Mental Health for GPs: Your Survival Guide

Updated Guidelines 2026:

NICE Depression Guidelines (NG222) updated - new recommendations for stepped care and digital therapies. Mental health referrals up 37.9% since 2019.

Mental Health for GPs: Your Survival Guide

Because "How are you feeling?" deserves more than a 30-second answer

☕ Tea-Friendly Learning ⏰ For GP Trainees Short on Time 🚩 Red Flag Focused

Date Updated: February 7, 2026

Executive Summary: What You'll Master Today

Because you have 47 other things to do before lunch, and that's just the morning list

What You'll Learn

• RCGP curriculum-aligned mental health assessment
• MSE that actually makes sense in 10 minutes
• Suicide risk assessment without the panic
• Antidepressant switching (Maudsley guidelines)
• SMI physical health checks that save lives
• Red flags you absolutely cannot miss

Quick Facts

25%

GP consultations involve mental health

15-20

Years earlier SMI patients die (CVD)

15-30%

Feel worse after SSRI initiation. 70-85% don't!

4-6

Weeks for antidepressants to work

Resources & Downloads

📥 Downloads

path: MENTAL HEALTH

🌐 Web Resources

Quick Navigation

Depression, Anxiety & Suicide

Common Conditions GPs Should Manage Confidently

Types of Mental Health Conditions

Mood Disorders

• Major Depressive Disorder: Persistent low mood, anhedonia
• Bipolar Disorder: Alternating depression and mania/hypomania
• Cyclothymia: Mild mood swings over 2+ years
• Seasonal Affective Disorder: Winter depression
• Persistent Depressive Disorder: Chronic low-grade depression

Anxiety Disorders

• Generalised Anxiety Disorder: Excessive worry about multiple areas
• Panic Disorder: Recurrent panic attacks
• Social Anxiety: Fear of social situations
• Specific Phobias: Fear of specific objects/situations
• Agoraphobia: Fear of open/crowded spaces

Trauma & Stress-Related

• PTSD: Following traumatic event
• Acute Stress Reaction: Immediate response to trauma
• Adjustment Disorders: Reaction to life stressors

Obsessive-Compulsive & Related

• OCD: Obsessions and compulsions
• Body Dysmorphic Disorder: Preoccupation with appearance
• Hoarding Disorder: Difficulty discarding possessions

Psychotic Disorders

• Schizophrenia: Chronic psychotic disorder
• Delusional Disorder: Fixed false beliefs
• Brief Psychotic Disorder: Short-term psychosis

Data-Gathering & Examination Tips

Mental State Examination (MSE) - The 10-Minute Version

Domain	What to Look For	Red Flags
Appearance & Behaviour	Dress, hygiene, eye contact, posture, psychomotor activity	Severe neglect, agitation, catatonia
Speech	Rate, volume, tone, fluency	Pressure of speech (mania), poverty of speech
Mood & Affect	Subjective mood, objective affect, congruence	Severe depression, euphoria, lability
Thought Form	Flow, coherence, goal-directedness	Flight of ideas, thought blocking, loosening
Thought Content	Delusions, obsessions, suicidal ideation	Fixed delusions, command hallucinations
Perception	Hallucinations (auditory, visual, tactile)	Command voices, visual hallucinations
Cognition	Orientation, attention, memory	Disorientation, severe memory loss
Insight & Judgement	Awareness of illness, treatment compliance	Complete lack of insight with risk

Screening Tools - PHQ-9 & GAD-7

PHQ-9 Depression Questions

"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 the opposite - being so fidgety or restless that you have been moving around a lot more than usual?

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

Score	Severity	Action
0-4	None	Reassure
5-9	Mild	Watchful waiting
10-14	Moderate	Treatment indicated
15-19	Mod-Severe	Active treatment
20-27	Severe	Urgent referral

GAD-7 Anxiety Questions

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

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 is hard to sit still?

6. Becoming easily annoyed or irritable?

7. Feeling afraid as if something awful might happen?

Score	Severity	Action
0-4	Minimal	Reassure
5-9	Mild	Self-help
10-14	Moderate	CBT/medication
15-21	Severe	Specialist referral

Suicide Risk Assessment - Structured Approach

🔥 TOP TIP

Be worried if a patient expresses:

1) Hopelessness - "Nothing will ever get better"
2) Helplessness - "I can't do anything about it"
3) Any violent form of ending - guns, knives, jumping, hanging

Risk Factors (Static)

• Male gender, older age
• Previous attempts
• Mental illness (depression, psychosis, substance use)
• Chronic physical illness
• Social isolation, unemployment
• Family history of suicide

Dynamic Risk Factors

• Current suicidal ideation
• Specific plans/means
• Recent losses/stressors
• Hopelessness
• Substance intoxication
• Command hallucinations

Assessment Questions (Use These Exact Words)

1. "Have you been having thoughts that life isn't worth living?"

