Psychiatry

🧠 Psychiatry Module

Pharma-Advance · Dept. of Pharmacology · IPS / APA / NICE Guidelines

🚨

Suicide Risk — Always Screen

Use PHQ-9 Q9 as initial screen. If positive → Columbia Suicide Severity Rating Scale (C-SSRS). iCall helpline (India): 9152987821

📋 Antipsychotic Metabolic Monitoring
Recommended at baseline and 3-monthly · IPS 2020
0 / 8 completed
⚠️ Psychiatric Emergency Quick Reference
Acute Agitation
Lorazepam 2mg IM + Haloperidol 5mg IM (if antipsychotic naive — reduce dose). De-escalation first. Secure environment. Vitals monitoring.
Neuroleptic Malignant Syndrome
STOP antipsychotic IMMEDIATELY. Dantrolene 1–2.5 mg/kg IV, Bromocriptine 2.5mg TDS. ICU admission. Supportive: cooling, IV fluids, monitor CK, creatinine.
Serotonin Syndrome
STOP all serotonergic agents. Cyproheptadine 12mg loading + 2mg q2h. IV fluids, benzodiazepines for agitation. Severe cases: ICU, intubation if needed.
Lithium Toxicity
STOP lithium. IV 0.9% NaCl. Haemodialysis if: level >2.5mmol/L, seizures, renal failure, or severe symptoms. Monitor ECG.
Acute Dystonia
Benztropine 1–2mg IM/IV OR Diphenhydramine 25–50mg IM/IV. Immediate relief usually in 5–15 minutes. Prevention: prophylactic benztropine with high-potency antipsychotics.
💡 Clinical Pearls
💎

Always rule out organic causes before diagnosing primary psychiatric illness: hypothyroidism (depression), hyperthyroidism (anxiety), B12 deficiency (psychosis/depression), SLE, Wilson's disease.

💎

SSRIs take 4–6 weeks for full antidepressant effect. Inform patients — poor compliance at week 2 due to "not working" is the most common cause of treatment failure.

💎

Never start antidepressants without screening for bipolar disorder (MDQ questionnaire) — risk of precipitating manic switch.

💎

Clozapine is the only evidence-based treatment for treatment-resistant schizophrenia (failed ≥2 adequate antipsychotic trials). ANC monitoring is mandatory.

💎

Lithium interacts with NSAIDs, ACE inhibitors, and thiazides — common cause of acute-on-chronic toxicity in Indian general medicine wards.

💎

Benzodiazepine prescriptions in India require special narcotic form (Form 7 in most states). Maximum 30 days supply.

Sources: KD Tripathi · BNF 2024 · CDSCO · IPS Guidelines 2020 · APA DSM-5-TR · NICE CG90/CG91
Compiled by Dept. of Pharmacology · pharmaadvance.in · v1.0

😔 PHQ-9
Patient Health Questionnaire · Depression Screening & Severity · Validated in Indian population
📌

Over the last 2 weeks, how often have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling or staying asleep, or sleeping too much

4. Feeling tired or having little energy

5. Poor appetite or overeating

6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down

7. Trouble concentrating on things, such as reading the newspaper or watching television

8. Moving or speaking so slowly that other people could have noticed? Or being so fidgety/restless you've been moving around more than usual

⚠️ Suicidality Screen

9. Thoughts that you would be better off dead, or thoughts of hurting yourself in some way

PHQ-9 Score Interpretation
ScoreSeverityAction
0–4MinimalWatch & wait
5–9MildCounselling
10–14ModerateStart SSRI
15–19Mod-SevereSSRI + refer
20–27SevereUrgent refer
😰 GAD-7
Generalized Anxiety Disorder Scale · Over the last 2 weeks
📌

Before diagnosing GAD, rule out: hyperthyroidism, phaeochromocytoma, cardiac arrhythmia, substance use (caffeine, stimulants, alcohol withdrawal), medication side effects (salbutamol, corticosteroids).

