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Summary Schizophrenia and related psychoses CHAPTER 1 ■ ■Assume that the use of all antipsychotics increases the risk of pneumonia, but especially clozapine and high-­dose olanzapine or quetiapine. ■ ■Concomitant benzodiazepine use should be avoided, where pos...

References 206 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Dzahini O, et al. Antipsychotic drug use and pneumonia: systematic review and meta-­analysis. J Psychopharmacol 2018; 32:1167–1181. Cepaityte D, et al. Exploring a safety s...

Switching antipsychotics Schizophrenia and related psychoses CHAPTER 1 Switching antipsychotics Table 1.48 gives a summary of recommendations for switching antipsychotic medications because of poor tolerability. Table 1.48  Switching antipsychotic medications ...

References 208 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Lumateperone and pimavanserin are not listed in the table because of their limited availability. Both drugs cause few or no EPSEs or akathisa, have no effect on prolactin or blood pres...

Venous thromboembolism

Evidence of an association Schizophrenia and related psychoses CHAPTER 1 Venous thromboembolism Evidence of an association Antipsychotic treatment was first linked to an increased risk of thromboembolism in 1965.1 Over a 10-­year observation period, 3.1% of 1,...

Mechanisms

Outcomes 212 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Mechanisms Several mechanisms have been suggested to explain the association between antipsychotics and thromboembolism. These proposed mechanisms are outlined in Box 1.3. Outcomes Incre...

Poor response to antipsychotic monotherapy

Summary

Practice points

References Schizophrenia and related psychoses CHAPTER 1 Summary Antipsychotics are almost certainly associated with a small but important increased risk of venous thromboembolism and associated hazards of pulmonary embolism, stroke and myocardial infarction. ...

REFRACTORY SCHIZOPHRENIA AND CLOZaPINE

Clozapine initiation schedules

Clozapine dosing regimen 214 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Table 1.50  Clozapine dose (in mg/day) with the highest likelihood of providing a plasma concentration of 350mcg/L, estimated by extrapolation of concentrations reported ...

Faster titrations Schizophrenia and related psychoses CHAPTER 1 Alternatively, an attempt can be made to include other factors into the predictive models, such as cytochrome enzyme metaboliser status, ancestry and concurrent medication to predict target dose a...

References 218 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Male smoker – target dose 375mg/day. Day Morning dose (mg) Evening dose (mg) Total daily dose (mg) – 6.25 6.25 6.25 6.25 12.5 12.5 12.5 4 12.5 37.5 25 50 25 50 25 75 25 75 50 100 50 12...

Intramuscular clozapine