After medical evaluation/"clearance":
Place patient on legal hold if meets local criteria
Arrange psychiatry evaluation (inpatient vs outpatient depending on clinical severity)
Place patient on legal hold if meets local criteria
Arrange psychiatry evaluation (inpatient vs outpatient depending on clinical severity)
Non-pharmacologic
Verbal de-escalation
Offer comforting items: blanket, meal, pillow, etc
Quiet room
Physical restraints (should administer medications if restraints used, as decreases restraint time)
Pharmacologic: Goal is to calm patient without oversedation
No history of psychosis
Haloperidol 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV)
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Consider risperidone 0.5-2mg PO or olanzapine 2.5-20mg (PO/IM/SL) or ziprasidone 10-20mg IM
Known or suspected underlying psychotic illness
Continue treatment with previous antipsychotic or
PO: olanzapine 5-10mg or risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
IM: olanzapine 2.5-20mg or ziprasidone 10-20mg or
(PO/IM/IV) Haloperidol 0.5-5mg +/- lorazepam 0.5-2mg
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Verbal de-escalation
Offer comforting items: blanket, meal, pillow, etc
Quiet room
Physical restraints (should administer medications if restraints used, as decreases restraint time)
No history of psychosis
Haloperidol 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV)
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Consider risperidone 0.5-2mg PO or olanzapine 2.5-20mg (PO/IM/SL) or ziprasidone 10-20mg IM
Known or suspected underlying psychotic illness
Continue treatment with previous antipsychotic or
PO: olanzapine 5-10mg or risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
IM: olanzapine 2.5-20mg or ziprasidone 10-20mg or
(PO/IM/IV) Haloperidol 0.5-5mg +/- lorazepam 0.5-2mg
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Haloperidol 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV)
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Consider risperidone 0.5-2mg PO or olanzapine 2.5-20mg (PO/IM/SL) or ziprasidone 10-20mg IM
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Continue treatment with previous antipsychotic or
PO: olanzapine 5-10mg or risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
IM: olanzapine 2.5-20mg or ziprasidone 10-20mg or
(PO/IM/IV) Haloperidol 0.5-5mg +/- lorazepam 0.5-2mg
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
Bipolar disorder
Organic causes
Depression
Delirium
Alcohol use disorder
Dementia
Schizoaffective disorder
Overdose