![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by Abby on June 30, 2000, at 22:47:50
I've been reading through kerry's posts, and it's obvious that her treatment regimen is not adequate. Nor does she seem to be in a situation where she can do much herself. I think she doesn't have any choice about what doctors she sees. I think it's going to be a somewhat unusual solution. I am not as informed about older and foreign medications as other people are. And right now my brain is in a macro, overarching kind of mode. In short analyzing what neurotransmitters are amiss and how the response to one drug might indicate what other drugs should be considered.
I believe that currently kerry is on stelazine and has bad side effects. These are pacing,"irritability in the legs" and excessive staring.
Diagnosis--Schizoaffective
History-- Multiple hospitalizations.
1995- Presented with severe depression and rage. Given prothiedine (sp?) an antidepressant ---obviously not an SSRI-- by GP. HOSPITAL Overdosed and in ICU but refused psych hospitalization. SYMPTOM Went home despite hearing voices.
At home further PSYCHOSIS. Heard voices. Demons were entering her body. "People" came by and were invited to chat.
INVOLUNTARY COMMITMENT
1.) Valium and Melleril--Bad side effects. (kerry, perhaps you could elaborate.)
2.) Switched to stelazine and aropax.POST COMMITMENT--Maintained stelazine and aropax until another episode. 4 hospitalizations in the intervening time.
Valium overdose while in hospital.
1.) Meds: Neulactil and Tegretol. Side effects: EPS specifically mouth contortions.
2.) Meds: Lithium and Risperidone. Side effects: Muscle. (which kind--TD, dystonia?)
3.) Meds: Zyprexa (Lithium still?) Side effects: Same as with risperidone.
4.) Meds: Zoloft and (Lithium?) Problem: Got sick. Kerry--do you mean that it made you vomit or that it triggered another episode?
5.) Meds: Lithium. No remission
6.) Meds: Stelazine. As above "leg irritability", staring and pacing.My own suggestions are very limited, but typing all this out has made me think through a couple of things. I think, though, that this is a tough case and will need a lot of input from others here.
Mellerill is, as far as I can tell, a crappy drug. It's cheap though and public hospitals still use it.
If kerry needs an anxiolytic, would Ativan be a better choice?
Tegretol is an anticonvulsant. What's neulactil? (sounds like it might be one too.) Anticonvulsants all work differently. So this might be an avenue to explore. The problem with Zoloft, sounds like SSRI induced mania, seems to be the tipoff concerning the bipolar compnent i.e. the affective part of schizoaffective. And that means you need some sort of mood stabilizing drug. Also, consider fish oils.
That you had severe side effects on risperdal and zyprexa---both of which are newer atypical antipsychotics and are not supposed to cause problems---is interesting and must be important.
kerry doesn't mention her financial situation. kerry-- do you have money to pay out of pocket for drugs you order from abroad? Would something like reboxetine be good to try for her depression?
I'm wondering if lamictal or topomax might be worth trying.I don't know enough about antipsychotics. Could some other type of drug help kerry's chemistry?
Sorry for the confusion with switching between she and you.
John L, AndrewB, Adam?
Abby
Posted by Abby on July 1, 2000, at 13:18:26
In reply to I think kerry B needs our help, posted by Abby on June 30, 2000, at 22:47:50
I'm going to be away for nearly three weeks starting tomorrow. I just want to make sure that somebody else reads some of these posts by and about kerry and provides some input. JohnL perhaps you could give some information on Dr. Jensen. Will he take cases on a reduced fee?
abby
Posted by Noa on July 1, 2000, at 13:25:37
In reply to I think kerry B needs our help, posted by Abby on June 30, 2000, at 22:47:50
Abby, what a great job you did of organizing Kerry's info. I feel for her, too, but don't know enough about the meds to suggest anything.
Of course, my own experience does make me itchy to suggest a good endocrine workup, but I don't know if it is appropriate for her or not.
Posted by stjames on July 1, 2000, at 14:26:34
In reply to I think kerry B needs our help, posted by Abby on June 30, 2000, at 22:47:50
Stelazine is really nasty, well know for it side effects like EPS and TD so I would avoid it. I also think Kerry needs to reconsider dignossis. Trying some of the newer antipsychotics would seem prudent, thought they are expensive. A compassionate use program like www.medicineprogram.com , which can get patients
free meds might help with the use.james
Posted by Abby on July 1, 2000, at 15:36:08
In reply to Re: I think kerry B needs our help, posted by stjames on July 1, 2000, at 14:26:34
>
>
> Stelazine is really nasty, well know for it side effects like EPS and TD so I would avoid it. I also think Kerry needs to reconsider dignossis. Trying some of the newer antipsychotics would seem prudent, thought they are expensive. A compassionate use program like www.medicineprogram.com , which can get patients
> free meds might help with the use.
