Medicine given to mental patient?

It all depends on what she's diagnosed with - and that includes any secondary diagnosis. Decide the MI first, then research the drugs that would be used.

PS - they're not called asylums any more.

It depends.

If she's acting in a way that may endanger herself or others--e.g., grabbing people and raving about seeing a demon--they will probably administer a sedative to calm her down immediately.

If she reports hallucinatory experiences, they will probably (after a thorough exam and diagnosis) start her on an antipsychotic and/or anti-anxiety med. There are many, many types of meds in these categories. Some of them don't take effect immediately and can take from days to weeks to build up in the body and produce noticeable effects.

And yes, they're not called "asylums" anymore. They're more often called "psychiatric hospitals," "mental health centers," etc. You'll want to research this to make sure you're representing them accurately. There is a ton of info out there.

When and where does your story take place?

That's a good question.

The type of drugs given and whether or not you refer to it as an asylum, depend on the the time and place.

As Leah said above, there are all sorts of antipsychotics that could be given and some of them do take a while to start working.

Paraldehyde, for example, can take as long as thirty seconds.

An important detail if you go with paraldehyde is that it must be given with a glass syringe because it has the unfortunate side effect of melting plastic.

It's viable if your story is set before the late eighties. These days, it's not so likely to be used.

Other possibilities from the sixties through to the eighties and nineties are chlorpromazine, thioridazine, stelazine droperidol, haloperidol, fluphenazine, pericyazine or thiothixene to name a few.

Side effects can range from extreme sedation, amotivation, cogwheel rigidity, dystonias, diarrhoea, constipation, blurred vision, photosensitivity in the case of thioridazine and...the list goes on.

Cogentin, 2 mg PRN or as a regular dose was often prescribed to counteract the side effects of the phenothiazine (all those ending in zine) and butyrophenone (those ending in idol) classes.

Some of them and some of the modern drugs can take a few days to start working properly. Drugs that take weeks are more likely to be antidepressants.

If it's an early setting you're going for and you opt for paraldehyde, an ornamental detail you might throw in is the smell.

It's really hard to describe but impossible to forget. Imagine the locked end (or high dependency section) of an acute ward. The drugs are all kept in a trolley in a room just off the nurses' station. The door to the nurses' station is shut and so is the door to the drug room. Someone cracks a vial of paraldehyde in the drug room. Within about five seconds, you can smell it through two shut doors at the far end of the day room. It's an acrid smell with connotations of flammability and some nurses in the drug room or even the nurses' station might actually get a headache.

After the patient has had a paraldehyde injection, you can smell it on their breath.

There's also the question of her mental state upon arrival at the psychiatric facility.

A person can be delusional, paranoid and hallucinating when they arrive, but that doesn't necessarily mean injections and seclusion rooms.

Even if someone is physically resistive when brought in, nursing staff will talk to them, try to reassure them and try to calm them down.

If that works, then the offer of a drink - tea, water, fruit juice or milk, biscuits and/or sandwiches is likely. Medication in tablet or syrup form would be offered.

Injections and seclusion are the last resort.

Silence said:

Thank you everyone for the advice. Thanks for pointing out about the 'asylum', I'll look up if I should call it that.
I was opting for the story to take place in the early 90's.

If its in the early 90's would Paraldehyde still be used?

Also wondering if a patient's mental state determines whether he/she is allowed to share a room with another patient.

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Speaking as an Australian psych' nurse in the Victorian system, no. In the early nineties, paraldehyde would only be used in a severe case of the DT's or maybe in a forensic unit for a particularly difficult patient.

I can't be sure about other states or countries though. I do know that the Queensland system had a reputation for being well behind the times. I also heard that ECT in the states was still being given unmodified ie - without an anaesthetic and muscle relaxant which I found surprising.

If a patient needs to be in a high dependency section, they'll have a private room. Once they're out of HD, if there's a private room available, they might get one.

