The Maudsley prescribing guidelines in psychiatry / David Taylor, Carol . the 11th edition sold more copies outside the UK than in it, and because there are, we. Vice Dean and Professor, Institute of Psychiatry, London. Page 7. vi. Preface. The 10th edition of the Maudsley Prescribing Guidelines fully updates the 9th edition . Antipsychotics – minimum effective doses. Antipsychotics – licensed. The fully updated 12th edition of an essential reference for anyone responsible for prescribing drugs for patients with mental health disorders. A well-respected.
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Anyone wishing to license this title for translation please contact [email protected] com. The Maudsley Prescribing Guidelines in Psychiatry 11th Edition David. The Maudsley Prescribing Guidelines in Psychiatry, 11th Edition. David M. Taylor (Editor), Carol Paton (Co-Editor), Shitij Kapur (Co-Editor). Request PDF on ResearchGate | On Jan 1, , D. Taylor and others published Maudsley Prescribing Guidelines in Psychiatry - 11th Edition.
The revised 13 th edition of the essential reference for the prescribing of drugs for patients with mental health disorders. There is advice on prescribing in children and adolescents, in substance misuse and in special patient groups. This world-renowned guide has been written in concise terms by an expert team of psychiatrists and specialist pharmacists. This important text:. Written for psychiatrists, neuropharmacologists, pharmacists and clinical psychologists as well as nurses and medical trainees, The Maudsley Prescribing Guidelines in Psychiatry are the established reference source for ensuring the safe and effective use of medications for patients presenting with mental health problems. Praise for previous editions: The revised 13th edition of the essential reference for the prescribing of drugs for patients with mental health disorders The revised and updated 13th edition of The Maudsley Prescribing Guidelines in Psychiatry provides up-to-date, expert guidance on prescribing practice in mental health, including drug choice, treatment of adverse effects and how to augment or switch medications.
Within the north-west of England, obtaining hyoscine has been difficult at times due to supply shortages and so alternatives have been sought.
Partnerships in Care have over 50 consultant psychiatrists nationwide caring for over in-patients, mostly within secure conditions, with a fair proportion prescribed clozapine. To examine prescribing alternatives to hyoscine, all consultants with clinical responsibilities were contacted regarding their prescribing practices and experiences.
Responses were sent back in the form of a patient non-identifiable response via email. In the absence of hyoscine hydrobromide, there was overall little confidence in alternatives, but clinicians tended to advocate one or two. Atropine, either sublingually or via eye drops was relatively popular and the 8 clinicians that supported its use had some confidence in it.
Four clinicians each supported the use of amitriptyline, pirenzepine and trihexyphenidyl. All the medication recommendations received were in the latest Maudsley Prescribing Guidelines in Psychiatry , except for procyclidine. Most options consisted of drugs with antimuscarinic properties such as pirenzepine and trihexyphenidyl.
Dose reduction of clozapine was recommended by 1 consultant. The third Maudsley Prescribing Guidelines International Conference "From evidence to practice" was held on Monday 17 December to celebrate the publication of the 13th edition . Over clinicians attended; more than 50 from outside the UK. From Wikipedia, the free encyclopedia.
Clinical and Experimental , London, Retrieved on 11 March Retrieved on 17 June Retrieved on 23 January Retrieved Sanz-Fuentenebro and colleagues 9 compared clozapine with risperidone in patients with first-episode psychosis and suggested that clozapine might have a slightly superior efficacy initially in the treatment of first-episode treatment naive patients with schizophrenia.
No published data are available from India.
Hence, the current study was planned to compare effectiveness and safety of clozapine and risperidone in a group of treatment-naive, first-episode patients with schizophrenia.
The patients were allocated to either of the group on the basis of computer-generated random table number. The patients were followed up for six months after initiation of treatment.
Patients were inducted from out- and inpatients both attending the department of Psychiatry, Government Medical College and Hospital, Chandigarh, a tertiary care teaching hospital of north India. Patients with the diagnosis of schizophrenia as per the International Classification of Diseases ICD criteria 10 , who gave informed written consent, and fulfilled inclusion and exclusion criteria were enrolled in the study from December to June , and the study was completed in January The consecutive patients of first-episode, treatment-naive schizophrenia, between the age group of 18 and 40 years, were included in the study.
