Chimp Attack!

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I suspect this was not the first time she'd tried Xanax on him.

Based on personal experience and that of others who've worked with primates and other less-than-tame animals, the initial reaction to being hit with a sedative is increased agitation and aggression.

Thinking about it from an evolutionary perspective, when things go out of whack, from an injury to a mental slowdown you don't expect, the right response is 'oh crap!'.

Thus, the fact that all of a sudden he felt slowed down, could have instigated a sympathetic/panic response. Looking around at what might have caused it, he sees his 'mom' and a person he knows and gets along with but isn't actually in his in-group, so to speak. He lashes out...And bad things happen.

I do feel bad for these people, but as a primatologist and a lover of animals, I'm dismayed that a 56 year old woman (at the time) still had the lack of maturity and insight to think that a chimp is a suitable pet.

We are talking about an animal with an IQ equivalent estimated to be around 70, adapted to live in an environment in which aggression is not always a bad thing, especially when you're the baddest guy in the room (which he was and always would be).

Monkeys and, especially, chimps do not make suitable pets. These are very, very intelligent animals with physical dexterity that often comes close to our own, and especially in larger animals, power that can greatly exceed ours. They also largely come from societies in which strict dominance hierarchies exist and in which cooperative and mutally supportive associations are limited in extent and length. In other words, they are always looking for a chance to assert their dominance. Always. And the chance of this NOT happening in a chimp, who are anywhere from 2-8 times as strong as a human of comparable size, are slim to none.

These aren't canids, who live and die on mutual cooperation, and will support an alpha who may be weaker than them physically if they have greater leadership potential.

Blah. Of course I feel bad for the lady who got her face ripped off. And I feel bad for the owner. But, call me an ass, mostly I feel bad for the chimp who should have never been raised in captivity.
 
It's more likely, in my opinion, that the Xanax disinhibited the chimp, much in the way that a few drinks will make it easier to slug someone you're angry at. It sounds like he was already agitated before he got the benzos and then let loose after the "Xanax tea." Once his inhibitions were released, the full force of his defensive/aggressive drive, which continued to exist in latent form despite his domestication, was unleashed.
 
I heard that Ms. Herold actually tended to feed Travis foods like lobster, steak, and items that are not normally a part of a chimp's diet. I know that his reaction did not involve trying to actually eat those he assailed, but could the diet have had a more than negligible effect on the severity of his behavior?
 
masterofmonkeys said:
I
We are talking about an animal with an IQ equivalent estimated to be around 70, adapted to live in an environment in which aggression is not always a bad thing, especially when you're the baddest guy in the room (which he was and always would be).

Monkeys and, especially, chimps do not make suitable pets. These are very, very intelligent animals with physical dexterity that often comes close to our own, and especially in larger animals, power that can greatly exceed ours. They also largely come from societies in which strict dominance hierarchies exist and in which cooperative and mutally supportive associations are limited in extent and length. In other words, they are always looking for a chance to assert their dominance. Always. And the chance of this NOT happening in a chimp, who are anywhere from 2-8 times as strong as a human of comparable size, are slim to none.
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...AND, they look good in a tuxedo smoking a cigar while riding a unicycle.
 
Doc Samson said:
I'm telling everyone in the hospital "See!! This is why you don't put the elderly demented patients on a benzo to keep 'em calm." I'll bet if she'd have given him IV Haldol her friend would still have a face.
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If this changes the practice of just ONE physician, Travis' death will not have been in vain...

You go, DS!
 
Doc Samson said:
I'm telling everyone in the hospital "See!! This is why you don't put the elderly demented patients on a benzo to keep 'em calm." I'll bet if she'd have given him IV Haldol her friend would still have a face.
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How dare you compare a shot-dead monkey to cute, cuddly, feces throwing delirious geriatric patients. Uh..wait a minute...strike that.

Anybody see the cartoon in the NY Post ? It's relevant to your analogy.

In all seriousnesss, I had heard my psych attendings give similar advice about disinhibition and benzo use in this population. And, I can attest to it happening on some occassions. However, I must say that it appears very infrequent to me that this occurs. Granted, this is in my experience only, but if I had to put a number on it, I'd say 8/10 cases would respond positively to the benzo. That is, they'd be more relaxed, able to sleep, would stop screaming at night, etc. The disinhibition situations are messy, but for an approximate 80% success rate, I tended to take it when the chips were down. I try not to use it as first line, but often resort to it. Considering the pseudo-dangerousness of both typicals and atypicals in the elderly also, do you find that it's useful in any such situation?
 