1. Feeling nervous, anxious, or on edge

2. Not being able to stop or control worrying

3. Worrying too much about different things

4. Trouble relaxing

5. Being so restless that it's hard to sit still

6. Becoming easily annoyed or irritable

7. Feeling afraid as if something awful might happen

GAD-7 Score Interpretation
ScoreSeverityAction
0–4MinimalReassurance
5–9MildSelf-help / CBT
10–14ModerateSSRI + CBT
15–21SevereUrgent refer
🍺 CIWA-Ar
Clinical Institute Withdrawal Assessment for Alcohol · Revised · Rate each item 0–7 based on current observation
⚠️ Alcohol withdrawal seizures typically occur within 6–48h of last drink. Delirium tremens peaks at 48–72h. CIWA-Ar is most useful when done serially every 4–8 hours.
Live Total Score
0

1. Nausea / Vomiting

Ask: "Do you feel sick to your stomach? Have you vomited?" 0=none, 7=constant nausea with dry heaves
0 7 0

2. Tremor

Observe arms extended. 0=no tremor, 7=severe tremor even without arm extension
0 7 0

3. Paroxysmal Sweats

Observe. 0=no sweat, 7=drenching sweats
0 7 0

4. Anxiety

Ask: "Do you feel nervous?" 0=none, 7=acute panic, severe anxiety
0 7 0

5. Agitation

Observe. 0=normal, 7=paces constantly or constantly thrashes about
0 7 0

6. Tactile Disturbances

"Any itching, pins and needles, burning, numbness, bugs crawling?" 0=none, 7=continuous hallucinations
0 7 0

7. Auditory Disturbances

"Sounds harsh? Hearing things disturbing you?" 0=none, 7=continuous hallucinations
0 7 0

8. Visual Disturbances

"Does light appear bright? Do you see unusual shapes?" 0=none, 7=continuous hallucinations
0 7 0

9. Headache / Fullness in Head

"Does your head feel different? Bandlike pressure?" 0=none, 7=extremely severe
0 7 0

10. Orientation / Clouding

Ask date, year, who is PM. 0=fully oriented, 4=disoriented to time by >2 calendar days
0 4 0
💎

Always give thiamine (B1) 100–300mg IV BEFORE any glucose — prevents precipitating Wernicke's encephalopathy. Never give glucose first in a malnourished alcoholic patient.

🤲 AIMS Scale
Abnormal Involuntary Movement Scale · Tardive Dyskinesia Monitoring · Rate after observing patient at rest and with activation
📌

Examine patient sitting quietly, standing, walking, protruding tongue, tapping fingers, and performing activation manoeuvres. Rate the highest severity observed.

Facial & Oral Movements

1. Muscles of facial expression (e.g., movements of forehead, eyebrows, periorbital area, cheeks)

2. Lips and perioral area (e.g., puckering, pouting, smacking)

3. Jaw (e.g., biting, clenching, chewing, mouth opening, lateral movement)

4. Tongue — Rate only involuntary tongue movements. If patient cannot fully extend tongue, do not score.

Extremity Movements

5. Upper (arms, wrists, hands, fingers) — Include choreic and athetoid movements

6. Lower (legs, knees, ankles, toes) — e.g., lateral knee movement, foot tapping, heel dropping

Trunk Movements

7. Neck, shoulders, hips (e.g., rocking, twisting, squirming)

Global Judgements

8. Severity of abnormal movements overall

9. Incapacitation due to abnormal movements

10. Patient's awareness of abnormal movements (0=no awareness, 4=aware, severe distress)

Dental Status (Not Scored)

