The most up-to-date edition of the gold-standard handbook on the safe and effective prescribing of psychotropic agents
Prescribing medications that treat mental illness is a challenging but essential component of clinical practice. Successful treatment outcomes require careful drug choice and dosage, and other considerations can also have an important impact on patient experiences and long-term care.
In the newly revised fifteenth edition of The Maudsley Prescribing Guidelines in Psychiatry, you will find up-to-date and authoritative guidance on prescribing psychotropic medications to patients. It is an indispensable evidence-based handbook that will continue to serve a new generation of clinicians and trainees.
The book includes analyses of all psychotropic drugs currently used in the United States, the United Kingdom, Canada, Australia, New Zealand, and Japan. It also contains detailed discussions of common and uncommon adverse effects, the ramifications of switching medications, special patient groups, and other clinically relevant subjects. A fully updated reference list closes out each section, as well.
The Maudsley Prescribing Guidelines in Psychiatry is perfect for trainees seeking essential and accurate information on the rational, safe, and effective use of medications for patients with mental illness. Practising clinicians will also benefit from the included guidance on complex issues that might arise less frequently.
Table of Contents:
Preface xi
Acknowledgements xiii
Contributors' conflict of interest xv
List of abbreviations xvii
Chapter 1 Schizophrenia and related psychoses 1
Antipsychotic Drugs 1
General introduction 1
General principles of prescribing 7
Antipsychotics – minimum effective doses 8
Quick reference for licensed maximum doses 11
Equivalent doses 14
High- dose antipsychotic medication: prescribing and monitoring 17
Combined antipsychotics (antipsychotic polypharmacy) 22
Antipsychotic prophylaxis 28
Negative symptoms 34
Monitoring 40
Relative adverse effects – a rough guide 43
Treatment algorithms for schizophrenia 45
First- generation antipsychotics – place in therapy 49
NICE guidelines for the treatment of schizophrenia 52
Antipsychotic response – to increase the dose, to switch, to add or just wait – what is the right move? 55
Acutely disturbed or violent behaviour 62
Antipsychotic depots/long- acting injections 74
Depot antipsychotics – summary of pharmacokinetics 81
Management of patients on long- term treatment with long- acting injectable antipsychotic medication 83
Aripiprazole long- acting injection 85
Olanzapine long- acting injection 90
Paliperidone palmitate long- acting injection 93
Risperidone long- acting injection 99
Penfluridol weekly 106
Electroconvulsive therapy and psychosis 108
Omega- 3 fatty acid (fish oils) in schizophrenia 111
Alternative routes of administration 115
Stopping antipsychotics 119
Antipsychotic Adverse Effects 126
Extrapyramidal symptoms 126
Akathisia 131
Treatment of tardive dyskinesia 135
Antipsychotic- induced weight gain 141
Treatment of antipsychotic- induced weight gain 144
Neuroleptic malignant syndrome 150
Catatonia 154
ECG changes – QT prolongation 161
Effects of antipsychotic medications on plasma lipids 169
Diabetes and impaired glucose tolerance 174
Blood pressure changes with antipsychotics 182
Antipsychotic- associated hyponatraemia 186
Hyperprolactinaemia 190
Sexual dysfunction and antipsychotics 195
Pneumonia 204
Switching antipsychotics 207
Venous thromboembolism 211
Refractory Schizophrenia and Clozapine 214
Clozapine initiation schedules 214
Intramuscular clozapine 219
Optimising clozapine treatment 220
Alternatives to clozapine 226
Restarting clozapine after a break in treatment 234
Initiation of clozapine in the community 236
Clozapine Adverse Effects 241
Clozapine: common adverse effects 241
Clozapine: uncommon or unusual adverse effects 245
Clozapine: serious haematological adverse effects 251
Clozapine: serious cardiovascular adverse effects 253
Clozapine- induced hypersalivation 258
Clozapine- induced gastrointestinal hypomotility 263
Clozapine, neutropenia and lithium 267
Clozapine and chemotherapy 273
Genetic testing for clozapine treatment 275
Chapter 2 Bipolar disorder 279
Lithium 279
Valproate 289
Carbamazepine 295
Antipsychotic drugs in bipolar disorder 300
Antipsychotic long- acting injections in bipolar disorder 305
Physical monitoring for people with bipolar disorder 308
Treatment of acute mania or hypomania 310
Rapid- cycling bipolar affective disorder 316
Bipolar depression 319
Prophylaxis in bipolar disorder 326
Stopping lithium and mood stabilisers 331
Chapter 3 Depression and anxiety disorders 335
Introduction to depression 335
Antidepressants – general overview 337
Recognised minimum effective doses of antidepressants 342
