Maudsley Prescribing Guidelines in Psychiatry

David M. Taylor, BSc, MSc, PhD, FFRPS, FRPharmS, FRCPEdin, FRCPsychHon, is Director of Pharmacy and Pathology at the Maudsley Hospital and Professor of Psychopharmacology at King's College, London.Thomas R. E. Barnes, MBBS, MD, FRCPsych, DSc, Emeritus Professor of Clinical Psychiatry at Imperial College London and joint head of the Prescribing Observatory for Mental Health at the Royal College of Psychiatrists’ Centre for Quality Improvement, London, UK.Allan H. Young, MB, ChB, MPhil, PhD, FRCP, FRCPsych, Chair of Mood Disorders and Director of the Centre for Affective Disorders in the Department of Psychological Medicine in the Institute of Psychiatry, Psychology and Neuroscience at King's College, London, UK.

• Preface xiAcknowledgements xiiiContributors' conflict of interest xvList of abbreviations xviiChapter 1 Schizophrenia and related psychoses 1Antipsychotic Drugs 1General introduction 1General principles of prescribing 7Antipsychotics – minimum effective doses 8Quick reference for licensed maximum doses 11Equivalent doses 14High- dose antipsychotic medication: prescribing and monitoring 17Combined antipsychotics (antipsychotic polypharmacy) 22Antipsychotic prophylaxis 28Negative symptoms 34Monitoring 40Relative adverse effects – a rough guide 43Treatment algorithms for schizophrenia 45First- generation antipsychotics – place in therapy 49NICE guidelines for the treatment of schizophrenia 52Antipsychotic response – to increase the dose, to switch, to add or just wait – what is the right move? 55Acutely disturbed or violent behaviour 62Antipsychotic depots/long- acting injections 74Depot antipsychotics – summary of pharmacokinetics 81Management of patients on long- term treatment with long- acting injectable antipsychotic medication 83Aripiprazole long- acting injection 85Olanzapine long- acting injection 90Paliperidone palmitate long- acting injection 93Risperidone long- acting injection 99Penfluridol weekly 106Electroconvulsive therapy and psychosis 108Omega- 3 fatty acid (fish oils) in schizophrenia 111Alternative routes of administration 115Stopping antipsychotics 119Antipsychotic Adverse Effects 126Extrapyramidal symptoms 126Akathisia 131Treatment of tardive dyskinesia 135Antipsychotic- induced weight gain 141Treatment of antipsychotic- induced weight gain 144Neuroleptic malignant syndrome 150Catatonia 154ECG changes – QT prolongation 161Effects of antipsychotic medications on plasma lipids 169Diabetes and impaired glucose tolerance 174Blood pressure changes with antipsychotics 182Antipsychotic- associated hyponatraemia 186Hyperprolactinaemia 190Sexual dysfunction and antipsychotics 195Pneumonia 204Switching antipsychotics 207Venous thromboembolism 211Refractory Schizophrenia and Clozapine 214Clozapine initiation schedules 214Intramuscular clozapine 219Optimising clozapine treatment 220Alternatives to clozapine 226Restarting clozapine after a break in treatment 234Initiation of clozapine in the community 236Clozapine Adverse Effects 241Clozapine: common adverse effects 241Clozapine: uncommon or unusual adverse effects 245Clozapine: serious haematological adverse effects 251Clozapine: serious cardiovascular adverse effects 253Clozapine- induced hypersalivation 258Clozapine- induced gastrointestinal hypomotility 263Clozapine, neutropenia and lithium 267Clozapine and chemotherapy 273Genetic testing for clozapine treatment 275Chapter 2 Bipolar disorder 279Lithium 279Valproate 289Carbamazepine 295Antipsychotic drugs in bipolar disorder 300Antipsychotic long- acting injections in bipolar disorder 305Physical monitoring for people with bipolar disorder 308Treatment of acute mania or hypomania 310Rapid- cycling bipolar affective disorder 316Bipolar depression 319Prophylaxis in bipolar disorder 326Stopping lithium and mood stabilisers 331Chapter 3 Depression and anxiety disorders 335Introduction to depression 335Antidepressants – general overview 337Recognised minimum effective doses of antidepressants 342Drug treatment of depression 344Management of treatment-resistant depression – commonly used treatments 348Management of treatment-resistant depression – other well-supported treatments 351Treatment-resistant depression – other reported treatments 353Ketamine 357Psychotic depression 362Switching antidepressants 