When do you switch antipsychotics in the inpatient setting?
Curious how long you guys trial a patient on an antipsychotic before switching course and changing meds? We are under the gun to move people of course, so I often find myself 7-8 days in and scared to change meds because we'll be starting from square one all over again. I also know that we may not get peak efficacy for 6-20 weeks out.
I find myself often going to olanzapine or risperdal, then changing to the other. Occasionally abilify if there's documented positive response in the...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 7, 2023 Category: Universities & Medical Training Authors: uhmocksuhsillen Tags: Psychiatry Source Type: forums
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...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 30, 2023 Category: Universities & Medical Training Authors: When is graduation again? Tags: Psychiatry Source Type: forums
Bipolar 1 Mania - Refusing Depakote and lithium, maxed on Zyprexa, thoughts?
I have a 60 something male with history of bipolar 1 disorder. Started on Zyprexa when they came in, is now sleeping and not receiving PRNs anymore. However, still very grandiose (knows several famous people, is writing a new Bible) and paranoid that his family is conspiring against him. Remains pressured and tangential. They are voluntary and up to 20 mg of Zyprexa, but refusing Depakote or lithium. Started Lamictal as they tolerated in the past but I know its not going to be as helpful for...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - February 10, 2023 Category: Universities & Medical Training Authors: FI-Prexa 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...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - August 10, 2022 Category: Universities & Medical Training Authors: Attending1985 Tags: Psychiatry Source Type: forums
Anorgasmia Treatments?
Looking for some input from the hive mind here.
33yo with schizophrenia. Had him on inpt for about 4 months before he was finally stabilised on Abilify Maintena 400mg and olanzapine 10mg. But he’s had Anorgasmia since being on the meds. Not sure which one did it as he came to me on both. No erectile difficulties, he just can’t finish. I tried bupropion and mirtazapine, no effect. Right now I’ve left him on trazodone 50mg qhs and amantadine 100mg BID (amantadine to counteract D2 blockade...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 11, 2022 Category: Universities & Medical Training Authors: vanfanal Tags: Psychiatry Source Type: forums
Olanzapine with Samidorphan was approved —will you all use it?
Only available as a fixed dose combo—Samidorphan not available on its own. Supposed to mitigate weight gain, but I wonder if it has any effect on the underlying metabolic changes olanzapine causes. (Source: Student Doctor Network)
Source: Student Doctor Network - June 2, 2021 Category: Universities & Medical Training Authors: birchswing Tags: Psychiatry Source Type: forums
ED boarders
Hypothetical case example:
Setting: Community hospital ED with inpatient adult psych unit attached.
39 year old male with psychosis presents to ED with law enforcement, off meds x 2 weeks he is hallucinating, delusional, agitated. Medically evaluated and cleared by ED doctor. ED doctor provides one time Zyprexa 10 mg PO and patient calms some, PRN Zyprexa available for agitation which helps overnight. Patient meets criteria for psych admission at 10 pm, but no beds, so patient is...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 10, 2021 Category: Universities & Medical Training Authors: nexus73 Tags: Psychiatry Source Type: forums
Options for clozapine-resistant schizophrenia?
I have a patient on the long term ward who transferred from a local short term ward, presented with persisting persecutory delusions and command hallucinations with accompanying violence risk, dx was schizophrenia. He came in on Risperidone 4mg BID, had previously been on Haloperidol, Olanzapine, Aripiprazole, and Lurasidone, Didn't want to up the Risperdal because anecdotally I haven't seen much success with doses above 8mg.
Given he had failed multiple antipsychotics and the fact he was...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - January 1, 2021 Category: Universities & Medical Training Authors: mmms85 Tags: Psychiatry Source Type: forums
Adding Metformin to VPA to control weight gain?
I have a moderately obese gentleman with Schizoaffective disorder and Meth use history who is still having a lot of AH and mood instability on VPA 1,000 mg, Risperdal 8 mg, Trazodone 150 mg and Wellbutrin 150 mg BID (has been snorting at group home a few times). His BMI is 37 and he wants to switch to Zyprexa as it worked for him in the past. I told him I would need labs before making any changes. But if I decide to cross-taper to Zyprexa, will adding the Metformin also help with the weight...
