Treatment Options for Psychosis in the Emergency Department

Patients presenting with a psychotic episode will arrive to an ED for treatment whenever the symptoms that the patient is experiencing become severe enough that family, friends, or others in the community near the patient are negatively affected by the symptoms or associated behaviors related to the symptoms.

When the task of treating a psychotic illness is presented to an ED team, the first logical question to arise is what options are available to the team for proper treatment of the symptoms. The primary and most efficient treatment for psychotic symptoms in the ED, whether caused by a primary psychiatric disorder or substance intoxication, is medication. Aripiprazole, risperidone, halo- peridol, olanzapine, ziprasidone, and clozapine are some of the commonly available antipsychotic medications that an ED treatment team may have at their disposal to treat psychotic symptoms. Troubling symptoms, both for the patient and their caregivers, including paranoia, command hallucinations, thought disorganization, and agitation, can be ameliorated by rapid and properly dosed administration of the antipsychotic class of medications.

With any patient presenting to the ED for assistance, asking them if they want help and what type of help they are seeking should be the initial starting point of the interaction (Mohr et al. 2005). If medications are being sought out by the patient or a cooperative decision is made, with the patient’s input, to start a medication, oral medication should be the initial treatment choice (Brown et al. 2012; Byrne 2007; Mohr et al. 2005). Intramuscular formulations of medications can be utilized to help treat an agitated and aggressive patient who is at risk of harming themselves or others and that has not responded to offers of oral medications or other calming interventions (Brown et al. 2012; Mohr et al. 2005; Zimbroff 2003).

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