psych meds in ICU

[cvryder]

I can understand doctors taking mentally ill patients off their psych meds if the patients are heavily sedated. That only makes sense. But when the patient is concious, even if they are vented, why in heck don't they restart the meds???? This is a question I've asked over and over and never got a satisfactory answer.

Case in point: in the MSICU where I'm working, we currently have a patient who is from another country, therefore English is a second language and I don't know how much she really understands. Her family tells me she has been diagnosed as schizophrenic. Briefly, she arrested on the way to the hospital, was intubated and shocked in the field, and arrived on our unit on the vent and sedated. When she woke up she was naturally extremely anxious and at some point she managed to extubate herself. Her sat was 99% on nasal cannula, but the docs insisted on re-intubating her because they felt her respiratory rate was too high. They haven't been able to get her off the vent and now she's trached. Meanwhile, she was on drugs (Risperdal and Xanax) at moderately high dosages regularly prior to admission, and the only thing that was restarted was the Xanax, but at a much lower dose. My feeling is that her anxiety level, which is out the roof, her underlying mental illness, and the limited command of English are as much a factor in her inability to get off the vent as her respiratory status. Maybe more. Some things have been done when a family member wasn't on hand to explain to her in her native language, mostly I think because it's the routine time to do them and families aren't on hand then. I did leave a note for the dr. about restarting her psych drugs but I won't know until tonight whether anything was done. This is far from the first time I've encountered the problem. It's like the patient's mental problems aren't even factored in when dealing with a physical illness, yet we know that the mind has a tremendous influence on the body.

Getting off my soapbox now.

[EricJRN, MSN, RN]

I don't work psych or adult ICU, but I do know that Risperdal is a drug that can have some serious consequences. Various studies have linked Risperdal to a host of adverse effects, ranging from cardiac arrhythmias to CVA's to an overal increased risk of death.

[dorimar, BSN, RN]

Some of the psyche meds ( i think haldol for instance) can prolong thte QT interval thereby increasing risk of torsades. I don't know if resperidal is one of them. However I know for sure Xanax doesn't do that, and i agreee with you whole-heartedly. Anti-depressants are another one they never think to resume.