There was a case in the state hospital I used to work at where a guy got very painful priapism with an antipsychotic to the degree where he had to be sent to the ER from the hospital several times, each time with this guy in tremendous pain and needing to having his penis drained of blood via procedure.
This is pretty rare but it can happen. Why it was happening was not known. The alpha adrenergic receptors were of course brought up since that was the most logical place to start. A big problem with that case was the attending working on this guy was one of those types not willing to hit the books to double check for the best options.
What eventually happened was she got the guy pseudo-stable, to the degree where he was no longer attacking people daily but on the order of once every few days and for her she wasn't going to push it further and not change the meds around more. She was fine with that since she was not on the frontline to get punched, and quite bluntly, she was quite happy with patients never being discharged from her unit. Such things happen in state hospitals. She had people on her unit for literally years that when transferred to a real doctor, that doctor got them stable within a matter of weeks.
she was on vacation for 3 days and I reviewed this guy's case while covering her unit. Quite simplistically, I simply got a Stahl book, told the treatment team which atypicals have the least amount of alpha adrenergic interaction and start from there in terms of trying to stabilize the guy. If a med didn't work because of side effects or lack of efficacy, we'd simply have to record what happened and try the next best candidate until something worked. Until several meds were tried, I'd recommend we push through though at a slow pace just in case with small dosages gradually being increased with the patient being monitored 24/7 .Since I was only going to be on this case for 3 days, I told the treatment team that I didn't want to drastically change his tx and let the other doctor handle it. She came back and just kept him on the same regimen he'd been on for several months with the guy not getting better.
If you work in a state hospital, you get an overwhelming majority of patients being psychotic and more manic and treatment resistant. Such things happen that are not commonly seen on short term units.
