease management  643, 644 anorexia nervosa  793–­794 fatigue in multiple sclerosis  837 obesity  145, 145–­146, 166, 169, 176, 580, see also weight gain Objective Opiate Withdrawal Scale (OOWS)  501 object relations  939 obsessive compulsive behaviours, Huntington’s disease  832, 833 obsessive compulsive disorder (OCD) alternative and experimental treatments  591 children and adolescents  587–­594 with autism spectrum disorder  610 clinical guidance  587, 588–­589 need for drug treatment  587 psychological therapies  587 SSRI use  588 NICE guidelines  449, 588–­589 specific drugs used  453–­454 SSRIs/SNRIs  447 treatment duration and follow-­up  591 treatment initiation  589 treatment-­refractory cases  590 use of adult treatments  592 obstetric and gynaecological haemorrhage, SSRI risks  435–­436 OCD see obsessive compulsive disorder ocular effects, and antipsychotics  245 oesophageal varices, consequences of reduced hepatic blood flow  753 oestrogen antipsychotics effects  858 decline in menopausal women  857, 858, 860 selective oestrogen receptor modulators  860

oestrogen augmentation psychosis treatment adjunct for menopausal women  860 see also hormone replacement therapy ‘off-­label’ prescribing (outside a drug’s licensed indications)  945–­948 legal issues  945–­946 recommendations  946–­947 OGTT see oral glucose tolerance tests Okedi see risperidone ISM olanzapine acute behavioural disturbance  62, 63 acute kidney injury risk  769 bipolar depression  322 bipolar disorder  302, 310 borderline personality disorder  788 children and adolescents, adverse effects  573, 574 dose reductions  121, 122 doses and frequencies  77, 90 efficacy  3 glucose tolerance impairment association  175 linear dose reductions  121 long-­acting injections  90–­92 in overdose  916 pharmacokinetics  81 plasma level monitoring  871–­872 plasma lipids, effect on  169–­170 post-­injection delirium sedation syndrome  91 rapid-­cycling bipolar affective disorder  316 risks in pregnancy  716, 717 smokers  893 stopping  90 suppositories  118 target range  869 weight restoration in anorexia nervosa  792 olanzapine/fluoxetine combination, children and adolescents with bipolar depression  574, 577 olanzapine pamoate  11, 15 olanzapine/samidorphan combination, bipolar disorder  302 older people  627–­712 Alzheimer’s disease  630–­647 behavioural and psychological symptoms of dementia management  667–­679 covert administration of medicines in food and drink  629, 694–­699 dementia  630–­687 depression  688–­693 dose recommendations for common psychotropics  700–­712 general prescribing principles  627–­629 inappropriate sexual behaviour  680–­687 safer prescribing/cognitive risks  654–­666 omega-­3 (polyunsaturated) fatty acids (fish oils or supplements) Alzheimer’s disease management  643 borderline personality disorder  790 dyslipidaemia treatment  171 mild/moderate depressions in older adults  689 schizophrenia treatment and prevention  111–­114, 221 tardive dyskinesia  137 ondansetron  137, 226, 228 OOWS see Objective Opiate Withdrawal Scale opioid antagonists, borderline personality disorder  789 opioid dependence  498–­522 changes in prescribing practice  498 overdoes  498–­499 prescribing psychotropic medications  515 timecourse of withdrawal symptoms  501 opioid receptor agonists, buprenorphine blocking other opioids  506, 507 opioids detoxification and reduction regimens  516–­518 diversion potential of prescribed substances  503, 512, 513, 514 driving impairment  922 misuse  498–­522 overdose risk after detoxification  518 overdose symptoms and treatment  498–­499 psychiatric adverse effects  969 relapse prevention with naltrexone  517–­518 safe storage importance  505 safety in older patients/ dementia  660–­661 transferring from prescription drugs to buprenorphine  512 opioid substitution treatment (OST)  500–­519 alternative oral preparations  514 induction and stabilisation of maintenance treatment  501 injectable diamorphine  514 pain control in patients  518–­519 relapse prevention with naltrexone  517–­518 safe prescribing  501 slow-­release oral morphine  514 see also buprenorphine; methadone opioid withdrawal buprenorphine  516–­517 community settings  516–­517 methadone  516 specialist addiction in-­patient settings  517 timecourse of symptoms  501 treatment of symptoms  515 validated scales  501 Index oral glucose tolerance tests (OGTT)  176, 177 oral nicotine products see nicotine replacement therapy orexin antagonists see lemborexant; suvorexant orlistat for antipsychotic-­induced weight gain  146 for constipation treatment  265 orodispersible drug administration, Espranor/buprenorphine  507–­508 orthostatic hypotension  182–­183, 207 OST see opioid substitution treatment osteoporosis, anorexia nervosa risk  794 overdose, psychotropics in  913–­920 oxazepam catatonia treatment  155 concentration in normal dosing and UK legal limit  923 use in patients with hepatic impairment  761 oxcarbazepine, risks in pregnancy  724 P450 (CYP) pathways inhibition by different SSRIs  339 see also cytochrome function packed cell volume, psychotropic agent effects  966 paediatric autoimmune neuropsychiatric disorder associated with Streptococcus (PANDAS)  617 pain control for patients on opioid substitution treatment  518–­519 see also analgesics paliperidone pharmacokinetics  81 target range  869 use in patients with hepatic impairment  761 paliperidone palmitate long-­acting injections  29, 31, 93–­98 dose and administration  11, 77, 93 pancreatitis  246 panic disorder NICE guidelines  448 specific drugs used  450–­451 SSRIs/SNRIs  446–­447 use of benzodiazepines  446 paracetamol (acetaminophen) for behavioural and psychological symptoms of dementia  668 hepatotoxicity  762 pain in alcohol withdrawal  489 safety in older patients/dementia  660 paradoxical disinhibitory/aggressive drug reactions, benzodiazepines  471–­473 parenteral thiamine, prophylaxis against Wernike’s encephalopathy in alcohol dependency  484–­485