2. "Have you been thinking about harming yourself or ending your life?"

3. "Do you have a plan for how you would do this?"

4. "What stops you from acting on these thoughts?"

5. "How likely is it that you would act on these thoughts?"

Diagnostic Approach & Investigations

GP-Appropriate Diagnostic Framework

Syndromic Diagnosis

• Mood disorders: Depression, bipolar, cyclothymia
• Anxiety disorders: GAD, panic, phobias, OCD
• Psychotic disorders: Schizophrenia, delusional disorder
• Organic causes: Delirium, dementia, substance-induced

Assessment Components

• Severity assessment: Mild, moderate, severe
• Functional impact: Work, relationships, self-care
• Risk stratification: Self-harm, violence, neglect
• Comorbidity: Physical health, substance use

Investigating Mental Health Presentations

When to Request Blood Tests

• First episode of depression/psychosis
• Rapid onset or atypical presentation
• Physical symptoms present
• Cognitive impairment
• Treatment resistance

Essential Investigations

• FBC: Anaemia, B12/folate deficiency
• U&Es: Electrolyte imbalance
• TFTs: Hypo/hyperthyroidism
• Glucose: Diabetes, hypoglycaemia
• LFTs: Liver disease, alcohol
• Calcium: Hypercalcaemia

Thresholds for Referral or Escalation

Urgency	Indicators	Action	Timeframe
Emergency	Imminent suicide risk, acute psychosis, severe agitation	Crisis team/A&E	Immediate
Urgent	High suicide risk, first episode psychosis, severe depression	Urgent referral	48 hours
Routine	Treatment-resistant, complex presentation, diagnostic uncertainty	Routine referral	6-18 weeks

Differential Diagnosis Frameworks

Biological Features of Depression

Sleep Disturbances

• Early morning wakening (2-4am)
• Difficulty falling asleep
• Frequent night-time awakening
• Non-restorative sleep
• Reduced REM sleep latency

Appetite & Weight

• Loss of appetite
• Weight loss (>5% body weight)
• Loss of interest in food
• Sometimes increased appetite (atypical)

Psychomotor Changes

• Psychomotor retardation (slowed movements)
• Reduced facial expression
• Slowed speech
• Sometimes agitation (pacing, restlessness)

Other Biological Features

• Diurnal mood variation (worse mornings)
• Loss of libido
• Fatigue and low energy
• Constipation
• Amenorrhoea (in women)

Features of Anxiety

Physical Symptoms

• Palpitations (racing heart)
• Shortness of breath (SOB)
• Tremors (shaking hands/voice)
• Sweating (especially palms)
• Tingling around mouth and eyes
• Chest tightness
• Nausea and stomach upset
• Dizziness or lightheadedness
• Muscle tension

Psychological Symptoms

• Intrusive thoughts about lots of different things
• Irritability and being short-tempered
• Restlessness (can't sit still)
• Excessive worry about future events
• Difficulty concentrating
• Feeling on edge or keyed up
• Fear of losing control
• Anticipatory anxiety
• Avoidance behaviours

Low Mood – Differential Diagnosis

Condition	Key Features	Duration	Triggers
Major Depression	Persistent low mood, anhedonia, biological symptoms	>2 weeks	May be none
Adjustment Disorder	Reaction to identifiable stressor, less severe	<6 months	Clear stressor
Grief Reaction	Waves of sadness, yearning, memories of deceased	Variable	Bereavement
Bipolar Depression	History of mania/hypomania, family history	Episodic	May be seasonal
Substance-Related	Temporal relationship with substance use	Variable	Alcohol/drugs

Psychotic Symptoms Framework

Primary Psychosis

• Schizophrenia: Chronic, deteriorating function
• Delusional disorder: Fixed delusions, preserved function
• Brief psychotic disorder: <1 month duration
• Schizoaffective: Psychosis + mood symptoms

Secondary Causes

• Mood disorders: Depression/mania with psychosis
• Substance-induced: Cannabis, amphetamines, alcohol
• Medical: Delirium, dementia, autoimmune
• Medication: Steroids, dopamine agonists

