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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by silva bonvicini on August 16, 2000, at 1:59:13
To the age of 16 years, my daughter came recovered to the psychiatric hospital
with the diagnosis of acute psychosis,I Think consequently to one strongly
depression (often cried, remainedin her bed, she did not eat anything,
and she didn't feel the necessity to go in bathroom for all the day.
Then she was like- blocked, she heared a crying child , and to the end she
did not sleep for an entire night, being much anxious, earing the
television speaker ignited in the other room who said:"Maria (she) is died
(or must die...)" having fear to die and seeing her body bleeding.
After a month she was discharged, continuation in regimen of day-hospital
and finally visited sometimes (always near the psychiatric hospital of Pisa)
with therapy and talks, with good recovery of the tone of humor,
(before she was introvert, timid and this because of the continuous arguments
in family and consequent separation from my husband, a violent type that
neglected also the sons, preferring the company of friends and poker's
table, without any work or taking care of its family).It was cured with Tegretol, Talofen, orap and Disipal, slowly diminishing
the doses, and in the arc of approximately three years was suspended
(the Tegretol in low doses was continued for approximately a year)
All this without having any relapse, having good relationships with the
other people and having exceeded its shyness, so that she was married in
1996, at 22 years, and changed city.
Lately it was a lot preoccupied why they had become indebted themselves for
the house, and therefore she has been working for an year.
Then they had a car crash, followed from breach of the glass crash
(in different times). Further she was preoccupied for its twin sister,
who also suffers from depression. Moreover she did not have good
relationships with her husband's mother, for which task that all these
stresses (also arguments with the husband) have caused one relapse on
June 24th.
She heared a voice saying she had to die, she did not sleep, and so on
,exactly, all like the first time, with the difference that in the previous
days it was not gotten depressed and didn't remain in her bed , but she was
nervous, she had no concentration ability and was agitated and nervous,it gave
annoyance to her to be in house of husband's parents where she did not feel
her privacy (were hosts from a month). All this on saturday night,in which she
didn't sleep for all the night. and the day of Sunday was the same one,
with lucid intervals.
But the situation in the night got worse and was necessary the emergency,so
that te doctor made an injection so that slept all the night.
The cure of the specialist was following:
Haldol (Halperidol)100 1/2 matt. 1/2 evening;
Mutabon (perfenazine + Amitriptiline) 1 matt 1 evening;
Surmontil(trimipramine) 1/2 the evening if insomnia;
Tranquirit (diazepam) 15 drops matt. - lunch and evening
.It Seemed that it was resumed well, and after a week quite had resumed
to work (what that had left me perplexed). But I had some doubts regarding
the cure, as Tegretol had not prescribed: I know it is a mood regolator and
in her case had given optimal result.
July 15th, (saturday): She began to feel anxious, finally returned in
confusion and Sunday she recommenced to hear voices etc.
Specialist absent on Sundays and finally in the evening he added as
follows:
Tranquirit 15 gtt. three times a day;
Mutabon 1 tbl lunch and evening
Haldol 1 tbl morning and evening
Surmontil in order to sleep.
"Sleep effect " was caught up, but the situation got worse. My daughter was
not else in psychosis, but she was in strongly depression and confusional
state.Change of doctor.
Speaking with the doctor of Pisa, cure therefore was changed:
Tegretol (carbamazepine) 200 1 cp. matt. 2 evening
Sereupin (Paroxetine) 20 1/2 matt 1/2 evening
Haldol(haloperidol) 20 drops. 10morn. 10 lunch 10 evening
En drops(a Benzodiazepine like diazepam) 12 12 12 .Primary said that the confusional state had to the humor jolts and needed
continuous surveillance, and no jobs , peace and so on.Some days later I discovered, after some questions, they had not gone to
Pisa, but that his mother was itself in this matter, changing specialist.
I was angriest, but for peace( and for my daughter) I kept myself enduring
within every thing, informing on the "new" cure.
Sereupin(Paroxetine) 20 1 matt.
Seroquel(quetiapine) 1/2 matt 1/2 evening
Noritren(Nortryptiline) 25 1 matt 1 evening
Tegretol 200 1 matt 1
En drops 15 at evening(benzodiazepine)
.
With this fact more I didn't not felt me calm, and the time after, that is
August 2nd: I observed better my daughter, and I had the
impression that her cheerful mood had something of " forced ". I had the
doubt that the combination of those drugs gave " an induced " joy, but I did
not have any element for being sure of this.
I feared that these drugs were not adapted, owing to the secondary effects of
Quetiapine . I seemed Haloperidol was adapted, as the second relapse wasn't
so serious like the first, and increasing Haldol the delirium was
cessed.
Further, in the instructions I have read that the association paroxetine with
nortriptiline provokes a strong antidepressant effect. Moreover in case of
mania Noritren must be suspended.
