Mental Health Monday

Today’s question was posed by Bethany Wiggins, author and blogger extraordinaire! Check out her blog (which she co-hosts with her sister Suzette Saxton) here. Her website is here.

Question: What’s the best “cocktail” to take down an aggressive psychotic patient? (Psst, cocktail does not mean alcohol. Bummer, I know.)

Fantastic question, Bethany!!!

Working in the psych ER, I had lots of opportunities to tackle this very situation. It’s especially exciting at 3 AM when you’re jacked from too much coffee, half-delirious from lack of sleep, your eyes burn from the ever-so-flattering fluorescent lighting, and your teeth feel like they’ve got hair growin’ on ’em. (Yeah, you probably didn’t need that visual).

Anyway, imagine a eerily silent unit, where the only sounds include the buzz of electronics, the clicks of fingers typing, and the snoring of patients. Your eyelids slip down, hindering your sight as you try to write up your most recent case.

A bang snaps your spine to attention. This is followed by a yell. Then a scream. Finally, the pounding of slippered feet echoes down the hallway. The guy you evaluated six hours ago (and who is waiting for a hospital bed), can’t keep it together any longer. He’s certain you’re a part of the FBI conspiracy against him. He KNOWS you’re working with his psychiatrist to kill him. And he’s going to do something about it. NOW.

In a fit of fury, he rips a cabinet off the wall. Smashes a table to smithereens. He takes the cabinet door as a shield and a table leg as a club.

You call security to announce a code. The staff needs back-up to handle this guy. Within thirty seconds, about a dozen big fellas show up.

You try to talk the guy down.

He’s not interested. And there ain’t no rationalizing a paranoid person out of their delusion (believe me, it’s part of the definition).

You tell the nurse to draw up Haldol (AKA haloperidol, an anti-psychotic/major tranquilizer) and Ativan (AKA lorazepam, an anti-anxiety medication with calming effects) in a syringe.

The staff negotiates with the patient to encourage him to cooperate.

He refuses. Swings the table leg/club. Security guards surround him. Remove his makeshift weapons and ease him to the floor. The medications you ordered are injected in his gluteus maximus and he’s walked to his room.

The experience is frustrating for the patient. He paces for a minute, yells at the staff members who are keeping an eye on him so he doesn’t rampage the unit more. In about ten to fifteen minutes, he gets sleepy, flops down on the bed, and goes to sleep.

For several hours.

You complete your shift, envious that someone is sleeping.


Disclaimer: This is NOT intended as medical advice or treatment. This is solely for the purposes of writing.

Check out Lydia’s blog for Medical Mondays!

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10 comments on “Mental Health Monday

  1. vtremp says:

    Laura, it’s awesome of you to share your psychological knowledge with the rest of us. I know that someday I’ll need to ask you a question, and you’ll be here to help!

  2. Lydia Kang says:

    Wow Laura, this post made it so real. Brings back memories of working in the psych ER during med school! Eep!

  3. I love your voice! I mean, wow!

  4. Emily Ann says:

    You draw up a very good scene. It’s like you’re a writer or something. ๐Ÿ˜‰
    Btw, I love Medical Mondays. ๐Ÿ˜€

  5. Lynn Rush says:

    Fantastic article! Love this stuff.

  6. Steve says:

    Laura- 5 and 2 is tried and true, but 50mg of Benadryl is the olive! I used to call it the Cleo cocktail…….

  7. lbdiamond says:

    Thanks, all for the positive feedback! ๐Ÿ˜€

  8. Wow. You are sooooooooo awesome! This is the best answer I have ever gotten! Thank you a million times over. You are the best.

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