‘Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness’ recommends that patients at risk of suicide, including all patients with a recent history of self-harm, who are treated with psychotropic drugs should receive modern, less toxic drugs and/or supplies lasting no more than 2 weeks.
NICE clinical guidelines on Schizophrenia (March 2009) include advice on pharmacological interventions:
Pharmacological interventions For people with newly diagnosed schizophrenia, offer oral antipsychotic medication. Provide information and discuss the benefits and side-effect profile of each drug with the service user. The choice of drug should be made by the service user and healthcare professional together, considering:
Before starting antipsychotics offer an ECG if: specified in the SPC; or a physical examination has identified specific cardiovascular risk; or there is personal history of cardiovascular disease; or the service user is being admitted as an inpatient.
Consider treatment with antipsychotic medication as an individual therapeutic trial, starting with a dose at the lower end of the licensed range and titrate upwards slowly, monitoring and recording efficacy and side effects regularly and systematically throughout treatment. Carry out a trial of the medication at optimum dosage for 4 - 6 weeks. Do not initiate regular combined antipsychotic medication, except for short periods (for example, when changing medication).