Will Benson

There are several things about Lexapro you should understand. 1. Lexapro (as well as ANY SSRI) takes at least 6-8 weeks to be effective. If you've only been on it for a month, you probably haven't given it a fair trial. 2. Nausea and vomiting may be dose related, but it may also occur if you are taking it on an empty stomach. Try coating it with butter or margerine, it will slow down the absorption rate and possibly eliminate the nausea. 3. Lexapro, as well as many of the SSRIs, can have a withdrawal effect if stopped "cold turkey". Sounds like you need to have a talk with your physician. Mediation alone often will not be effective. Are you receiving some sort of counseling / therapy? Good luck.

Hi For several years now Depakote has been approved for treatment of Bipolar Disorder and is considered a First-line medication for this. It's true that it was originally marketed for treating seizure disorders but research has shown that many of the problems of bipolar disorder also have origins in the same area of the brain that can induce seizures. Incidentally Depakote has also recently been approved for migraine headaches (another "off-label" use). Depakote, Tegretol, Gabitril and other anticonvulsant medications have been used for years in the treatment of bipolar disorder and is equal to lithium in efficacy. Check with the drug reps sometime and they can give you more information Will

Angelbear Let me start by telling you I have the deepest respect and admiration for LPNs and nursing assistants. You are the very often the "front line" when it comes to patient care and you are often the first ones to pick up on changes in patient conditions. Any RN who will tell the truth will admit that their jobs are often less hectic if their LPN is good and "on top of things". I admire your determination to return to school. I just received my Masters' Degree in nursing as well as my nurse practitioner license in August and I undersatand how hard it is to work full-time, go to school and keep up with everything else. Be encouraged. Your career will begin to take off once you have taken and passed your board exams for your RN.

kona2 I'm sorry to hear about your family. As a psych nurse, let me lay some ground work for you. An involuntary admission is a situation in which a patient is admitted to an inpatient facility for evaluation. That 72 hours is the time that doctor has to make an evaluation and disposition of the patient. In Ohio, weekends don't count. Meaning if you are admitted on Fri., the doctor has until Wed., to make a decision. In the meantime, the patient may decide that an admission may help and sign as a voluntary patient. If the patient doesn't sign voluntary, the doctor doesn't HAVE to release the patient. He often can get a court order after a probate hearing (in the hospital) to keep the patient (up to 90 days) until they no longer represent a threat a danger to themselves or others. He can send them to another facility for longer term care. OR discharge them. Many psychiatrists use improvements in insight and judgment as criteria for discharge. I HIGHLY suggest that your family sign voluntary. If the psych unit has a program during the day (ie groups, occupational therapy, etc), this will also help toward discharge. A psychiatrist is more likely to consider discharge for a patient who is taking medications, participating in milieu and groups and is cooperative, than for a patient who is demanding discharge, is disruptive and shows poor judgmant. An average length of stay for my hospital is 7-10 days - if the patient shows improvement. I know all this is frightening to absorb, but that's the way it is in many states. I would imagine it is similar in your situation. As for the methadone, half life is 15-30 hours. It has a lot of bad withdrawal symptoms if weaned too quickly. Check out your PDR for specifics. ChicagolandRN had a good suggestion. Set up an appointment with the psychiatrist to have a family meeting. And get the patient's permission for him to talk with you (HIPAA, you know). Only the psychiatrist can tell you how long they'll be there and what he wants to see before sending them home. Good luck and keep us posted!! Will Benson