11. Current problems with teeth and/or dentures

12. Does patient usually wear dentures?

⚠️ AIMS should be performed at baseline before starting antipsychotics, then every 6 months (or 3 monthly if high-dose or high-risk). Document in patient records for medico-legal purposes.
⚖️ Benzodiazepine Equivalence Calculator
Ashton Manual–based equivalences · For tapering / switching · India brands included
Tapering Guidance (Ashton Protocol)
1
Switch to an equivalent dose of diazepam (longest half-life, smoothest taper)
2
Reduce by ~10% of current dose every 2–4 weeks
3
Slow down further in the lower dose range (e.g., <5mg diazepam)
4
Never stop abruptly — risk of seizures, rebound anxiety, delirium
5
Total taper duration: typically 3–12 months depending on duration of use
6
Monitor for: rebound anxiety, insomnia, seizures, depersonalisation
⚠️ In India, benzodiazepines are Schedule H drugs. Prescription required. Maximum 30 days supply. Alprazolam and triazolam are Schedule X (higher control). Prescriptions must be retained by chemist.
💊 Psychiatric Drug Reference
Tap a card to expand · Indian brands · IPS/BNF/KD Tripathi
Sertraline
SSRI
🏷️ Indian Brands: Daxid, Serlift, Zosert
Dose Range
50–200mg OD
Starting Dose
25–50mg OD with food (morning or evening). Increase by 25–50mg every 1–2 weeks.
Onset of Action
4–6 weeks
Half-Life
26h (active metabolite: 66h)
Mechanism of Action
Selective serotonin reuptake inhibitor (SERT). Minimal effect on NE/DA reuptake.
Indications
MDD, GAD, Panic disorder, OCD, PTSD, Social anxiety, PMDD
Key Side Effects
GI upset (nausea, diarrhoea) — take with food. Sexual dysfunction. Insomnia or drowsiness. Initial anxiety. Rarely: serotonin syndrome.
Drug Interactions
MAOIs (contraindicated, 14-day washout). Tramadol, triptans, lithium (serotonin syndrome risk). Warfarin (monitor INR). CYP2D6 inhibitor.
Monitoring
Clinical response at 4–6 weeks. Suicide risk in first 4 weeks. Sodium if elderly.
Tapering
Taper over ≥4 weeks to avoid discontinuation syndrome. Never stop abruptly.
⚠️ Black box: Increased suicidal ideation in <25 years in first 1–4 weeks. Counsel and monitor.
Preg: C (preferred SSRI in pregnancy — best safety data) Max: 200mg/day
Escitalopram
SSRI
🏷️ Indian Brands: Nexito, Stalopam, Feliz-S
Dose Range
10–20mg OD
Starting Dose
5–10mg OD. Increase to 20mg after 1–2 weeks if tolerated.
Onset of Action
4–6 weeks
Half-Life
27–32h
Mechanism of Action
S-enantiomer of citalopram. Highly selective SERT inhibitor. Minimal off-target receptor activity.
Indications
MDD, GAD, Panic disorder, OCD, Social anxiety. Preferred in elderly.
Key Side Effects
Similar to sertraline. Less drug interactions (minimal CYP inhibition). QTc prolongation at higher doses.
Drug Interactions
MAOIs. QTc-prolonging drugs (avoid combo — check QTc calculator). Serotonergic drugs.
Monitoring
ECG if dose >10mg in cardiac patients or elderly. Response at 4–6 weeks.
Tapering
Taper over 4–8 weeks.
⚠️ Dose-dependent QTc prolongation — caution in patients with cardiac disease.
Preg: C (generally safe; neonatal adaptation syndrome with late pregnancy use) Max: 20mg/day (10mg in elderly, hepatic impairment)
Fluoxetine
SSRI
🏷️ Indian Brands: Fludac, Prozac, Flunil
Dose Range
20–80mg OD
Starting Dose
20mg OD morning. Increase by 20mg every 4 weeks. Activating — give morning dose.
Onset of Action
4–6 weeks
Half-Life
1–4 days (norfluoxetine: 4–16 days)
Mechanism of Action
SERT inhibitor. Longest half-life of SSRIs — least discontinuation syndrome.
Indications
MDD, Bulimia nervosa, OCD, Panic disorder, PMDD (20mg once weekly approved)
Key Side Effects
Activation/insomnia (give morning). Anorexia/weight loss initially. Sexual dysfunction.
Drug Interactions
Potent CYP2D6 inhibitor — CRITICAL: Increases TCAs, antipsychotics, opioids (tramadol, codeine), tamoxifen levels. MAOIs: 5-week washout required (ultra-long half-life).
Monitoring
Drug interactions — always check for CYP2D6 substrates. Response at 6 weeks.
