Selected patient is an adolescent brought to our inpatient psychiatric hospital under an involuntary order (Baker Act)
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My selected patient is an adolescent brought to our inpatient psychiatric hospital under an involuntary order (Baker Act). The young man ran away from a group home he lived in after having a physical altercation with another resident. He has an extensive history of aggression and has been diagnosed with PTSD and ODD. Upon arrival, the client was attempting to hit staff and other patients. An order was given that included Haldol administered IM. Haldol is a typical antipsychotic drug that is efficient in controlling aggressive behavior (Jegede, 2018). Unfortunately, this drug can cause acute dystonic reactions (Jegede, 2018).
Later, the patient was complaining of severe jaw pain and his jaw being “locked.” It was difficult for him to speak, and his tongue appeared to be swollen. The patient was experiencing an acute dystonic reaction.
Haldol has a dopamine-blocking mechanism (Lewis, 2021). When there is a dopaminergic-cholinergic imbalance in the basal ganglia, it is thought to cause an acute dystonic reaction (Lewis, 2021). The risk factors for the acute dystonic reaction include being male, young age, recent cocaine use, and a previous episode of dystonia (Lewis, 2021). Being our patient met all risk factors, it is not surprising that he had this reaction.
The patient was treated with Diphenhydramine 50mg IM, and Haldol orders were discontinued. It was a short time, and the dystonia and pain abated. Diphenhydramine is an H1 antagonist with sedative and anticholinergic properties that penetrate the central nervous system making it a highly effective drug in treating dystonia (Grañana et al., 1999).
Haldol is still used commonly in psychiatric facilities, but clinicians must recognize and treat acute dystonic reactions early. All patients administered medications known to cause acute dystonic reactions should be monitored closely, especially those with known risk factors.
Grañana, N., Ferrea, M., Scorticati, M. C., Díaz, S., Arrebola, M., Torres, L., & Micheli, F. (1999). Beneficial effects of diphenhydramine in dystonia. Medicina, 59(1), 38–42.
Jegede, O. (2018). Haloperidol induced unilateral temporomandibular joint dysfunction. MOJ Toxicology, 4(5). https://doi.org/10.15406/mojt.2018.04.00127
Lewis, K. (2021, May 15). Dystonic reactions. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/30350