994 Index parenteral treatment, for acutely disturbed/ violent patients  62–­65 parkinsonian symptoms dementia with Lewy bodies  648 see also pseudoparkinsonism Parkinson’s disease (PD)  840–­844 cholinesterase inhibitors  842 complementary therapies  842 depression  840 and nicotine  910 pimavanserin use  842 psychiatric adverse effects of treatments  970 psychosis  841–­842 parotid gland swelling  246 paroxetine in pregnancy  720 use in patients with hepatic impairment  761 paroxysmal atrial fibrillation  845 pathological laughing or crying (pseudobulbar affect), multiple sclerosis  836 patient factors, affecting adherence  940–­942 patient monitoring bipolar disorder  283, 291, 297, 308–­309 mitigating serious consequences of non-­adherence  928 plasma level monitoring of psychotropic drugs  865–­878 PD see Parkinson’s disease PDSS see post-­injection delirium sedation syndrome penfluridol  43, 106–­107 people with epilepsy (PWE)  811–­819 driving restrictions  817 drug interactions between antiseizure medications and psychotropics  813–­814 possible causes of psychiatric symptoms  811–­812 prescribing principles  811 psychiatric comorbidities  811–­812 psychiatric side effects of antiseizure medications  812–­813 seizure risk from psychotropic drugs  814–­817 people living with human immunodeficiency virus (PLWH)  803–­810 bipolar affective disorder  805 depression  804–­805 factors contributing to psychiatric symptoms  803 prescribing principles  803–­804 psychosis  804 secondary mania  805 see also human immunodeficiency virus pericardial effusion  246 pericarditis  246 pericyazine  11, 14 perimenopause  857, 861 perioperative blood loss, SSRI risks  436–­437 permanent atrial fibrillation  845 perospirone  12 perphenazine  11, 14, 43 Perseris (RBP-­7000)  101–­102 persistent atrial fibrillation  845 personal and cultural beliefs, influencing adherence  940 personality disorders antipsychotic prescriptions  119, 331 benzodiazepines causing disinhibition  472 substance misuse  477 see also borderline personality disorder P-­glycoprotein (P-­gp)  883 pharmacodynamic drug interactions with alcohol  897–­898 antidepressants  339, 402, 404–­405 antiretroviral drugs and psychotropics  807–­808 antiseizure medications and psychotropics  814 pharmacodynamics changes in older people  627–­628 menopause effects  858 pharmacokinetic drug interactions antidepressants  401–­402, 403 antiretroviral drugs and psychotropics  807 antiseizure medications and psychotropics  813 pharmacokinetics  865–­899 caffeine  902–­903 changes in older people  627, 628 cytochrome function  883–­891 depot antipsychotics  81 drug interactions with alcohol  895–­899 half-­life increased in hepatic impairment  754 impaired drug absorption following bariatric surgery  849 menopause effects  858 plasma level monitoring of psychotropic drugs  865–­878 postmortem blood concentrations  879–­880 smoking and psychotropic drugs  892–­894 phenothiazines, in overdose  916 phenytoin, target range  869 phosphate in blood, psychotropic agent effects  964 pimavanserin  8, 12, 15, 208 managing behavioural and psychological symptoms of dementia  675 use in Parkinson’s disease  842 pitolisant  761, 778, 917 placebo and nocebo effects, patient expectations of treatment  941 plasma creatine kinase (CK)  150 plasma drug levels, elevated due to reduced hepatic blood flow  753 plasma glucose levels, antipsychotic medication monitoring  40 plasma level monitoring of psychotropic drugs  865–­878 amisulpride  869–­870 aripiprazole  870 clozapine  870–­871, 881–­882 first-­order pharmacokinetics  865 interpretation of results  867 olanzapine  871–­872 quetiapine  872–­873 risperidone  873 sampling time  866, 868–­869 steady state  865–­866, 868–­869 target ranges  867–­869 plasma levels risperidone long-­acting injections  99 variations in  56–­57 plasma lipids  169–­173 screening and monitoring  170, 171 see also dyslipidaemia plasma protein synthesis reduction, hepatic impairment  753 platelets agents associated with aggregation  967 psychotropic agent effects  967 SSRI effects bleeding  393–­394, 404, 409, 432–­437 decreasing embolic events/MI risk  433 plecanatide, for constipation treatment  265 PMDD see premenstrual dysphoric disorder PMR see postmortem redistribution PMS see premenstrual syndrome pneumonia, antipsychotic-­induced  204–­206, 242 polypharmacy, menopausal women  858 polyserositis  246 polysubstance abuse benzodiazepine dependence  541, 542 opioids and cocaine, substitution therapy reducing both  534 polyunsaturated fatty acids (PUFAs) see omega-­3 fatty acids PORT see Program of Rehabilitation and Therapy study positive predictive value (PPV)  275 post-­injection delirium sedation syndrome (PDSS)  76, 77, 91 post menopause, continuous combined HRT  861 postmortem blood concentrations  879–­880 postmortem redistribution (PMR)  879 postpartum depression  719 postpartum haemorrhage, antidepressant use in pregnancy  435–­436, 720, 721, 722 postpartum medication, breastfeeding mothers  734–­737

