Unintentional overdose of an opioid can usually be managed expectantly; however, if partial reversal is necessary, very low-dose naloxone (formerly Narcan) can be quickly administered by giving - to -mg (or mcg per kg) intravenous or intramuscular boluses every three to five minutes, titrated to respiratory rate or mental status (mix one mg per mL ampule of naloxone with saline to make 10 mL, which equals mg per mL). 27 Continued close monitoring is necessary because duration of opioid effect may outlast naloxone.
Ms. S frequently requires administration of oral and IM haloperidol, as needed, when she becomes aggressive with the staff. She has poor insight into her mental illness and does not believe that she needs medication. Ms. S has a long history of stopping her oral antipsychotic after a few days, reporting that it is “harming her baby.” Monotherapy has been tried with various long-acting injectable antipsychotics (LAIAs), but she still exhibits persistent delusions. The treatment team decides to add a second LAIA, haloperidol decanoate, 200 mg every 4 weeks, to her regimen.
Positive reinforcement programs appear to be most helpful in the management of tic disorders. Target behaviors may be categorized into two groups: (1) skill deficiencies, or areas that initially require concentration to build social and academic skills; and (2) behavior excesses, in which the goal is to help the patient decrease the frequency of these behaviors. Caution should be exercised in the management of behavior excesses, since some children who undergo behavior modification to directly target the Tourette's syndrome symptoms have an exacerbation of symptoms. 29