Zyprexa before agitation

[fairwaysngreens]

Long time lurker as a student, finally have a question I couldn't find discussed prior. What do you think about Zyprexa 20mg PO and Zyprexa 10mg IM for PEC pts before they get acutely psychotic if they look like they are heading that way? Thanks

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[southerndoc]

Welcome to SDN long-time lurker (who just joined this month?).

Anyhoo, anti-psychotics are frequently given to patients who look like they are deteriorating into psychosis.

 

[DrQuinn]

Welcome to SDN long-time lurker (who just joined this month?).

Anyhoo, anti-psychotics are frequently given to patients who look like they are deteriorating into psychosis.

I'm not sure what PEC stands for, but I generally stick to good old haldol. Our psych department hasn't really decried using it, (we are very blessed with an awesome psych department), and its what I'm used to. Not to mention much cheaper.

And I generally only give haldol to those that request it, or are very agitated. Not just people that are perhaps mildly psychotic or just a bit hyperverbal.

Q

 

[fairwaysngreens]

Thanks for the replies. I was wondering more about what you thought of the dosage of Zyprexa, seems like a lot but works well.

 

[DeLaughterDO]

PEC = psych emergency center?

nothing helpful here, move along

 

[USCDiver]

Thanks for the replies. I was wondering more about what you thought of the dosage of Zyprexa, seems like a lot but works well.

I haven't used Zyprexa since... well never. I remember reading about it when I was in medical school.

So to answer your question, that dose means nothing to me.

 

[docB]

Those dosages are what we have on our psych protocols. Problem is (and I've had this exact discussion with the Zyprexa and Geodon rep) our "psych patients" really tend to be more acutely intoxicated + psych than strictly psych exacerbations. Consequently I'm not trying to get them calm so I can chat with them (as is depicted on the Geodon ads). I want them out. Put them out, let them metabolize and then try to figure out what the main malfunction is. That's why I usually go with the good ole B-52.

 

[fairwaysngreens]

Thanks docB.

 

[southerndoc]

If I remember right, a PEC is a psychiatric emergency conservation. We "PEC" patients -- paper them to hold them against their will if they are a danger to themselves or others.

 

[DrQuinn]

Consequently I'm not trying to get them calm so I can chat with them (as is depicted on the Geodon ads). I want them out..

HAHA! I have always thought of those Geodon ads as funny. The last thing I want is to really find out what the voices are telling the patient or how many hits of cocaine/PCP he did. By the time I am giving any antipsychotic I usually am on the phone with our psych social worker to get them a bed upstairs.

I so DO NOT want to be sitting across a desk with my patient once they clear up. This is something out of a weird LOST episode.

Haha.

Q

 

[GeneralVeers]

I agree with above. None of us really care what the voices are saying.

However, the psych triage at my prior facility would not accept patients who were "out". Consequently we often used Zyprexa just to de-agitate them enough to get them out of my ED.

 

[fairwaysngreens]

PEC is an involuntary psychiatric commitment, I believe for 2 weeks, but I assume the admiting psych doc could cancel it if they needed to. I am just getting started in the department but that is a good point about the ones that are intoxicated, just knock them out. The couple of times I used Zyprexa the pts where not combative and were purely psychotic s intoxication. They slept for a few hours woke up and were pretty chilled the rest of my shift. Psych pts tend to stay in the dept for a while waiting on a bed somewhere.

 

[Dukes]

I have given Zyprexa a few times and go with 10mg PO or IV. Has worked well each time. It tends to be quite sedating which is obviously a good thing for the sanity of both patient and staff. The only negative I've observed so far is that duration of sedation has been quite variable.

 

[Apollyon]

I agree with above. None of us really care what the voices are saying.

Do you ask the patients if the voices are talking to them or about them? This actually can give you a big insight as to whether they're really nutty or just looking for "3 hots and a cot". Also, ask them whether they can understand what the voices are saying.

 

[WakeDoc]

FYI-Zydis is a 5 or 10 mg orally dissolvable zyprexa. I use it frequently on those pt's that are right on the edge...you know, pacing, pissed, verbally abusive but not yet uncontrollable. It is pharmacologically cleaner then haldol and can be done w/o getting 5 security guards to hold someone down while the RN tries to dart them. Obviously, some people are too combative or too resistant to give PO, but for those that aren't Zydis is very fast and has been very effective in the small number I have used it on.

 

[GeneralVeers]

Do you ask the patients if the voices are talking to them or about them? This actually can give you a big insight as to whether they're really nutty or just looking for "3 hots and a cot". Also, ask them whether they can understand what the voices are saying.

No, I let psych sort all of that out. I usually don't have time to sit there and talk to the voices, real or imagined.

 

[Apollyon]

No, I let psych sort all of that out. I usually don't have time to sit there and talk to the voices, real or imagined.

Well, I manage to make 2.1 patients per hour as the attending, and I can.

What do you put on the papers when you have to sign them, to commit someone? Or do you have an attending psychiatrist right there in real time to evaluate the patients?

 

[GeneralVeers]

Well, I manage to make 2.1 patients per hour as the attending, and I can.

What do you put on the papers when you have to sign them, to commit someone? Or do you have an attending psychiatrist right there in real time to evaluate the patients?

Not sure what we do in Nevada yet. In Texas we always had the police put people on a "hold". I never had to personally committ someone.

 

[fairwaysngreens]

Stupid question but truely psychotic pts voices talk to them right?

 

[Apollyon]

Not sure what we do in Nevada yet. In Texas we always had the police put people on a "hold". I never had to personally committ someone.

In North and South Carolina (at least), the attending in the ED is the one that signs the commitment papers. People can come in committed already (by police or a judge/JOP), but, if they're not, it's up to me and my colleagues.

 

[fairwaysngreens]

Same way where I am too, ED doc actually does the commiting.

 

[southerndoc]

In North and South Carolina (at least), the attending in the ED is the one that signs the commitment papers. People can come in committed already (by police or a judge/JOP), but, if they're not, it's up to me and my colleagues.

Most places have a police hold that is a hold only until evaluated by a physician. If you have 24/7 psychiatry, then that's great, but otherwise it's you -- the attending -- that must determine if the patient qualifies for involuntary treatment. In many states, PA's and NP's cannot sign PEC papers.

 

[bartleby]

I only use atypicals if the patient needs sedation and is willing to take an oral med because we stock them in an orally disintegrating form despite their expense. Otherwise, in the ED in particular, there is a lack of evidence to support using the atypicals like zyprexa or risperdal (expensive) over haldol plus an anticholinergic agent [cogentin or benadryl] (cheap).

 

[ditch doctor]

PEC = Physcians Emergency Certificate. It's a Louisiana thing, for 14 days. Also there is a CEC = Coroner's Emergency Certificate. It's for longer, like 30 days or something. In LA, the coroner has oversight over all involuntary commitments. Don't know why, but he/she does.

Can't beat a B-52. Although I had a guy that was so out of the box the other day I had to give him a B-105. He was still mildly agitated after that. He was a hoss, too....

 

[skee lo]

Anyhoo, anti-psychotics are frequently given to anyone who encounters a psychiatrist.

fixed