Mental Health Monthly #16: Psychosis in the ED Part II

<p dir="ltr"><strong>Contributors:</strong> Andrew White MD & Travis Barlock MD</p> <p dir="ltr">In this follow-up episode Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency physician at Swedish Medical Center, discuss mental health holds, psychiatric placement, pharmacologic vs. non-pharmacologic treatments, and outpatient care of psychotic patients. If you missed it, be sure to listen to part I for details on the management of psychotic patients in the ED.</p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <ul> <li dir="ltr">Mental health holds should be approached on a case-by-case basis; this includes assessing safety risks immediately, over a 24-hour period, and chronically over the last few months. Lastly, collateral information is useful in assessing a mental health hold.</li> </ul> <p> </p> <ul> <li dir="ltr">What happens after patients get placed in inpatient psychiatry? Typically an antipsychotic is started; in the absence of metabolic risks, patients will often be started on Zyprexa, especially in oral dissolvable form. Doses of Zyprexa ODT start at 2.5 - 5 mg per day.</li> </ul> <p> </p> <ul> <li dir="ltr">If psychotic patients do not pose direct harm to the environment, they do not necessarily need to be medicated. However, patients will often need medication at some point; for example, some people may be calm during their psychosis but unable to feed themselves or perform other ADLs.</li> </ul> <p> </p> <ul> <li dir="ltr">The goal of pharmacologic treatment for psychosis is to save the brain; each episode of psychosis damages the brain. Oftentimes, patients will be started on long-acting injectables like aripiprazole or risperidone to give patients 30 days of treatment with one shot.</li> </ul> <p> </p> <ul> <li dir="ltr">Non-pharmacologic approaches to psychosis are challenging given the nature of the disease. There have been attempts at therapy for psychosis but not have not been hugely successful. Options for support incl