Adding Metformin to VPA to control weight gain? (Source: Student Doctor Network)
Source: Student Doctor Network - October 20, 2020 Category: Universities & Medical Training Authors: shahseh22 Tags: Psychiatry Source Type: forums
Pushing antipsychotics beyond maximum doses
I constantly see psychiatrists going above the maximum recommended dose of antipsychotics (not even mentioning max effective dose). Zyprexa 30-40mg, geodon 320mg, high doses of risperdal. It is a personal pet peeve of mine and I especially hate it when they are on multiple antipsychotics along with the excess doses. I always adhere to the max FDA dose even in severe patients in the hospital, do you guys agree? (Source: Student Doctor Network)
Source: Student Doctor Network - April 1, 2018 Category: Universities & Medical Training Authors: sweetlenovo88 Source Type: forums
Using Zyprexa in someone you suspect has Diabetes?
Hi,
I've been trying to see some intakes at a local center where we don't have ability to get labwork done before patients are seen with us. Typically, we start meds then tell patient's to get their bloodwork done by their future providers. I was wondering, considering how wonderful Zyprexa has worked, is it possible to have the patient start the medication (depending on severity) and have the ongoing provider or PCP just check labs? Some of these patients have very severe symptoms and...
Using Zyprexa in someone you suspect has Diabetes? (Source: Student Doctor Network)
Source: Student Doctor Network - March 30, 2018 Category: Universities & Medical Training Authors: ara96 Source Type: forums
Agitation in children-what's your preferred IM?
Affective or psychotic agitation in younger children 3-16 y/o, what's your go to IM? 5/2/2 [haldol/Ativan/benadryl]? Thorazine? zyprexa? ativan? (Source: Student Doctor Network)
Source: Student Doctor Network - October 6, 2017 Category: Universities & Medical Training Authors: Madden007 Source Type: forums
What would you do?
Patient is a female 30 years old. Has seen other psychiatrists in the past all with the same diagnosis: schizoaffective depressive type. Takes Zyprexa and Paxil and Topamax for migraines. She is on disability and going to school. She says she hopes to work for a bank. You continue treatment she appears to be doing well. She hits a bump in the road and almost dies. Turns out she was drinking her way through college. (Medical report shows her lipase rose to 1200). She goes to rehab and comes...
What would you do? (Source: Student Doctor Network)
Source: Student Doctor Network - September 20, 2017 Category: Universities & Medical Training Authors: Maggie Martin Source Type: forums
experience using zyprexa relprevv?
hi all,
does anybody have experience using zyprexa relprevv? i've been working with some patients lately who have failed multiple trials of the other depot antipsychotics, including very high doses of consta. i've never used relprevv, nor do i know anybody who has. i understand that patients have to be monitored for several hours after getting the injection because it can lead to coma or ms changes, which sounds scary. anybody have experience with relprevv? what's your take on it? (Source: Student Doctor Network)
Source: Student Doctor Network - August 28, 2017 Category: Universities & Medical Training Authors: jamesearlejones Source Type: forums
Unorthodox Use of Antipsychotics in Bipolar Disorder
Two questions:
1. I was reading UptoDate (Bipolar disorder in pregnant women: Treatment of mania and hypomania) and saw the following:
"The efficacy of haloperidol for treating mood elevated syndromes appears to be comparable to risperidone and olanzapine, and superior to quetiapine and lithium."
None of the attendings I work with prescribe typical antipsychotics for mania. Do you have experience doing so in non-pregnant patients? What was the result?
2. Do you use long-acting...
Unorthodox Use of Antipsychotics in Bipolar Disorder (Source: Student Doctor Network)
Source: Student Doctor Network - February 5, 2017 Category: Universities & Medical Training Authors: AD04 Source Type: forums