Drug treatment of depression 344
Management of treatment-resistant depression – commonly used treatments 348
Management of treatment-resistant depression – other well-supported treatments 351
Treatment-resistant depression – other reported treatments 353
Ketamine 357
Psychotic depression 362
Switching antidepressants 366
Antidepressant withdrawal symptoms 373\
Stopping antidepressants 378
Electroconvulsive therapy and psychotropic drugs 384
Psychostimulants in depression 388
Post- stroke depression 393
Antidepressant prophylaxis 397
Drug interactions with antidepressants 401
Cardiac effects of antidepressants – summary 406
Antidepressant- induced arrhythmia 411
Antidepressant- induced hyponatraemia 416
Antidepressants and hyperprolactinaemia 420
Antidepressants and diabetes mellitus 423
Antidepressants and sexual dysfunction 426
SSRIs and bleeding 432
St John's wort 440
Antidepressants: relative adverse effects – a rough guide 444
Anxiety spectrum disorders 446
Benzodiazepines in the treatment of psychiatric disorders 460
Benzodiazepines, z-drugs and gabapentinoids: dependence, withdrawal effects and discontinuation 464
Benzodiazepines and disinhibition 471
Premenstrual syndrome 474
Chapter 4 Addictions and substance misuse 477
Introduction 477
Alcohol dependence 479
Opioid dependence 498
Nicotine and smoking cessation 523
Stimulant use disorder (SUD) 532
GHB and GBL dependence 537
Benzodiazepine misuse 540
Drug- induced excited state 543
Interactions between illicit drugs and prescribed psychotropic drugs 545
Drugs of misuse – a summary 549
Substance misuse in pregnancy 554
Gambling disorder 560
Chapter 5 Prescribing in children and adolescents 561
Principles of prescribing practice in childhood and adolescence 561
Depression in children and adolescents 566
Bipolar disorder in children and adolescents 573
Psychosis in children and adolescents 580
Anxiety disorders in children and adolescents 582
Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) in children and adolescents 587
Post- traumatic stress disorder (PTSD) in children and adolescents 595
Attention deficit hyperactivity disorder (ADHD) in children and adolescents 597
Autism spectrum disorder (ASD) in children and adolescents 605
Tics and Tourette’s syndrome in children and adolescents 614
Melatonin in the treatment of insomnia in children and adolescents 620
Rapid tranquillisation (RT) in children and adolescents 623
Doses of commonly used psychotropic drugs in children and adolescents 626
Chapter 6 Prescribing in older people 627
General principles in prescribing in older adults 627
Dementia 630
Safer prescribing for physical conditions in dementia 654
Management of behavioural and psychological symptoms of dementia (BPSD) 667
Management of inappropriate sexual behaviour in older adults 680
Depression in older adults 688
Covert administration of medicines within food and drink 694
A guide to medication doses of commonly used psychotropics in older adults 700
Chapter 7 Prescribing in pregnancy and breastfeeding 713
Drug choice in pregnancy 713
Drug choice in breastfeeding 734
Chapter 8 Prescribing in hepatic and renal impairment 753
Hepatic impairment 753
Renal impairment 766
Chapter 9 Drug treatment of other psychiatric conditions 787
Borderline personality disorder (BPD) 787
Eating disorders 792
Attention deficit hyperactivity disorder (ADHD) in adults 798
Chapter 10 Drug treatment of psychiatric symptoms occurring in the context of other conditions 803
Prescribing in human immunodeficiency virus (HIV) 803
Epilepsy 811
22q11.2 deletion syndrome 820
Learning disabilities 824
Huntington’s disease 830
Multiple sclerosis 835
Parkinson’s disease 840
Atrial fibrillation 845
Bariatric surgery 849
Menopause 857
Chapter 11 Pharmacokinetics 865
Plasma level monitoring of psychotropic drugs 865
Interpreting postmortem blood concentrations 879
Acting on clozapine plasma concentration results 881
Psychotropic drugs and cytochrome (CYP) function 883
Smoking and psychotropic drugs 892
Drug interactions with alcohol 895
Chapter 12 Other substances 901
Caffeine 901
Nicotine 908
Chapter 13 Psychotropic drugs in special conditions 913
Psychotropics in overdose 913
Driving and psychotropic medicines 921
Chapter 14 Prescribing psychotropics 927
Working towards adherence 927
Restarting psychotropic medications after a period of non- compliance 937
Relational aspects of prescribing practice 939
Prescribing drugs outside their licensed indications (‘off- label’ prescribing) 945
The Mental Health Act in England and Wales 949
Site of administration of intramuscular injections 954
Chapter 15 Miscellany 959
Biochemical and haematological effects of psychotropics 959
Summary of psychiatric adverse effects of non- psychotropics 969
Index 975