Acute Mental Health Emergencies

Immediate Risks & Actions

Immediate Risks

• Acute suicidal crisis: Plan, means, intent
• Acute psychosis: Command hallucinations, paranoid delusions
• Severe agitation: Risk to self/others
• Catatonia: Stupor, posturing, mutism
• Delirium: Acute confusion, fluctuating consciousness
• Severe self-neglect: Not eating, drinking, or caring for self
• Violence/aggression: Towards others or property

Actions Required

• Do not leave patient alone
• Remove potential means of harm
• Contact crisis team/psychiatry
• Consider A&E if immediate risk
• Document risk assessment thoroughly
• Involve family/carers if appropriate
• Consider police if violence risk

Emergency Contact Numbers

Crisis Services

• Crisis Resolution Team: Local number
• Duty Psychiatrist: Via hospital switchboard
• AMHP Service: Via local authority
• Samaritans: 116 123 (free, 24/7)

Emergency Services

• 999: Police, ambulance, fire
• 111: NHS non-emergency
• A&E: Immediate medical attention
• Police: If violence/public safety risk

Mental Health Act - Sectioning Process

🎯 Key Principle: Always Try Voluntary Admission First

What to say to encourage voluntary admission:

"I can see you're going through a really difficult time right now, and I'm worried about your safety. The hospital has a specialist team who are experts at helping people in situations like yours. They have treatments that can help you feel better quite quickly. Would you be willing to come with me to the hospital so we can get you the help you need? You'll be in a safe place where people understand what you're going through."

Who is Required for Sectioning

Standard Sectioning

• 2 Doctors: One approved under Section 12 (usually psychiatrist) + one who knows patient (usually GP)
• 1 Approved Mental Health Professional (AMHP): Usually social worker
• Nearest Relative: Must be consulted (except in emergencies)

Emergency Section 4

• 1 Doctor (any doctor) + 1 AMHP
• When waiting for second doctor would cause undesirable delay
• Lasts 72 hours maximum

Common Sections & Duration

• Section 2: Assessment - up to 28 days
• Section 3: Treatment - up to 6 months (renewable)
• Section 4: Emergency - up to 72 hours
• Section 5(2): Doctor's holding power - 72 hours
• Section 136: Police powers - 72 hours

Process Flow

1. Identify need for assessment
2. Contact AMHP (via local authority)
3. AMHP coordinates medical assessments
4. If criteria met, section applied
5. Patient transported to hospital
6. Hospital accepts section

Criteria for Sectioning (All Must Be Met)

• Patient has a mental disorder
• Risk to health or safety of patient or others
• Treatment is necessary and available
• Patient lacks capacity to consent or refuses treatment
• No less restrictive alternative available

Organic & Reversible Causes

Medical Causes of Psychiatric Symptoms

Endocrine Disorders

• Thyroid disorders: Hypo/hyperthyroidism
• Cushing's syndrome: Depression, mania
• Addison's disease: Depression, fatigue
• Diabetes: Hypoglycaemia, ketoacidosis
• Parathyroid disorders: Hypercalcaemia

Neurological Disorders

• Dementia: Alzheimer's, vascular, Lewy body
• Parkinson's disease: Depression, psychosis
• Multiple sclerosis: Mood changes
• Stroke: Post-stroke depression
• Brain tumours: Personality changes

Infectious Causes

• UTI (elderly): Confusion, agitation
• Encephalitis: Behavioural changes
• Syphilis: Late-stage neuropsychiatric
• HIV: Cognitive impairment
• COVID-19: Long COVID psychiatric symptoms

Metabolic & Nutritional

• B12 deficiency: Depression, psychosis
• Folate deficiency: Depression
• Hypercalcaemia: Depression, confusion
• Hyponatraemia: Confusion, agitation
• Liver failure: Hepatic encephalopathy

Drug-Induced Mental Health Problems

Prescribed Medications

• Steroids: Mania, depression, psychosis
• Dopamine agonists: Impulse control disorders
• Antimalarials: Psychosis, mood changes
• Interferon: Depression
• Beta-blockers: Depression
• Benzodiazepines: Paradoxical agitation

Substance Use & Withdrawal

• Alcohol withdrawal: Delirium tremens
• Benzodiazepine withdrawal: Anxiety, seizures
• Cannabis: Psychosis, anxiety
• Stimulants: Psychosis, paranoia
• Opioid withdrawal: Depression, anxiety

