Rx Note

Introduction Schizophrenia is a major psychiatric disorder that alters an individual's perception, thought, affect and behaviour. Onset is usually between adolescence and early adulthood. Most patients fluctuate between acute episodes and remission. Residual symptoms may present between episodes. Risk Factors Family history of schizophrenia. Substance-induced psychoses associated with cannabis, hallucinogens and amphetamines. Increasing paternal age. Most urban environment. Refugee and migrant status. History of obstetric complications, e.g. pre-eclampsia and extreme prematurity. Prenatal exposure to infections, e.g. Herpes Simplex (HSV-2) and toxoplasma gondii. History of childhood central nervous system infection. Symptoms The Diagnostic and Statistical Manual for Mental Disorders (DSM-5) identifies 5 symptoms for diagnosis. At least 2 of the following symptoms must be present for at least 1 month , and Delusions Hallucinations Disorganized speech (e.g. frequent derailment or in...

Indications Clozapine is an antipsychotic that should be offered to people with schizophrenia whose illness has not responded adequately to treatment despite the sequential use of adequate doses of at least 2 different antipsychotic drugs (i.e. treatment resistant schizophrenia ). Also, it is used to treat psychosis associated with Parkinson's disease . Initiation Schedule Start treatment at a low dose and to increase dosage slowly. Many of the adverse effects of clozapine are dose-dependent and associated with speed of titration. Adverse effects (e.g. sedation, hypersalivation and hypotension) also tend to be more common and severe at the beginning of therapy. Taken at night. Blood pressure should be monitored hourly for 6 hours because of the hypotensive effect of clozapine. This monitoring is not usually necessary if the first dose is given at night. Missed Doses If, for any reason, a patient misses <2 days' clozapine, restart at the dose prescribed before the event. Do ...