Principle | Key elements |
---|---|
1. Adjunctive treatment in selected patients | a. In context of comprehensive medical and psychological assessment and treatment, including weight restoration |
 | b. For relief of persistent distressing symptoms |
 | c. For treatment of comorbid psychiatric disorders |
2. Informed consent | a. Patient and family/carers |
 | b. Discuss rationale, potential benefits, potential risks, alternative treatment options, data available |
 | c. Choice of medication informed by individual characteristics |
 | d. Documentation |
3. Record baseline information | a. Identify target symptoms |
 | b. Document level of baseline symptoms and social/occupational function |
 | c. Use appropriate pre and post rating scales |
 | d. Screen for suicidality and binge eating |
 | e. Baseline investigations e.g. electrolytes, ECG, fasting lipids and fasting blood sugar prior to prescribing SGAs |
4. Treat | a. Start at low doses, increase cautiously |
 | b. Safe prescription and storage to reduce harm from intentional overdose |
 | c. Enlist patient and family in adherence and monitoring |
5. Monitor | a. Monitor treatment response clinically and using appropriate rating scales |
 | b. Monitor for adverse effects |
 | 1. Screen for binge eating and suicidality |
 | 2. Examination for extrapyramidal adverse effects of SGAs |
 | 3. Monitor for SGAs with ECG, serum lipids, fasting blood sugar, weight, any other measures specific to the drug |
6. Review | a. Regular review of balance of benefit and risk |
 | b. Continue if effective and tolerated, cease if ineffective or poorly tolerated |
 | c. Minimise polypharmacy |
 | d. Maintain emphasis on non-pharmacological treatments |
 | e. Review appropriateness as patient’s nutritional state changes |
7. Audit | a. Collect and share data on prescription, effectiveness and adverse effects |
 | b. Implement service-wide procedures that facilitate good prescribing and monitoring practices and allow data collection |