Background: Antipsychotics are frequently used in the hospital setting for managing both acute and chronic neuropsychiatric disorders. However, antipsychotics have been associated with higher rates of adverse events, including mortality, due to their association with QT prolongation, which can lead to fatal cardiac arrhythmias such as torsade de pointes, earning a black box warning for use in dementia related psychosis. Yet, [...]

Background: Delirium is a common clinical syndrome, particularly among elderly patients in the inpatient hospital setting, and carries considerable associated morbidity. These patients can display symptoms of inattention, agitation, and restlessness, often necessitating the use of chemical or physical restraints to ensure the safety of the patient and staff. Unfortunately, these interventions are not without [...]

Background: Antipsychotics are frequently used in the hospital setting for managing both acute and chronic psychiatric disorders. However, antipsychotics have been associated with higher rates of mortality due to their cardiovascular risk factors, such as QT prolongation. This study aimed to determine the association between cumulative dose of antipsychotics (first and second-generation) and QT prolongation, [...]

Background: It is common practice to monitor QTc interval in hospitalized patients newly started on antipsychotics. While some guidelines exist for frequency of ordering EKGs in the outpatient setting, these may not apply to inpatients due to comorbid electrolyte disturbances or addition of other new medications. There are no evidence-based guidelines for QTc monitoring frequency [...]

Background: Antipsychotics can prolong QTc interval and lead to development of the fatal arrhythmia Torsade de Pointes. Accordingly, serial EKG monitoring of QTc in patients newly started on antipsychotics has become common practice in hospitals. By current standards, medical management of antipsychotic therapy is clinically indicated when QTc > 500ms and/or there is an increase [...]

Case Presentation: A 47-year-old woman with migraines, bipolar disorder, and hypothyroidism presented with a 2-day headache that was not improving with sumatriptan. She also complained of generalized weakness, dizziness, nausea, and vomiting. Workup revealed diabetic ketoacidosis, with blood glucose 530 mg/dL, venous pH 7.02, bicarbonate of 8 mmol/L, and anion gap 29. The patient had [...]

Case Presentation: A 26-year-old male with a history of schizophrenia presented with generalized abdominal pain and altered mental status. He has a history of multiple psychiatric admissions, specifically seven times in the past two years, and long-term antipsychotic usage. Most recently, he was discharged on clozapine, divaloproex, and trazodone. Initial physical exam was notable for [...]

Background: Although popular belief often suggests a link between lunar cycles and human behavior, particularly in psychiatric contexts, scientific evidence supporting this association remains limited. This study explores the potential association between lunar phases and antipsychotic medication administration in psychiatric patient encounters at select hospital units from July 2018 to August 2023. Methods: Data were [...]

Background: Delirium is a common clinical syndrome, particularly among elderly patients in the inpatient hospital setting, and carries considerable associated morbidity. These patients can display symptoms of inattention, agitation, and restlessness, often necessitating the use of chemical or physical restraints to ensure the safety of the patient and staff. Unfortunately, these interventions are not without [...]

Background: Delirium is a reversible condition that is common in hospitalized patients. Antipsychotics are often used to manage acute behavioral disturbances associated with hyperactive delirium. During transitions of care, plans to taper or discontinue these newly initiated antipsychotics can be unclear. As a result, these medications may be continued long-term, even as the acute episode [...]