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Tips for dealing with aggression. Avoid any verbal confrontation if possible. Offer food and cold liquids. I once saw a psychiatric outline in a course like this where they said, offer the patient coffee. Agitated patients, coffee, no. Not unless you want to be wearing it. So offer food and cold liquids. I mean, you know how it is. You come home from work and you are kind of cranky. You have something. Somebody says, here’s a sandwich and a nice glass of Pepsi. You feel better. It’s like, “Okay, I was kind of irritable but now I feel better.” Works the same way with confused patients in an ER. You give them a cold sandwich and a glass of pop and a lot of times they will calm down. Avoid eye contact with intensely paranoid patients. Some cultures are different. As you know, in the American culture we like to make eye contact and that’s seen as a sign of honesty. There are some cultures where it is thought to be rude if you look people directly in the eye. For paranoid patients, don’t look at them in the eye. Look away or look down because a lot of people find that very intimidating and confrontational.
Let the patient vent. Cialis professional pharmacy. This is so important. Chlorpromazine or Thorazine can cause hypotension. Get these elderly people, or even young people, and they suddenly go from agitated to on the floor, clunk. Then you have to call the radiologist because you’ve got to get a CT scan. Haloperidol or Haldol is very nice because it causes essentially no hypotension.
Apart from drugs, non-pharmacological options is letting the patient vent.
Supportive therapy, including cooling blankets, ice baths, hydration, maybe Tylenol. How about dantrolene and bromocriptine? In real life, probably not. For the Board, probably so. I don’t think in looking at the literature, and I’m not the internationally recognized authority on NMS, but looking at the literature I don’t think that bromocriptine or dantrolene really help. I don’t think they are any better than just supportive therapy. But if I were answering the question on the Board, I would pick one of those two. How about Sinemet? Have people ever heard of that or used that? I have read that, that Sinemet causes NMS. It’s not something I classically associated with NMS. How many people have ever heard that? Using Sinemet? What’s that? Can cause NMS? Okay, have you ever heard about it for just people who get it from Haldol, where it is not Sinemet caused?
Laboratory abnormalities. The most common laboratory abnormality in a psychiatric patient is hyponatremia. Why is that? There is a classic med that you use and that I use, Tegretol, carbamazepine can cause hyponatremia. One that I use a lot that you probably don’t prescribe, clozapine. Clozaril, which we’ll talk about at length. That was the first traditional antipsychotic, that’s the agranulocytosis one and we’ll talk about that, that can cause hyponatremia. Also lithium possibly. People on lithium like to drink a lot of water. And then, Depakote. How many of you have seen Depakote hyponatremia? I don’t think of that as classically but I’m sure you’re right. Then finally, psychogenic polydipsia. What’s psychogenic polydipsia? Psychiatric patients sometimes, like in state hospitals – and now sometimes in the community because nobody is in state hospitals anymore – will just drink and drink and drink. They will just drink until they dilute all their sodium. Their sodium will go down to like 108 and then they’ll have seizures.

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