Preface Acknowledgements Notes on using The Maudsley Prescribing Guidelines List of abbreviations Chapter 1 Plasma level monitoring of psychotropic drugs Interpreting sample results Acting on clozapine plasma concentration results Interpreting post-mortem blood concentrations Chapter 2 Schizophrenia ANTIPSYCHOTIC DRUGS General introduction General principles of prescribing Minimum effective doses Quick reference for licensed maximum doses Equivalent doses High�\dose antipsychotics: prescribing and monitoring Antipsychotic prophylaxis Combined antipsychotics Negative symptoms Monitoring Relative adverse effects – a rough guide Treatment algorithms for schizophrenia First�\generation antipsychotics–place in therapy Omega�\3 fatty acid (fish oils) in schizophrenia New and developing drugs to treat schizophrenia 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? Antipsychotic long�\acting injections Depot antipsychotics – pharmacokinetics Management of patients on long�\term depots Aripiprazole LAI Olanzapine LAI Paliperidone palmitate LAI Risperidone LAI ANTIPSYCHOT ICS – ADVERS E EFFECTS Extrapyramidal side�\effects Akathisia Weight gain Treatment of drug�\induced weight gain Tardive dyskinesia Neuroleptic malignant syndrome Catatonia QT prolongation Dyslipidaemia Diabetes and impaired glucose tolerance Hypertension Hyponatraemia Hyperprolactinaemia Sexual dysfunction Pneumonia Switching antipsychotics REFRACTORY SCHIZOPHRENIA AND CLOZAPINE Clozapine – dosing regimen Optimising clozapine treatment Alternatives to clozapine Re�\starting clozapine after a break in treatment Initiation of clozapine for community�\based patients CLOZAPINE – ADVERS E EFFECTS 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 3 Bipolar affective disorder Lithium Valproate Carbamazepine Antipsychotics in bipolar disorder Treatment of acute mania or hypomania Bipolar depression Rapid�\cycling bipolar affective disorder Prophylaxis in bipolar affective disorder Physical monitoring for people with bipolar affective disorder Chapter 4 Depression and anxiety Introduction Basic principles of prescribing in depression Official guidance on the treatment of depression Antidepressants: general overview St John’s wort Recognised minimum effective doses of antidepressants Drug treatment of depression Treatment of refractory depression Psychotic depression Electroconvulsive therapy and psychotropic drugs Psychostimulants in depression Post�\stroke depression Treatment of depression in the elderly Antidepressant discontinuation symptoms Antidepressant prophylaxis Antidepressants: alternative routes of administration Antidepressants: swapping and stopping Drug interactions with antidepressants Cardiac effects of antidepressants Antidepressant�\induced arrhythmia Antidepressant�\induced hyponatraemia Antidepressants and hyperprolactinaemia Antidepressants and diabetes mellitus Antidepressants and sexual dysfunction SSRIs and bleeding Antidepressants: relative adverse effects – a rough guide Anxiety spectrum disorders Benzodiazepines in the treatment of psychiatric disorders Benzodiazepines: dependence and detoxification Benzodiazepines and disinhibition 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 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 in children and adolescents Doses of commonly used psychotropic drugs in children and adolescents Chapter 6 Substance misuse Introduction Alcohol dependence Opioid misuse and dependence Nicotine and smoking cessation Pharmacological treatment of dependence on stimulants Benzodiazepine misuse GBL and GHB dependence Drugs of misuse: a summary Interactions between ‘street drugs’ and prescribed psychotropic drugs Chapter 7 Use of psychotropic drugs in special patient groups The elderly Dementia Safer prescribing of physical health medicines in dementia Management of non-cognitive symptoms of dementia Parkinson’s disease Multiple sclerosis Huntington’s disease Pregnancy Breastfeeding Renal impairment Hepatic impairment HIV infection Eating disorders Acutely disturbed or violent behaviour Borderline personality disorder Learning disabilities Delirium Epilepsy Surgery Velo-cardio-facial syndrome Cytochrome (CYP) function Psychiatric side-effects of non-psychotropic drugs Atrial fibrillation Chapter 8 Miscellaneous conditions and substances Psychotropic drugs in overdose Biochemical and haematological effects of psychotropics Prescribing drugs outside their licensed indications(‘off-label’ prescribing) Observations on the placebo effect in mental illness Drug interactions with alcohol Nicotine Smoking and psychotropic drugs Caffeine Complementary therapies Enhancing medication adherence Driving and psychotropic medicines Covert administration of medicines within food and drink Index