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