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Buccal

Transdermal Schizophrenia and related psychoses CHAPTER 1 ­haloperidol had a shorter time to peak levels (15 minutes) and a bioavailability comparable to oral routes of administration. Similar findings have been reported with droperidol.6 Intravenous Intraveno...

Rectal

References 118 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Rectal Chlorpromazine suppositories are available from specials manufacturers in the UK in 25mg and 100mg strengths.21 The rectal route is not licensed in adults.17 100mg given rectall...

Stopping antipsychotics

Withdrawal effects of antipsychotics Schizophrenia and related psychoses CHAPTER 1 Stopping antipsychotics Antipsychotics are recommended for long-­term treatment of schizophrenia because they reduce symptoms and lessen the risk of relapse.1 However, antipsych...

Neurobiology of withdrawal 120 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Neurobiology of withdrawal Withdrawal-­associated relapse has been attributed to neural adaptations to long-­term antipsychotic treatment (dopaminergic hypersensitivity...

Pattern of tapering Schizophrenia and related psychoses CHAPTER 1 Pattern of tapering Positron emission tomography demonstrates a hyperbolic relationship between dose of antipsychotic and D2 receptor occupancy.31 This hyperbolic relationship applies to other r...

Tapering in practice 122 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Exponentially reducing regimens (reducing by a fixed proportion of the most recent dose, e.g. 10%) will produce roughly linear reductions at all receptor targets of anti­ psy...

When to attempt discontinuation Schizophrenia and related psychoses CHAPTER 1 When to attempt discontinuation Longstanding or lifelong antipsychotic treatment is something of a modern-­day phenomenon. In the 1960s, discontinuation of antipsychotics was usually...

References 16 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Foster P. Neuroleptic equivalence. Pharmaceutical J 1989; 243:431–432. Atkins M, et  al. Chlorpromazine equivalents: a consensus of opinion for both clinical and research im...

References 124 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Leucht S, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-­analysis. Lancet 2012; 379:2063–2071. Murray RM, ...

ANTIPSYCHOTIC ADVERSE EFFECTS

Extrapyramidal symptoms 126 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 ANTIPSYCHOTIC ADVERSE EFFECTS Extrapyramidal symptoms The EPS associated with antipsychotic medication can be stigmatising, distressing, potentially disabling and act as a...

References Schizophrenia and related psychoses CHAPTER 1 References Owens DGC. A Guide to the Extrapyramidal Side-­Effects of Antipsychotic Drugs, 2nd edn. Cambridge: Cambridge University Press; 2014. Martino D, et al. Movement disorders associated with antip...

Akathisia Schizophrenia and related psychoses CHAPTER 1 Akathisia Akathisia is a fairly common adverse effect of most antipsychotic medications, although the risk of developing akathisia varies markedly between such medications.1–3 For example, a 2023 dose–res...

References Schizophrenia and related psychoses CHAPTER 1 Notes ■ ■Akathisia can be difficult to diagnose with certainty and is commonly overlooked or misdiagnosed in clinical practice. Clinical physical examination schedules for EPS and akathisia have been pro...

Treatment of tardive dyskinesia