In the eighties, when I started training, it wasn't rooms, it was cubicles which were privateish but that was when psych' hospitals were separate.

Even though they were institutional, in some ways it was a better system. These days, with psych wards being tacked onto general hospitals, the whole model is about medication and confinement. Deinstitutionalization gave with one hand and took with the other.

It does depend on where this takes place. Early 90s in the US, a client would have a private room only if they were in a private hospital (ie, could pay extra). Most clients didn't have health insurance coverage so the state paid - so no private rooms. Not necessarily wards, though - typically 2 or 3 to a room, like a college dorm. Socialization is a big deal with MI treatment. Isolation rooms only if they got violent, and that only until they calmed down.

"Asylum" hasn't been used for ages (so not in the 90s).

You're going to want to think carefully about whether it is reasonable for your character to be hospitalized involuntarily. For her to be a "danger to society", she's going to need to be homicidal, basically. If she truly presents no danger to other human beings and none to herself (i.e., she's not suicidal and/or actively harming herself to the point of losing life or limb), she's not going to be hospitalized against her will. -- at least not for long. If she *is* hospitalized, except in unusual circumstances, she can opt to take or not take any meds that are offered.


Her treatment team would take a good history and try to determine if this was a fleeing, brief psychotic episode, a symptom of a more pervasive mental illness (e.g., schizophrenia), or possibly a psychotic episode related to an ongoing, very severe mood disorder (e.g., depression).

The meds she would receive would depend on her actual diagnosis. If the episode was thought to have stemmed from a manic episode, they might try her on mood stabilizers. If it was thought to have stemmed from severe depression, possibly an anti-depressant supplemented with an anti-psychotic. If the episode was one of many and thought to be a symptom of schizophrenia, she'd probably get an anti-psychotic.

Yes, people can still think clearly while on anti-psychotics (at least the newer varieties). There are a variety of possible side effects, but many people tolerate them quite well.

Good luck with your story,
~STS~

p.s. The term "asylum" was definitely not used in the 1990s (nor a great many years prior to that) -- at least not by those in the profession.

strictlytopsecret said:

For her to be a "danger to society", she's going to need to be homicidal, basically. If she truly presents no danger to other human beings and none to herself (i.e., she's not suicidal and/or actively harming herself to the point of losing life or limb), she's not going to be hospitalized against her will.

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A person might be deemed a danger to themselves or others even if they're neither suicidal nor homicidal. A psychotic person might still be a danger through misadventure.

An extreme example might be that someone thinks they can fly or due to their paranoia, might drive dangerously to escape from their delusional persecutors. In the first case, obviously they're a danger to themselves and in the second, a potential danger to others. There is also the possibly of self-harm through simple self-neglect brought about by gross thought-disorder and/or disorganization.

If she *is* hospitalized, except in unusual circumstances, she can opt to take or not take any meds that are offered.

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That might be the case with the psychiatric services in some jurisdictions but by no means all. With the system I work in, only a voluntary patient can refuse medications. An involuntary patient doesn't have that right, although they do have the right to appeal to a mental health review board and to seek a second opinion from a different consultant psychiatrist.

Rufus Coppertop said:

A person might be deemed a danger to themselves or others even if they're neither suicidal nor homicidal. A psychotic person might still be a danger through misadventure.

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In the USA, that danger must be clear and imminent. A single hallucination, particularly if it was not accompanied by any sort of overtly violent behavior on the part of the patient, would not necessarily constitute clear and imminent danger to anyone.

A more likely scenario for the above character would be that the cops would take her to a psych. hospital for an evaluation if they were interviewing her as a witness to the murder of her parents and she started with the demon story. You might be able to get an on call doc to commit her for a 23 hour eval (possibly 72), but after that, unless she displayed some sort of violent (toward self or others) behavior or threatened to do so, she'd be released on her request with a recommendation to follow up with a psychiatrist for outpatient treatment with meds (she'd probably walk out the door with a script, as well).

