Process - Physician - Fraser Health Authority

Approved Use1. schizoaffective disorder2. Drug psychosis3. schizophrenia4. Bipolar (Risperidone, olanzapine, quetiapine)5. Aggression and psychosis in dementia (Risperdal only)Off label Use1. Agitation/insomniaa. Olanzapine 2.5 – 5mgb. Quetiapine 12.5 – 100mgc. Very effective without rebound or addiction potential2. Anxiety – SSRI’s still mainstay of treatment3. PTSD – improves sleep and anxiety4. Depression – Olanzipine and Quetiapine XR alone or with SSRI5. Borderline Personality disorder – good for anxiety, paranoia, impulsivity but notdepression associated with BPD6. Autism7. Tourettes, stutteringRecommended Monitoring- Increased risk of DM which can be independent of weight gain (up to 10x risk of DM)especially clozapine and Olanzapine- Increased risk of metabolic syndrome- Weight gain especially in first few monthso Worst with clozapine, Olanzapineo Then risperidone, quetiapineo Least likely with Zeldoxo Recommend small, frequent meals with protein and exercise1. Check weight at 0, 1, 2, 3 and 6 mos then q 6 mos2. BP 0 then q 6 mos3. FBS 0, 3 then q 6 mos4. lipids 0, 3 then q 6 mos5. waist circumference with wt.Switching from one to another, go slowly with fragile patients. 20% taper off old and 20%increase on new q weekly over 4 – 5 weeks.