postpartum psychosis  715 post-­SSRI sexual dysfunction (PSSD)  428–­429 post stroke depression  393–­396 prophylaxis  393 SSRI risks  393–­394 post-­traumatic stress disorder (PTSD) benzodiazepine use  446 children and adolescents  595–­596 specific drugs used  452 SSRIs/SNRIs  447 postural hypotension see orthostatic hypotension potassium levels, psychotropic agent effects  964 power to treat, under S58 of the Mental Health Act  949–­950 PPH see postpartum haemorrhage PPIs see proton pump inhibitors PPV see positive predictive value pramipexole, bipolar depression  321 pregabalin generalised anxiety disorder  447–­448 in overdose  917 in pregnancy  724–­725 use in opiate misusers  519 use in patients with hepatic impairment  761 pregnancy  713–­733 alcohol use  492–­493 benzodiazepines  541 depression/antidepressants  719–­726 evidence of psychotropic drug effects  713 gynaecological and obstetric haemorrhage risk  435–­436 newly diagnosed mental illness  714 planning when taking psychotropic drugs  714 psychiatric illness as risk factor  713 psychosis  715–­718 selective serotonin reuptake inhibitors  435–­436, 720–­721 substance misuse  492–­493, 554–­559 tricyclic antidepressants  719–­720 in women taking psychotropic drugs  714 premature ejaculation, antidepressants as treatment  426, 428 premenstrual dysphoric disorder (PMDD)  474 medical menopause using gonadotrophin-­ prescribers, duty of, medical conditions and safe driving  924 prescribing checklists, relational aspects  942–­943 prescribing drugs outside their licensed indications (off-­label)  945–­948 legal issues  945–­946 recommendations  946–­948 preterm delivery risk antidepressants  720 antipsychotics  716, 717 lithium  723 tricyclic antidepressants  720 primavanserin  43, 916 procedural memory, clinicians’ unconscious influences  939 prochlorperazine  117, 118 pro-­drugs, not recommended in hepatic impairment  754 Product Licences  945 Program of Rehabilitation and Therapy (PORT) study  112 prolactin levels antidepressant effects  420–­422 antipsychotic medication monitoring  41 elevation  43, 44 menopausal women  860 psychotropic agent effects  190, 964 prolonged QT interval see QTc prolongation prolonged-­release injection, buprenorphine/ Buvidal  509–­510 prolonged release preparations, see also extended release preparations; long-­acting injectable antipsychotics; modified-­release preparations; slow-­release oral morphine promazine  43 promethazine acutely disturbed or violent behaviour in schizophrenia  63, 64, 68 breastfeeding  746 not recommended for managing behavioural and psychological symptoms of dementia  674 in pregnancy  726 prophylaxis antidepressants  397–­400 after first episode of depression  397 dosing  399 post stroke  393 for recurrent depression  397–­398 bipolar disorder  281, 290, 326–­330 lithium for depression/mood disorders  281 post stroke depression  393 thiamine for Wernicke’s encephalopathy in alcohol dependency  487–­488 propranolol, for tardive dyskinesia  137 protein in blood, psychotropic agent effects  964 proteinuria, renal impairment assessment  766 releasing hormone agonists  475 premenstrual syndrome (PMS)  474–­475 hormonal treatment  474–­475 medical menopause using gonadotrophin-­ releasing hormone agonists  475 non-­hormonal treatment  474 pharmacological management chart  474 prenatal exposure to medications see pregnancy pre-­school children, anxiety disorders  586 Index prothrombin time (PT), psychotropic agent effects  967 proton pump inhibitors (PPIs), safety in older patients/dementia  662 prucalopride, for constipation treatment  265 pseudobulbar affect, multiple sclerosis  836 pseudoparkinsonism (drug-­induced parkinsonism)  34, 35, 43, 44, 50, 126, 127, 128, 291, 804 PSSD see post-­SSRI sexual dysfunction psychiatric adverse effects of non-­ psychotropic drugs  969–­974 antiretroviral therapy  808–­809 differential diagnosis  972–­973 drugs and effects  969–­972 Naranjo scale  972, 973 psychiatric symptoms in the context of other disorders  803–­864 psychodynamic interventions adherence  929 depression  336 psychoeducation  932 psychological/psychosocial interventions anorexia nervosa  795 anxiety spectrum disorders  448 behavioural disturbance in people with learning difficulties  825 benzodiazepine withdrawal  466, 468, 541, 542 borderline personality disorder  787 children and adolescents  566, 568, 587, 597 depression  336, 337, 566, 568 improving medication adherence  932, 933–­934 learning disabilities  825 schizophrenia  29, 52, 53, 54, 230 see also cognitive behavioural therapy; dialectical behaviour therapy psychosis acute behavioural disturbance  62–­73 atrial fibrillation patients  846 cannabis  36 catatonic stupor in  155 children and adolescents  580–­581 during pregnancy  715–­718 electroconvulsive therapy  108–­110 first episode  28–­29, 31 duration of treatment  54 negative symptoms  34 NICE guidelines  52–­53 treatment algorithm  45 gamma-­butyrolactone withdrawal  534, 537 Huntington’s disease  832, 833 menopausal women  858–­860 methamphetamine use disorder  534–­535 multi-­episode  29–­30 multiple sclerosis  836–­837 and nicotine  908–­909

