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Reducing Higher Doses of Psychotropic Medications Cheat Sheet (DRAFT) by [deleted]

Reducing Higher than Recommended Doses of Psychotropic Medications

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Introd­uction

Prescr­ibers may prescribe psycho­tropic medica­tions at higher than recomm­ended doses for a number of clinical reasons. A client may have experi­enced a partial remission of symptoms without signif­icant side effects at the upper limit of approved dosing, and in collab­oration with the prescriber prefers to continue upward medication titration. Clients with poor response to the usual medication doses may receive higher doses of medication in an attempt to reduce their symptoms and improve function. Higher doses of medication may be used to attempt to dampen violent thoughts or behaviors toward self or others. Medication blood levels in indivi­duals with rapid metabolism may be at the lower range of effect­iveness at high doses despite documented adherence. A client may prefer the subjective sense of wellbeing obtained at a higher dose of medica­tion, and may be willing, for instance, to trade in long term risks for symptom reduction

Clinical Recomm­end­ations

1. Consumers who are prescribed higher than recomm­ended doses of psycho­tropics should be engaged by their prescr­ibers in a conver­sat­ion­about the risks associated with their regimen, and the benefits of making a change. Dose reduction should be considered if clinically approp­riate.
2. Using monoth­erapy is recomm­ended whenever possible. Monoth­erapy reduces the total dose exposure for consumers of medication that affect the brain.
3. Collab­orative develo­pment of strategies for adherence with clients will maximize clinical benefit and avoid dose increases.
4. Prescr­ibers should ensure that the dose and duration of medication trials are adequate and consistent with eviden­ce-­based guidel­ines. Medication should be given an adequate time to work prior to increasing the dose.
5. Careful diagnostic evaluation over time and consid­eration of character structure will assist in avoidance of medication treatment and escalating doses for clients whose symptoms will respond better to psycho­social treatm­ents.
6. Nonpha­rma­cologic therapies, for instance cognitive behavioral therapy for insomnia, anxiety, or depres­sion, are well researched and effective for management of symptoms. Psycho­social interv­entions should be considered as an altern­ative strategy to high dosing.
7. Consumers and families will benefit from supportive services from the clinic during periods of medication change. These services may include frequent check-in calls with the clinic nurse, increased appoin­tment frequency with the prescriber and therapist, medication groups with other consumers, and psycho­edu­cation about side effects or symptoms likely to be experi­enced. Specific interv­entions for management of changes in wellbeing may be developed by the clinical staff to provide clients with tools to use during the change.
8. Psycho­edu­cation in varied formats should be available to all consumers. Brochures, scientific summaries, inform­ation sessions, and ongoing medication education groups can be helpful in providing inform­ation helpful to consumers and promote dialogue with prescr­ibers clinical practice is to change a medication by no more than 1/3 of the current dose, no more frequently than every 2-3 weeks.
10. Strategies for commun­ication by prescr­ibers with the consumer’s primary care provider will be helpful in addressing medical causes of psychi­atric symptoms which otherwise may result in high doses or polyph­armacy.
11.Rating scales­filled out by the client can be very helpful during medication changes. Rating scales can educate consumers in unders­tanding and observing symptom conste­lla­tions over time; and provide clinicians with accurate longit­udinal inform­ation about the effect of medication change or discon­tin­uation on symptoms and function.
12. For consumers receiving high doses of psycho­tro­pics, periodic efforts should be made to taper the dose once the consumer is doing well.