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The Maudsley Prescribing Guidelines in Psychiatry, 11th Edition

David Taylor (Editor), Carol Paton (Co-Editor), Shitij Kapur (Co-Editor)
ISBN: 978-1-118-32325-0
680 pages
February 2012, Wiley-Blackwell
The Maudsley Prescribing Guidelines in Psychiatry, 11th Edition (1118323254) cover image
Helps with complex prescribing needs

The evidence base for drug treatments in psychiatry ranges from meta-analyses and randomised controlled clinical trials to single case reports, and from NICE guidelines to individual SPCs.  Where do you look for information when transferring a patient from one drug to another?  Where do you find a clear overview when dealing with a complex patient (e.g, with co-morbid epilepsy or liver disease or HIV infection)?   Where can you seek advice on prescribing psychotropics during pregnancy?  The Maudsley Prescribing Guidelines in Psychiatry! The leading clinical reference for handling prescribing problems as encountered in daily practice and for formulating prescribing policy. 

Evidence-based and written by experts

This book is the essential guide for anyone responsible for prescribing, dispensing or administering drugs for patients with mental health disorders.  All the evidence has been reviewed and summarized succinctly by an expert team of psychiatrists and pharmacists. 

New content and improved format

This new edition makes greater use of tables and boxes to facilitate quick reference and includes new sections on cytochrome-mediated interactions and psychiatric side effects of non-psychotropic drugs.

Clinically relevant

Chapters address plasma monitoring, schizophrenia, bipolar disorder, depression and anxiety, children and adolescents, substance abuse and special patient groups.  Each section has a full reference list.  The book covers prescribing drugs outside their licensed indications and their interaction with substances such as alcohol, nicotine and caffeine.

Useful for all levels of experience

Trainees will gain important information regarding the rational, safe and effective use of medications for patients with mental illness.  Experienced clinicians will find excellent guidance regarding more complex issues that they may not encounter regularly. 

Why the Maudsley Prescribing Guidelines in Psychiatry?

Long recognized as an international trailblazer in mental health care, the Maudsley Hospital earned its reputation for excellence in both in-patient and community care.  It is highly regarded for its research, and pioneered the use of clinical neuroscience. You can trust The Maudsley Prescribing Guidelines in Psychiatry to be scientifically sound and clinically effective.

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Preface ix

Acknowledgements x

Notes on using The Maudsley Prescribing Guidelines xi

Notes on inclusion of drugs xi

List of abbreviations xii

Chapter 1 Plasma level monitoring of psychotropic drugs and anticonvulsants 1

Interpreting sample results 2

Chapter 2 Schizophrenia 11

Antipsychotic drugs 11

Antipsychotic drugs: equivalent doses 13

Antipsychotic drugs: minimum effective doses 14

Antipsychotic drugs: licensed maximum doses 16

New antipsychotic drugs 17

Antipsychotic drugs: general principles of prescribing 21

National Institute for Health and Clinical Excellence guidelines for the treatment of schizophrenia 22

Treatment algorithms for schizophrenia 24

Antipsychotic drugs: monitoring of metabolic effects 26

Switching antipsychotic drugs because of poor tolerability 31

Antipsychotic response: to increase the dose, to switch, to add or just wait – what is the right move? 33

Speed and onset of antipsychotic drug action 36

First-generation antipsychotic drugs: place in therapy 39

Antipsychotic drugs: long-acting injections 40

Risperidone long-acting injection 44

Paliperidone palmitate long-acting injection 47

Management of patients on long-term depots: dose reduction 50

Combined antipsychotic drugs 51

High-dose antipsychotic drugs: prescribing and monitoring 54

Negative symptoms in schizophrenia 57

Antipsychotic prophylaxis 60

Refractory schizophrenia and clozapine 64

Clozapine augmentation 66

Refractory schizophrenia: alternatives to clozapine 69

Clozapine: management of common adverse effects 75

Clozapine: uncommon or unusual adverse effects 78

Clozapine: serious haematological and cardiovascular adverse effects 80

Clozapine, neutropenia and lithium 84

Clozapine and chemotherapy 88

Clozapine-related hypersalivation 89

Guidelines for the initiation of clozapine for patients based in the community 92

