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The Maudsley Prescribing Guidelines in Psychiatry, 12th Edition



The Maudsley Prescribing Guidelines in Psychiatry, 12th Edition

David M. Taylor, Carol Paton, Shitij Kapur

ISBN: 978-1-118-75459-7 April 2015 Wiley-Blackwell 760 Pages

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The fully updated 12th edition of an essential reference for anyone responsible for prescribing drugs for patients with mental health disorders.

  • A well-respected and widely-used source of information on which drugs to prescribe, which side effects to look out for, how best to augment or switch drugs, and more
  • Provides concise reviews of psychiatric disorders and relevant psychopharmacology, along with general guidance based on the data reviewed and current clinical practice
  • Includes specific guidance for schizophrenia, bipolar disorder, depression, anxiety, substance abuse, and special populations such as children, the elderly and pregnant women
  • Each section features a full reference list so the evidence base can be checked quickly and easily
This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.
Preface xi

Acknowledgements xii

Notes on using The Maudsley Prescribing Guidelines xiii

List of abbreviations xv

Chapter 1 Plasma level monitoring of psychotropic drugs 1

Interpreting sample results 2

Acting on clozapine plasma concentration results 11

Interpreting post-mortem blood concentrations 13

Chapter 2 Schizophrenia 15

Antipsychotic drugs 15

General introduction 15

General principles of prescribing 20

Minimum effective doses 22

Quick reference for licensed maximum doses 24

Equivalent doses 26

High-dose antipsychotics: prescribing and monitoring 28

Antipsychotic prophylaxis 31

Combined antipsychotics 37

Negative symptoms 41

Monitoring 45

Relative adverse effects – a rough guide 48

Treatment algorithms for schizophrenia 49

First?]generation antipsychotics – place in therapy 52

Omega-3 fatty acid (fish oils) in schizophrenia 54

New and developing drugs to treat schizophrenia 56

NICE guidelines for the treatment of schizophrenia 59

Antipsychotic response – to increase the dose, to switch, to add or just wait – what is the right move? 61

Antipsychotic long?]acting injections 66

Depot antipsychotics – pharmacokinetics 70

Management of patients on long?]term depots 72

Aripiprazole LAI 74

Olanzapine LAI 75

Paliperidone palmitate LAI 77

Risperidone LAI 80


Extrapyramidal side-effects 84

Akathisia 88

Weight gain 90

Treatment of drug-induced weight gain 92

Tardive dyskinesia 97

Neuroleptic malignant syndrome 102

Catatonia 105

QT prolongation 110

Dyslipidaemia 117

Diabetes and impaired glucose tolerance 121

Hypertension 128

Hyponatraemia 130

Hyperprolactinaemia 133

Sexual dysfunction 137

Pneumonia 143

Switching antipsychotics 144


Clozapine – dosing regimen 147

Optimising clozapine treatment 149

Alternatives to clozapine 153

Restarting clozapine after a break in treatment 159

Initiation of clozapine for community-based patients 160


Common adverse effects 165

Clozapine: uncommon or unusual adverse effects 168

Clozapine: serious haematological and cardiovascular adverse effects 170

Clozapine-induced hypersalivation 174

Clozapine-induced gastrointestinal hypomotility (CIGH) 177

Clozapine, neutropenia and lithium 181

Clozapine and chemotherapy 186

Chapter 3 Bipolar affective disorder 189

Lithium 189

Valproate 197

Carbamazepine 203

Antipsychotics in bipolar disorder 208

Treatment of acute mania or hypomania 211

Bipolar depression 216

Rapid-cycling bipolar affective disorder 223

Prophylaxis in bipolar affective disorder 225

Physical monitoring for people with bipolar affective disorder 228

Chapter 4 Depression and anxiety 231

Introduction 231

Basic principles of prescribing in depression 231

Official guidance on the treatment of depression 232

Antidepressants: general overview 233

St John’s wort 246

Recognised minimum effective doses of antidepressants 250

Drug treatment of depression 252

Treatment of refractory depression 255

Psychotic depression 266

Electroconvulsive therapy and psychotropic drugs 269

Psychostimulants in depression 272

Post-stroke depression 276

Treatment of depression in the elderly 279

Antidepressant discontinuation symptoms 283

Antidepressant prophylaxis 287

Antidepressants: alternative routes of administration 290

Antidepressants: swapping and stopping 296

Drug interactions with antidepressants 303

Cardiac effects of antidepressants 307

Antidepressant-induced arrhythmia 312

Antidepressant-induced hyponatraemia 316

Antidepressants and hyperprolactinaemia 319

Antidepressants and diabetes mellitus 321

Antidepressants and sexual dysfunction 324

SSR Is and bleeding 328

Antidepressants: relative adverse effects – a rough guide 332

Anxiety spectrum disorders 334

Benzodiazepines in the treatment of psychiatric disorders 343

Benzodiazepines: dependence and detoxification 346

Benzodiazepines and disinhibition 350

Chapter 5 Children and adolescents 353

Principles of prescribing practice in childhood and adolescence 353

Depression in children and adolescents 355

Bipolar illness in children and adolescents 362

Psychosis in children and adolescents 367

Anxiety disorders in children and adolescents 369

Obsessive compulsive disorder in children and adolescents 374

Post-traumatic stress disorder in children and adolescents 379

Attention deficit hyperactivity disorder 384

Autism spectrum disorders 390

Tics and Tourette’s syndrome 397

Melatonin in the treatment of insomnia in children and adolescents 402

Rapid tranquillisation in children and adolescents 405

Doses of commonly used psychotropic drugs in children and adolescents 408

Chapter 6 Substance misuse 409

Introduction 409

Alcohol dependence 411

Opioid misuse and dependence 429

Nicotine and smoking cessation 456

Pharmacological treatment of dependence on stimulants 463

Benzodiazepine misuse 466

GBL and GHB dependence 467

Drugs of misuse: a summary 469

Interactions between ‘street drugs’ and prescribed psychotropic drugs 472

Chapter 7 Use of psychotropic drugs in special patient groups 477

The elderly 477

Dementia 487

Safer prescribing of physical health medicines in dementia 507

Management of non-cognitive symptoms of dementia 517

Parkinson’s disease 529

Multiple sclerosis 533

Huntington’s disease 538

Pregnancy 541

Breastfeeding 559

Renal impairment 576

Hepatic impairment 590

HIV infection 598

Eating disorders 607

Acutely disturbed or violent behaviour 611

Borderline personality disorder 618

Learning disabilities 621

Delirium 625

Epilepsy 632

Surgery 637

Velo-cardio-facial syndrome 643

Cytochrome (CY P) function 646

Psychiatric side-effects of non-psychotropic drugs 650

Atrial fibrillation 656

Chapter 8 Miscellaneous conditions and substances 659

Psychotropic drugs in overdose 659

Biochemical and haematological effects of psychotropics 665

Prescribing drugs outside their licensed indications (‘off-label’ prescribing) 673

Observations on the placebo effect in mental illness 676

Drug interactions with alcohol 679

Nicotine 684

Smoking and psychotropic drugs 688

Caffeine 690

Complementary therapies 695

Enhancing medication adherence 700

Driving and psychotropic medicines 706

Covert administration of medicines within food and drink 714

Index 717