Treating New Patients on Preexisting First-Generation Antipsychotic Regimens

Amber Hoberg, MSN, APRN, PMHNP-BC, a member of the Psych Congress NP Institute steering committee, shares insights on managing new patients to your practice who are currently on a first-generation antipsychotic treatment regimen. Hoberg provides recommendations on medication assessment, monitoring, and risk evaluation to ensure patient safety and well-being. She offers guidance on optimizing patient care and medication management in your psychiatric practice.

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Read the Transcript:

Hi, I am Amber Hoberg. I'm a psychiatric mental health nurse practitioner in San Antonio, Texas with Morningstar Family Medicine, and I'm also a section editor for Psych Congress Network.

If you have a patient come to you from another clinician that's been treated with first-generation antipsychotic medications, what I would recommend to you is first talk to your patient. Ask them, "is this medication working? What else have they failed?" Because you really want to see if you have only ever been on first-generation or if they have ever tried a second-generation antipsychotic medication. This may be the perfect time for you to talk to that patient about maybe trying a different agent that has less risk.

Now, if they've tried second-generation antipsychotics and this first-generation antipsychotic is the only thing that works for them, fine, keep them on it. I always say, 'don't break a record that's not broken.' So, keep patients on what works for them.

The only thing is to make sure you're doing more frequent assessments. [Meaning,] seeing these patients back more frequently, doing more frequent abnormal involuntary movement scales, especially if they carry high risk. [High risk is defined as] if they're older, over the age of 60, they're already on a first-generation—[they are] on a very potent drug. How long they been on this medicine also makes a difference. Are they female? Do they have substance [use] disorders?

Especially if they've been on stimulant prescription drugs or stimulant illegal drugs, which puts them at higher risk. Or, if they've ever developed any type of movement disorder like dystonia, akathisia, or drug-induced Parkinsonism, this also makes them at higher risk.

[Clinicians should] monitor them a little more frequently, maybe every 3 months to 6 months. Making sure that we're monitoring the patient for any movements. I also talk to my patients about what these movements look like and that in between visits, if they start to notice any of these movements, to call the office so that I can get them in sooner and we can make sure to take care of this issue.

I would just say if you're going to keep them on these medications, monitor them on a more frequent basis, and do more abnormal and voluntary movements, and more discussions with your patients

Amber Hoberg, MSN, APRN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner from University of Texas Health Science Center San Antonio. She has been working for the past 12 years with the adult and geriatric populations, treating all types of psychiatric conditions. Her background, as a Psychiatric Advanced Practice Nurse, includes outpatient, inpatient, group home, and nursing home/ALF settings. She currently works for Baptist Health System and Morning Star Family Medicine PLLC treating the chronically mentally ill in both inpatient and outpatient settings.