tailieunhanh - HANDBOOK OF PSYCHIATRIC DRUGS - PART 2

Mặc dù hy vọng điều này, có ít, nếu có bằng chứng lâm sàng rằng một liều cao thuốc chống loạn thần trong bất kỳ cách nào thuận lợi, trong thực tế, nó sẽ chỉ làm tăng khả năng tác dụng phụ. Trong thời gian khó khăn này có thể cần thêm thuốc an thần | 12 handbook of psychiatric drugs ill there is often a tremendous temptation and external pressure to increase the dose of the antipsychotic in the hope that the patient s condition will improve more rapidly. Despite this hope there is little if any clinical evidence that a higher dose of antipsychotic is in any way advantageous in fact it will only increase the likelihood of side effects. During this difficult time it may be necessary to add sedating medications such as shortacting benzodiazepines . lorazepam to help the patient maintain control until the antipsychotic has started to work. TREATMENT EVALUATION AND DRUG SWITCHING If the first-episode patient has failed to respond to a 6-week trial of an antipsychotic the clinician should evaluate possible non-compliance with medication the likelihood of a partial response or a complete nonresponse to treatment. If there was no response a change to a second antipsychotic from a new family is recommended. If one of the newer agents was not the clinician s first choice it should be used at this point in the decision tree. If a patient has already discontinued use of a medication then the new treatment is selected and initiated as described above. However if the patient is undergoing maintenance drug treatment and drugs are to be electively switched in the hope of achieving a better therapeutic response or alleviating drug side effects then the goal is to switch medications without destabilizing the patient. Medication changes should be performed by a concurrent slow tapering of the initial antipsychotic while the second antipsychotic is being slowly titrated. The specific rate of crosstitration depends on the dose of the old medication and the relative stability of the patient. In general the higher the dose and the more unstable the patient the longer and more gradual the cross-titration schedule. Although this varies a rule of thumb is to cross-titrate by yoked increments and decrements of 25 every 2 to 5 days. .

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