August 4th, friday:
Her husband said on telephone that she had not slept and that it feared
nervous. Sure I didn't wait for, and in the afternoon went to my daugher.
She was in confusion, monosillabic answers, on her face was an expression
sometimes interrogative, sometimes perplexd ,like speaking with someone
invisible without emitting words .Towards the 7 p.m. began also to make
gestures, she cames without reason in other rooms, observing and then exit
ing. Once she tried also to get off home, feeling the usual " voices ".
However to the evening the specialist said to increase :
1 Seroquel and to 1 Tegretol, adding with the up said drugs.This didn't her calm. Only with 40 drops of En she felt asleep.
Her husband confessed to me that from the psichiatry they have demanded
" something " to aweaken herselve" up, as they say (he and his mother)
that " she was like a doll".
Today 8 Mondays August my daughter do not have psychosis but it sleeps a lot,
even if when wide awake she is seemed stable like humor.
These are my askings:
1 - It's possible my daughter suffers from bipolar desorders?
(I have read that Tegretol is used in these cases) I know that the
mania crises determine also a well-being and euphoria sense, and this
does not seems to me in my daughter's case. She has been also
irritable and stressed, previously crisis.Further her hallucinatory
fantasies are not euforic, but they concern on death, or bugs that
exit from her ears. The hallucinations generate anguish (After the
crises she remembers all perfectly,thinking that is a dream, even if
she did not reveal them easily.2) - My impression is that the association of two antidepressants provocates
a speed to mood provoking one psychotic crisis (maniac). It may be
possible?
3) - Quetiapine is " an atypical " antipsychotic: what does it means? In
which it's different from the Haloperidolo (Haldol)? Can Quetiapine
have therefore insufficient effect on my daughter, so to provocate the third
relapse in psychosis?4) - The " crises " have been manifested to the distance of approximately
fifteen days , (always in the weekend) .May it have a meaning for her
disease?5) - Are the two successive relapses caused by a not adapted therapy or
by an aggravation?6) - Can be useful psicoterapy of support of psicoanalisis?
I attend with anxiety an answer, thanking of the opportunity gived to the people
to contact someone who can give indications.Silva Bonvicini
Posted by shar on August 16, 2000, at 16:53:06
In reply to Psycosis and relapses, posted by silva bonvicini on August 16, 2000, at 1:59:13
Silva,
I am sorry I cannot answer your medical questions, but it seems that it would be harder for your daughter to improve if her medication is being changed often.
You said she improved in the hospital in Pisa. Is there any way she could go back there and have her medication supervised? If there are changes to be made in medication, the hospital has her records there.
I believe it is helpful to have a psychologist or psychiatrist, or both, to help her talk about how she is feeling, and watch over her reactions to medication.
I am sure more people will answer your questions, and I wish you good luck in helping your daughter.
Shar
Posted by stjames on August 18, 2000, at 2:05:17
In reply to Psycosis and relapses, posted by silva bonvicini on August 16, 2000, at 1:59:13
It was cured with Tegretol, Talofen, orap and Disipal, slowly diminishing
the doses, and in the arc of approximately three years was suspended
(the Tegretol in low doses was continued for approximately a year)
All this without having any relapse, having good relationships with the
other people and having exceeded its shyness, so that she was married in
1996, at 22 years, and changed city.James here....
If it has not been tried why not return to what has worked well in the past ? I would suspect that due the the stress of family matters her
condition has gotten worse. This might be why weekends are worse. Also if any traumatic or abusive events happened in the past, these issues
need to be worked on with talk thearpy.James
Posted by Cam W. on August 18, 2000, at 7:37:46
In reply to Psycosis and relapses, posted by silva bonvicini on August 16, 2000, at 1:59:13
Silva - I can only help you with 2 of your questions. I think the most important thing that you can do for your daughter is to be there for her. Also, you can see that she gets into a stable doctor-patient relationship. This is important because a doctor who knows her situation intimately is far more likely to be able to diagnose her condition and prescribe the appropriate treatments.
>
> 3) - Quetiapine is " an atypical " antipsychotic: what does it means? In
> which it's different from the Haloperidolo (Haldol)? Can Quetiapine
> have therefore insufficient effect on my daughter, so to provocate the third
> relapse in psychosis?
>
Quetiapine is a relatively new antipsychotic. Studies have not shown it to be superior to Haldol™ in the treatment of psychoses. There are several other atypical antipsychotics (olanzapine, risperidone, clozaril and several others available in Europe). Atypical is a name they give to a heterogeneous (differing) group of newer antipsychotics, whose main similar features are a reduced risk of causing movement disorders, particularily tardive dyskinesia.