Autoimmune & Other Causes

Autoimmune Conditions

• SLE: Psychosis, mood changes
• Anti-NMDA encephalitis: Psychosis, catatonia
• Hashimoto's encephalopathy: Confusion
• Coeliac disease: Depression, anxiety

Other Causes

• Sleep disorders: Sleep apnoea
• Chronic pain: Depression
• Malignancy: Paraneoplastic syndromes
• Wilson's disease: Psychiatric symptoms

Suicide Risk Assessment & Management

💡 Clinical Pearl

In suicidal risk assessment, be worried if there is any of:

1) Hopelessness - "Nothing will ever get better"
2) Helplessness - "I can't do anything about it"
3) Violent thoughts of ending - guns, knives, jumping, hanging

Risk Factors Assessment

Static Risk Factors

• Demographics: Male gender, older age (>65)
• History: Previous suicide attempts
• Mental illness: Depression, psychosis, substance use
• Physical illness: Chronic pain, terminal illness
• Social factors: Social isolation, unemployment
• Family history: Suicide in family
• Trauma: Childhood abuse, recent bereavement

Dynamic Risk Factors

• Current ideation: Frequency, intensity, duration
• Specific plans: Method, timing, location
• Access to means: Weapons, medications, heights
• Recent stressors: Relationship breakdown, job loss
• Hopelessness: No future, nothing will improve
• Substance use: Current intoxication
• Command hallucinations: Voices telling to self-harm

Structured Assessment Questions

Use These Exact Questions:

1. "Have you been having thoughts that life isn't worth living?"

2. "Have you been thinking about harming yourself or ending your life?"

3. "Do you have a plan for how you would do this?"

4. "Have you thought about when you might do this?"

5. "What stops you from acting on these thoughts?"

6. "How likely is it that you would act on these thoughts?"

7. "Have you made any preparations or taken any steps?"

Protective Factors to Explore:

• Social support: Family, friends, pets
• Religious beliefs: Moral objections to suicide
• Future plans: Things to look forward to
• Responsibility: Children, dependents
• Treatment engagement: Willingness to accept help

Risk Stratification & Management

Risk Level	Indicators	Management
High Risk	Specific plan, means available, no protective factors, hopelessness	Urgent psychiatric referral, consider sectioning, remove means
Medium Risk	Suicidal ideation, some planning, mixed protective factors	Same-day psychiatric assessment, safety planning, follow-up
Low Risk	Passive ideation, no plan, good protective factors	Safety planning, routine referral, regular monitoring

Safety Planning

Immediate Safety Plan

• Remove means: Medications, weapons, ligatures
• 24/7 supervision: Family member or friend
• Crisis contacts: GP, crisis team, Samaritans
• Coping strategies: Distraction, relaxation
• Warning signs: Triggers to watch for

Follow-up Plan

• Next appointment: Within 24-48 hours
• Treatment plan: Medication, therapy
• Support network: Activate family/friends
• Crisis plan: What to do if thoughts worsen
• Documentation: Detailed risk assessment

💬 Language Matters - Reducing Stigma

Please use the words:

• "A patient died by suicide" - most neutral medical/clinical phrasing
• "A patient completed suicide" - factual + compassionate → reduces stigma

Avoid:

• "Committed suicide" → sounds like a crime/sin → adds stigma

Clinical Management - The Complete Guide

First-Line Drug Treatments

Depression Treatment Lines

1st Line

• Sertraline 50mg daily (SSRI of choice)
• Citalopram 20mg daily (if sertraline not tolerated)
• Fluoxetine 20mg daily (good for young people)

2nd Line

• Different SSRI or Mirtazapine 15-30mg
• Venlafaxine 75mg (SNRI - specialist initiation)

3rd Line

• Duloxetine 60mg (SNRI)
• Tricyclics (amitriptyline, nortriptyline)

4th Line

• MAOIs (phenelzine, tranylcypromine)
• Augmentation (lithium, antipsychotics)

Anxiety Treatment Lines

1st Line

• Sertraline 25-50mg daily (start low)
• Escitalopram 5-10mg daily
• Paroxetine 10-20mg daily

2nd Line

• Different SSRI or Venlafaxine 75mg
• Duloxetine 30-60mg

3rd Line

• Pregabalin 150-600mg daily
• Buspirone 15-30mg daily

4th Line

• Tricyclics (imipramine, clomipramine)
• MAOIs (specialist use)

⏰ How Long Do Antidepressants Take to Work?

