Comment by msrenee | Hacker News Reader

Comment by msrenee | Hacker News Reader

I haven't finished the article yet. I got sidetracked by the claim that Haldol is "a powerful sedative." I understand that journalists are neither doctors nor pharmacists, but if you're reporting on a story about medical ethics, maybe know a little bit about drugs, how they work, and what the words you're using mean in a medical context.

Haldol is a typical antipsychotic. If the patient has no symptoms that indicate its use, they should absolutely not be taking it. There's a lot of side effects. Some may even persist after the medication is discontinued.

One of these side effects is that it can be sedating. I've been on the patient side of a misapplied antipsychotic myself. They can make you very tired and cause you to feel "drugged". This is not the same as a drug being a "powerful sedative". Words mean things. Words in a medical context have specific definitions and nuance. If you're reporting on medical malpractice, it's important to get the vocabulary correct so that the way you word something represents the truth rather than a sensationalized version of it.

I can definitely believe that these people were medicated in ways that were dangerous to their health for the convenience of the staff. However, when you call Haldol a powerful sedative, I have to assume you're either trying to make the situation sound as horrible as possible or you have no idea what you're talking about.

Haloperidol is absolutely a powerful sedative (amongst its other effects). This isn’t a misplaced claim or hyperbole, it is used (and I have used it) to sedate agitated patients in hospitals.

I mean, it actually sounds like you don’t really know what you’re talking about. It’s not quite in our ‘take down’ class of drugs (think meth patient in the emergency room) but it sure as hell knocks patients out in IV/IM administration.

Which should definitely not be the administration in aged care, but even in oral form it is used unfortunately in a long term role as a sedative (which is not what it is indicated for), which is basically what the article is about

Having sedating properties is not the same as being a powerful sedative. If they had said it was used because it can be sedating, I wouldn't have said a word.

At this point, and reading your other replies, it really seems as though you’re just trying to justify a position you took which is not borne about by the factual evidence.

The other day I read an article in the paper about a woman’s journey with uterine fibroids and how it had affected her life. It contained a large amount of misinformation that my partner (obs and gynae doctor) objected to strongly but at the end of the day it’s been published and that’s that. But in this case what you’re objecting to isn’t even incorrect information.

I mean, the first typical antipsychotic, Thorazine was literally called ‘a lobotomy in a pill’. The trade name, Largactil, is because it was ‘large acting’ in basically turning the patient into a walking vegetable.

This is at a point in the history of psychology when asylums were being shut down and over the next few decades the large numbers of people who had previously been held in often awful conditions were released into society, and despite the literal sledgehammer effect of these ‘typical antipsychotics’, any side-effects we’re considered mild in comparison to not having them. Until the extrapyramidal effects started showing up.

Haloperidol acts on the same system as Thorazine.

Maybe it's an issue of dosage. At the levels you would prescribe outside of the hospital to a patient presenting with symptoms of schizophrenia, it can definitely cause sedation. At higher doses, you could probably say that it is a powerful seditive. It just seems disingenuous in the context of this article - to explain to the layman what the medication is - to call it a powerful sedative. It is an antipsychotic which has sedating effects.

Warfarin is a blood thinner. Warfarin was originally used as rat poison. If a nurse gave it to someone they didn't like to increase their risk of internal bleeding, would it be more accurate for a journalist to say that the nurse administered a blood thinner that was not appropriate or rat poison?

Your claim that describing Haldol as a sedative is disingenuous is entirely about intention and justification, not about anything material. Yes, you can use it with the intention of improving a schizophrenic's condition. That doesn't make it any less of a sedative.

If you give Warfarin to somebody at the dosages used to poison rats, it'll probably kill that person, too. I think I get what you were going for with the comparison, but all medicines are very light poisons at the dosages in which they are administered (all substances in general are poisons at the right dosages, really) but Haldol is a strong sedative at the dosages at the dosages in which it is administered.

And can we really say categorically that we aren't actually using the sedation itself (to some degree) to calm the schizophrenic?

Haldol, Benadryl and one other drug are part of the common rotation used by nurses to sedate troublesome patients so they can skate out of handling said patient during their shift.

When said patient regains control of their faculties they are often confused and angry as a day is missing from their memory.

I assume the “one other drug” you are referencing is Ativan (lorazepam)?

Benadryl and Haldol arguably don’t belong in the same sentence at all, considering their ridiculously different effects and profile. You’re right that they’re used though. Is there any reason Haldol should be used like that at all, beyond it already being available as a psych drug? And even if Benadryl isn’t as effective (I dunno) surely something that isn’t as bad in side effects could be found? Many instances of said sedation are totally unnecessary, but many are eminently necessary to restrain someone actively violent.

I only ever saw this B52 trifecta used when untrained nurses from other units had to do a shift staffing the psych ward. Thankfully that particular psych ward was closed down 2 years ago due to repeatedly assigning untrained nurses to work in that department.

The regular nurses who had completed the state mandated training did not usin this combination of drugs on patients.

In a psych ED it was a lot more common to use 20mg ziprasidone and 2 mg lorazepam - "20 and 2" - for acutely agitated/psychotic patients. Before anyone passes judgement on doing that ask yourself if you've actually seen someone who is truly in psychosis or mania. I almost considered going into psychiatry because of how well antipsychotics and mood stabilizers work, particularly the monthly depot forms of antipsychotics, work and how they really do give patients their lives back.

I think psychiatrists have moved away from haloperidol and the internists or family doctors in nursing homes haven't caught up yet. Not that there's going to be much practical difference between Geodon and Haldol. Of course psych ED is a much different situation than on the floor of a nursing home where it might be more appropriate to use a low dose of Seroquel for delirious patients.

So if you were writing an article about benedryl, you would feel comfortable describing it as a powerful sedative?

It is with a high enough dosage, which nurses using it to knock out patients presumably are using

See also: "nightmare tripping"

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