Tapering
Long half-life means minimal discontinuation syndrome. Can taper rapidly or even stop directly in most cases.
⚠️ ⚠️ Potent CYP2D6 inhibitor — many drug interactions. 5-week washout before MAOI.
Preg: C (avoid in 3rd trimester if possible — neonatal pulmonary hypertension rare risk) Max: 80mg/day (OCD), 60mg/day (depression)
Venlafaxine
SNRI
🏷️ Indian Brands: Veniz, Venlor, Effexor
Dose Range
75–375mg OD (XR preferred)
Starting Dose
37.5–75mg OD XR with food. Increase by 75mg every 2–4 weeks.
Onset of Action
4–6 weeks
Half-Life
5h (O-desmethylvenlafaxine: 11h)
Mechanism of Action
SNRI — dose-dependent: 5-HT reuptake at low doses (75mg), NE reuptake added at higher doses (≥150mg). DA at very high doses.
Indications
MDD (especially with comorbid anxiety/pain), GAD, Panic, Social anxiety, PTSD. Diabetic neuropathy pain.
Key Side Effects
Dose-dependent BP increase (check BP before and after dose change). Nausea (pass with time), sweating, sexual dysfunction, dry mouth.
Drug Interactions
MAOIs. CYP2D6 substrate. Serotonergic drugs. Weak CYP2D6 inhibitor.
Monitoring
BP at each dose increase. Heart rate (can increase HR). Discontinuation syndrome is severe — never stop abruptly.
Tapering
Taper VERY slowly (10% reduction per 2–4 weeks). Switch to fluoxetine 20mg then taper for very difficult cases.
⚠️ ⚠️ Discontinuation syndrome is intense (dizziness, electric shock sensations, flu-like). Taper very slowly. Also: dose-dependent hypertension — monitor BP.
Preg: C Max: 375mg/day
Amitriptyline
TCA
🏷️ Indian Brands: Tryptomer, Amitone, Elavil
Dose Range
25–150mg OD (nightly)
Starting Dose
10–25mg nocte. Increase by 10–25mg every 1–2 weeks. For pain: often 10–25mg sufficient.
Onset of Action
2–6 weeks (antidepressant), analgesic effect earlier
Half-Life
9–25h
Mechanism of Action
NE + 5-HT reuptake inhibition + anticholinergic + antihistaminergic + alpha-1 blockade + Na-channel block.
Indications
Neuropathic pain (very widely used in India), tension headache prophylaxis, fibromyalgia, MDD (less preferred now), insomnia, IBS.
Key Side Effects
Anticholinergic (dry mouth, constipation, urinary retention, blurred vision). Sedation. Orthostatic hypotension. Weight gain. QTc prolongation.
Drug Interactions
MAOIs (contraindicated). Serotonergic drugs. QTc-prolonging drugs. Anticholinergic drugs. CYP2D6 substrate (fluoxetine increases levels).
Monitoring
ECG before starting (check QTc). BP. Caution in elderly (falls, confusion).
Tapering
Taper over 4–8 weeks. Abrupt stoppage causes: flu-like symptoms, GI distress, sleep disturbance.
⚠️ ⚠️ FATAL in overdose (cardiac arrhythmia — Na channel blockade). Do NOT prescribe to patients at suicide risk. Contraindicated in: glaucoma, BPH, post-MI, heart block.
Preg: C (relatively safer TCA in pregnancy) Max: 300mg/day (depression). 75mg commonly effective for pain.
Haloperidol
Typical Antipsychotic
🏷️ Indian Brands: Serenace, Haloperi
Dose Range
0.5–20mg/day (divided or OD)
Starting Dose
Oral: 0.5–2mg BD-TDS. Acute agitation: 5mg IM (2.5mg in elderly/naive).
Onset of Action
Sedation: hours. Antipsychotic: 2–4 weeks
Half-Life
14–36h
Mechanism of Action
D2 receptor antagonist (high affinity). Also H1, alpha-1, muscarinic blockade (weak).
Indications
Acute psychosis/agitation (IM), Schizophrenia, Mania (adjunct), Delirium (low dose), Tourette syndrome, Intractable hiccups, Nausea (low dose).
Key Side Effects
EPS (MOST common typical AP side effect): dystonia, akathisia, Parkinsonism, tardive dyskinesia. QTc prolongation (esp. IV haloperidol). Hyperprolactinemia. NMS (rare but life-threatening).
Drug Interactions
QTc-prolonging drugs (⚠️ — use QTc calculator). CNS depressants. Anticholinergics.
Monitoring
ECG (QTc) before and after starting. AIMS score 6-monthly. EPSE monitoring. Check for NMS if fever + rigidity.
Tapering
Taper over months. Never stop abruptly in stable schizophrenia — high relapse risk.