996 Index psychosis (cont’d) oestrogen augmentation in menopausal women  860 oestrogen decline reducing antipsychotic activity in menopausal women  858 people living with human immunodeficiency virus  804 postpartum  715, 736 prevention with polyunsaturated fatty acids  111–­114 relapse, withdrawal-­associated  119 and sexual dysfunction  195–­196 ‘super-­sensitivity psychosis’  31 use of benzodiazepines  461 see also schizophrenia and related psychoses psychosocial interventions see psychological/ psychosocial interventions psychostimulants attention deficit hyperactivity disorder in adults  798, 799, 800 depression  388–­392 psychotherapies, post-­traumatic stress disorder  595 psychotic depression  362–­365 acute treatment  362 combination therapies  362, 364 ECT treatment  363 ketamine  363 maintenance treatment  363–­364 psychotropic drugs with alcohol  895–­899 driving impairment  921–­926 interactions with illicit drugs  545, 546–­548 in overdose  913–­920 plasma level monitoring  865–­878 steady state  865–­866, 868–­869 target ranges  867–­869 smokers  892–­894 target ranges  867–­869 use in renal impairment  769–­778, 779 PT see prothrombin time PTSD see post-­traumatic stress disorder PUFAs see polyunsaturated fatty acids PUFAs (polyunsaturated fatty acids) see omega-­3 fatty acids pure red cell aplasia, psychotropic agent effects  967 PWE see people with epilepsy pyridoxine, for tardive dyskinesia  136 QTc prolongation antipsychotic-­related  43, 44, 161–­168 cardiovascular risk factors  166 ECG monitoring  165 management  166 metabolic inhibition  165 non-­psychotropic association  165 physiological risk factors  164 QT interval  161–­162 risk factors  164–­165 risk quantification  162–­164 switching antipsychotics  207 methadone risk  506 prescribing in atrial fibrillation patients  845 quercetin Alzheimer’s disease management  645 for tardive dyskinesia  137 questionnaires adherence assessment  930, 931 severity of alcohol dependence  480, 482, 485 quetiapine acute kidney injury risk  769 bipolar disorder  302 borderline personality disorder  788 glucose tolerance impairment association  175 in overdose  916 plasma level monitoring  872–­873 rapid-­cycling bipolar affective disorder  316 risks in pregnancy  717 target range  869 thyroid function tests  41 weight restoration in anorexia nervosa  792 patient factors  940–­942 prescribing checklist  942–­943 relational aspects of prescribing practice  939–­944 relative infant dose (RID), medication in breastfeeding mothers  734 renal adverse effects antiretrovirals  807 lithium  282 renal function, NSAIDs affecting sodium/ lithium reabsorption  285 renal impairment in patients  766–­785 anti-­dementia drugs  778 antidepressants  772–­775 antipsychotics  769–­771 anxiolytics and hypnotics  776–­777 classification of stages  767 clinical guidance  768 lithium  282 methadone  505 monitoring  768 mood-­stabilisers  775–­776 other psychotropic drugs  768 recommended psychotropic drugs  779 repetitive transcranial magnetic stimulation (rTMS) for catatonia  155–­156 for negative symptoms in schizophrenia  36 for tardive dyskinesia  137 restarting psychotropic medications after a break in treatment  234–­235 after neuroleptic malignant syndrome  150 after period of non-­compliance  937–­938 restlessness (akathisia)  43, 44, 127, 128, 131–­134 restraint, exacerbating risks in drug-­induced excited states  543 restricted repetitive behaviours and interests (RRBIs), core symptom of autism spectrum disorder  606 reticulocyte count, psychotropic agent effects  967 re-­titration, after period of non-­adherence to medication regime  937, 938 RID see relative infant dose rilpivirine, psychiatric adverse reactions  809 risk awareness, clinician responsibilities to patients  945 Risperdal Consta  99–­101, 103 risperidone  2, 3, 8, 29, 58, 228 bipolar disorder  302, 305–­306 clozapine augmentation  221 efficacy  3, 17 equivalent dose  15 glucose tolerance impairment association  175 maximum dose  11 maximum doses  12 in overdose  916 raloxifene  228, 860 see also selective oestrogen receptor modulators rapid-­cycling bipolar affective disorder  290, 316–­318 rapid tranquilisation (RT)  62, 68–­70 children and adolescents  623–­625 physical monitoring  69 remedial measures  70 site of administration of intramuscular injections  956–­957 Rating of Medication Influences (ROMI) scale  931 RBP-­7000 (Perseris)  101–­102 readiness to change, influencing adherence  940 recommendations to patients, adherence  927 rectal administration, antipsychotics  116, 118 recurrent depression, prophylaxis  397–­398 red blood count/red cell distribution width, psychotropic agent effects  967 reduced hepatic blood flow, consequences of hepatic impairment  753 reduced metabolism of drugs changes with old age  628 hepatic impairment  753 refractory schizophrenia see treatment-­resistant schizophrenia refusal of treatment, older people’s mental health and capacity  629, 694–­699 relational aspects of adherence clinician factors  939