Clozapine was started at the dose of Patients who showed response to the drugs were continued as per the assessment schedule at one, two, four and at six months. Concomitant medications such as benzodiazepines for restlessness and sleep disturbances, anticholinergic drugs for extrapyramidal side effects and clonidine and amitriptyline for sialorrhoea were permitted wherever required and doses of such medications were documented in both the groups. Sociodemographic and clinical variables of patients were recorded in the prescribed proforma designed for the study.
TLC, differential leucocyte count, platelet count and absolute neutrophil counts were measured on weekly basis for initial 18 wk as per the Maudsley prescribing guidelines 13 for patients receiving clozapine and thereafter monthly. Measurements of body mass index, lipid profile, fasting blood sugar and serum drug levels were done at one, two, four and six months. The drug levels were measured by reversed-phase high-pressure liquid chromatography technique 14 , and blood samples ml were collected into vacuum tubes in the morning, before the administration of morning dose.
Besides these assessments, patients were on regular follow up after every two weeks, for six months. All these scales were used in the morning before administration of morning dose. Patients were asked to bring the empty strips of medicines in both the groups during every follow up visit. The confidentiality of the information obtained was maintained and the principles enunciated in the ICMR's ethical guidelines for biomedical research on human cases were adhered to The study was approved by the Institutional Ethics Committee.
Data were analyzed using SPSS The two groups were comparable on sociodemographic variables including mean age, sex, locality, education, occupation, income, family type and marital status.
The mean duration of illness was The difference in duration of illness between two groups was not significant.
Table I shows comparison between two groups at baseline assessment. In addition, the baseline comparison between the two groups for sexual functioning on ASEX scale clozapine group: Both the drugs led to significant reduction in positive symptom score from baseline and two groups were comparable.
At this point of time, patients in clozapine group received mean dose of Similarly, in risperidone at six months, there was The comparison on GASS between the two groups revealed significant difference at each assessment, and clozapine was found to be superior than risperidone. The most common side effects observed in clozapine group were sedation The most common side effects noted in risperidone group were rigidity However, none of the patients discontinued treatment because of side effects.
Table III Open in a separate window Patients in clozapine group had a significant increase in BMI as compared to the risperidone group from fourth month onward; however, none of the patient in either group developed hypertension, impaired glucose tolerance, dyslipidaemia or any other electrocardiogram abnormalities.
Similarly, comparison on ASEX did not reveal any significance. Discussion In the present study, both the groups were comparable on sociodemographic variables as well as on severity of psychopathology and quality of life at the baseline. The results showed that both clozapine and risperidone fared equally well in terms of reducing the positive symptoms whereas clozapine was significantly superior to risperidone in reduction of negative symptoms at each assessment.
Earlier studies carried out on clozapine versus typical antipsychotics did not find benefit of clozapine over conventional antipsychotics in patients of first episode of schizophrenia or schizoaffective disorder 5 , 6 , 7.
Girgis et al 6 studied individuals with treatment-naive, first-episode schizophrenia or schizophreniform disorder who were randomized to clozapine or chlorpromazine treatment for up to two years and reported no significant differences in the effectiveness of two drugs.
However, the adherence to clozapine was better than chlorpromazine 26 vs. Woerner et al 5 while studying 34 cases of first episode of schizophrenia or schizoaffective disorder concluded that there was no benefit of clozapine over conventional antipsychotics for acute treatment of the first episode.
The Cochrane schizophrenia group performed a meta-analysis to compare several commonly used second-generation antipsychotics SGAs, risperidone, olanzapine, clozapine, amisulpride and quetiapine agents to investigate the efficacy and tolerability of these drugs in patients with schizophrenia or schizophrenia-like psychoses 20 , and the results showed that among the SGAs, no drug was better than the other.
The results showed that the Negative Syndrome Scale and total scores decreased more in patients treated with clozapine than in patients treated with quetiapine or risperidone, and treatment discontinuation for any reason was significantly longer for clozapine.
However, in our study, the mean dose of clozapine at six months was