Preface x Acknowledgements xii Notes on using The Maudsley Prescribing Guidelines in Psychiatry xiii List of abbreviations xv Part 1 Drug treatment of major psychiatric conditions 1 Chapter 1 Schizophrenia and related psychoses 3 ANTIPSYCHOTIC DRUGS 3 General introduction 3 General principles of prescribing 8 Minimum effective doses 9 Licensed maximum doses 12 Equivalent doses 14 High‐dose antipsychotics: prescribing and monitoring 16 Combined antipsychotics 20 Antipsychotic prophylaxis 25 Negative symptoms 31 Monitoring 36 Relative adverse effects – a rough guide 39 Treatment algorithms for schizophrenia 40 First‐generation antipsychotics – place in therapy 44 NICE guidelines for the treatment of schizophrenia 46 Antipsychotic response – to increase the dose, to switch, to add or just wait – what is the right move? 49 Acutely disturbed or violent behaviour 54 Antipsychotic depots/long‐acting injections (LAIs) 66 Depot/LAI antipsychotics – pharmacokinetics 71 Management of patients on long‐term depots/LAIs 73 Aripiprazole long‐acting injection 75 Olanzapine long‐acting injection 77 Paliperidone palmitate long‐acting injection 79 Risperidone long‐acting injection 82 Electroconvulsive therapy and psychosis 86 Omega‐3 fatty acid (fish oils) in schizophrenia 88 ANTIPSYCHOTIC ADVERSE EFFECTS 90 Extrapyramidal symptoms 90 Akathisia 94 Weight gain 97 Treatment of antipsychotic‐induced weight gain 99 Neuroleptic malignant syndrome 104 Catatonia 107 ECG changes – QT prolongation 112 Effect of antipsychotic medications on plasma lipids 119 Diabetes and impaired glucose tolerance 123 Blood pressure changes 130 Hyponatraemia 134 Hyperprolactinaemia 137 Sexual dysfunction 141 Pneumonia 148 Switching antipsychotics 150 Venous thromboembolism 153 REFRACTORY SCHIZOPHRENIA AND CLOZAPINE 156 Clozapine initiation schedule 156 Optimising clozapine treatment 158 Alternatives to clozapine 162 Re‐starting clozapine after a break in treatment 169 Initiation of clozapine for community‐based patients 170 CLOZAPINE ADVERSE EFFECTS 175 Clozapine: common adverse effects 175 Clozapine: uncommon or unusual adverse effects 179 Clozapine: serious haematological and cardiovascular adverse effects 184 Clozapine‐induced hypersalivation 189 Clozapine‐induced gastrointestinal hypomotility (CIGH) 193 Clozapine, neutropenia and lithium 197 Clozapine and chemotherapy 202 Chapter 2 Bipolar disorder 205 Lithium 205 Valproate 214 Carbamazepine 221 Antipsychotic drugs in bipolar disorder 226 Antipsychotic long‐acting injections in bipolar disorder 229 Physical monitoring for people with bipolar disorder 232 Treatment of acute mania or hypomania 235 Rapid‐cycling bipolar disorder 241 Bipolar depression 243 Prophylaxis in bipolar disorder 250 Chapter 3 Depression and anxiety disorders 255 Depression: introduction 255 Basic principles of prescribing in depression 255 Official guidance on the treatment of depression 256 Antidepressants: general overview 257 Recognised minimum effective doses of antidepressants 262 Drug treatment of depression 264 Treatment of refractory depression: first choice 267 Treatment of refractory depression: second choice 271 Treatment of refractory depression: other reported treatments 274 Psychotic depression 278 Electroconvulsive therapy and psychotropic drugs 281 Stimulants in depression 285 Post‐stroke depression 290 Treatment of depression in the elderly 293 Antidepressants: alternative routes of administration 298 Antidepressant prophylaxis 306 Antidepressant discontinuation symptoms 310 Antidepressants: swapping and stopping 314 Drug interactions with antidepressants 321 Cardiac effects of antidepressants 325 Antidepressant‐induced arrhythmia 329 Antidepressant‐induced hyponatraemia 333 Antidepressants and hyperprolactinaemia 337 Antidepressants and diabetes mellitus 340 Antidepressants