pharmacokinetics  81 plasma level monitoring  873 possible teratogen  716 relative adverse effects  43 target range  869 use in children and adolescents with autism spectrum disorder  609, 610 weight restoration in anorexia nervosa  792 risperidone intramuscular injection (Rykindo)  100, 103 risperidone ISM (in situ microparticles)  81, 100, 101, 103, 873, 956 risperidone long-­acting injections (RLAIs)  12, 15, 81, 99–­105, 103 approximate dose equivalence  94 bipolar disorder  305–­306 blood levels following discontinuation  99 doses and frequencies  78 equivalent doses  103 intramuscular injections  99–­101 plasma concentrations timescale  99 Rykindo  100, 103 subcutaneous injections  101–­102 switching from  100 RISQ-­PATH study  163 Risvan see risperidone ISM rivastigmine, Alzheimer’s disease  630–­636, 639, 642 RLAIs see risperidone long-­acting injections road traffic accidents (RTAs), psychotropic drugs and driving impairment  922 ROMI see Rating of Medication Influences scale routine monitoring, mitigating serious consequences of non-­adherence  928 Roux-­en-­Y gastric bypass (RYGB)  849 RRBI see restricted repetitive behaviours and interests RT see rapid tranquilisation RTAs see road traffic accidents rTMS see repetitive transcranial magnetic stimulation RYGB see Roux-­en-­Y gastric bypass Rykindo see risperidone intramuscular injection antipsychotic response  55–­61 atrial fibrillation patients  846 caffeine effects  904 cardiometabolic risk factors  169 catatonia  155 comorbid alcohol use disorder  495–­496 diabetes association  174 electroconvulsive therapy  108–­109 first episode  28–­29, 31 duration of treatment  54 negative symptoms  34 treatment algorithm  45 maintenance treatment  29, 53 multi-­episode  29–­30 negative symptoms  34–­39 NICE guidelines  2, 53–­54 and nicotine  908–­909 people with 22q11.2 deletion syndrome  822 people living with human immunodeficiency virus  804 poorly responsive to standard antipsychotic treatment  57–­59 prescribing practice for  17 QTc prolongation  161 relapse  28, 29, 30, 31 withdrawal-­associated  120 relapse/acute exacerbation, treatment algorithms  46–­47 suicide risk  29 ‘super-­sensitivity psychosis’  31 treatment adherence  30, 928–­929, 933–­934 algorithms  45–­48 NICE guidelines  2, 52–­54 polyunsaturated fatty acids  111–­114 for poorly responsive schizophrenia  57–­59 treatment-­resistant  18, 53–­54, 108–­109, 214–­233 see also antipsychotics second-­generation antidepressants anorexia nervosa  794 see also bupropion; monoamine oxidase inhibitors; tricyclic antidepressants second-­generation antipsychotics (SGAs)  49, 50 adverse effects  3–­4 bipolar disorder  300–­302 borderline personality disorder  788 children and adolescents  568, 573, 580, 590, 608, 615, 623 classification  2 diabetes, antipsychotic-­related  174–­176 equivalent doses  14, 15 long-­acting injectable antipsychotics  4, 75 maximum doses  11, 12 minimum effective doses  8 neuroleptic malignant syndrome association  151 ‘off-­label’ prescribing  947 SADQ see Severity of Alcohol Dependence Questionnaire safer prescribing, older people/ dementia  654–­666 saffron see Crocus sativus St John’s wort (SJW) (Hypericum perforatum), treating depression  440–­443 SAWS see Short Alcohol Withdrawal Scale schizoaffective disorder, atrial fibrillation patients  846 schizophrenia and related psychoses  1–­277 acute behavioural disturbance  62–­73 adherence to treatment  30 Index optimal dosage  55 people with learning difficulties  826 people living with human immunodeficiency virus  804 in pregnancy  716–­717 relative efficacy  3 site of administration of intramuscular injections  955–­956 treatment algorithm  46 treatment of negative symptoms  35 Second Opinion Appointed Doctor (SOAD), the Mental Health Act  950–­951, 953 sedation  43, 44 alcohol effects  897 management  242 medication-­induced  923 over-­sedation  64 switching antipsychotics  207 sedatives antihistamines not recommended for behavioural and psychological symptoms of dementia  674 ‘high-­dose sedation’  64 in pregnancy  726–­727 respiratory depression role in death from opioid agonists overdose  545 use in patients with hepatic impairment  754, 760, 761 see also benzodiazepines; promethazine seizures antiretrovirals  808 drug risks for people with 22q11.2 deletion syndrome  820, 821–­822 management  242, 882 psychotropic drug risks in people with epilepsy  814–­817 severe alcohol withdrawal  480, 481 selective oestrogen receptor modulators (SERMs) psychosis treatment adjunct for menopausal women  860 see also raloxifene selective serotonin reuptake inhibitors (SSRIs) adverse effects relative to other antidepressants  338 anxiety spectrum disorders  446–­447 arrhythmia risk  411 atrial fibrillation patients  845, 846 bipolar depression  322 bleeding risks  432–­439 gastrointestinal  433–­434 gynaecological and obstetric haemorrhage  435–­436 intracranial/intracerebral haemorrhage  434–­435 mechanisms  432 post stroke depression  393–­394 risk factors  432–­433 surgical and postoperative  436–­437

