Drugs used to Treat Antipsychotic-Induced Weight-Gain (Mnemonic) The following mnemonic is for the drugs used to treat antipsychotic-induced weight gain. The list is not based on priority; however, metformin is the preferred choice, especially when there is comorbid polycystic ovary disease. Orlistat, with calorie restriction, is also an effective choice. FORMAT-B F luoxetine  Orlistat Reboxetine Metformin, methylcellulose, melatonin Topiramate Bupropion 

Psychotherapy      Reassurance Self-help and psychoeducation à Pure self-help, guided self-help, group psychoeducation Relaxation therapy à applied relaxation, progressive muscle relaxation, deep breathing exercises Cognitive behavior therapy Exercise Pharmacotherapies Indications of pharmacotherapy While on psychotherapy, short-term Psychotherapy ineffective, Psychotherapies not available First-line         Selective Serotonin Reuptake Inhibitors à These and SNRIs may initially exacerbate symptoms; a lower starting dose is often required.   Fluoxetine and sertraline are preferred options.   Sertraline is the most tolerable and cost effective, recommended as first choice by NICE. Fluoxetine is most effective choice. Effexor (venlafaxine) SR up to 225 mg/day Dulan/Duron (duloxetine) up to 60 mg/day pregabalin 150–600 mg/day Second-line choices             Agoviz (agomelatine) 25 mg                2 x nocte Agoviz (agomelatine) 25 mg    

Treatment of Guidelines for Psychotic Depression First-line        Tricyclic with olanzapine or quetiapine Second choice         SSRI/SNRI Consider Electroconvulsive therapy           

Because of its N-methyl-d-aspartic acid antagonist properties, amantadine (100–500   mg three times a day), and its derivative memantine (5–20   mg/day), have been tried in catatonia. Carroll and coworkers identified 25 cases of amantadine and memantine use in the treatment of catatonia. All cases improved, mostly after 1–7   days. It should be noted, however, that six were unpublished, and that seven other were cases experiencing a “catatonia-parkinsonian syndrome” while under treatment with the high-potency neuroleptic drugs haloperidol or fluphenazine. The symptoms diminished when neuroleptics were tapered, and they added amantadine. Since then, they have published eleven additional cases describing the successful use of amantadine or memantine in catatonia. In one case, in an adolescent girl, catatonia that was resistant to ECT improved after the addition of amantadine. Only in a review of Hawkins and coworkers, they report a case in which the use of amantadine remained without eff

Zolpidem, a positive allosteric modulator of gamma-aminobutyric acid receptors, seems to be a safe and effective treatment alternative. 

Benzodiazepines for the Treatment of Catatonia Benzodiazepines are the first-choice treatment for catatonia, regardless of the underlying condition. Benzodiazepines are positive allosteric modulators of GABA-A receptors and will correct deficient GABA-ergic function in the orbitofrontal cortex. Following a positive Lorazepam Challenge Test , repeated doses of benzodiazepines can a treatment. Their use is safe, easy, and effective, with remission rates reported to be as high as 70–80%. About 65% Rates in a Naturalistic Study In a naturalistic study of 66 children and adolescents with catatonia, they found that benzodiazepines improved catatonia in 65% of cases , that there was no relation between dose and level of improvement, that the dose was higher sometimes (up to 15 mg of lorazepam) than the dose recommended in pediatric patients, and that side effects were few. Two-thirds Improved in a Trial of 107 adults In a recent trial in 107 adult inpatients ( 49% with a psychotic disorde

NICE recommends to use electroconvulsive therapy (ECT) only to attain quick and short-term improvement of severe symptoms if an adequate trial of other options has not been effective and/or when the condition is considered to be potentially life-threatening, in individuals with: catatonia a prolonged or severe manic episode. Indication to an individual must be based a documented assessment of the risks and potential benefits to the individual. Exercise caution when considering electroconvulsive therapy during pregnancy, in older people, and in children and young people. Valid consent should be obtained in all cases where the individual can grant or refuse consent. The decision to use electroconvulsive therapy should be made jointly by the individual and the clinician(s) responsible for treatment, based on an informed discussion after full information about the risks and potential benefits, without pressure or coercion, the involvement of patient advocates and/or carers is strongly enc