Medication Resumption Upon Psychiatric Hospital Admission
In most cases, you should resume a patient's previous psychiatric medications upon admission to an inpatient acute psychiatric hospital, unless there are specific safety concerns, documented ineffectiveness, or acute medical contraindications that warrant modification.
Primary Approach: Continuation of Home Medications
Resuming baseline psychiatric medications is the standard practice unless there is clear evidence of harm, ineffectiveness, or a compelling reason to modify the regimen 1.
Discontinuing effective medications during short inpatient stays may result in unexpected and unmonitored return of symptoms after discharge, particularly problematic in psychiatric settings with brief lengths of stay 1.
Restarting baseline psychiatric medications is explicitly recommended in critical care guidelines when managing delirium and agitation, recognizing the importance of medication continuity 1.
Critical Assessment Before Resuming Medications
Before automatically resuming all medications, you must evaluate:
Obtain comprehensive medication history including previous psychiatric symptoms and documented response to each medication, reviewing medical records and consulting with previous prescribers when possible 1.
Verify medication history accuracy, as up to 67% of admission medication histories contain errors, with 27-54% of patients having at least one unintentional medication discrepancy 2.
Assess for recent changes in the patient's clinical status, including new medical comorbidities, substance use, or acute medical conditions that might contraindicate specific psychiatric medications 1.
When NOT to Resume Previous Medications
Hold or modify medications if:
Documented severe or recurrent adverse effects occurred with the previous regimen, such as significant weight gain, movement disorders, or dangerous side effects 1.
Clear evidence of ineffectiveness exists, with documented treatment failure or lack of symptom control on the current regimen 1.
Acute medical contraindications are present, such as QTc prolongation with antipsychotics, uncontrolled hypertension with stimulants, or drug-drug interactions with new medical treatments 1, 3.
Medication complexity increased during a recent hospitalization - in rehabilitation or recovery settings, it may be reasonable to reinstate the simpler prehospitalization regimen 1.
Special Considerations for Specific Medication Classes
Antipsychotics
Long-acting injectable antipsychotics should be continued as they represent a valuable tool for managing schizophrenia and preventing relapse, particularly in patients with adherence challenges 1.
Avoid abrupt discontinuation to prevent rebound worsening of symptoms, particularly with antipsychotics used for tics or psychosis 1.
Mood Stabilizers
Lithium requires particular caution with abrupt discontinuation due to risk of rebound mania 1.
Continue mood stabilizers unless there are acute safety concerns, as discontinuation can precipitate relapse 1.
Antidepressants
- Taper slowly if discontinuation is necessary to avoid withdrawal symptoms, particularly with SSRIs 1.
Benzodiazepines
Continue if prescribed chronically but avoid initiating or increasing doses in patients at risk for delirium unless treating alcohol or benzodiazepine withdrawal 1.
Gradual tapering is essential if discontinuation is planned to avoid withdrawal symptoms 1.
Stimulants (e.g., Methylphenidate)
- Can be safely held without tapering due to short half-life and lack of dangerous withdrawal syndrome, though monitor for return of ADHD symptoms 3.
Medication Reconciliation Process
Verify all home medications through multiple sources: patient/family interview, community pharmacy records, and previous medical records to minimize the 27-67% error rate in admission medication histories 2.
Document the rationale for any changes to the home medication regimen, distinguishing between intentional therapeutic modifications and unintentional omissions 2.
Establish monitoring plans for medication effectiveness and side effects, as psychiatric inpatients are at high risk for medication errors (17% error rate with 8% potentially harmful) 4.
Common Pitfalls to Avoid
Do not automatically discontinue all home medications simply because the patient is hospitalized - this increases risk of symptom relapse and complicates discharge planning 1.
Do not assume the admission medication list is accurate - independently verify with pharmacy records and collateral sources, as medication history errors occur in up to 67% of admissions 2.
Avoid starting multiple new medications simultaneously without first assessing response to the home regimen, as this complicates attribution of therapeutic effects and adverse events 1.
Do not delay restarting medications while awaiting complete psychiatric evaluation if the patient has been stable on their current regimen - continuation provides a baseline for assessment 1.