998 Index selective serotonin reuptake inhibitors (SSRIs) (cont’d) body dysmorphic disorder  447 with caffeine  903 cardiac effects  406–­408, 409, 411–­412 co-­prescribed with low-­dose aspirin/ NSAIDs, GI bleeding risk  433, 434 co-­prescribed with warfarin, non-­GI bleeding risk  433, 434 driving impairment  922 gastric acid secretion effects  432 gastrointestinal effects  432, 433–­434 generalised anxiety disorder  446 hyperprolactinaemia induction  420 hyponatraemia induction  416, 417, 418 increased free plasma levels in hepatic impairment  753–­754 increased risk of bleeding in hepatic impairment  753 interactions with anticoagulants  846 lithium interactions  286 obsessive compulsive disorder  447 in overdose  914 panic disorder  446–­447 people with learning difficulties  826 people living with human immunodeficiency virus  805, 806 pharmacodynamic drug interactions  404 pharmacokinetic drug interactions  401 platelet effects  393–­394, 404, 409, 432, 433 bleeding  432–­439 decreasing embolic events/MI risk  433 post stroke depression  393–­394 post-­traumatic stress disorder  447 in pregnancy  720–­721 premenstrual syndrome treatment  474 sexual dysfunction  199, 427, 428–­429 social phobia  447 type II diabetes improvement  423 use in children and adolescents  566–­567, 583–­584, 585, 588 withdrawal symptoms  373 semaglutide, for antipsychotic-­induced weight gain  146 SERMs see selective oestrogen receptor modulators serotonergic antidepressants, treatment of sexual dysfunction  426, 428 serotonin-­noradrenaline reuptake inhibitors (SNRIs) anxiety spectrum disorders  446–­447 hyperprolactinaemia induction  420 hyponatraemia induction  416, 417 pharmacokinetic drug interactions  401, 404 in pregnancy  720 use in children and adolescents  583, 584, 585, 592, 598 serotonin reuptake inhibition see selective serotonin reuptake inhibitors serotonin syndrome renal impairment  769 switching antidepressants  367 sertindole  11, 15, 43, 228 sertraline bulimia nervosa/binge eating disorder  794 ‘off-­label’ prescribing  947 in pregnancy  720 use in patients with hepatic impairment  761 severe alcohol dependence  480, 486 severe alcohol withdrawal  481, 484 Severity of Alcohol Dependence Questionnaire (SADQ)  480, 482, 485 sexual behaviour (inappropriate) in older people  680–­687 sexual drive reduction by hormone implants  682 sexual dysfunction antidepressants  426–­431 effects of antipsychotics  195–­203, 196–­197, 207 effects of psychosis  195–­196 management of antidepressant effects  428–­429 selective serotonin reuptake inhibitors  199, 427, 428–­429 treatment  198, 199 SGAs see second-­generation antipsychotics Short Alcohol Withdrawal Scale (SAWS)  482, 484, 485, 486 SIADH see syndrome of inappropriate antidiuretic hormone sialorrhoea see hypersalivation site of administration of intramuscular injections  954–­958 SJW see St John’s wort skin diseases, and antipsychotics  246 sleep disturbance children and adolescents autism spectrum disorder  609–­610 use of melatonin  575, 609–­610, 620–­622 managing behavioural and psychological symptoms of dementia  674 see also insomnia slow-­release oral morphine (SROM)  514 smokers/non-­smokers, clozapine dosing regimens  216–­218 smoking with caffeine  903 cessation  523–­531, 909 pregnant women with mental illness  714 and psychotropic drugs  892–­894 see also nicotine SNRIs see serotonin-­noradrenaline reuptake inhibitors SOAD see Second Opinion Appointed Doctor social and communication impairment, core symptom of autism spectrum disorder in children and adolescents  606 social phobia (social anxiety disorder)  447, 454–­455 sodium levels lithium toxicity  283, 284–­286 psychotropic agent effects  964 sodium oxybate, for tardive dyskinesia  137 sodium valproate clozapine augmentation  221 ‘off-­label’ prescribing  947 solriamfetol in overdose  917 use in patients with hepatic impairment  761 use in renal impairment  778 Souvenaid (dietary supplement), Alzheimer’s disease management  644 special educational needs see learning difficulties SROM see slow-­release oral morphine SSRIs see selective serotonin reuptake inhibitors statins no evidence for benefit in vascular dementia  647 preventing cardiovascular events  170, 171 safety/use in older patients  661 vascular dementia  647 stimulants attention deficit hyperactivity disorder in adults  798, 799, 800 breastfeeding mothers  747 definition  532 depression  388–­392 use in patients with hepatic impairment  760 see also psychostimulants stimulant use disorder (SUD)  532–­536 amfetamines/ methamphetamine  533–­534 cocaine  533 depression/anhedonia from abstinence  535 polysubstance abuse, opioids plus cocaine  534 psychotic symptoms  534–­535 stopping medication abrupt cessation by non-­compliant patients  928 antidepressants  339, 378 antipsychotics  119–­125 benzodiazepines  466 lithium  331–­334 long-­acting antipsychotics reducing impacts of non-­adherence  932–­933 see also withdrawal

sulpiride  8, 11, 14, 43 clozapine augmentation  221 clozapine-­induced hypersalivation treatment  260 typical or atypical classification  2 use in patients with hepatic impairment  754, 756, 761 see also amisulpride suppositories, antipsychotics  116, 118 surgical and postoperative bleeding, SSRI risks  436–­437 surgical procedures, bariatric surgery  849–­856 suvorexant managing sleep disturbance in dementia  674 in overdose  917 use in patients with hepatic impairment  761 switching between drugs antidepressants  366–­372 general guidelines  366–­367 swapping and stopping guide  368–­370 timing  345–­346 within and between drug classes  345 symptom-­triggered regimen, benzodiazepines for alcohol withdrawal management  485 syndrome of inappropriate antidiuretic hormone (SIADH)  186, 188 synthetic cannabinoids  543 stroke antipsychotic risks  212–­213, 669 dyslipidaemia  171 post stroke depression  393–­396 stupor see catatonia stuttering, and antipsychotics  246 