Most of the serious side effects of antipsychotics are predicated on extended use. I should hope an elderly deilrious patient is not placed on PRN IM Haldol for several months or longer.

I got quite annoyed during third year (med school) at how often we were using benzos in the elderly. Although I didn't see a whole lot of disinhibitory aggression (but did see 2-3 cases), I didn't feel like it was doing a whole lot to improve the situation of AMS.

The one thing I'd be most worried about in using antipsychotics for the acute management of agitation/delirium is antihistaminergic effects. Antihistaminergic effects contribute to delirium as well. Offhand I don't know what the 'cleanest' antipsychotic in IM/IV formulation is. Had a good reference for that, but not on this comp.
 
masterofmonkeys said:
Most of the serious side effects of antipsychotics are predicated on extended use. I should hope an elderly deilrious patient is not placed on PRN IM Haldol for several months or longer.

I got quite annoyed during third year (med school) at how often we were using benzos in the elderly. Although I didn't see a whole lot of disinhibitory aggression (but did see 2-3 cases), I didn't feel like it was doing a whole lot to improve the situation of AMS.

The one thing I'd be most worried about in using antipsychotics for the acute management of agitation/delirium is antihistaminergic effects. Antihistaminergic effects contribute to delirium as well. Offhand I don't know what the 'cleanest' antipsychotic in IM/IV formulation is. Had a good reference for that, but not on this comp.
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IM? It should be IV (though I appreciate that IV access is rarely available on inpt psych units). Haldol is the cleanest of the typicals (and thus the cleanest of all of the neuroleptics) which is why it's used for delirium (based on the hyperdopaminergic/hypocholinergic model of oxidative stress). These's also some new research coming to publication about neuroprotective effects of the butyrophenones (i.e., Haldol and Droperidol) in delirium due to interactions at the sigma receptor.
 
should have said IM/IV. Like you said, IV is better, but you don't always have access or have a pt able to sit still long enough to get access.
 
masterofmonkeys said:
The one thing I'd be most worried about in using antipsychotics for the acute management of agitation/delirium is antihistaminergic effects. Antihistaminergic effects contribute to delirium as well. Offhand I don't know what the 'cleanest' antipsychotic in IM/IV formulation is. Had a good reference for that, but not on this comp.
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It's been my understanding that a pure antihistamine usually doesn't cause delirium, it's the anticholinergic effects that cause delirium.
 
michaelrack said:
It's been my understanding that a pure antihistamine usually doesn't cause delirium, it's the anticholinergic effects that cause delirium.
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yup. Literature seems to implicate M1 subtype. I am a spaz who needs to remember to be more precise in my writing.

The way I remember it is 'how do we treat alzheimer's? AChASE inhibitors. So in cognition, more ACh=good. Less ACh=bad.
 
This certainly was an unfortunate case and it gives a lot for the mob, ahem, cough cough, public to devour.

Monkeys and, especially, chimps do not make suitable pets.
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From my own experience of having pets in the past (and I never was a good pet owner), you really have to do some research on raising the animal adequately. I remember my parents coming home when I was a little kid with a kitten, and they expected me to raise this kitten having no idea how to do so. They didn't help. Ask one could imagine, I didn't do a good job, and the kitten showed a lot of behavioral problems. Other children I've seen had similar outcomes with similar situations. I compare that to my brother who in his late 20s got some pets, he actually read several books on rearing them successfully, and they ended up being very good pets.

Chimps also are immensely strong, and as mentioned above, in the wild are known to be quite fierce. Unless you know what you're doing, there'd be a lot of unneeded some risk involved.

I had read some reports indicating that Travis had suffered Lyme Disease in the past. That could've affected his behavior. There's also reports that Travis may have been scared because Charla Nash came to visit appearing different and this may have scared Travis. There's lots of info that invites more questions. Who knows the answer to them? I don't.