⚠️ ⚠️ IV haloperidol causes severe QTc prolongation — cardiac monitoring mandatory. High EPS risk — consider prophylactic benztropine if first-episode or high dose.
Preg: C Max: 100mg/day (rarely needed; generally <20mg)
Olanzapine
Atypical Antipsychotic
🏷️ Indian Brands: Oliza, Oladay, Oleanz
Dose Range
5–20mg OD (nocte)
Starting Dose
5–10mg OD nocte. Increase by 5mg every 1–2 weeks.
Onset of Action
1–4 weeks
Half-Life
21–54h
Mechanism of Action
D2 + 5-HT2A antagonist. Also D1, D4, muscarinic, H1, alpha-1 blockade.
Indications
Schizophrenia, Bipolar mania (acute + maintenance), Treatment-resistant depression (augmentation), Acute agitation (IM).
Key Side Effects
⚠️ Metabolic syndrome (MOST significant) — weight gain (2–3kg in first month), hyperglycaemia, dyslipidaemia, diabetes. Sedation. Orthostatic hypotension. Low EPS risk. Anticholinergic.
Drug Interactions
Carbamazepine (reduces olanzapine levels 30–50%). Fluvoxamine (increases levels). CNS depressants. QTc drugs (lower risk than haloperidol).
Monitoring
Metabolic monitoring: FBG, fasting lipids, weight, BMI, BP at baseline, 1 month, 3 months, 6 months. HbA1c if prolonged use.
Tapering
Taper slowly. Cholinergic rebound (nausea, sweating, insomnia) on rapid cessation.
⚠️ ⚠️ Highest metabolic risk among atypicals. Avoid in pre-diabetic/obese patients if possible — consider alternative. Olanzapine + lorazepam IM: rare fatal respiratory depression.
Preg: C (most data among atypicals) Max: 20mg/day (occasionally higher in treatment resistance)
Clozapine
Atypical Antipsychotic
🏷️ Indian Brands: Sizopin, Clozaril, Lozapin
Dose Range
12.5–900mg/day (divided BD)
Starting Dose
12.5mg OD-BD, titrate 25–50mg every 1–2 days as tolerated. Target: 300–600mg/day.
Onset of Action
4–12 weeks
Half-Life
12h
Mechanism of Action
D4 > D2 antagonist. 5-HT2A, 5-HT2C, H1, M1, alpha-1, alpha-2 blockade. Low D2 — minimal EPS.
Indications
Treatment-resistant schizophrenia (ONLY after ≥2 adequate AP trials). Psychosis in Parkinson's disease. Suicidal ideation in schizophrenia/schizoaffective disorder.
Key Side Effects
⚠️ AGRANULOCYTOSIS (1–2%) — mandatory ANC monitoring. Seizures (dose-dependent, >600mg). Hypersalivation (nocturnal drooling — very common). Sedation. Metabolic syndrome. Orthostatic hypotension. Myocarditis (first 4–8 weeks).
Drug Interactions
NEVER combine with drugs that suppress bone marrow (carbamazepine, chloramphenicol). Fluvoxamine markedly increases clozapine levels. Caffeine increases levels.
Monitoring
ANC MANDATORY: Weekly for 18 weeks, then monthly. STOP if ANC <1.5×10³/μL (moderate neutropenia) or <1.0 (severe — never re-challenge). ECG, BP, TFTs, metabolic parameters. Clozapine blood level if poor response or toxicity (target 250–350 ng/mL).
Tapering
Discontinue over ≥1–2 weeks (NEVER abrupt — risk of rebound psychosis, cholinergic rebound, seizures).
⚠️ 🚨 BOXED WARNING: Agranulocytosis. Seizures. Myocarditis. Orthostatic hypotension. CNS/respiratory depression. Available ONLY through REMS programme (controlled monitoring) in some regions.
Preg: B (use only if essential) Max: 900mg/day
Lithium
Mood Stabilizer
🏷️ Indian Brands: Licab, Lithosun, Priadel
Dose Range
600–1800mg/day (divided BD-TDS)
Starting Dose
300mg BD-TDS. Check level after 5 days (steady state). Adjust to therapeutic level. Give 12h after last dose for levels.
Onset of Action
5–14 days
Half-Life
18–36h (increases with age, renal impairment)
Mechanism of Action
Inhibits inositol monophosphatase, GSK-3β, adenylyl cyclase. Modulates serotonin, NE. Neuroprotective.
Indications
Bipolar disorder (gold standard for maintenance, anti-manic, anti-suicide). Treatment-resistant depression augmentation. Cluster headache prophylaxis.
Key Side Effects
Tremor (fine postural — dose-related, propranolol 10–40mg PRN). Polyuria/polydipsia (nephrogenic DI). Hypothyroidism (20%). Weight gain. GI upset (take with food). Memory dulling. Teratogen (Ebstein's anomaly).
