By Michael Robertson
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Extra info for Acute Psychiatric Management
Serious risk of teratogenicity. Increases risk of spina bifida to 1-4%. Commencing and monitoring valproate Before or at commencement, take baseline LFTs and a ß-HCG if relevant. Warn women about teratogenicity and polycystic ovarian syndrome. Warn about rare hepatic failure and other side effects. Warn manic patients and their families that post-manic depression is common, and is not the result of the mood stabiliser. They should seek treatment for this, if it occurs, and not cease the medication.
A novel antipsychotic agent. New England Journal Medicine. 1991;324(11):746-54 and UK clozapine study group. The safety and efficacy of clozapine in severe treatment-resistant schizophrenic patients in the UK. British Journal Psych. 1993;150-54. 40. Kane J, Honigfield G, Singer J, et al. Clozapine for the treatment-resistant schizophrenic; results of a US multicenter trial. Psychopharmacol. 1989;99:560-63. 41. Lieberman JA, Safferman AZ, Pollack S, et al. Clinical effects of clozapine in chronic schizophrenia: response to treatment and predictors of outcome.
Warn women about teratogenicity and polycystic ovarian syndrome. Warn about rare hepatic failure and other side effects. Warn manic patients and their families that post-manic depression is common, and is not the result of the mood stabiliser. They should seek treatment for this, if it occurs, and not cease the medication. Dosing Gradual (starting with 500mg and increasing to therapeutic dose over 2 or more weeks) or loading (20mg/kg, around 1500mg per day) regimes are safe and generally well tolerated.
Acute Psychiatric Management by Michael Robertson