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11. Mental/psychical disorders in adults
T he goa l of the tr e a tm e nt is to r e d uc e p s yc hologic a l s uffe r ing a nd d is a bling
s ym p tom s ,
p a r tic ula r ly on th e r e la tiona l le v e l. I t offe r s r e a l be n e fits , e v e n if c h r onic
s ym p tom s
p e r s is t ( te n d e nc y tow a r d s oc ia l is ola tion, p os s ible r e la p s e s a n d p e r iod s of
inc r e a s e d
be ha v iour a l p r oble m s , e tc .).
T he tr e a tm e nt s hould la s t a t le a s t one ye a r , w ith a gr a d ua l d os e r e d uc tion.
L ow d os e
m a y be m a inta ine d for longe r p e r iod s if ne c e s s a r y.
U nc e r ta inty a bout the p os s ibility of follow -up a t one ye a r or be yond is no r e a s on not
to
rtrisepearitd.oHneoPw Oe v: 2e rm, itgisin b2e dtteivr idnoet dto ds toasret ps hoanr Dm a1 ,ctohleognic4aml trge/ ad tamyeinn2t fodr ivp aidtiee dntsd os
w ho ha v e
onsroehfvaaloempreeirliyd/olsPocOia l:s5ump pgo/r dt (aey.ign.,2hdomiv ied lee ds sd) o, sper osv; iidf inesdufftihc eieyndt, 1o 0n omt hga/ dv ae y in 2 d
be ha v iour a l d is or d e r s .
Sta r t tr e a tm e nt a t a low d os e :
D 2 . If ins uffic ie nt, inc r e a s e to 6 m g/ d a y (8 m g/ d a y m a xim um ).
2
d os e s . N ot to e xc e e d 2 0 m g/ d a y.
Antipsychotic therapy
Risperidone (m g/ d a y) Haloperidol (m g/ d a y)
W e e k/ m onth D1 W1-W2 W3 M1 W1 W2 W3 M1
BA rdeualtss tfe e d ing 2C a n be u4s e d 4 to 6 4 to 6 5 5 5 to 1 0 5 to 1 5
> 6 0 ye a r s M onitor 1the ne w 2bor n for 2thteo 4fir s t fe2wto 4 2 2 2 to 5 2 to 1 0
d a ys of life .
rd
Inc r e a s e only if ne c e s s a r y.
A v oid ; if a bs olut e ly n e c e s s a r y,
a d m inis te r le s s tha n 5 m g/ d a y.
P r e gna nc y M onitor the ne w bor n for the fir s t fe w
d a ys of life if the m othe r r e c e iv e d
high d os e s d ur ing the 3 tr im e s te r .
In e ld e r ly p a tie nts , r e d uc e the d os e by ha lf, w hic he v e r m e d ic a tion is us e d .
11nwEexcitt rheaspsyar raym, r eidfearl etoftfheec ttasb, lwe ahbicovh ea.rMe omnitoorr ethec onme wm boonr nwfoirt he hxtar aloppyer ar imd oidl tah la n
sr isymp eprtoidmonse , c a n be c ounte r a c te d by a d d ing biperiden P O : 2 to 4 m g/ d a y in 2
d iv id e d
d os e s .
P s yc hos e s (fir s t a c ute e p is od e or d e c om p e ns a tion of a c hr onic p s yc hos is )
a r e m uc h le s s
c om m on d ur ing p r e gn a nc y tha n p os tp a r tum . I n the e v e nt of p r e gna nc y in a
w om a n
ta king a ntip s yc hotic s , r e -e v a lua te the ne e d to c ontinue the tr e a tm e nt. If
tr e a tm e nt is s till
d ur ing the fir s t fe w d a ys of life .
T he goa l of the tr e a tm e nt is to r e d uc e p s yc hologic a l s uffe r ing a nd d is a bling
s ym p tom s ,
p a r tic ula r ly on th e r e la tiona l le v e l. I t offe r s r e a l be n e fits , e v e n if c h r onic
s ym p tom s
p e r s is t ( te n d e nc y tow a r d s oc ia l is ola tion, p os s ible r e la p s e s a n d p e r iod s of
inc r e a s e d
be ha v iour a l p r oble m s , e tc .).
T he tr e a tm e nt s hould la s t a t le a s t one ye a r , w ith a gr a d ua l d os e r e d uc tion.
L ow d os e
m a y be m a inta ine d for longe r p e r iod s if ne c e s s a r y.
U nc e r ta inty a bout the p os s ibility of follow -up a t one ye a r or be yond is no r e a s on not
to
rtrisepearitd.oHneoPw Oe v: 2e rm, itgisin b2e dtteivr idnoet dto ds toasret ps hoanr Dm a1 ,ctohleognic4aml trge/ ad tamyeinn2t fodr ivp aidtiee dntsd os
w ho ha v e
onsroehfvaaloempreeirliyd/olsPocOia l:s5ump pgo/r dt (aey.ign.,2hdomiv ied lee ds sd) o, sper osv; iidf inesdufftihc eieyndt, 1o 0n omt hga/ dv ae y in 2 d
be ha v iour a l d is or d e r s .
Sta r t tr e a tm e nt a t a low d os e :
D 2 . If ins uffic ie nt, inc r e a s e to 6 m g/ d a y (8 m g/ d a y m a xim um ).
2
d os e s . N ot to e xc e e d 2 0 m g/ d a y.
Antipsychotic therapy
Risperidone (m g/ d a y) Haloperidol (m g/ d a y)
W e e k/ m onth D1 W1-W2 W3 M1 W1 W2 W3 M1
BA rdeualtss tfe e d ing 2C a n be u4s e d 4 to 6 4 to 6 5 5 5 to 1 0 5 to 1 5
> 6 0 ye a r s M onitor 1the ne w 2bor n for 2thteo 4fir s t fe2wto 4 2 2 2 to 5 2 to 1 0
d a ys of life .
rd
Inc r e a s e only if ne c e s s a r y.
A v oid ; if a bs olut e ly n e c e s s a r y,
a d m inis te r le s s tha n 5 m g/ d a y.
P r e gna nc y M onitor the ne w bor n for the fir s t fe w
d a ys of life if the m othe r r e c e iv e d
high d os e s d ur ing the 3 tr im e s te r .
In e ld e r ly p a tie nts , r e d uc e the d os e by ha lf, w hic he v e r m e d ic a tion is us e d .
11nwEexcitt rheaspsyar raym, r eidfearl etoftfheec ttasb, lwe ahbicovh ea.rMe omnitoorr ethec onme wm boonr nwfoirt he hxtar aloppyer ar imd oidl tah la n
sr isymp eprtoidmonse , c a n be c ounte r a c te d by a d d ing biperiden P O : 2 to 4 m g/ d a y in 2
d iv id e d
d os e s .
P s yc hos e s (fir s t a c ute e p is od e or d e c om p e ns a tion of a c hr onic p s yc hos is )
a r e m uc h le s s
c om m on d ur ing p r e gn a nc y tha n p os tp a r tum . I n the e v e nt of p r e gna nc y in a
w om a n
ta king a ntip s yc hotic s , r e -e v a lua te the ne e d to c ontinue the tr e a tm e nt. If
tr e a tm e nt is s till
d ur ing the fir s t fe w d a ys of life .