sublingual administration antipsychotics  115, 117 buprenorphine  503, 507–­508 Suboxone (buprenorphine with naloxone)  513 substance misuse and dependence alcohol  479–­497 benzodiazepine misuse  540–­542 concurrent alcohol and other substance use disorders  493–­494 drugs of misuse summary  549–­553 dual diagnosis with mental illness  477 illicit drug interactions with prescribed psychotropic drugs  545–­548 mixed substance use  532 mutual aid and peer support for stimulant abstinence  532 nicotine dependence  523–­531 opioid dependence  498–­522 people living with human immunodeficiency virus  806 personality disorders  477 pregnancy  554–­559 stimulant use disorder  532–­536 SUD see stimulant use disorder sudden cardiac death, antidepressants  411, 412 suicidality antidepressant cessation  339 antidepressant use in adolescents and young adults  339 antidepressant use balance  339 body dysmorphic disorder in children and adolescents  587, 588 cognitive behavioural therapy decreasing effects of fluoxetine  566 depression in children and adolescents  570–­571 environmental lithium effects  279 fluoxetine use in children and adolescents  566, 570–­571, 588, 610 Huntington’s disease  832, 833 lithium reducing risk in bipolar and unipolar depression  281, 284 non-­adherence impacts  928 obsessive compulsive disorder in children and adolescents  587, 588 overdose of psychotropics  913 peri-­natal risks from psychotropic medication withdrawal  713 psychotic depression  362 PTSD in children and adolescents  595 schizophrenia  29 SSRI use in children and adolescents  566, 570–­571, 584, 588, 610 valproate risk  291 tachycardia, clozapine effects  184, 234, 242, 253, 255 tapering antidepressants  366, 376, 378–­382 benzodiazepines  466–­469 drug formulation problems  382 z-­drugs/gabapentinoids  469 tardive dyskinesia (TD)  3, 29, 50, 120, 127, 128 switching antipsychotics  208 treatment  135–­140 tDCS see transcranial direct current stimulation temazepam concentration in normal dosing and UK legal limit  923 use in patients with hepatic impairment  761 use in patients with renal impairment  777 teratogenic potential antidepressants  721, 722 carbamazepine  297, 714, 723–­724 first generation antipsychotics  715–­716 mood stabilisers (eg valproate)  714, 723–­724 second generation antipsychotics  716–­717 valproate  292 Index test doses, long-­acting injectable antipsychotics  75 testosterone in blood, psychotropic agent effects  964 tetrabenazine Huntington’s chorea  831 tardive dyskinesia  136 theophylline, safety in older patients/ dementia  659 therapeutic threshold  867 thiamine deficiency (Wernicke’s encephalopathy), alcohol dependency  487–­488 thiamine (vitamin B1) injections, alcohol withdrawal adjunctive treatment  484–­485 thiazide diuretics, lithium interaction  285 thrombocytopenia  246, 291, 745, 820 thromboembolism  211–­213, 246, 253, 860 thyroid adverse effects, lithium  282 thyroid function tests, antipsychotic medication monitoring  41 thyroid-­stimulating hormone, psychotropic agent effects  964 thyroxine in blood, psychotropic agent effects  964 tics and Tourette’s syndrome children and adolescents  614–­619 adrenergic a2 agonists  615 antipsychotics  615–­616 comorbid conditions  614 education and behavioural treatments  614 pharmacological treatments  614–­615 recommended treatments  617 TMS see transcranial magnetic stimulation tobacco see nicotine; smoking tolerance, dependence syndrome  477–­478 topical vaginal oestrogen  862 topiramate  35, 228 for antipsychotic-­induced weight gain  146 borderline personality disorder  789 clozapine augmentation  221 teratogenic risk  714, 724 torsades de pointes, methadone risk  506 Tourette’s syndrome (TS) children and adolescents  614–­619 see also tics training of practitioners, compliance therapy and adherence  933–­934 tranquilisation see rapid tranquilisation transaminases, drug induced increase in hepatic impairment  754 transcranial direct current stimulation (tDCS)  36, 156 transcranial magnetic stimulation (TMS) stimulant use disorder  533 see also repetitive transcranial magnetic stimulation

1000 Index transdermal patches antipsychotics  116 equivalent doses  15 maximum doses  12 nicotine  494, 524, 616 trazodone Alzheimer’s disease management  645 driving impairment  922 increased free plasma levels in hepatic impairment  753–­754 in overdose  915 in pregnancy  721 smokers  893 TRBD see treatment-­resistant bipolar disorder TRD see treatment resistant depression treatment framework, clinicians using knowledge of their normal practices to avoid psychological factors influencing decision-­making  939 treatment preferences of patients, affecting outcomes  941–­942 treatment-­resistant bipolar disorder (TRBD), clozapine  301–­302 treatment resistant depression (TRD)  348–­356 addition of extra drugs  348–­349, 351 commonly used treatments  348–­350 ketamine  351, 357–­361 less commonly used treatments  351–­352 potential therapies  353–­356 treatment-­resistant schizophrenia (TRS)  18 and clozapine  214–­233 alternatives to clozapine  226–­233 dosing regime  214–­218 intramuscular clozapine  219 treatment optimisation  220–­225 NICE guidelines  53–­54 tremor see pseudoparkinsonism tricyclic antidepressants (TCAs) adverse effects relative to other antidepressants  338 with alcohol  899 arrhythmogenic activity  411 driving