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niyi

neuroleptic naive patients

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Hi guys,

id like some advice on a clinical scenario. How would you manage a neuroleptic naive patient with late onset first episode psychosis who is on a section 2 and refusing oral antipsychotics ? Is it okay to start him on a depot even though he's neuroleptic naive and if not what are the other options ??? ??? (imagine this is an exam PMP)

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Now you have the options of orodispersible tablets of atypicals and also the risperidone depot so it should not be a big issue.

you can start with the trial dose of depot even in the neuroleptic naive patients if he totally refuses oral medications. lots of people give clopixol acuphase to control agitation in newly admitted patients.

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Sorry, have to disagree with the above. College and Maudsley guidelines specifically state that clopixol acuphase shoud not be used in neuroleptic niave patients. As it can last upto 3 days within the system any adverse reaction can last that long. Notwithstanding the fact that you may be destroying any chance of future compliance with medication it may actually be quite dangerous. If a neuroleptic has to be used for patients/ others safety and benzodiazepines alone arn't sufficient then short acting IMs can be used, eg haloperidol or olanzapine (less well studied). Section 2 of the Mental Health Act allows treatment against patients wishes if necessary.

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I agree with anthonyc with regards to clopixol acuphase. Infact it should not be used in neuroleptic naive patients.

The best is benzos/haloperidol

Section 2 does not allow to treat a patient.I think we treat them under common law if meds have to be given whilst on sec2 and pt refuses to take voluntarily.(in the best interst of pt)

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Oh dear ???

1. I agree that clopixol accuphase is a truly awful idea (but equally that it seems to be used a lot)

2. There's a difference between IM and depot - you can give IM medication to see a) if there are bad side effects or B) if the patient will start taking oral medication if he's a bit calmer

3. Section 2 absolutely allows treatment of mental illness - see Part IV of the Act, partic sections 56 and 63 and treatment is not therefore under common law and counts towards the 3/12 period before either consent or a second opinion is needed (section 58.)

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Yup. Section 2 does allow for treatment despite the common misbelief that it doesn't.

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Section 2 allows for treatment that aids you to complete your assessment

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