Pre-treatment Health Assessments

General Health Check

Your healthcare provider should evaluate :

• Your weight and waist circumference
• Blood pressure and heart rate
• Lifestyle habits, like diet and exercise levels
• Signs of movement disorders
• Smoking habits
• Any other medications or substances you're using

Lab Tests

You'll undergo blood tests to measure :

• Blood sugar levels
• Red blood cell count (haemoglobin)
• Blood fat levels (cholesterol)
• Prolactin hormone levels

Heart Evaluation

An Electrocardiogram (ECG) might be conducted, especially if:

• You exhibit symptoms related to heart health
• You have a family history of cardiac issues
• Hospital admission is imminent
• The specific antipsychotic medication warrants an ECG

Ongoing Monitoring

After starting antipsychotics, your care team will track :

• Medication adherence
• Efficacy of the treatment
• Side effects, including symptoms resembling psychosis

For those on higher doses, frequent ECG tests, every 1-3 months, are recommended due to the risk of heart-related side effects.

Special Considerations

Existing Medical Conditions

Be transparent about any health conditions you have, as they may influence the choice and monitoring of your antipsychotic medication. Examples include :

• Liver or kidney dysfunction
• Cardiovascular issues
• Diabetes
• Neurological disorders like Parkinson’s and epilepsy
• Respiratory issues and certain blood disorders

Age-Related Factors

For older individuals, careful dosing adjustments are often required due to :

• Increased risk of blood pressure changes
• Temperature regulation issues
• Reduced drug metabolism with age

Drug Interactions

Always consult your healthcare provider about other drugs you're taking, including over-the-counter medication, as interactions can occur.

Specific risks exist with :

• Drugs with antimuscarinic properties
• Certain sleep aids and anti-anxiety medication
• Mood stabilisers like carbamazepine and lithium
• Various types of antidepressants
• Alcohol and recreational substances

Remember, always discuss your medication plan in detail with your healthcare providers, and don't hesitate to ask for periodic reviews.

The Dosage

Determining the appropriate dosage of your antipsychotic medication is a nuanced process that hinges on various factors. Here's what to consider :

• The particular antipsychotic you're taking : Different drugs have different safe dosage guidelines.
• Concurrent medications : Other drugs could interact with your antipsychotic if taken simultaneously or close in time.
• Personal factors : Medications affect everyone differently, influenced by age, weight, genetics, overall health, and even liver and kidney function.

Your healthcare team, including your GP or psychiatrist, will collaborate with you to assess the medication's effectiveness and its suitability for you.

They should inform you about how the medication could benefit you and when you're likely to notice its impact. The goal is to pinpoint a dosage that maximises benefits while minimising adverse side effects.

How to Fine-Tune Your Dosage?

• Start with a low dosage, as lower maintenance doses are often as effective as higher ones.
• Trial the recommended dosage for about a month to six weeks to gauge its efficacy.

Your dosage may be adjusted by your healthcare provider, but only with mutual agreement.

If the medication isn't working despite reaching the maximum recommended dosage, or if it's causing hard-to-tolerate side effects, your healthcare provider should consider alternative antipsychotic options for you.

All medication-related decisions should be clearly documented in your medical records, especially if the dosage deviates from usual recommendations.

Potential Risks of Higher Dosages :

Higher dosages may lead to an increased likelihood of side effects. Some antipsychotics can affect your :

• Morning routine
• Natural muscle movements
• Everyday activities

Higher doses can also escalate the risk of tardive dyskinesia, a serious side effect causing uncontrollable facial or bodily movements.

PRN Prescribing :

'PRN' stands for 'pro re nata,' which translates to 'as circumstances require' in Latin. This refers to additional doses given on top of your regular daily dosage, often in hospital settings. Any PRN doses must be meticulously documented in your medical records, and your healthcare provider should monitor the total daily dosage.

Is My Dosage Too High?

You can refer to the British National Formulary (BNF) for recommended maximum dosages of medications available in the UK. If you're concerned about your daily dosage, especially if it exceeds the BNF's recommended limits, consult your healthcare provider for a review, even if it falls within the typical range.