Drug Interactions
⚠️ NSAIDs (↑Li levels), ACE inhibitors/ARBs (↑Li levels), Thiazide diuretics (↑Li levels), Loop diuretics (↓Li levels usually). All increase toxicity risk. Haloperidol + Li: NMS risk.
Monitoring
See Lithium Monitor tab for full protocol. Level, eGFR, TFTs, FBC, weight.
Tapering
Do NOT stop abruptly — risk of rebound mania. Taper over ≥4 weeks minimum.
⚠️ ⚠️ NARROW THERAPEUTIC INDEX. Toxicity at >1.5mmol/L. Risk: dehydration, fever, diarrhoea, vomiting, drug interactions. Patients must be educated about maintaining hydration and when to seek help.
Preg: D (Ebstein's anomaly risk — relative, not absolute. Counsel and risk-benefit). Max: Guided by serum level (not dose)
Sodium Valproate
Mood Stabilizer
🏷️ Indian Brands: Valparin, Encorate, Depakote
Dose Range
500–2500mg/day (divided BD)
Starting Dose
200–500mg BD. Increase by 200mg every 3 days. Valproate CR preferred for mood stabilisation.
Onset of Action
3–14 days
Half-Life
9–16h (CR formulation smoother)
Mechanism of Action
Increases GABA (inhibits GABA transaminase + increases synthesis). Sodium channel blockade. Inhibits histone deacetylase.
Indications
Bipolar mania (acute + maintenance, especially if rapid cycling or mixed states), Epilepsy (primary), Migraine prophylaxis.
Key Side Effects
GI upset (take with food). Weight gain. Hair loss (telogen effluvium — try zinc + selenium supplements). Tremor. Liver toxicity (rare but monitor). Polycystic ovarian syndrome (women of reproductive age). Cognitive dulling.
Drug Interactions
Carbamazepine (decreases valproate levels). Lamotrigine (valproate DOUBLES lamotrigine levels — halve lamotrigine dose). Aspirin (increases free valproate). Enzyme inducers reduce VPA levels.
Monitoring
LFTs at baseline, 1 month, 3 months. FBC. Valproate level (trough) at 50–125 μg/mL. Serum ammonia if encephalopathy suspected. Weight, menstrual cycle in women.
Tapering
Taper over months if discontinuing. Risk of seizure recurrence even in mood disorder.
⚠️ 🚨 TERATOGEN — absolute contraindication in pregnancy. Always discuss contraception with female patients. CDSCO: Pregnancy Prevention Programme advised.
Preg: X / D — ⚠️ CONTRAINDICATED in pregnancy (neural tube defects, neurodevelopmental teratogen — IQ reduction). HIGHEST teratogenic risk among mood stabilizers. Absolute contraindication in women who may become pregnant without contraception. Max: 2500mg/day (guided by levels: 50–125 μg/mL)
Lorazepam
Benzodiazepine
🏷️ Indian Brands: Ativan, Trapex, Lorazep
Dose Range
0.5–4mg/day (oral/IM/IV)
Starting Dose
Agitation: 1–2mg IM. Repeat after 30–60 min PRN. Status epilepticus: 0.1 mg/kg IV slow.
Onset of Action
IM: 15–30 min. IV: 1–5 min.
Half-Life
10–20h (no active metabolites)
Mechanism of Action
GABAA positive allosteric modulator — increases Cl⁻ influx frequency.
Indications
Acute agitation (IM), Acute alcohol withdrawal seizure, Panic disorder (short-term), Status epilepticus (IV), Pre-procedural anxiolysis.
Key Side Effects
Sedation, respiratory depression (IV), anterograde amnesia, confusion (elderly), paradoxical agitation (rare).
Drug Interactions
Other CNS depressants, opioids (⚠️ respiratory depression — avoid combo if possible). Valproate (increases lorazepam levels). Probenecid.
Monitoring
Respiratory rate, O2 saturation when used IV. Consciousness level. Duration of use — avoid >4 weeks.
Tapering
Switch to equivalent diazepam and taper slowly (see Benzo Equivalence tab).
⚠️ ⚠️ IV + IM lorazepam — have resuscitation equipment available (flumazenil reversal). Schedule X in India (highest control). Prescribe only short-term.
Preg: D (neonatal withdrawal syndrome, respiratory depression) Max: 10mg/day acutely
🔬 Lithium Monitoring Protocol
Narrow therapeutic index · Serum level 12h post-dose · IPS/NICE Guidelines
0.6–0.8
Maintenance
0.8–1.2
Acute Mania
1.2–1.5
Caution Zone
>1.5 mmol/L
⚠️ TOXIC — Action Required
🩺 Serum Level Interpreter