Norm - If I may, I'd like to suggest a few things. First, allow the family to experience some of the problems you have been having with being the "buffer" in these situations. If they have to be put in that position, maybe they will be less reluctant to seek help. Second, be aware that the paranoid person rarely sees themselves as the problem. Getting them to voluntarily see a counselor is often futile because they will say "I'm not the problem, it's everybody else" thus creating a situation where they rarely follow up with medication or appointments. This then creates a situation where an involuntary admission may occur if the person is a danger to themselves or anyone else or represents a risk to the public welfare because of flawed judgment. Right now it is still just a "family affair". If her judgment is erroneous and her insight is non-existant, it might not be a bad idea to consider guardianship. This could eliminate involuntary admissions. Someone could "sign in" voluntarily for her if she were to need admission. Paranoid persons are at a greater risk for harm to self or others in the community because of greater access to weapons, drugs, etc. Those risks decrease significantly when they are hospitalized. I appreciate how hard these decisions are to make, but you sound like a great person who is trying to break a vicious cycle and start a tradition of getting help within the family. I wish you well. Keep us posted on how this is going. Will Benson Finally, it is good that

Norm I'm very sorry to hear about your sister. 4 years is a long time to go without help. I'm also sorry that your family fails to recognize the need for counseling and assistance. I'm guessing they are "running interference" for her when her behavior becomes erratic. However, at some point, she may cause a public disturbance and your family may be put in the position of mandating admission. This is occasionally the case when everyone involved ignores the problem, as though it will go away. Eventually, the problem becomes too large to handle. Maybe if your family understood this, they might be more objective in their view on your sister and seeking professional help. I don't want this to be taken the wrong way, but perhaps, the sooner the crisis "comes to a head", the sooner she can get help. Please keep us posted on how she is doing. Will Benson

Hi martha This will be my 24th year in nursing, most of that (18 years) in psychiatry. I am rather passionate about my job and my patients. So much so that I got my Master's in May and my Practitioner's Cert. If you go into psych nursing (or OB or peds or ANY specialty), you will find that people either love it or hate it with a passion. There's usually not much middle ground. The people who hate it don't stay around long. Those that love it become very proficient at it and often foster professional growth of others around them. psychrn is right about a number of things. Psych nursing is good in a number of ways but people have misconceptions about psych nursing. Many believe that we sit, thinking lofty thoughts and drink coffee all day. They don't see what we do on a daily basis. Out on the M/S units you can see if the wounds are getting better and if your patients are healing like they should. That isn't so evident in psychiatry. Managed care has changed the way we work in psychiatry and, at least at my facility, we are seeing more medically compromised people. My m/s skills are coming back into play out of necessity. We are caring for clients with central lines, PEG tubes, IVs etc that we didn't see before. Add into that the potential for violence, suicide and other safety risks and you can have a pretty volatile situation. Staffing needs are still a problem just like anywhere else. I'll end by telling you that if you like working in psychiatry, psychiatry will love having you. However there's a saying that goes "The devil you know may be better than the devil you don't know". Much luck on your decision to change specialties.:kiss

RN-PA Wow! You have a lot of advice! I hope my contribution doesn't "muddy the water" for you. Have you talked to your doctor about how to handle the stress non-pharmacologically? Talk with the occupational therapists on the psych unit of the hospital where you work. They probably have stress reduction skills you can practice to lower your stress level. Benzodiazepines (like Ativan, Xanax, Klonopin, Librium, Valium, and others) are extremely addictive and can produce a withdrawal that can be fatal if not handled properly. Are you sure you want to open that door? BuSpar CAN be effective, but it takes a long time to start working. Also be aware, if your employer does periodic uring drug screens, benzos will show up in your urine. They can also impair judgment. I don't want to scare you away from help, but there are pretty serious consequences in many states, if you are ever accused of being chemically "impaired" on duty. What ever you can do to handle your anxiety outside of medication (or alcohol) will be your best bet.

