California Department of State Hospitals Psychotropic Medication Operational Procedures (updated 8/26/2026)

These operational procedures are appended to the California Department of State Hospitals Policy Directive 3400 and reflect departmental regulations related to the use of psychotropic medications, protocols for use of specific medications and classes of medications, and informational chapters for prescribers.

(The last revision date is noted in parenthesis after each chapter title.)

00 Table of Attached Chapters (7/27/2026)

01 Chaptering (1/4/2023)

02 Acknowledgement (1/4/2023)

03 Introduction (1/4/2023)

04 Treatment Decisions & Algorithms (8/6/2025)

05 Medication Terminology (1/4/2023)

06 Medication or Therapeutic Review Committee (1/4/2023)

07 Polypharmacy (1/4/2023)

08 PRN and STAT Orders (1/4/2023)

09 Long-Acting Injectable Antipsychotics (7/27/2026)

10 Dose Maximum Tables  (7/27/2026)

11 Aripiprazole Protocol (7/27/2026)

12 Asenapine Protocol (8/17/2023)

13 Brexpiprazole Protocol (8/17/2023)

14 Cariprazine Protocol (8/17/2023)

15 Clozapine Protocol (7/27/2026)

16 Iloperidone Protocol (7/27/2026)

17 Lumateperone Protocol (8/17/2023)

18 Lurasidone Protocol (8/17/2023)

19 Milsaperidone Protocol (7/27/2026)

20 Olanzapine Protocol (8/6/2025)

21 Paliperidone Protocol (3/7/2025)

22 Quetiapine Protocol (8/17/2023)

23 Risperidone Protocol (1/28/2026)

24 Xanomeline/Trospium Protocol (3/7/2025)

25 Ziprasidone Protocol (8/17/2023)

26 First-generation (Conventional) Antipsychotics Protocol (3/7/2025)

27 Carbamazepine Protocol (8/5/2026)

28 Lamotrigine Protocol (3/7/2025)

29 Lithium Protocol (3/7/2025)

30 VPA-Divalproex Protocol (5/30/2024)

31 Antidepressant Protocol (1/4/2023)

32 SSRI Antidepressant Protocol (8/17/2023)

33 Benzodiazepine Protocol (1/28/2026)

34 Alpha-2 Adrenergic Agonists Protocol (2/7/2024)

35 Appendix – Common Drug Formulary Web Address (1/23/2024)

36 Appendix – PRN and STAT Guidelines (1/28/2026)

37 Appendix – Psychopharmacology Algorithms and Guidelines Resources (2/7/2024)

38 Appendix – Geriatric Prescribing Guidelines (1/23/2024)

39 Appendix – Clozapine Historical Review (1/23/20o24)

40 Appendix – Management of Medication-induced Constipation (11/12/2025)

41 Appendix – Hyperprolactinemia (8/6/2025)

42 Appendix – Tardive Dyskinesia (7/27/2026)

43 Appendix – Neuroleptic Malignant Syndrome (8/6/2025)

44 Appendix – Metabolic Syndrome (8/6/2025)

45 Appendix – Medications to Prevent or Treat Obesity (8/6/2025)

46 Appendix – Selected Treatment of Psychomotor Agitation (STOP-A) (1/28/2026)

47 Appendix – Therapeutic Plasma-Serum Concentrations for Antipsychotics and Mood Stabilizers (8/6/2025)

48 Appendix – Medications for Substance Use Disorders (7/27/2026)

49 Appendix—Naloxone Hydrochloride Nasal Spray (Narcan) Protocol (8/6/2025)

50 Appendix—Managing Patients on Select Psychotropic Medications with Mild-Moderate COVID-19 Infection Treated with ® (8/6/2025)

51 Appendix—Management of Medication-Induced Sialorrhea (8/6/2025)

52 Appendix — IST Treatment Guidelines (08/62/2025)

53 Appendix – Drug Utilization Evaluation (DUE) Guideline (8/6/2025)

54 Appendix – Special Clinical Review (8/6/2025)

55 Appendix – Non-formulary Review Process (8/6/2025)

56 Appendix – Informed Consent Form (DSH 9181) (8/6/2025)