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Acute Phase
Î Dosing
• Many drugs are dosed higher in practice than in clinical trials (eg, olanzapine,
quetiapine, paliperidone ER, ziprasidone)
• Higher dosing for multi-episode patients
• Maintenance doses lower than acute treatment doses
• Lower doses in elderly and children
Î Adequate treatment trial
• Wait a minimum of 3 weeks and maximum of 6 weeks before making a major
change to the treatment regimen
• In patients showing a partial response, extend trial duration to 4-10 weeks
Stabilization Phase
Î Monitor medication response and dose for the next 6 months
Î Assess adverse effects and adjust medication as needed to
minimize them
Î Continue psychotherapeutic interventions
Î Patient and family education
• Course and outcome of illness
• Importance of treatment adherence
• Realistic goal setting
Î Arrange for linkage of services between hospital and community
treatment before the patient is discharged from the hospital
Stable Phase
Î Ongoing monitoring and assessment
• EPS at each clinical visit
• Abnormal involuntary movements
▶ Every 6 months for patients taking conventional antipsychotics
Note: Every 3 months for patients at increased risk
▶ Every 12 months for patients taking atypical antipsychotics
Note: Every 6 months for patients at increased risk
• Weight and calculate BMI; waist circumference when possible
▶ Every 3 months; quarterly thereafter for outpatients; monthly for inpatients
• Triglycerides monthly in patients at high risk for metabolic complications or on
high risk agents such as clozapine or olanzapine
• Fasting glucose and glycosylated hemoglobin a1c at 3 months then annually for
outpatients and low risk antipsychotics; more frequently for inpatients and with
high risk agents
• Electrolytes, renal, liver and thyroid function annually
• Vital signs, CBC, ECG; prolactin when clinically indicated
• Where feasible, maintain an alliance with individuals who are likely to notice
resurgence of symptoms in the patient
