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NICE guidelines - first medication atypical antipsychotic, if needed change to another antipsychotic, if two trials tried and remains in need of treatment, for consideration of clozapine.
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Clinical assessment - consider duration of untreated psychosis, risks, insight etc.
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Consider side effect profile and tolerability.
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Compliance; if monitoring is an issue, plasma levels, compliance aids, electronic devices, legal frameworks, MH/external services direct monitoring.
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If compliance is an issue consider depot, ¼ to 1/3 community patients on depot.
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If treatment resistant consider clozapine as soon as appropriate following trial of two antipsychotics at treatment doses and length, limited by tolerability and blood testing.
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Avoid poly pharmacy with two antipsychotics, no evidence for this unless augmenting clozapine or adding aripiprazole for hyperprolactinemia.
Treatments > Biological > Medication > Choice Of Antipsychotic