Introduction: Cognitive behavioral therapy (CBT) is an effective approach for patients with various mental health disorders, including anxiety, depression, PTSD, and OCD —but only if they demonstrate motivation and a commitment to complete therapeutic exercises and apply learned coping mechanisms.

Introduction: Once a patient who experienced suicidal thoughts is feeling better and is ready for discharge, help them create a safety plan so they can be prepared in case their emotional state deteriorates at some later point. For kids, share this plan with the child’s parents and make sure it’s easy to find, e.g., by having it stored on the child’s phone. Here's a sample blank safety plan:

Introduction: When patients become agitated and threatening, we often think first about chemical or physical restraints, particularly if staff safety is at risk. But coercive interventions can be degrading and might escalate the agitation and violence. Verbal de-escalation techniques can be very effective in calming a patient and potentially eliminating the need for forceful interventions. In this guide we review the key principles of verbal de-escalation.

We often switch antipsychotics due to side effects or lack of efficacy. There are two types of switches: immediate and cross-tapering. You can use either one, though cross-tapering is more standard.

Introduction ● Apathy is the most common behavioral disturbance in dementia, impacting up to 36% of patients with dementia (Lyketsos CG et al, JAMA 2002 288;12:1475-1483) and 12% to 40% of people with mild cognitive impairment (MCI) (Burgon C et al, Dement Geriatr Cogn Disord 2021;50(2):111–123). ● Apathy is almost universally present in patients with severe dementia but may also be the first sign of dementia in some individuals. It’s associated with increased conversion from MCI to dementia and worsened disease progression. ● Apathy’s been linked with impaired everyday functioning, increased carer burden, worse adherence to interventions, and worse quality of life (Burgon C et al., Dement Geriatr Cogn Disord 2021;50(2):111–123).

Introduction: Older adults undergo substantial changes in drug metabolism and elimination.

Introduction: Conducting a capacity evaluation is a critical aspect of healthcare, particularly when you’re faced with patients who may not be able to make informed decisions about their treatment. Any physician can evaluate a patient’s capacity, but psychiatric clinicians are often consulted to assist with cases where mental illness or cognitive impairment might be influencing the patient’s decision-making abilities.

Note: Information is accurate as of April 2023. Listing is alphabetical by brand name. Abbreviations used: LAI (Long Acting Injectable); ODT (orally disintegrating tablet); IM (intramuscular); EPS (extra pyramidal symptoms); TD (tardive dyskinesia).

Introduction: When new mothers are admitted to the inpatient psychiatric unit, they might ask about the safety of taking psychiatric medications while breast-feeding. If they were nursing an infant prior to admission, provide them with a breast pump so they can continue producing milk. The milk should be refrigerated until a family member or designated person can pick it up. Most psychiatric medications pose little risk to breastfeeding infants. Here’s a guide to the safety of psychiatric medications during breastfeeding.

While we do our best to prevent inpatients from injuring themselves on the unit, it is impossible to prevent very determined self-destructive patients from engaging in certain common self-injurious behaviors. When they occur, you will likely get a medicine consult to help with management, but you should also understand the basic evaluation and medical management of these common self-injuries. (Also see accompanying fact sheet on psychiatric management of self-injurious behaviors).