Most antidepressants take 4-6 weeks to work

Key Message: Do not deem an antidepressant treatment to have failed if used for less than 4 weeks.

What to Say to Patients:

"The medicine slowly builds up into your system each day and that is why you must take it every day roughly at the same time without any missed days. Otherwise, if you do miss a dose, it's back to square one again. But once it builds up to a good level, it kicks in and helps with your mood. That usually happens at the 4-6 week stage. However, I have given this one because you may even notice some early effects as early as 2 weeks in."

Clinical Pearl:

If at the 4 week stage the antidepressant has not worked, it's worthwhile increasing the dose of the same antidepressant rather than changing to another one.

🔄 Switching or Withdrawing Antidepressants

SWITCHING ANTIDEPRESSANTS

When switching, make sure you follow the Maudsley guidelines on switching. Often you will need to taper one antidepressant down before starting the next and sometimes you may need a 2 week antidepressant free period before starting the new one.

Maudsley Antidepressant Switching Guidelines

The Maudsley Hospital is a British psychiatric hospital in south London. The Maudsley is the largest mental health training institution in the UK. It produces some exceptional guidelines in the field of Psychiatry.

For specific switching advice: GP Notebook - Switching Antidepressants

WITHDRAWING ANTIDEPRESSANTS

Remember, sudden stopping of antidepressants can cause withdrawal symptoms which are very upsetting for the patient.

Warning: Always taper gradually to avoid discontinuation syndrome. Symptoms can include dizziness, flu-like symptoms, sensory disturbances, and mood changes.

⚠️ Suicidal Thoughts & Worsening Symptoms

Suicidal Thoughts

In rare cases, some people experience suicidal thoughts and a desire to self-harm when they first take antidepressants. Young people under 25 seem particularly at risk.

What to Say to Patients:

"In rare cases, some people experience suicidal thoughts and a desire to self-harm when they first take antidepressants. I must stress that it is rare and it is more likely that these tablets will make you feel happier. But in the rare occasion that you do experience thoughts of killing or harming yourself at any time, then contact your GP, or go to A&E immediately. It may also be useful to tell a relative or close friend if you've started taking antidepressants and ask them to read the leaflet that comes with your medicines."

Worsening of Symptoms

Some patients may experience a worsening of symptoms before they get better, especially with Sertraline and Paroxetine. Things like increased anxiety, restlessness, and agitation.

Balanced Patient Communication:

"At the start of taking the antidepressant, a small number people may experience some worsening of symptoms before they get better. Please try and persevere through this if you can by reminding yourself things will get better. And remember, you can always call us or 111 or 999 for advice if this happens. However, most people do not experience this and so, please don't get too worried about it at this stage."

🧠 Serotonin Syndrome - SHIVERS Mnemonic

SHIVERS Mnemonic

Shivering

Neuromuscular symptom unique to serotonin syndrome

Hyperreflexia and Myoclonus

Most prominent in lower extremities

Increased Temperature

Usually in more severe cases

Vital Sign Abnormalities

Tachycardia, tachypnea, labile BP

Encephalopathy

Agitation, delirium, confusion

Restlessness

Due to excess serotonin activity

Sweating

Autonomic response to excess serotonin

Common Triggers

• SSRI/SNRI + another antidepressant
• SSRI/SNRI + Lithium
• SSRI/SNRI + St John's wort
• SSRI/SNRI + Tramadol
• SSRI/SNRI + Triptans (migraine)
• SSRI/SNRI + Metoclopramide
• SSRI/SNRI + Street drugs (MDMA, cocaine)

vs Neuroleptic Malignant Syndrome

• SS: Hyperreflexia, clonus
• NMS: Lead-pipe rigidity
• SS: Usually 2+ drugs
• NMS: Usually single antipsychotic

Emergency Management

Stop all serotonergic medications immediately. Supportive care with benzodiazepines. Severe cases may need cyproheptadine and ICU care. Can be fatal if untreated.

