Antipsychotic Titration — MRCPsych Paper B MCQ
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Correct answer: A — Start at the lower end of the licensed range and titrate slowly upwards within the recommended dose range
The correct answer is A. NICE recommends treating antipsychotic prescribing as an explicit individual therapeutic trial. Treatment should start at the lower end of the licensed dose range and be titrated slowly upwards within the recommended range, with clinical response and adverse effects monitored particularly closely during titration. Any reason for using a dose outside the recommended range should be justified and recorded. Starting at the upper end or immediately at a target dose increases avoidable adverse-effect burden. Automatic daily dose doubling is not recommended because titration should be individualised rather than determined by a fixed rapid schedule. Loading doses, sometimes termed rapid neuroleptisation, should not be used.
Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendations 1.3.6.3 and 1.3.6.9. 2014. https://www.nice.org.uk/guidance/cg178/chapter/recommendations