2023 14th Annual NUBE Conference

Psychotic illness causes significant burdens of disease both domestically and globally. Antipsychotic medication is a cornerstone of treatment for psychosis. Long term adherence to these medications has been shown to have a host of benefits to patients. One practice setting where the effect of scheduled antipsychotics has not been thoroughly explored is in the emergency department (ED). Antipsychotic medication administration in the ED has shown great promise both in terms of safety and patient outcomes. Unfortunately, they have only been utilized in the acute management of agitation and for treatment of somatic symptoms such as nausea and migraine. The use of antipsychotic medication for the management of acute agitation in the ED has been extensively studied. Literature review shows Droperidol and olanzapine appear to be more efficacious than other antipsychotic medications, however they have similar efficacy to midazolam and ketamine (Cole et al, 2021). Antipsychotic use in the ED decreases the risk of violent events but is linked to increased lengths of stay (Wilson et al, 2015). Scheduled, long term use of antipsychotic medication has, so far, not been studied in this setting. Determining whether initiating scheduled antipsychotic medication in the ED provides any benefit to patients is critical to determining how to provide optimal care for this patient population. Our review of the current antipsychotic practice habits described in emergency medicine and emergency psychiatry literature shows that even intermittent antipsychotic dosing for acute agitation improves patient outcomes. This suggests that purposeful scheduling of standing antipsychotic medication could be just as beneficial, if not more so to helping treat patients with psychosis sooner and more effectively. Unfortunately, there is scant literature exploring the topic of initiating routine, scheduled antipsychotic medication for non-agitated patients in the ED. This represents a critical knowledge gap that both emergency medicine and psychiatric physicians should work to remedy.

Learning Objectives:

1. Provide an overview of literature studying antipsychotic use in emergency departments.
2. Examine the psychiatric indications for antipsychotic use in emergency departments.
3. Discuss the evidence base for starting scheduled antipsychotic medications in the emergency department.