Prescribing guidelines. The souTh london and Maudsley nhs FoundaTion TrusT oxleas nhs FoundaTion TrusT. 10th edition david Taylor carol Paton shitij Kapur. Pris: kr. E-bok, Laddas ned direkt. Köp Maudsley Prescribing Guidelines in Psychiatry. E-bok (PDF - DRM), Engelska, Ladda ned. Maudsley Prescribing Guidelines Conference To mark the launch of the 11th edition of The Maudsley Prescribing Guidelines.
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C David Taylor, Carol Paton and Shitij Kapur. Published by John Wiley & Sons, Ltd. 2 The Maudsley Prescribing Guidelines in Psychiatry (e.g. Request PDF on ResearchGate | On Jan 1, , D. Taylor and others published Maudsley Prescribing Guidelines in Psychiatry - 11th Edition. Apr , Wiley-Blackwell The lead author of all editions of the Maudsley Prescribing Guidelines, Professor Taylor is the author of several other texts and.
This is a reliable and well-validated tool utilising an electronic checklist of psychopathological symptoms that are scored, with algorithms for clinical diagnosis. Of sequential notes, had sufficiently detailed clinical information at the time of admission and of discharge for such assessment and accurate completion of OPCRIT scores at the two time points to be made. All patients, 86 male and 67 female, met ICD criteria for a primary diagnosis of schizophrenia, with 36 having a co-existent Axis II diagnosis: 36 had a lifetime history of alcohol dependence or harmful use 24 at the point of admission ; 49 a lifetime history of cannabis dependence or harmful use 37 at the point of admission ; and 31 a lifetime history of harmful use or dependency on other substances 23 on admission. The mean age on admission was 33 years s. Thirty patients had their first psychotic episode before the age of 16; in 53 patients it occurred between 17 and 20 years old; in 29, between 21 and 25 years; in 20, between 26 and 35; and 12 had their first episode after the age of At the time of admission, 21 patients were on clozapine monotherapy and 55 patients were taking clozapine with a second antipsychotic. To evaluate whether there was a significant difference between admission and discharge scores, paired-samples t-tests were conducted on the scores for appearance and behaviour, speech and form of thought, affect and associated features, abnormal beliefs and ideas, abnormal perceptions, and total clinical score.
Furthermore, it is also a significant cost to society in lost economic contribution and increased healthcare service use Kennedy et al. Clozapine remains the gold standard treatment for treatment-resistant schizophrenia and the only treatment with a really solid evidence base to support its use Taylor et al.
For a patient who has not responded to two different non-clozapine antipsychotic drugs, the chances of a response with another non-clozapine drug are very low, less than one in twenty, whereas with clozapine, it is one in two Kane et al.
This is a number needed to treat of 2: an astonishingly low number for any field of medicine and testament to the unique place for clozapine in the treatment of schizophrenia. However, it has a narrow therapeutic window and a number of dose-related side-effects, requiring a complex dose titration Howes et al. Furthermore, levels much above 0. Interpatient variability in clozapine metabolism is considerable, and this combined with the potential for other pharmacokinetic interactions not least smoking may make achieving therapeutic plasma levels difficult.
Clinicians could prescribe doses above the licensed maximum but if metabolism is rapid, this may simply increase the levels of metabolites and attendant side effects, with little appreciable increase in clozapine levels. Furthermore, dose increases, even within the licensed range, may be unacceptable to patients because of the increased tablet burden. In this context, fluvoxamine added to clozapine treatment may have a special role.
Polypharmacy is usually considered a dirty word in psychiatry. Adding more medicines to established treatments, including to clozapine, usually results in disappointing clinical outcomes Taylor et al. However, in some circumstances, it may be justifiable. The article in this edition from Polcwiarkek and Nielsen reviews the use of the antidepressant fluvoxamine as an augmenting agent to clozapine Polcwiartek and Nielsen The benefits may be twofold—firstly for residual negative and depressive symptoms.
Secondly, fluvoxamine is a potent CYP1A2 inhibitor, and this lends it some characteristics when combined with clozapine that are unusual. Until then, helpful approaches to staging, including multi-dimensional models are being developed.
The initial development of the model was based on extensive literature review, and systematic assessment of the dimensions making the MSM as well as testing of the construct using original data. The MSM has shown promising predictive validity for both short-term [ 24 — 26 ] and longer-term outcomes [ 27 , 28 ] of TRD.
In addition to indications of construct validity based on more elaborate evaluation [ 29 ], the MSM has also been used for screening purposes in clinical trials [ 30 , 31 ] and in studies of determinants of treatment outcomes [ 32 ]. The tool was developed as a loosely structured instrument such that a clinician with mental health training would be able to complete it. However, we have not published a detailed guidance on how the MSM should be completed. We have received many requests by researchers to provide such guidance to help standardise the completion of the MSM.
The primary aim of this paper is to offer tools for standardisation of the MSM.
The paper also provides context by providing an overview of the definitions and staging methods of treatment-resistance in depression and by providing an overview of the main staging methods to date. Methods The methods were guided by three questions relevant to the objectives of the study: 1 How is TRD defined and what are the staging methods for TRD employed in clinical practice and research? We relied on three complementary approaches to answer these questions. Narrative review was chosen because of the need to focus on high level answers to the questions raised above given the relatively broad nature of the questions asked.
We were also convinced that a broad range of papers of sufficient quality would be obtained through this method. Nevertheless, we borrow some approaches from systematic review methodology to make sure all key works in the field of research are captured and minimise risk of bias.
Thus, we searched in Embase, Medline and PsycInfo databases using key terms relevant for treatment resistant depression and staging developed in Pubmed. The reviewed literature was imported into Endnote software. Ethical considerations Not applicable. These tools include measures of the MSM dimensions, illness severity and remission, duration of illness and treatment. We provide a new instrument to collect data on the treatments offered during the course of illness, the Maudsley Treatment Inventory MTI.
Definitions Definitions from treatment studies A review of 47 treatment trials explored the definitions and staging criteria in TRD [ 37 ]. Lack of consensus was described in both the definition of the depressive syndrome and in how treatment response was operationalised. The required number of antidepressant failure to define treatment non-response was failure of at least one antidepressant medication in about a quarter of studies, while about half required non-response to at least two antidepressant medications [ 37 ].
Treatment non-response was characterized either in terms of failure to achieve a specified percentage reduction in the score of a rating scale or the continuation of a major depressive episode despite treatment.
Most studies defined treatment failure only in relation to the presenting episode while few also included treatment failures, or recurrences whilst on treatment, in previous episodes. The National Institute of Clinical Excellence NICE defined treatment-resistance in a similar way as failure to respond to two or more sequentially given antidepressant medications [ 41 ].