Difficult case (schizoaffective, FND, and extensive allergy list)
Hi all. So I have a difficult case that I wanted to put to the group. I have a young ACT patient with schizoaffective disorder, bipolar type resulting in many hospitalizations and very bad destruction of property, in the years before I took over his care. Throughout those years, he was tried on a variety of antipsychotics (risperidone, olanzapine, haldol, prolixin, invega, etc), but each time would manifest "allergies", which he states (and are listed in his medical record) typically as...
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Source: Student Doctor Network - May 30, 2023 Category: Universities & Medical Training Authors: When is graduation again? Tags: Psychiatry Source Type: forums
Capacity consult, chronic delusions, refusing pacemaker
Patient in their 60s with schizophrenia, meds optimized on Invega Sustenna, stable at ALF for years. Has chronic delusions of being monitored, doesn't trust machines. Then he started passing out, admitted to the hospital, found to have frequent runs of asystole and cardiology recommends pacemaker. He doesn't want it (it's a machine, of course). He lacks decisional capacity. High likelihood of death without it.
What do you think should happen with someone like this. Other than refusing care...
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Source: Student Doctor Network - November 26, 2022 Category: Universities & Medical Training Authors: nexus73 Tags: Psychiatry Source Type: forums
Benzos vs benztropine for EPS in the elderly
So I got an outpatient consult recently for med recs on an 65ish year old lady with well-documented late-onset schizophrenia (onset around 52-53) who has been on Invega LAI for years and done very well with it. Patient and daughter are adamant about staying on it, as apparently previous periods without meds were disastrous. She's also been taking benztropine 1 mg BID for EPS (appears to be parkinsonism and akathisia) and clonazepam 1 mg daily for anxiety. When clonazepam was previously...
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Source: Student Doctor Network - November 25, 2022 Category: Universities & Medical Training Authors: Stagg737 Tags: Psychiatry Source Type: forums
Opinions on stopping zyprexa
I have a schizophrenic patient who was on saphris doing ok but not great. He stopped it became very psychotic and was started on Invega inpatient. He was still psychotic after initial 156 mg dosage and it was upped to 234 the next dosage. A week after that dosage (because he was still psychotic) Zyprexa 5 mg was added. He then improved. He’s been on the invega 234 plus 5 of zyprexa for a few months and is doing well. He wants to taper the Zyprexa to be on monotherapy. I’m nervous about...
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Source: Student Doctor Network - August 10, 2022 Category: Universities & Medical Training Authors: Attending1985 Tags: Psychiatry Source Type: forums
Difficulties transitioning to Invega Sustenna
I've had two patients that decompensated during transitions to Sustenna.
The first was very, very carefully titrated to 9 mg of oral paliperidone with almost complete remittance of psychosis before starting Sustenna. They were admitted for NMS after stopping Trinza and being overloaded with various antipsychotics at another hospital, so I wanted to make sure it wouldn't recur before restarting a long-acting injectable. I followed the manufacturer recommendations exactly (234 mg on day 1 and...
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Source: Student Doctor Network - May 26, 2022 Category: Universities & Medical Training Authors: Kirby Tags: Psychiatry Source Type: forums
Pt case: invega works but risperdal really doesn't. Any similar cases?
As stated, interesting situation where invega is the only thing that has worked well, but risperdal surprisingly is one of the worst ones for the pt
Any similar cases/thoughts and comments as to why? Do the other risperdal metabolites really have that much variation in clinical effects? Or is it likely moreso the difference in pharmacokinetics (Source: Student Doctor Network)
Source: Student Doctor Network - February 19, 2022 Category: Universities & Medical Training Authors: caxoo Tags: Psychiatry Source Type: forums
Good resource for long acting injectables?
I'm taking over a clinic where there are several patients on Clozaril and LAI's. I am Child trained and even the work that I've been doing since fellowship has been mainly child focused. I really need a good resource to learn more about how many days to give oral and then stop after the injection for the different ones. Before in residency I would give Risperdal for 5-6 days at low dose and then send the pt out with Invega Sustenna after discharge.
For example, I had a patient today who...
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Source: Student Doctor Network - November 23, 2020 Category: Universities & Medical Training Authors: shahseh22 Tags: Psychiatry Source Type: forums
Persistent creatine kinase elevation following NMS
I'm hoping to get your opinions on this case. Case involves a 20 year old man with schizophrenia who was fairly treatment naive. Psychosis started over the last 6 months. He was previously on short trials of Zyprexa, but would stop after a few days of hospital discharge and end up getting rehospitalized. He was switched to Invega during his last hospital stay which was helpful. He transitioned to Sustenna, receiving the initial 234 and 156 loading doses; he stabilized and discharged....
Persistent creatine kinase elevation following NMS (Source: Student Doctor Network)
Source: Student Doctor Network - July 17, 2016 Category: Universities & Medical Training Authors: nexus73 Source Type: forums