>
> 6) - Can be useful psicoterapy of support of psicoanalisis?
>
Psychotherapy (eg cognitive behavioral therapy), but usually not psychoanalysis is often a great adjunct to medication. It does give the person insight into their disorder.I know this is not much of what you asked, but it is all that I truly feel comfortable answering with any confidence. Sincerely, Cam
Posted by Sunnely on August 18, 2000, at 20:28:19
In reply to Psycosis and relapses, posted by silva bonvicini on August 16, 2000, at 1:59:13
Hi Silva,
> 1 - It's possible my daughter suffers from bipolar desorders?
I am not sure. However, she does exhibit some symptoms that are indicative of bipolar disorder, manic type with psychotic features (agitation, being "nervous," poor concentration, less need for sleep, hallucinations, confusion, and even delusions). I'd venture to say that she may even meet the criteria for a bipolar disorder type II (history of depression, now in hypomanic state). Other supporting features include her own history of depression, and a family history of a mood disorder (twin sister with depression). Euphoria, although a common feature of bipolar disorder, does not always have to be present to satisfy this diagnosis.
Her acute relapse could have been triggered by several recent and ongoing stresses such as family arguments, financial debts, working hard to pay debts, car accident, worry about her depressed twin sister. Of course, all these stresses no doubt affect her sleep pattern which in turn contributed to the development of a manic state. For your information, sleep deprivation is a top trigger to manic relapse. Therefore, a major part of her treatment should include adequate sleep and restful nights.
==============================
> 2) - My impression is that the association of two antidepressants provocates
> a speed to mood provoking one psychotic crisis (maniac). It may be
> possible?It is possible. In fact, antidepressants are known to trigger mania or worse, rapid cycling episodes, especially in women with bipolar disorder. Rapid-cycling is the occurrence of at least 4 or more manic or depressed states in a year. If antidepressant treatment becomes an absolute necessity for a bipolar disorder patient, he/she should be adequately covered with a mood stabilizer.
Your daughter is on Tegretol (carbamazepine) which is a mood stabilizer. This should be continued and make sure that blood level is within "therapeutic" range. Other mood stabilizers that are also equally effective include valproic acid or valproate (Depakote, Depakene) and lithium. Newer drugs with potential mood stabilizing effects (secondary choice) include gabapentin (Neurontin), lamotrigine (Lamictal), and topiramate (Topamax).
================================
> 3) - Quetiapine is " an atypical " antipsychotic: what does it means? In
> which it's different from the Haloperidolo (Haldol)? Can Quetiapine
> have therefore insufficient effect on my daughter, so to provocate the third
> relapse in psychosis?For lack of a better term, and to distinguish them from the older ones, the newer generation of antipsychotics have been called "atypical antipsychotics" (sometimes called "novel antipshotics.")
Atypical antipsychotics simply means antipsychotics that have minimal extrapyramidal symptoms or EPS (muscle rigidity, motor restlessness, parkinsonism, tardive dyskinesia) at antipsychotic dosages. It was hypothesized that the minimal EPS with atypical antipsychotics is due to their ratio of blockade of the serotonin receptors (5HT2) and dopamine receptors (D2), favoring the former. Atypical antipsychotics that are available in the U.S. include clozapine (Clozaril, Leponex), risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). Ziprasidone (Zeldox), another atypical antipsychotic, will soon be available in the US market.
Quetiapine supposedly has similar antipsychotic effectiveness for the positive psychotic symptoms as haloperidol. (Its effectiveness for the negative symptoms has been questioned, however. But don't mention that to the Zeneca people.) The optimal antipsychotic dosages for quetiapine is between 300 to 500 mg/day. The maximum dose is 800 mg/day. It has a short half-life, and must be given 2 or 3 times daily.
I can't tell you for sure if quetiapine had an insufficient effect on your daughter. However, before it (or other antipsychotic) could be considered ineffective as antipsychotic, it must be first tried in adequate dosage and duration. Also, remember that different individuals respond to medications differently. Quetiapine may be effective for one person but ineffective for another. This holds true with the other antipsychotics.
====================================
> 4) - The " crises " have been manifested to the distance of approximately
> fifteen days , (always in the weekend) .May it have a meaning for her
> disease?Sorry, I don't know if there is a connection.
===========================================
> 5) - Are the two successive relapses caused by a not adapted therapy or
> by an aggravation?It could be either one or both. However, I do believe that the stressors (aggravation) she is going through play major roles in her relapse. For your information, relapses have been known to occur in stable bipolar disorder patients but experiencing major stressors, even though they are religiously compliant with their medications and therapy.
=========================================
> 6) - Can be useful psicoterapy of support of psicoanalisis?Definitely, but must be in conjunction with pharmacotherapy.
==========================================
Hope the best for you and your daughter.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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