Psychoses and schizophrenia
Prescribing should only be commenced after seeking specialist advice, except in circumstances where prescribers feel confident to prescribe e.g. an existing patient suffering a recurrent acute episode previously managed on antipsychotic treatment.
Where a specialist opinion has been sought, GP’s will be asked to continue prescribing and monitor the physical health of the patient, where appropriate
NICE CG178 - Psychosis and schizophrenia in adults
Further information can be found at: SPfT: Guidance on the use of antipsychotics
Atypical Antipsychotics: metabolic effects
Some second-generation antipsychotics are associated with metabolic adverse effects, namely significant weight gain (>7% of baseline), dyslipidaemia, and hyperglycaemia. Atypical antipsychotics vary in the extent to which they cause metabolic adverse effects but clozapine, olanzapine, and quetiapine are especially implicated.
Atypical Antipsychotics: Stroke
Antipsychotics are associated with an increased risk of cerebrovascular adverse events and greater mortality when used in patients with dementia.
Use of antipsychotics should be avoided except in cases of severe distress or if there is an immediate risk of harm to the person or others.
DO NOT USE antipsychotics in Lewy Body dementia or Parkinson’s disease dementia.For information on short term use of risperidone in dementia. See the Dementia Prescribing Support document for GPs
Choice of Antipsychotic
All antipsychotics should be initiated by a specialist when used to treat psychosis and schizophrenia. Information on suitable choices can be found here.