Difficult to treat given limited insight, however individual outpatient psychotherapy recommended.
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)
Delusional disorder
Acute psychosis
Borderline personality disorder
Schizophrenia
Dependent personality disorder
Schizoaffective disorder
Schizoid personality disorder
Paranoid personality disorder