⚠️ Lithium Toxicity — Early Signs (Level 1.0–1.5)

  • Coarse tremor (different from fine therapeutic tremor)
  • Nausea, vomiting, diarrhoea
  • Ataxia, drowsiness, cognitive slowing
  • Muscle weakness
  • Slurred speech
Severe Toxicity (>2.0 mmol/L):
  • Seizures
  • Confusion / delirium / coma
  • Cardiac arrhythmias, T-wave changes
  • Renal failure
  • → HAEMODIALYSIS if level >2.5 OR severe symptoms
📋 Monitoring Schedule (IPS/NICE)
ParameterInitiationOngoing
Serum Li levelAfter 5 days, then weekly until stableEvery 3–6 months
eGFR / CreatinineBaselineEvery 6 months
TFTs (TSH + T4)BaselineEvery 6 months
FBCBaselineAnnually
Urine specific gravityBaselineIf polyuria
Weight / BMIBaselineEvery 3 months
ECGBaseline (if cardiac Hx)Annually if >50y
CalciumBaselineAnnually (hyperCa possible)
⚠️ Sick day rules: Patients must be counselled to HOLD lithium and seek medical advice during: diarrhoea, vomiting, fever, excessive sweating, or starting NSAIDs/ACE inhibitors. Dehydration → rapid rise in lithium levels.
💎

Lithium is the only drug with proven anti-suicide effect in bipolar disorder (60–70% reduction in suicide risk — NEJM 2000). It should not be avoided solely due to monitoring burden; educate patients and carers effectively.

📋 Clinical Guidelines Summary
IPS · APA · NICE · WHO · Stepwise management protocols
IPS
IPS Guidelines — Major Depressive Disorder (2020)
Last updated: 2020
1
Diagnosis

Minimum 5 of 9 DSM-5 criteria for ≥2 weeks. Rule out: hypothyroidism, B12/folate deficiency, substance use, medical illness. Assess suicide risk at every visit.

2
Mild–Moderate MDD

First-line: Psychotherapy (CBT, IPT) ± SSRI. Preferred SSRIs in India: Sertraline 50–100mg, Escitalopram 10–20mg. Continue for minimum 6–9 months after remission.

3
Moderate–Severe MDD

Pharmacotherapy mandatory. SSRI first-line. Add psychotherapy when possible. Review at 4 weeks — partial response: increase dose. No response at 8 weeks: switch antidepressant or augment.

4
Treatment Resistance

TRD = failure of ≥2 adequate antidepressant trials. Options: augmentation (lithium, atypical AP), switch class (SNRI, TCA), referral, ECT consideration.

5
Maintenance

First episode: 6–12 months. Two or more episodes: 2 years or indefinitely. Reassess at each visit. Psychoeducation essential.

APA
APA Practice Guideline — Bipolar Disorder (2023)
Updated: 2023
1
Acute Mania

First-line: Lithium OR valproate + antipsychotic (olanzapine, risperidone, quetiapine). Haloperidol for severe agitation. STOP antidepressants (risk of switching).

