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The Maudsley Prescribing Guidelines in Psychiatry


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Part 1: Drug treatment of major psychiatric conditions Chapter 1: Schizophrenia and related psychoses ANTIPSYCHOTIC DRUGS General introduction General principles of prescribing Minimum effective doses Licensed maximum doses Equivalent doses High-dose antipsychotics: prescribing and monitoring Combined antipsychotics Antipsychotic prophylaxis Negative symptoms Monitoring Relative adverse effects a rough guide Treatment algorithms for schizophrenia First-generation antipsychotics place in therapy NICE guidelines for the treatment of schizophrenia Antipsychotic response to increase the dose, to switch, to add or just wait what is the right move? Acutely disturbed or violent behaviour Antipsychotic long-acting injections Depot antipsychotics pharmacokinetics Management of patients on long-term depots Aripiprazole long-acting injection Olanzapine long-acting injection Paliperidone palmitate long-acting injection Risperidone long-acting injection Omega-3 fatty acid (fish oils) in schizophrenia ANTIPSYCHOTIC ADVERSE EFFECTS Extrapyramidal symptoms Akathisia Weight gain Treatment of antipsychotic-induced weight gain Electroconvulsive therapy and psychosis Neuroleptic malignant syndrome Catatonia QT prolongation Dyslipidaemia Diabetes and impaired glucose tolerance Blood pressure changes Hyponatraemia Hyperprolactinaemia Sexual dysfunction Pneumonia Switching antipsychotics Venous thromboembolism REFRACTORY SCHIZOPHRENIA AND CLOZAPINE Clozapine initiation schedule Optimising clozapine treatment Alternatives to clozapine Re-starting clozapine after a break in treatment Initiation of clozapine for community-based patients CLOZAPINE ADVERSE EFFECTS Clozapine: common adverse effects Clozapine: uncommon or unusual adverse effects Clozapine: serious haematological and cardiovascular adverse effects Clozapine-induced hypersalivation Clozapine-induced gastrointestinal hypomotility (CIGH) Clozapine, neutropenia and lithium Clozapine and chemotherapy Chapter 2: Bipolar disorder Lithium Valproate Carbamazepine Antipsychotic drugs in bipolar disorder Antipsychotic long-acting injections in bipolar disorder Physical monitoring for people with bipolar disorder Treatment of acute mania or hypomania Rapid-cycling bipolar disorder Bipolar depression Prophylaxis in bipolar disorder Chapter 3: Depression and anxiety disorders Chapter 4 Addictions and substance misuse Introduction Alcohol dependence Opioid dependence Nicotine and smoking cessation Pharmacological treatment of dependence on stimulants GHB and GBL dependence Benzodiazepine misuse Synthetic cannabinoid receptor agonists (SCRAs) Interactions between street drugs and prescribed psychotropic drugs Drugs of misuse a summary Part 2: Drug treatment of special patient groups Chapter 5 Children and adolescents Principles of prescribing practice in childhood and adolescence Depression in children and adolescents Bipolar illness in children and adolescents Psychosis in children and adolescents Anxiety disorders in children and adolescents Obsessive compulsive disorder (OCD) in children and adolescents Post-traumatic stress disorder in children and adolescents Attention deficit hyperactivity disorder Autism spectrum disorders Tics and Tourette s syndrome Melatonin in the treatment of insomnia in children and adolescents Rapid tranquillisation (RT) in children and adolescents Doses of commonly used psychotropic drugs in children and adolescents Chapter 6 Prescribing in older people General principles Dementia Safer prescribing for physical conditions in dementia Management of behavioural and psychological symptoms of dementia A guide to medication doses of commonly used psychotropic drugs in older adults Covert administration of medicines within food and drink Chapter 7: Pregnancy and breastfeeding Drug choice in pregnancy Breastfeeding Chapter 8: Hepatic and renal impairment Hepatic impairment Renal impairment Part 3: Prescribing in specialist conditions Chapter 9: Drug treatment of other psychiatric conditions Borderline personality disorder Eating disorders Delirium Chapter 10: Drug treatment of psychiatric symptoms occurring in the context of other disorders General principles of prescribing in human immunodeficiency virus (HIV) Prescribing psychotropics in HIV Epilepsy 22q11.2 Deletion syndrome Learning disabilities Huntington s disease Multiple sclerosis Parkinson s disease Atrial fibrillation Bariatric surgery Part 4: Other aspects of psychotropic drug use Chapter 11 Pharmacokinetics Plasma level monitoring of psychotropic drugs Interpreting post-mortem blood concentrations Acting on clozapine plasma concentration results Psychotropic drugs and cytochrome (CYP) function Smoking and psychotropic drugs Drug interactions with alcohol Chapter 12 Other substances Caffeine Nicotine Chapter 13: Psychotropic drugs in special conditions Psychotropic drugs in overdose Driving and psychotropic drugs Psychotropic drugs and surgery Chapter 14: Miscellany Enhancing medication adherence Re-starting psychotropic medications after a period of non-compliance Biochemical and haematological effects of psychotropic medications Summary of psychiatric adverse effects of non-psychotropic medications Prescribing drugs outside their licensed indications ( off-label prescribing) The Mental Health Act in England and Wales Site of administration of intramuscular injections

About the Author

David M. Taylor BSc, MSc, PhD, FFRPS, FRPharmS, 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, is 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. Allan H. Young, MB, ChB, MPhil, PhD, FRCPC, FRCPsych, is Chair of Mood Disorders and is Director of the Centre for Affective Disorders in the Department of Psychological Medicine in the Institute of Psychiatry at King's College London, UK.

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