RevisePsych

Choice of Antipsychotic

• 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.

• Clinical assessment - consider duration of untreated psychosis, risks, insight etc.

• Consider side effect profile and tolerability.

• Compliance; if monitoring is an issue, plasma levels, compliance aids, electronic devices, legal frameworks, MH/external services direct monitoring.

• If compliance is an issue consider depot, ¼ to 1/3 community patients on depot.

• 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.

• Avoid poly pharmacy with two antipsychotics, no evidence for this unless augmenting clozapine or adding aripiprazole for hyperprolactinemia.