366Antidepressant withdrawal symptoms 373\Stopping antidepressants 378Electroconvulsive therapy and psychotropic drugs 384Psychostimulants in depression 388Post- stroke depression 393Antidepressant prophylaxis 397Drug interactions with antidepressants 401Cardiac effects of antidepressants – summary 406Antidepressant- induced arrhythmia 411Antidepressant- induced hyponatraemia 416Antidepressants and hyperprolactinaemia 420Antidepressants and diabetes mellitus 423Antidepressants and sexual dysfunction 426SSRIs and bleeding 432St John's wort 440Antidepressants: relative adverse effects – a rough guide 444Anxiety spectrum disorders 446Benzodiazepines in the treatment of psychiatric disorders 460Benzodiazepines, z-drugs and gabapentinoids: dependence, withdrawal effects and discontinuation 464Benzodiazepines and disinhibition 471Premenstrual syndrome 474Chapter 4 Addictions and substance misuse 477Introduction 477Alcohol dependence 479Opioid dependence 498Nicotine and smoking cessation 523Stimulant use disorder (SUD) 532GHB and GBL dependence 537Benzodiazepine misuse 540Drug- induced excited state 543Interactions between illicit drugs and prescribed psychotropic drugs 545Drugs of misuse – a summary 549Substance misuse in pregnancy 554Gambling disorder 560Chapter 5 Prescribing in children and adolescents 561Principles of prescribing practice in childhood and adolescence 561Depression in children and adolescents 566Bipolar disorder in children and adolescents 573Psychosis in children and adolescents 580Anxiety disorders in children and adolescents 582Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) in children and adolescents 587Post- traumatic stress disorder (PTSD) in children and adolescents 595Attention deficit hyperactivity disorder (ADHD) in children and adolescents 597Autism spectrum disorder (ASD) in children and adolescents 605Tics and Tourette’s syndrome in children and adolescents 614Melatonin in the treatment of insomnia in children and adolescents 620Rapid tranquillisation (RT) in children and adolescents 623Doses of commonly used psychotropic drugs in children and adolescents 626Chapter 6 Prescribing in older people 627General principles in prescribing in older adults 627Dementia 630Safer prescribing for physical conditions in dementia 654Management of behavioural and psychological symptoms of dementia (BPSD) 667Management of inappropriate sexual behaviour in older adults 680Depression in older adults 688Covert administration of medicines within food and drink 694A guide to medication doses of commonly used psychotropics in older adults 700Chapter 7 Prescribing in pregnancy and breastfeeding 713Drug choice in pregnancy 713Drug choice in breastfeeding 734Chapter 8 Prescribing in hepatic and renal impairment 753Hepatic impairment 753Renal impairment 766Chapter 9 Drug treatment of other psychiatric conditions 787Borderline personality disorder (BPD) 787Eating disorders 792Attention deficit hyperactivity disorder (ADHD) in adults 798Chapter 10 Drug treatment of psychiatric symptoms occurring in the context of other conditions 803Prescribing in human immunodeficiency virus (HIV) 803Epilepsy 81122q11.2 deletion syndrome 820Learning disabilities 824Huntington’s disease 830Multiple sclerosis 835Parkinson’s disease 840Atrial fibrillation 845Bariatric surgery 849Menopause 857Chapter 11 Pharmacokinetics 865Plasma level monitoring of psychotropic drugs 865Interpreting postmortem blood concentrations 879Acting on clozapine plasma concentration results 881Psychotropic drugs and cytochrome (CYP) function 883Smoking and psychotropic drugs 892Drug interactions with alcohol 895Chapter 12 Other substances 901Caffeine 901Nicotine 908Chapter 13 Psychotropic drugs in special conditions 913Psychotropics in overdose 913Driving and psychotropic medicines 921Chapter 14 Prescribing psychotropics 927Working towards adherence 927Restarting psychotropic medications after a period of non- compliance 937Relational aspects of prescribing practice 939Prescribing drugs outside their licensed indications (‘off- label’ prescribing) 945The Mental Health Act in England and Wales 949Site of administration of intramuscular injections 954Chapter 15 Miscellany 959Biochemical and haematological effects of psychotropics 959Summary of psychiatric adverse effects of non- psychotropics 969Index 975