Remarks y The medicines included in the recommendation correspond to the WHO EML (13) and are listed in alphabetical order. y Clozapine should be offered for treatment-resistant psychosis, defined as psychosis that has not shown improvement after receiving treatment from two alternative antipsychotics with adequate dose and time. Clozapine should only be offered where lab tests are available to monitor white blood cell count, and under a mental health specialist supervision. y Evidence regarding the safety and effectiveness of fluphenazine is mainly concerning the longacting injectable formulations. Please refer to PSY4 recommendations for further information. y This recommendation does not suggest that only medicine should be offered, but medicine may be offered in combination with psychotherapy. Please refer to PSY11 for further information.

Implementation considerations y People living with psychotic disorders should be involved in medicine choice in a supported decisionmaking process, without coercion and in line with human rights instruments. y Treatment with antipsychotic medicines should be combined with psychosocial interventions (see other PICO questions in this module). y Acquisition costs can differ substantially and also throughout the world. Recent antipsychotics may have currently higher costs than some older antipsychotics. y Disruption in medicine supply (common in LMICs) may interfere with continuation of treatment. y For the treatment of psychotic disorders, the WHO EML (13) includes the following oral medicines:

• haloperidol (therapeutic alternative: chlopromazine);
• risperidone (therapeutic alternatives: aripiprazole, olanzapine, paliperidone, quetiapine);
• complementary list: clozapine.