2
Acute Bipolar Depression

First-line: Quetiapine, lurasidone, or lithium/valproate. AVOID antidepressants alone (risk of manic switch). Lamotrigine effective for prevention, not acute.

3
Maintenance

Lithium (gold standard — anti-manic + anti-depressant + anti-suicide). Valproate, quetiapine, lamotrigine alternatives. Assess adherence, substance use, sleep.

4
Special Populations

Pregnancy: Risk-benefit for each drug. Valproate CONTRAINDICATED. Lithium relatively acceptable with monitoring. Consult specialist. Children: specialist referral mandatory.

5
Monitoring

Lithium: levels + renal + thyroid. Valproate: LFTs + FBC + levels. Atypical APs: metabolic monitoring (see metabolic checklist). Lamotrigine: slow titration (SJS risk).

NICE
NICE CG178 — Psychosis & Schizophrenia (2014, Updated 2023)
Updated: 2023
1
First Episode

Oral antipsychotic + CBT + family therapy. Avoid polypharmacy. Start at lowest effective dose. Document target symptoms and baseline.

2
Antipsychotic Choice

Use shared decision-making. Consider metabolic risk, patient history, adherence, EPSE risk. Prescribe one antipsychotic at a time. Clozapine only after 2 failed trials.

3
Treatment Resistance

Clozapine after ≥2 antipsychotics at adequate dose/duration (one should be atypical). Start clozapine with ANC monitoring. Target level 250–350 ng/mL.

4
Monitoring (NICE)

Physical health check annually minimum: weight, BP, glucose, lipids, smoking status. Prolactin if symptomatic. AIMS 6-monthly.

5
Discontinuation

Do not stop antipsychotic without specialist review. Relapse risk increases significantly within 3–6 months of stopping. Gradual taper if indicated.

IPS
IPS Guidelines — Anxiety Disorders (2019)
Last updated: 2019
1
GAD First-Line

SSRI (sertraline, escitalopram) or SNRI (venlafaxine 75–225mg). Buspirone 10–30mg TDS as alternative/adjunct. Avoid long-term benzodiazepines.

2
Panic Disorder

SSRI first-line (sertraline, escitalopram, paroxetine). Start low, go slow (initial anxiety increase). CBT equally effective. Add benzodiazepine short-term if distress severe.

3
OCD

High-dose SSRI (fluvoxamine 150–300mg, fluoxetine 40–80mg, sertraline 100–200mg). ERP (Exposure and Response Prevention) therapy — essential. Clomipramine if SSRI failure.

4
PTSD

Trauma-focused CBT first-line. If medication needed: SSRI (sertraline, paroxetine). Prazosin for nightmares. Avoid benzodiazepines in PTSD — may worsen outcomes.

5
Benzodiazepine Use

Short-term adjunct only (maximum 4 weeks). Taper slowly if used longer. Never first-line for chronic anxiety. High dependence risk.

WHO
WHO mhGAP — Acute Agitation Protocol
mhGAP-IG v2.0
1
De-escalation First

Always attempt verbal de-escalation first. Calm environment, reduce stimuli, offer food/water, maintain personal space (arm's length). Avoid confrontational stance.

2
Oral Medication

If de-escalation insufficient: Oral lorazepam 1–2mg OR oral haloperidol 5mg. Allow 30–60 minutes to work before next step.

3
IM Medication

Lorazepam 2mg IM + haloperidol 5mg IM. Separate syringes, different sites. Alternative: droperidol 10mg IM (if available).

4
Monitoring Post-Sedation

Every 15 minutes: vitals, consciousness, airway, oxygen saturation. Position recovery. Resuscitation equipment available. Document time and doses.

5
Special Populations

Elderly: halve all doses. Pregnant: lorazepam preferred, minimise haloperidol. Substance intoxication: caution — check for co-ingestion.

References: KD Tripathi Essentials of Medical Pharmacology (9th Ed) · BNF 2024 · CDSCO Drug Database · IPS Clinical Practice Guidelines 2019–2020 · APA Practice Guidelines 2023 · NICE CG90/CG91/CG178 · WHO mhGAP Intervention Guide v2.0
Compiled by Dept. of Pharmacology · pharmaadvance.in · v1.0 · For educational use only
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