Dude sometimes we still give thorazine. And tbh ime the 3rd gens don’t do shit for my typical patient. For context also though, I’m essentially providing ICU level care, so when you say the word “symptom control” it’s often referring to like, fists.
We had a Lady maxxed on Haldol BID one time and she managed to cheek for a week and eventually she just hauled off and rapid fire punched a nurse in the head three times. She legit thought a man was entering through her window every night on a beam of light to forcibly impregnate her and deliver the baby. She kept demanding to see the 50 babies she had up on L&D from the past few months. I’ve actually seen quite a few pregnancy delusions and they’re almost always completely wild psychosis. Another was such an angry manic but high insight enough that when she couldn’t take it anymore she would just come scream at me for the thorazine.
I’m unsure if you don’t work inpatient psychiatry or you just work somewhere significantly classier than I do. I do work in an inner city area that’s flush with people stuck in a cycle of drugs / homelessness so I’m also not going to tell you that any of this is the best solution, just that it’s the only one avaliable to any of us right now due to shitty government policies.
i.e. “I need Olanzapine [broad receptor affinity, highly anti-cholinergic, well-tolerated], but, like, faster.” I’m surprised that particular aspect of the side effect profile comes into play with acute usage.
I’m unsure if you don’t work inpatient psychiatry or you just work somewhere significantly classier than I do.
Ah, yes, this happens a lot. No, I don’t work in the medical field at all. I just know things, for reasons.
I do work in an inner city area that’s flush with people stuck in a cycle of drugs / homelessness
i.e. the psychosis has done so much cumulative damage at this point that you need to fall back to the typicals. That explains why the third-gens are useless.
On a different note, have you heard about Cobenfy yet?
It obviously isn’t suited to the needs of your practice. But I’m really glad we’re making progress on alternative treatment approaches, especially novel ones like anti-muscarinics.
Hopefully the new glutamatergics can reach your setting soon.
Dude sometimes we still give thorazine. And tbh ime the 3rd gens don’t do shit for my typical patient. For context also though, I’m essentially providing ICU level care, so when you say the word “symptom control” it’s often referring to like, fists.
We had a Lady maxxed on Haldol BID one time and she managed to cheek for a week and eventually she just hauled off and rapid fire punched a nurse in the head three times. She legit thought a man was entering through her window every night on a beam of light to forcibly impregnate her and deliver the baby. She kept demanding to see the 50 babies she had up on L&D from the past few months. I’ve actually seen quite a few pregnancy delusions and they’re almost always completely wild psychosis. Another was such an angry manic but high insight enough that when she couldn’t take it anymore she would just come scream at me for the thorazine.
I’m unsure if you don’t work inpatient psychiatry or you just work somewhere significantly classier than I do. I do work in an inner city area that’s flush with people stuck in a cycle of drugs / homelessness so I’m also not going to tell you that any of this is the best solution, just that it’s the only one avaliable to any of us right now due to shitty government policies.
Acute care, understood.
i.e. “I need Olanzapine [broad receptor affinity, highly anti-cholinergic, well-tolerated], but, like, faster.” I’m surprised that particular aspect of the side effect profile comes into play with acute usage.
Ah, yes, this happens a lot. No, I don’t work in the medical field at all. I just know things, for reasons.
i.e. the psychosis has done so much cumulative damage at this point that you need to fall back to the typicals. That explains why the third-gens are useless.
On a different note, have you heard about Cobenfy yet?
https://www.npr.org/sections/shots-health-news/2024/09/27/g-s1-25089/karxt-cobenfy-schizophrenia-psychosis-fda
It obviously isn’t suited to the needs of your practice. But I’m really glad we’re making progress on alternative treatment approaches, especially novel ones like anti-muscarinics.
Hopefully the new glutamatergics can reach your setting soon.