The Landscape of Psych Meds, Part 2: Antipsychotics and Mood Stabilizers

In this second of a two part series, Dr. Mohammed Soliman, MD, PhD, MBA speaks with us about the landscape of psychiatric medications, a discussion is geared towards hospitals nurses who work in non-psychiatric units such as medical-surgical floors, ICUs, or emergency departments.

This episode will cover antipsychotic and mood stabilizing medications as well as when to request a psychiatric consult.

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First-generation antipsychotics

  • Ex: Haloperidol (Haldol), Chlorpromazine (Thorazine)
  • Effective in treating positive symptoms of schizophrenia (hallucinations and severe delusion)
  • Can worsen negative symptoms (flat affect)
  • Associated with extrapyramidal symptoms (EPS) which are a constellation of movement disorders such as acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.
    • EPS can be managed with short-term use of Cogentin

Second-generation antipsychotics

  • Ex: Quetiapine (Seroquel), Olanzapine (Zyprexa), Clozapine (Clozaril)
  • Target dopamine and serotonin systems and can help with both positive and negative symptoms
  • Associated with metabolic disorders such as diabetes, high cholesterol, and high blood pressure

Long-acting injections (LAIs)

  • Ex: Paliperidone (Invega) and Aripiprazole (Abilify)
  • LAIs are helpful for patients with schizophrenia who do not like taking medication, especially due to side effects or because they do not think they need it.

Mood Stabilizers

Commons mood stabilizing medications:

  • Lithium
  • Anticonvulsants: Valproic Acid (Depakote) and Carbamazepine (Tegretol)
  • Antidepressants: Remeron (Mirtazapine)

Bipolar vs. Unipolar Depression

Bipolar depression and its treatment are different from unipolar depression, as antidepressants may increase the risk of flipping into mania.

Important nursing considerations for mood stabilizers

Most require therapeutic drug monitoring through blood draws, e.g. Lithium, Depakote, and Tegretol.

When should psychiatry be consulted for a medical patient?

Psychiatric consultation may be appropriate for acutely agitated patients on medical floors after medical causes have been excluded.

A psychiatric consultation may also be appropriate with baseline psychiatrics medications need to be stopped (e.g. for surgery) or for delirium on top of dementia.

Always consult psychiatry if a patient has suicidal ideation (SI).