Maudsley Guidelines on Advanced Prescribing in Psychosis

Paul Morrison, PhD, FRCPsych., is a consultant psychiatrist in Argyll and Bute Hospital, Scotland, UK. He is also an honorary Clinical senior lecturer in psychopharmacology at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. David M. Taylor, PhD, FRPharmS, is Director of Pharmacy and Pathology at the Maudsley Hospital and is Professor of Psychopharmacology at King's College London, London, UK. Phillip McGuire, PhD, is a professor of Psychiatry and Cognitive Neuroscience and head of the Department of Psychosis Studies at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

• List of tables ixPreface xiGlossary xiiiAcknowledgments xvChapter 1 Psychosis 11.1 What is psychosis? 11.2 Lack of insight 11.3 Causes of psychosis 21.4 Schizophrenia: loss of personality and psychosocial decline 21.5 Bipolar disorder 31.6 Cannabis, synthetic cannabinoids, and psychosis 4Chapter 2 Towards evidence based treatments for psychosis 72.1 Traditional medicine 72.2 The randomised controlled trial 72.3 The roots of community care 82.4 Treatment algorithms versus personalised care 8Chapter 3 The antipsychotics 93.1 General principles in the pharmacology of psychosis 93.2 Neurotransmitters and receptors 103.3 Choosing drugs 123.4 Acute psychotic episodes 133.4.1 Olanzapine in acute psychotic episodes 153.4.2 Antipsychotic dosing in acute psychotic episodes 153.4.3 Timescale of response in acute psychotic episodes 173.4.4 Very agitated patients 173.5 The maintenance phase: relapse prevention 183.5.1 Beyond the early years: more harm than good? 183.6 The utility of long]acting depot antipsychotics 223.7 Principles of long]acting depot antipsychotic prescribing 233.7.1 Clozapine 253.7.2 Clozapine resistant psychosis 263.7.3 Side effects of clozapine 273.7.4 Myocarditis: inflammation of heart muscle 283.7.5 Cardiomyopathy: impaired function of heart muscle 293.7.6 The effects of clozapine at muscarinic M1–M4 acetylcholine receptors 293.7.7 Weight]gain and type II diabetes 303.7.8 Neutropenia and agranulocytosis 303.7.9 Lowered seizure threshold 31Chapter 4 Bipolar disorder 334.1 Diagnosis of bipolar 334.2 Treatment of mania 344.3 Treatment of bipolar depression 344.4 The maintenance phase of bipolar: relapse prevention 394.5 Bipolar in females of childbearing age 414.5.1 Valproate and carbamazepine in females of childbearing age 414.5.2 Lithium in females of childbearing age 414.5.3 Lamotrigine in females of childbearing age 424.5.4 Antipsychotics in females of childbearing age 42Chapter 5 The role of talking therapies in the treatment of psychosis 435.1 Psychoanalytical insights 435.2 Psychological treatments 43Chapter 6 Side effects of antipsychotic treatment 456.1 Weight gain 456.1.1 Antipsychotics at 5HT2c receptors 456.1.2 The management of weight gain and obesity 466.2 Type II diabetes 466.3 Dyslipidemia 486.3.1 The management of dyslipidemia in psychosis services 486.4 Motor side effects 496.4.1 Tardive dyskinesia 516.4.2 First versus second generation 516.5 Hyperprolactinemia 516.5.1 The management of hyperprolactinemia 526.6 Sexual side effects 526.6.1 Management 536.7 Prolonged QTc 536.7.1 Calculating the QTc 536.7.2 QTc thresholds 546.7.3 Torsades de points 546.7.4 Antipsychotics and QTc prolongation 546.7.5 Management 556.8 Neuroleptic malignant syndrome 556.8.1 Management 56Chapter 7 Services: pathway specific care 577.1 Background 577.2 The at]risk]mental]state 577.3 Early intervention services 587.4 Acute services 597.5 Continuing care services: promoting recovery 59Chapter 8 Measuring outcomes 618.1 Value]based healthcare 618.2 Evidence]based healthcare management (EBMGT) 62Appendix 1 Pharmacokinetics of selected psychotropics 65Appendix 2 The metabolic syndrome 71Appendix 3 Physical health monitoring for patients prescribed antipsychotics 73Appendix 4 Physical health monitoring for patients prescribed mood stabilisers 75References 77Index 91

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