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.