That might be the case with the psychiatric services in some jurisdictions but by no means all.

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In the USA (the setting of the OP's story), even involuntary patients must provide informed consent for treatment with medication. Unless they are deemed incompetent to provide that consent (a different procedure from the involuntary hospitalization itself), they still retain the right to refuse meds unless the situation is urgent (e.g., the patient is attacking staff members with a knife and the on call doc orders an emergency restraint and sedation).

In the patient described by the OP (unless she's left out some major pieces), you would probably be hard pressed to find a psychiatrist who would involuntarily commit her for more than 23 - 72 hours (a 3-day wouldn't be out of the question) and then take it further and have the court declare her incompetent to provide informed consent for treatment with medication.

strictlytopsecret said:

In the USA, that danger must be clear and imminent.

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On a state by state level, one can be involuntarily committed if it can be shown that they are unable to provide basic care for themselves due to a mental disorder, thus leading to the probability of physical danger. However, this wouldn't be the case for the OP's character.

You really have to start with the diagnosis. Also she could be voluntarily committed or in voluntary inpatient care as a minor while custody was determined.

Rufus Coppertop said:

Paraldehyde, for example, can take as long as thirty seconds.

An important detail if you go with paraldehyde is that it must be given with a glass syringe because it has the unfortunate side effect of melting plastic.
(snip)
It's really hard to describe but impossible to forget. Imagine the locked end (or high dependency section) of an acute ward. The drugs are all kept in a trolley in a room just off the nurses' station. The door to the nurses' station is shut and so is the door to the drug room. Someone cracks a vial of paraldehyde in the drug room. Within about five seconds, you can smell it through two shut doors at the far end of the day room. It's an acrid smell with connotations of flammability and some nurses in the drug room or even the nurses' station might actually get a headache.

After the patient has had a paraldehyde injection, you can smell it on their breath.

Click to expand...

Fascinating details and information, but I can't get past the 'melting plastic' part. It melts plastic but they inject it into people? Suspiciously thinking that usage dropped off once they started implanting plastic joints in people.

A lot of drugs can't be stored in plastic but are safe to inject.

strictlytopsecret said:

In the USA, that danger must be clear and imminent. A single hallucination, particularly if it was not accompanied by any sort of overtly violent behavior on the part of the patient, would not necessarily constitute clear and imminent danger to anyone.

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In Australia, a single hallucination unaccompanied by overtly violent behaviour would not be considered grounds for involuntary admission, especially if the person was deemed able to look after themselves.

If there was reason to think that the person actually killed her parents though...and there was any reason to suspect psychosis...then non-violent behaviour would not be sufficient grounds to release them into the community.

Duty of care to the client and the community trumps everything in a situation like that.

The person would be sectioned and hospitalized for observation. There's a strong possibility that they would not be given antipsychotics initially as the nursing staff and doctors need to observe them in their normal mental state as part of the assessment process.

There's a chance that they might be offered voluntary admission but nursing staff would be instructed to detain and section them if they try to leave before the consultant is satisfied that they're not a danger. I'm sure the Victorian Mental Health Act is not the only one in the world with a provision for that.

Human rights balanced with duty of care.

PRN antipsychotics would be written up though. For those who don't know, a PRN order states a dosage range of a particular medication with a daily limit that can't be exceeded without another order. It is to be used at the discretion of nursing staff.

so if she's the only suspect...but she hasn't been convicted yet, wouldn't she be in police custody?

LJD said:

so if she's the only suspect...but she hasn't been convicted yet, wouldn't she be in police custody?

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If they had enough evidence to hold her, yes. And if, during their questioning, they felt she was not mentally sound, they would request a psych evaluation, and that could end up with an involuntary hold - as part of being held for suspicion of murder. Then of course it goes to the legalese part as to when she would be mentally competent to be tried, and all the complications involved with that.