Anti-psychotics and geriatrics

achot chavi · Mar 04, 2009, 10:52 AM

Originally Posted by psychRNinNY

This makes sense as the new behaviors likely are r/t the dementia and not mental illness. It is really not a commmon thing --if even at all possible to have an 80 YO suddenly develop schizophrenia......this desn't happen. If they are suddenly behaving differently, even showing signs of "psychosis" such as paranoia or the common visual hallucinations-- it is almost always organic--medical in nature, in my experience. Most common, of course, the infamous UTI or any infection really, some meds--I have seen IV Avalox do crazy things to a geri patient! lol, brain or liver CA.....etc. So treating these things with an anti-psychotic is really not appropriate-- you have to treat the cause of the behavior/psych s/s. So this info from the doc totally makes sense to me.

Exactly- well put!

ksangel · Mar 04, 2009, 11:48 PM

just a thought: has anyone else noted that when geriatrics start having behavior and demntia issues..... some simple lab like electrolytes and u/a can be the answer. its so suprising when dr says confusion is not sign of uti.... but with increased incontinence and strong urine.,..... it is. seen the uti and electrolyte imbalances can really mess up the thinking process in the elderly...... find the source before starting a new med..... nursing 101

achot chavi · Mar 05, 2009, 11:49 PM

Not just that, it could be side effects of meds like morphine, it could be an undetected infection, or B12 deficiency etc.
Sometimes a new admit will have behavior problems till they settle in and if you overmedicate- they will be a zombie for no reason. We had a recent new admit who became agitated at night (hello- new environment, and staff, etc.) nurse (on her own) injected Halidol 5 mg. the guy was out of it for 4 days!!! (nurse was called on the carpet, explained that the doc said give it and she forgot to ask for a faxed order... doc confirmed...still...)
any other sources of behavior changes...

1214RN · Mar 06, 2009, 09:41 AM

DEPAKOTE is utilized as a mood stablizer and often with good results in our geriatric behavioral psych unit... following a taper of seroquel or some other antipsychotic meds. We start out at 125 mg BID for one week and increase to 250mg BID. In the sprinkle form it is easier for some residents to consume as well.

Candyheart · Mar 10, 2009, 10:29 PM

Thanks for the Depakote idea. Maybe it will work better than Serequel for some agitated behavior. One of the things I have noticed is that one day the resident gets their med and doesn't slow down a bit, just as wild as ever. The next day, same med knocks them out all evening. Of course, thats the day the family visits and is alarmed that "Mom is so sedated". If only they could see her on the other evenings!

1214RN · Mar 12, 2009, 10:34 AM

I should specify we actually start the depakote while the other psychotropic is being tapered, so the depakote is ramped up while the others are ramped down.
And isn't that the truth about family visits!

Originally Posted by Candyheart

One of the things I have noticed is that one day the resident gets their med and doesn't slow down a bit, just as wild as ever. The next day, same med knocks them out all evening. Of course, thats the day the family visits and is alarmed that "Mom is so sedated". If only they could see her on the other evenings!