Hi MLOS I'm sorry to hear about your sister's troubles. What you are describing sounds like the DSM IV definition of an oppositional defiant disorder (O.D.D.). Having never met your sister, I couldn't say for sure (Only a fool makes a diagnosis without ever seeing the patient). She has problems with losing her temper, argues with adults, defies or refuses to comply with rules, blames others for her mistakes, is angry, resentful, spiteful, vindictive, etc. (Sound Familiar?) If this is truly the case, it may be more than "depression". O.D.D. can be a precursor to Conduct Disorder, which is more serious, and the patient can get into trouble with the law. Once the patient becomes an adult, the diagnosis may change to Antisocial Personality Disorder. Now that I've scared you with this information, the counseling and antidepressant medication are the treatments of choice for this. If the counselor does, indeed agree with this, it would be prudent on your part to see how therapy is going. If your sister's behavior becomes more serious (ie physical cruelty to people or animals, deliberate destruction of property, theft, truancy, running away, etc), the counseling may not be working. Many teenagers respond well to counseling and antidepressants. O.D.D. is very common in families in which there are serious marital problems. Your parent's divorce is still recent (about a year). Some grief counseling might be in order, too. As maureeno suggested, depression might olny be one end of the spectrum. Many counselors will test for depression, but neglect to test for mania. There is the possibility of Bipolar disorder. If this is the case, antidepressants may not work and MAY actually bring on a manic episode. Keep us posted with how thing go.

Colleenee2 Congratulations on your choice of Psychiatric Nursing. I have been in nursing 23 years, 15 in psych. I find it fascinating (so much so that I just got my Master's Degree and Nurse Practitioner in Adult Psych). ANY job in nursing is stressful because of the nature of nursing and the current nursing shortage across the country. No one feels neutral about working in a specialty. You either love it or hate it!!! Those that hate it don't stay in it very long. Psychiatric Nursing has along line of distinguished nurses including Hildegarde Peplau, Linda Richards and many others. If your folks are afraid of you being involved in violent situations, I can't lie - violence does occur sometimes, but most hospitals have policies and protocols in place to deal with violent situations. You must like to work in abstracts. That is what psych is all about. In med/surg you can see if your patient is getting better by observing wounds, checking for pain, etc. This isn't so obvious in psychiatry. Improvements in depression are often very subtle. Psychiatric nursing needs motivated people. Congratulations on you choice. I hope your parents will come to agree with you!! Will:roll

Hi Carol, I've been a psych nurse for 15 out of 23 years in nursing. I think that if you are really committed to helping the homeless, you should consider starting in the community mental health centers. They see a lot of outpatients for medication management and counseling. Many of them also have some sort of homeless outreach program. The biggest role you will have is that of patient advocate. When you care for homeless clients, realize that many of them are homeless because they choose to remain homeless. Reasons include "not wanting to be found", not wishing to give up the ability to come and go as they please, fear of institutions and many others that you will discover if you pursue this type of nursing. This doen't mean they can't be helped. It just means you'll have to help them on THEIR terms. Congratulations on your graduation. I just finished my Master's in nursing in May as a non-traditional student (I'm 52).

Unfortunately, in the nursing "world" of blond-haired, blue eyed perfect specimens, we psych nurses have been the red-haired, bastard step-children. In the unit where I work, we receive ER patients for psych who have "medically cleared", but will code once they arrive to our unit. I think the docs don't give the psych patients any creedance because 1). they are afraid of the psych patients or 2) the patients have difficulty explaining what is wrong. We have had a number of elderly arrive to our floor, diagnosed as dementia, when they really have a delirium because they have a UTI ( or low potassium, or anemia, etc) and had the doc even done the minimum "medical clearance" (such as order a CBC, for God's sake) he would have found this. I think that it's unfortunate, but we are going to see more medically compromised psych patients. Managed care has made it significantly more difficult to be admitted to a hospital. This will translate into a high incidence of medical co-morbidity for the psych patients that ARE admitted. Our unit not only takes IVs, we also are doing NG tubes, PEG tubes,TPN, tube feeds, PICC lines and Central Lines. Sometimes I think there's no such thing as "pure" psychiatry anymore. When I get a report from the ER stating that the patient has been "medically cleared" for admission to the unit, I ask for the name of the doctor who medically cleared him.