and sexual dysfunction 343 SSRIs and bleeding 347 St John’s wort 355 Antidepressants: relative adverse effects – a rough guide 358 Anxiety spectrum disorders 360 Benzodiazepines in the treatment of psychiatric disorders 373 Benzodiazepines: dependence and detoxification 377 Benzodiazepines and disinhibition 381 Chapter 4 Addictions and substance misuse 385 Introduction 385 Alcohol dependence 387 Opioid dependence 405 Nicotine and smoking cessation 431 Pharmacological treatment of dependence on stimulants 439 GHB and GBL dependence 442 Benzodiazepine misuse 445 Synthetic cannabinoid receptor agonists (SCRAs) 447 Interactions between ‘street drugs’ and prescribed psychotropic drugs 450 Drugs of misuse – a summary 454 Part 2 Drug treatment of special patient groups 459 Chapter 5 Children and adolescents 461 Principles of prescribing practice in childhood and adolescence 461 Depression in children and adolescents 463 Bipolar illness in children and adolescents 471 Psychosis in children and adolescents 478 Anxiety disorders in children and adolescents 480 Obsessive compulsive disorder (OCD) in children and adolescents 485 Post‐traumatic stress disorder in children and adolescents 491 Attention deficit hyperactivity disorder 496 Autism spectrum disorder 504 Tics and Tourette’s syndrome 512 Melatonin in the treatment of insomnia in children and adolescents 517 Rapid tranquillisation (RT) in children and adolescents 521 Doses of commonly used psychotropic drugs in children and adolescents 524 Chapter 6 Prescribing in older people 525 General principles 525 Dementia 529 Safer prescribing for physical conditions in dementia 570 Management of behavioural and psychological symptoms of dementia 557 A guide to medication doses of commonly used psychotropic drugs in older adults 586 Covert administration of medicines within food and drink 593 Chapter 7 Pregnancy and breastfeeding 599 Drug choice in pregnancy 599 Breastfeeding 619 Chapter 8 Hepatic and renal impairment 635 Hepatic impairment 635 Renal impairment 645 Part 3 Prescribing in specialist conditions 661 Chapter 9 Drug treatment of other psychiatric conditions 663 Borderline personality disorder 663 Eating disorders 667 Delirium 672 Chapter 10 Drug treatment of psychiatric symptoms occurring in the context of other disorders 679 General principles of prescribing in human immunodeficiency virus (HIV) 679 Prescribing psychotropics in HIV 685 Epilepsy 688 22q11.2 Deletion syndrome 696 Learning disabilities 699 Huntington’s disease 704 Multiple sclerosis 709 Parkinson’s disease 715 Atrial fibrillation 719 Bariatric surgery 722 Part 4 Other aspects of psychotropic drug use 729 Chapter 11 Pharmacokinetics 731 Plasma level monitoring of psychotropic drugs 731 Interpreting post‐mortem blood concentrations 742 Acting on clozapine plasma concentration results 744 Psychotropic drugs and cytochrome (CYP) function 746 Smoking and psychotropic drugs 750 Drug interactions with alcohol 753 Chapter 12 Other substances 759 Caffeine 759 Nicotine 765 Chapter 13 Psychotropic drugs in special conditions 769 Psychotropic drugs in overdose 769 Driving and psychotropic drugs 776 Psychotropic drugs and surgery 781 Chapter 14 Miscellany 787 Enhancing medication adherence 787 Re‐starting psychotropic medications after a period of non‐compliance 794 Biochemical and haematological effects of psychotropic medications 798 Summary of psychiatric adverse effects of non‐psychotropic medications 808 Prescribing drugs outside their licensed indications (‘off‐label’ prescribing) 813 The Mental Health Act in England and Wales 816 Site of administration of intramuscular injections 821 Index 825

• Clinical & internal medicine

• Psychiatry

• Psychopharmacology

• Psychopharmacology

• Professional & Vocational

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