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Psychological symptoms of the menopause 858 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Psychological symptoms of the menopause Depression and anxiety The impact of the menopause on mental well-­being is significant. Suicidal ideation is pres...

Elderly care

Use of HRT Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 Elderly care Genitourinary symptoms of menopause (GSM) may be a factor in agitation and aggression in elderly care. Consider vaginal atrophy and localised vaginal o...

References Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 Starting treatment Start HRT at 25–50mcg estradiol patch dose equivalents (1mg estradiol tablet/1–2 pumps estradiol 0.6mg/g gel). Increase after 6–8 weeks if sympto...

Plasma level monitoring of psychotropic drugs

First-order pharmacokinetics

Steady state 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. Chapter 11 Plasma level monitoring of psychotropic dru...

Timing of sampling 866 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 to know when a drug is or is not at steady state but there are two concepts connected to steady state that are often misunderstood. ■ ■Time to reach steady state follows a log...

Interpretation of results

Target ranges Pharmacokinetics CHAPTER 11 Interpretation of results Is there a target range of plasma levels? If so, then plasma levels (from samples taken at the right time) will usefully guide dosing. If there is not an accepted target range, plasma levels c...

Amisulpride Pharmacokinetics CHAPTER 11 Amisulpride Amisulpride plasma levels are closely related to dose with insufficient variation to make routine plasma level monitoring prudent. Higher levels observed in women27–29 seem to have little significant clinical...

Aripiprazole

Clozapine 870 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 psychosis, studies suggest plasma concentrations of 20–60mcg/L may give optimal D2 occupancy and clinical response.34,35 In practice, only a minority of treated patients have ‘therapeu...

Olanzapine Pharmacokinetics CHAPTER 11 an individual’s clozapine plasma levels are common with a tendency for concentrations to slightly decrease over time,72 although one study suggests a decrease only in norclozapine concentrations.73 Despite these somewhat ...

Quetiapine 872 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 11 further therapeutic benefit than lower levels.94 Severe toxicity is uncommon but may be associated with levels above 100mcg/L, and death is occasionally seen at levels above 160mcg/L9...

Risperidone

Target ranges for other psychotropics Pharmacokinetics CHAPTER 11 Quetiapine has an established dose–response relationship, and appears to be well tolerated at doses well beyond the licensed dose range.115 In practice, dose adjustment should be based on patien...

References Pharmacokinetics CHAPTER 11 References Jakobsen MI, et  al. The significance of sampling time in therapeutic drug monitoring of clozapine. Acta Psychiatr Scand 2017; 135:159–169. Hiemke C. Concentration-­effect relationships of psychoactive drugs a...