Mental Health Monthly #14: Substance-Induced Psychosis (Part II)

<p><span style="font-weight: 400;">In this second episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with comorbid medical conditions. Lastly, they consider the different causes for repeat visits from mentally ill patients. </span></p> <p> </p> <p><strong>Key Points:</strong></p> <p> </p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Pharmacologic treatments for substance-induced psychosis are similar to those for other types of psychosis; these include medications like Zyprexa, Haldol, and, as a third-line treatment, IM Thorazine. </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Droperidol is used more commonly in the emergency setting, compared with the psychiatric setting. </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Given the risk for respiratory depression from Zyprexa combined with benzodiazepines, psychiatrists may choose to use Thorazine or Haldol/Ativan/Benadryl instead. </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">It is important to reassess patients after substances wear off to determine whether they meet criteria for admission to inpatient psychiatry, though psychiatric assessments are limited by geographic constraints.</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The admitting psychiatry team will reassess the patient to differentiate substance-induced psychosis vs other psychoses; often this includes obtaining collateral.</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Helpful notes from the ED include: medications ad