impairment  922 hyperprolactinaemia  420, 420 increased free plasma levels in hepatic impairment  753–­754 not recommended for managing behavioural and psychological symptoms of dementia  673 in overdose  915 people living with human immunodeficiency virus  805 pharmacodynamic drug interactions  404 pharmacokinetic drug interactions  402 in pregnancy  719–­720 psychotic depression  362 smokers  893 target range  869 trifluoperazine  8, 11, 14, 44 triglycerides in blood, psychotropic agent effects  965 triiodothyronine in blood, psychotropic agent effects  965 TRS see treatment-­resistant schizophrenia TS see Tourette’s syndrome TV-­46000 see Uzedy typical/atypical antipsychotic classification  1–­2 tyramine-­containing foods, monoamine oxidase inhibitor interactions  338–­339 adverse effects  526 clinical effectiveness  525 nicotine addiction  524–­526 preparations and doses  526, 529 vascular dementia (VaD)  647 velocardiofacial syndrome (22q11.2 deletion syndrome)  820–­823 venlafaxine in overdose  915 possible teratogen  721 venous thromboembolism (VTE) antipsychotic risks  211–­213 clozapine adverse effects  253 oestrogen augmentation risk in menopausal women  860 risk of pathological blood clotting  212 Vienna High Risk (VHR) study  111 viloxazine, attention deficit hyperactivity disorder in adults  799, 801 violent behaviour see acutely disturbed/ violent behaviour vitamin B1 (thiamine), alcohol withdrawal adjunctive treatment  484–­485 vitamin B6 akathisia adjunctive treatment  131 hyperprolactinaemia  191 vitamin D3 intake, hyperprolactinaemia  191 vitamin D supplementation anorexia nervosa  793 fatigue in multiple sclerosis  837 vitamin E for tardive dyskinesia  136 vitamin K, prophylactic if caprbamazepine given in pregnancy  724, 726 vitamin K-­dependent clotting factor synthesis reduction, hepatic impairment  753 vitamin and mineral supplements, anorexia nervosa  793 vitamin replacement, alcohol withdrawal adjunctive treatment  484–­485 vitamin supplements Alzheimer’s disease management  643 hyperprolactinaemia  191, 192 VMAT2 inhibitors, Huntington’s chorea  831 vortioxetine in overdose  915 use in patients with hepatic impairment  761 VTE see venous thromboembolism UGIB see upper gastro-­intestinal bleeding UGT see uridine diphosphate glucuronosyltransferase unintentional non-­adherence  932 upper gastro-­intestinal bleeding (UGIB), antidepressants  433 urate (uric acid) in blood, psychotropic agent effects  965 urea in blood, psychotropic agent effects  40, 965 urgent treatment, S62 of the Mental Health Act  952, 953 uridine diphosphate glucuronosyltransferase (UGT)  883 urinary incontinence, anticholinergic drugs  658 urine testing for illicit drugs, in psychiatric care settings  549 Uzedy (TV-­46000) risperidone injections  12, 15, 81, 101–­102, 103 VaD see vascular dementia vaginal bleeding abnormalities, SSRI risks  435 valbenazine for tardive dyskinesia  136 use in patients with hepatic impairment  761 use in renal impairment  778 valproate  229, 883 adverse effects  291 bipolar disorder  289–­294, 310, 311 borderline personality disorder  789 discontinuation  291, 292 drug interactions  292 formulations  289, 292 indications  289–­290, 292 mechanism of action  289 not recommended for dementia patients  673 in overdose  916 pharmacokinetics  290 plasma levels  290 prescribing  292 pre-­treatment tests and monitoring  291, 292 restricted use  311 target range  869 teratogenic risk  292, 714, 723–­726 use in pregnancy  714, 723–­726 vaping see nicotine vaping devices varenicline warfarin atrial fibrillation patients  845, 846 co-­prescribed with SSRIs, non-­GI bleeding risk  433, 434 water intoxication  186 WCC see white cell count weight changes after bariatric surgery  854 antipsychotic medication monitoring  40

weight gain  43, 44, 141–­149 after bariatric surgery  854 dose-­response  142 drugs to aid weight restoration in anorexia nervosa  792 management  242 risk/extent of  141–­142 switching antipsychotics  208 time course  142 treatment  144–­149 Wernicke-­Korsakoff syndrome  485 Wernicke’s encephalopathy (thiamine deficiency), alcohol dependence  487–­488 white cell count (WCC)  267, 268, 269, 271 withdrawal antipsychotics  119–­120, 123 benzodiazepines  464–­465, 540–­542 buprenorphine  501, 516–­517 caffeine  902 gabapentinoids  464, 469 gamma-­hydroxybutyrate or gamma-­ butyrolactone  534, 537–­539 lithium and other mood stabilisers, bipolar disorder  331 methadone  516 non-­adherence impacts  937 role of hyperbolic tapering  379 z-­drugs  464, 469 see also alcohol withdrawal; antidepressant withdrawal; opioid withdrawal women of child-­bearing potential avoid contra-­indicated drugs even if not planning pregnancy  714 see also teratogenic potential xanomeline  8, 12, 15, 44 xanomeline-­trospium (KarXT), Alzheimer’s disease management  645 Index ZA see zuclopenthixol acetate z-­drugs (zolpidem/zopiclone/zaleplon) breastfeeding  746 dependence and withdrawal  464, 469 insomnia in dementia patients  674 in overdose  917 in pregnancy  727 for tardive dyskinesia  137 use in patients with hepatic impairment  761 ziprasidone  8, 12, 15, 17, 44, 229 clozapine augmentation  221 in overdose  916 zonisamide, for antipsychotic-­induced weight gain  146 zotepine  229 zuclopenthixol  11, 14, 44, 893 zuclopenthixol acetate (ZA)  66–­67 zuclopenthixol decanoate  12, 14, 81