in my work as a non-psychiatrist that seemingly was more saavy about some of these things, these were common and majorly bad mistakes I frequently saw, or questions that come up:
--providers that don't recognize not uncommon SE, EPS stuff like dystonia or akathisia, or how to assess for them, also how EPS can affect swallowing (really good to know)
--I've seen a patient that was delirious, yet past acute EtOH w/d, in whom Seroquel was being used, who just wiggled around in bed in a way that just did not look like delirium. They just were not getting better despite all other issues resolved. Chart review revealed they had a documented hx of akathisia from Seroquel. Oops. D'ced it and cleared quickly. This illustrates the sort of consideration that should be going on when using atypicals in this sort of situation.
--"restless legs" with atypicals is not always what that is, and how to address that (I've seen propranolol and know a psychiatrist who says the data shows it to be more effective than benzos which I've also seen used for it)
--care with atypicals in Parkinson's patients, such as seroquel (according to UTD atypicals in Parkinson's patients is not totally contraindicated, but care must be used)
--not recognizing that atypicals used in agitated delirium, are merely meant to address sx so one can safely address/wait to clear the underlying cause or normalize sleep patterns, and that sedating atypicals can prolong delirium, so it's a bit of a balancing act not to snow the patient with them, calibrate dose, and when it's doing more harm than good on these fronts
--theoretically it's psych that orders a fasting lipid panel etc, but sometimes that isn't happening, and while IM inpt is not necessarily the place for that to happen, sometimes it is pertinent to check these things, so any generalists need to know what to test/look for, especially given the risk of metabolic syndrome, possible HHS, pancreatitis from elevated triglycerides (yes, I've seen the connection between these medication-induced conditions and the atypical on the med list not recognized in the most timely fashion)
--guidelines for using different atypicals in the inpt setting, like seroquel vs zyprexa (what is the issue there? is it Qtc prolongation?), as well as starting doses and how high to go up on them for different indications (I frequently saw that no one really had an idea about this, even seasoned attendings)
--I see EKGs constantly ordered for everyone getting seroquel, but when things are borderline or there's more than one prolonging med on board, it seems like one of those tests that people know what to do when it's normalish, and no idea when it finds a problem (this doesn't render the test useless, but it's nice to know how to manage a more concerning result)
--I've seen the question, "to atypical or benzo, that is the question."
--side note, I've seen w/d vomiting and hives from rapid d/c of seroquel in someone habituated to them outpt, not common but probably good to know
--obvs contraindications to use in the inpt setting
I think the main thing, is to help those outside psych, recognize how psych drugs like the atypicals, can have somatic effects, how to recognize them, and how to deal with them.
