The Maudsley Prescribing Guidelines for Mental Health Conditions in Physical Illness

Psychotropic medications are serious treatments for serious illnesses. Whilst often effective in the medically fit population, they frequently produce disappointing efficacy outcomes in the medically unwell patient. Their use is made more difficult by wide-ranging side effects which may complicate management or worsen symptoms or disease pathology of physical illnesses. Medical illnesses themselves may impact on the pharmacokinetics, pharmacodynamics and physical practicalities of administering psychiatric medications, with implications for their effectiveness and safe use.  

The availability of information to guide the clinician through drug choice for these patients is limited; research trials frequently exclude the medically unwell, guidelines are written for those without comorbidity, and where policies do exist, they do not account for the multimorbidity frequently seen in real-world practice. Further, prescribing and management of psychotropic medicines in non-mental health specialist settings may be fraught with practical difficulties, including access to medication and experience with its use.

This book will discuss safe and effective pharmacological management of depression, anxiety, psychosis, bipolar affective disorder and other psychiatric illnesses in patients with a range of physical health conditions, including cardiac disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and renal and hepatic impairment. It will include advice for those with comorbid conditions that commonly occur alongside these diseases. The evidence base for the use of medicines will be discussed, as well as drug interactions, relative contraindications, and management of side effects.

Pharmacological measures for the management of agitation and aggression in the non-mental health hospital setting will be outlined, and the management of psychotropics for a variety of scenarios in critical care settings will be discussed. Complex and frequently encountered scenarios facing the clinician working with medically unwell patients will be covered, including restarting psychotropics after overdose, the use of clozapine in physical illness, steroid-induced psychiatric conditions, venous thromboembolism in psychiatry, and delirium.Psychotropic medications are serious treatments for serious illnesses. Whilst often effective in the medically fit population, they frequently produce disappointing efficacy outcomes in the medically unwell patient. Their use is made more difficult by wide-ranging side effects which may complicate management or worsen symptoms or disease pathology of physical illnesses. Medical illnesses themselves may impact on the pharmacokinetics, pharmacodynamics and physical practicalities of administering psychiatric medications, with implications for their effectiveness and safe use. The availability of information to guide the clinician through drug choice for these patients is limited; research trials frequently exclude the medically unwell, guidelines are written for those without comorbidity, and where policies do exist, they do not account for the multimorbidity frequently seen in real-world practice. Further, prescribing and management of psychotropic medicines in non-mental health specialist settings may be fraught with practical difficulties, including access to medication and experience with its use. This book will discuss safe and effective pharmacological management of depression, anxiety, psychosis, bipolar affective disorder and other psychiatric illnesses in patients with a range of physical health conditions, including cardiac disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and renal and hepatic impairment. It will include advice for those with comorbid conditions that commonly occur alongside these diseases. The evidence base for the use of medicines will be discussed, as well as drug interactions, relative contraindications, and management of side effects. Pharmacological measures for the management of agitation and aggression in the non-mental health hospital setting will be outlined, and the management of psychotropics for a variety of scenarios in critical care settings will be discussed. Complex and frequently encountered scenarios facing the clinician working with medically unwell patients will be covered, including restarting psychotropics after overdose, the use of clozapine in physical illness, steroid-induced psychiatric conditions, venous thromboembolism in psychiatry, and delirium.