Omega-3 fatty acids (fish oils) in schizophrenia 96

Extrapyramidal side-effects of antipsychotic drug treatment 98

Treatment of antipsychotic-induced akathisia 103

Treatment of tardive dyskinesia 105

Neuroleptic malignant syndrome 110

Catatonia 113

Cardiovascular effects of antipsychotic drug treatment 115

Antipsychotic drugs and hypertension 122

Hyperprolactinaemia 123

Antipsychotic-induced weight gain 126

Treatment of drug-induced weight gain 128

Antipsychotic drugs, diabetes and impaired glucose tolerance 132

Antipsychotic drugs and dyslipidaemia 138

Antipsychotic drugs and sexual dysfunction 142

Antipsychotic-associated hyponatraemia 148

Antipsychotics and pneumonia 150

Relative adverse effects of antipsychotic drugs: a rough guide 151

Chapter 3 Bipolar disorder 153

Valproate 153

Lithium 159

Carbamazepine 168

Physical monitoring of people with bipolar disorder 173

Treatment of acute mania or hypomania 176

Antipsychotic drugs in bipolar disorder 182

Bipolar depression 185

Rapid cycling bipolar disorder 191

Prophylaxis in bipolar disorder 193

Chapter 4 Depression and anxiety 197

Depression 197

Antidepressants 201

Treatment of resistant depression 222

Treatment of psychotic depression 233

Electroconvulsive therapy and psychotropic drugs 235

Psychostimulants in depression 239

Treatment of depression in the elderly 243

Treatment of depression in stroke 247

Adverse effects of antidepressants 249

Selective serotonin reuptake inhibitors and bleeding 252

Depression and diabetes 255

Cardiac effects of antidepressants 257

Antidepressants and sexual dysfunction 264

Antidepressants and hyperprolactinaemia 268

Antidepressants: swapping and stopping 270

St John’s wort in the treatment of depression 278

Drug interactions with antidepressants 281

Alternative routes of administration for antidepressants 286

Anxiety spectrum disorders 292

Benzodiazepines in the treatment of psychiatric disorders 301

Benzodiazepines and disinhibition 304

Benzodiazepines: dependence and detoxification 306

Insomnia 310

Chapter 5 Children and adolescents 315

Principles of prescribing practice in childhood and adolescence 315

Depression in children and adolescents 316

Bipolar illness in children and adolescents 321

Psychosis in children and adolescents 326

Anxiety in children and adolescents 327

Obsessive compulsive disorder in children and adolescents 328

Attention deficit hyperactivity disorder 332

Autism spectrum disorders 337

Tics and Tourette’s syndrome 345

Melatonin in the treatment of insomnia in children and adolescents 349

Rapid tranquillisation in children and adolescents 351

Doses of commonly used psychotropic drugs in children and adolescents 354

Chapter 6 Substance misuse 355

Alcohol dependence 356

Opioid misuse and dependence 372

Nicotine and smoking cessation 398

Stimulant drugs of dependence 406

Benzodiazepine misuse 407

-Butaryl-lactone and -hydroxybutyrate dependence 408

Drugs of misuse: a summary 410

Interactions between ‘street drugs’ and prescribed psychotropic drugs 414

Chapter 7 Use of psychotropic drugs in special patient groups 419

Epilepsy 419

Pregnancy 430

Breast feeding 446

Renal impairment 462

Hepatic impairment 478

Prescribing in the elderly 487

Dementia 490

Behavioural and psychological symptoms of dementia 509

Parkinson’s disease 518

Multiple sclerosis 522

Eating disorders 527

Acutely disturbed or violent behaviour 531

Psychotropic medications for adults with learning disabilities 539

Borderline personality disorder 545

Delirium 547

Huntington’s disease 554

Psychotropic drugs and surgery 558

Prescribing psychotropic drugs for patients with HIV infection 564

Psychotropic drugs and cytochrome (CYP) function 573

Summary of psychiatric side-effects of non-psychotropic drugs 578

Chapter 8 Miscellaneous conditions and substances 587

Psychotropic drugs in overdose 587

Biochemical and haematological effects of psychotropic drugs 593

Prescribing drugs outside their licensed indications 604

Observations on the placebo effect in mental illness 606

Drug interactions with alcohol 608

Nicotine 613

Smoking and psychotropic drugs 616

Caffeine 618

Complementary therapies 624

Enhancing medication adherence 628

Driving and psychotropic medicines 634

Covert administration of medicines within food and drink 643

Index 647

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David Taylor is Director of Pharmacy and Pathology at the South London and Maudsley NHS Foundation Trust, and Professor of Psychopharmacology at King’s College London.  The lead author of all editions of the Maudsley Prescribing Guidelines, Professor Taylor is the author of several other texts and editor of Therapeutic Advances in Psychopharmacology.

Carol Paton is Chief Pharmacist at Oxleas NHS Foundation Trust, London: she is also joint Head of the Prescribing Observatory for Mental Health and an Honorary Research Fellow at Imperial College London. 

Shitij Kapur is Professor of Schizophrenia, Imaging and Therapeutics and the Dean and Head of School at the Institute of Psychiatry, King's College London.

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“This comprehensive guide presents clinicians with evidence-based information on prescribing psychotropic drugs for mental health … This book will help nurses to be confident, sensitive and informed when discussing medication with patients and relatives, exploring treatment options within their professional teams and liaising with allied health professionals.”  (Nursing Standard, 30 May 2012)

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