Jul 27, 2022
In this second episode of a
two-part mini-series, we feature Dr. Nadia Haddad, a Colorado
psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine
physician, as they discuss the various treatment modalities for
substance-induced psychosis. They explore pharmacologic treatments,
inpatient and outpatient treatments, and ways that emergency
providers can improve their care for psychiatric patients with
comorbid medical conditions. Lastly, they consider the different
causes for repeat visits from mentally ill
- Pharmacologic treatments for substance-induced
psychosis are similar to those for other types of psychosis; these
include medications like Zyprexa, Haldol, and, as a third-line
treatment, IM Thorazine.
- Droperidol is used more commonly in the
emergency setting, compared with the psychiatric
- Given the risk for respiratory depression from
Zyprexa combined with benzodiazepines, psychiatrists may choose to
use Thorazine or Haldol/Ativan/Benadryl instead.
- It is important to reassess patients after
substances wear off to determine whether they meet criteria for
admission to inpatient psychiatry, though psychiatric assessments
are limited by geographic constraints.
- The admitting psychiatry team will reassess the
patient to differentiate substance-induced psychosis vs other
psychoses; often this includes obtaining collateral.
- Helpful notes from the ED include: medications
administered or restraints placed (can help extrapolate a patient’s
level of agitation), vital signs, prior records.
- Some people will be more open about suicidality
while intoxicated and less open about it while sober so it is
important to obtain additional information for
- On average, patients stay in the detox unit for
3-4 days, though some may stay longer for protracted
substance-induced psychosis if they have a long-standing history of
daily substance use.
- It is important to discharge patients with
quick follow-up and potential placement into the various mental
health programs including partial hospitalization, residential, or
- Emergency rooms can improve by taking
psychiatric patients seriously, especially when they are
transferred to the hospital from a psychiatric facility for medical
- Repeat visits stem partially from the
ambivalence that accompanies substance use disorders, including
patients’ difficulty in giving up the substance due the purpose it
may serve in their lives.
- Many substance use disorder programs are siloed
from the medical system, which pose a challenge to