I don't know if Travis was neutered. If not, I'd imagine he probably had a lot of raging hormones channeling some of his behaviors, and no sexual outlet. I don't know how much an unneutered animal would be happy even with a thoughtful & loving owner if he couldn't get his freak on.

In any case, there's a lot of brain candy with this case, but given how unfortunate it is, how little it directly impacts my life, how much it has already lead to some of the more scandalous aspects of our own nature, I'm just going to wish the best for the survivors of the incident, and hope that the public's fascination with it doesn't make this situation worse for those involved.
 
masterofmonkeys said:
I got quite annoyed during third year (med school) at how often we were using benzos in the elderly. Although I didn't see a whole lot of disinhibitory aggression (but did see 2-3 cases), I didn't feel like it was doing a whole lot to improve the situation of AMS.
Click to expand...

My favorite consult when I was doing neurology was for AMS in an 80 year old guy who was on Klonopin, Ativan, and Ambien.

Do you really need a consult to figure that one out?
 
tr said:
Say what?? I thought IM was preferred because IV carries an elevated risk of inducing arrhythmias--

http://www.fda.gov/cder/drug/InfoSheets/HCP/haloperidol.htm

http://pn.psychiatryonline.org/cgi/content/full/42/21/14-a
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Qtc prolongation occurs with all neuroleptics (not to mention Ca channel blockers, fluoroquinolones, methadone, and so on). Of the neuroleptics, Haldol causes the lowest per-dose-equivalent prolongation of the Qtc (~4 ms). IV administration is deemed the gold standard for management of delirium (as per the practice guidelines of the APA and the critical care societies) since it's associated with reduced EPS and is less painful for the patient. Repeated scheduled IM injections (when IV access is available) are unneccessary torture for the patient, and are likely to result in increased agitation and suspicion of staff. The FDA warnings are based on association not causation. Since the population of patients receiving IV haldol are (a) a very, very large group (think every ICU in the world), and (b) already very, very sick, I find the suggestion that IV Haldol is potentially causative questionable at best. I'm also suspicious that the ongoing campaign against IV Haldol might have something to do with the fact that it costs pennies per dose (especially since the "new kid on the block" Precedex can cost thousands of dollars per day).
 
So, would it be reasonable to check the EKG before giving the first dose of Haldol IV and then to check it again after the first dose and then every so often after subsequent doses?

In the case of our monkey, the likely route would have been IM, as it would probably have been given by dart gun (do animal tranquilizer dart guns contain 5/2/1?). And it sounds like he was already pretty "suspicious of staff."
 
strangeglove said:
So, would it be reasonable to check the EKG before giving the first dose of Haldol IV and then to check it again after the first dose and then every so often after subsequent doses?

In the case of our monkey, the likely route would have been IM, as it would probably have been given by dart gun (do animal tranquilizer dart guns contain 5/2/1?). And it sounds like he was already pretty "suspicious of staff."
Click to expand...

I have been told that the dart guns contain Thorazine.
FWIW
 
strangeglove said:
So, would it be reasonable to check the EKG before giving the first dose of Haldol IV and then to check it again after the first dose and then every so often after subsequent doses?

In the case of our monkey, the likely route would have been IM, as it would probably have been given by dart gun (do animal tranquilizer dart guns contain 5/2/1?). And it sounds like he was already pretty "suspicious of staff."
Click to expand...

Absolutely - in fact I document a baseline QTc in the note that I recommend initiation of IV Haldol in, and I always write "daily monitoring of QTc, K, and Mg" (since hypokalemia and hypomagnesemia are independent predictors of QTc prolongation).
 
Doc Samson said:
I'm also suspicious that the ongoing campaign against IV Haldol might have something to do with the fact that it costs pennies per dose (especially since the "new kid on the block" Precedex can cost thousands of dollars per day).
Click to expand...

That's funny - when I was doing my anesthesiology rotation a drug rep gave a talk about Precedex. I remember wondering when they would start marketing it as a drug to treat agitated delirium (or just to sedate patients that staff didn't like).
 
Kazema said:
That's funny - when I was doing my anesthesiology rotation a drug rep gave a talk about Precedex. I remember wondering when they would start marketing it as a drug to treat agitated delirium (or just to sedate patients that staff didn't like).
Click to expand...

We're about 2 years into that marketing strategy already. Not a bad drug, just remarkably expensive.
 
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