Electroconvulsive Therapy (ECT)

Treatment-Resistant Depression & ECT

Defining Treatment Resistance

• Failure to respond to 2 adequate trials of antidepressants
• Each trial: 6-8 weeks at therapeutic dose
• Different classes preferred (e.g., SSRI then SNRI)
• Consider adherence, drug interactions, comorbidities

Management Options

• Switch: To different class (SSRI → SNRI)
• Augment: Add lithium, antipsychotic, or thyroid hormone
• Combine: Two antidepressants (specialist advice)
• Refer: For specialist assessment

ECT Indications (NICE Guidelines)

• Severe depression with life-threatening symptoms
• Catatonia not responding to treatment
• Prolonged/severe mania not responding to medication
• When rapid response is clinically required

ECT Considerations

• Informed consent essential (or best interests)
• Memory loss main side effect (usually temporary)
• 6-12 treatments typically required
• Maintenance ECT may be needed

Severe Mental Illness (SMI) - Physical Health Checks

🚨 Why SMI Physical Health Checks Save Lives

Shocking Statistics

SMI patients die 15-20 years EARLIER than their peers

Mainly due to cardiovascular disease

Hence, the annual health check is crucial in this vulnerable group

Don't just screen – intervene!

Death Rates vs General Population

• 5x higher for liver disease
• 5x higher for respiratory disease
• 3x higher for cardiovascular disease
• 2x higher for cancer

📋 Examples of SMI

SMI Type	More Common Gender	Age of Onset (Men)	Age of Onset (Women)
Schizophrenia	Men	16-25	Similar across all ages
Bipolar Disorder	Women	35-45	25-35
Other Psychosis	Men	16-25	>75 years old

✅ The SMI Physical Health Check

Measurements Required

• Weight (BMI)
• Blood pressure/pulse
• Lipid profile and QRISK
• HbA1c
• Assessment of alcohol consumption
• Smoking status
• Nutritional status/diet/physical activity
• Illicit substances/non-prescribed drugs
• Access to relevant national screenings
• Medication review
• Sexual and oral health

Key Interventions

• Alcohol and substance use brief interventions
• Obesity management & prevention
• Physical activity promotion
• Hypertension management
• Type 2 diabetes prevention/treatment
• Lipid modification
• Smoking cessation support
• Follow them up!

🔬 Investigations

Blood Tests

Basically do bloods for (i) CVD risk assessment and (ii) checking levels of psychotropic drugs

All patients: FBC, U&Es, LFTs, HbA1c, Total chol:HDL, Prolactin, TFTs

Patients on Lithium: Above bloods + Lithium levels

ECG

In all patients - looking for prolonged QT interval and/or CVD changes

💊 Schizophrenia: Psychiatric Medications & Monitoring

Commonly Used Antipsychotics

First-Generation (Typical)

• Haloperidol 5-20mg daily
• Chlorpromazine 200-800mg daily
• Higher risk of extrapyramidal side effects

Second-Generation (Atypical)

• Olanzapine 10-20mg daily
• Risperidone 4-8mg daily
• Quetiapine 300-800mg daily
• Aripiprazole 10-30mg daily
• Clozapine 200-900mg (treatment-resistant)

Monitoring Requirements

Olanzapine Monitoring

• Weight/BMI: Monthly for 6 months, then 3-monthly
• Glucose/HbA1c: Baseline, 4-6 months, then annually
• Lipids: Baseline, 3 months, then annually
• BP: Baseline, then regularly
• Prolactin: Baseline, 6 months, then annually

Clozapine Monitoring

• FBC: Weekly for 18 weeks, then fortnightly for 1 year, then monthly
• Neutrophil count: Must be >1.5 x 10⁹/L
• Stop immediately if neutropenia develops
• Clozapine levels: 12 hours post-dose

⚠️ Side Effects of Antipsychotics

General Side Effects

• Weight gain
• Sedation (warn about driving/machinery)
• Dyslipidaemia (dietary advice ± statin)
• Hyperglycaemia (can cause diabetes/ketoacidosis)
• Neutropenia (stop if <1.5 x 10⁹/L)
• Abnormal LFTs (stop if transaminases >3x normal)
• Hyperprolactinaemia (galactorrhoea, amenorrhoea)

Cardiovascular Problems

• Postural hypotension (especially clozapine, quetiapine)
• Hypertension (commonly with clozapine)
• QT prolongation (class effect - avoid other QT drugs)
• Stroke risk (olanzapine/risperidone in elderly)
• VTE risk (review risk factors)

Neuroleptic Malignant Syndrome (NMS)

Rare but potentially fatal adverse effect of all antipsychotics.

Signs: Fever, sweating, rigidity, confusion, fluctuating consciousness, BP changes, tachycardia, raised CK, leucocytosis, raised LFTs

Urgent admission required

🎯 Remember

You don't need to be a psychiatrist to provide excellent mental health care. You just need to know when to worry, when to treat, and when to refer.

Now go reward yourself with that well-deserved coffee ☕

You've got this!