>
> jamesJames---the problem is that she's already tried risperidone and zyprexa. Any other thoughts?--Abby
Posted by ChrisK on July 1, 2000, at 17:03:37
In reply to I think kerry B needs our help, posted by Abby on June 30, 2000, at 22:47:50
Kerry, Abby,
What really happened with the antipsychotics? How long were you using them before the side effects showed up? I would expect from the description given that Zyprexa or Risperdal would be one of the best choices for your condition. I'm not personally familiar with Sterazine. For all I know it may be in the same family but you may want to look at Seroquel also.
As far as an anxiolytic, I would reccomend Klonpin (clonazepam) as a good choice. It is very smooth acting and has a long half life compared to some of the other Benzo's.
Overall I'd say that the voices indicate the need for an antipsychotic above anything else. Sometimes it takes a couple of weeks to get through the initial side effects but can be worth the wait.
Chris
Posted by stjames on July 1, 2000, at 18:40:27
In reply to Re: stjames---any other ideas?, posted by Abby on July 1, 2000, at 15:36:08
>
> James---the problem is that she's already tried risperidone and zyprexa. Any other thoughts?--AbbyJames here....
Yes, ask Cam W ! I know there are other newer antipsychotics than the ones she tried. As i don't take this class of meds I am not up on them.
Seems like she should be on an antiparkinsons med to lessen the EPS, also.
Posted by stjames on July 1, 2000, at 21:11:45
In reply to I think kerry B needs our help, posted by Abby on June 30, 2000, at 22:47:50
>
> Tegretol is an anticonvulsant. What's neulactil? (sounds like it might be one too.)James here....
Neulactil (brand) is Pericyazine, a Phenothiazines
which is the class Stelazine and Melleril are in. It's not on the market in the states, ABIK.
I don't understand why no one perscribed antiparkinson meds to counter side effects. Kerry,
it seems you only get treatment when things get bad, then you go to the hospital, is this correct ? It might help if you could give us a little more information. The voices started for the first time in 1995 and how old were you then ? Were you abused in any way at any time in your life ? It seems you are not from the USA, would you tell us what country you are from ? Do you have health insurance or do you pay full price for doc's and meds ?My impression is that you only get to a doc in crisis and I think it would be better to see someone outside of the hospital who could re-think your dignossis. Anytime someone has such adverse reactions it can be a sign the wrong condition is being treated. Have you ever had a scan of your brain or checks for other non-pych conditions that could cause this ?
In the mean time, if you are not on meds to counter act the side effects you mentioned, start
taking Benydryl, which is often used for this problem. Call your doc Monday and ask for a medication to counter the side effects.james
Posted by Abby on July 2, 2000, at 0:12:47
In reply to Re: I think kerry B needs our help, posted by stjames on July 1, 2000, at 21:11:45
> >
> > Tegretol is an anticonvulsant. What's neulactil? (sounds like it might be one too.)
>
> James here....
>
> Neulactil (brand) is Pericyazine, a Phenothiazines
> which is the class Stelazine and Melleril are in. It's not on the market in the states, ABIK.
> I don't understand why no one perscribed antiparkinson meds to counter side effects. Kerry,
> it seems you only get treatment when things get bad, then you go to the hospital, is this correct ? It might help if you could give us a little more information. The voices started for the first time in 1995 and how old were you then ? Were you abused in any way at any time in your life ? It seems you are not from the USA, would you tell us what country you are from ? Do you have health insurance or do you pay full price for doc's and meds ?
>
> My impression is that you only get to a doc in crisis and I think it would be better to see someone outside of the hospital who could re-think your dignossis. Anytime someone has such adverse reactions it can be a sign the wrong condition is being treated. Have you ever had a scan of your brain or checks for other non-pych conditions that could cause this ?
>
> In the mean time, if you are not on meds to counter act the side effects you mentioned, start
> taking Benydryl, which is often used for this problem. Call your doc Monday and ask for a medication to counter the side effects.
>
> jamesCam-- what do you know about different antipsychotics? Kerry got EPS on both Risperdal and Zyprexa. Do you have any suggestions?--Abby
Posted by Abby on July 2, 2000, at 0:27:09
In reply to Re: I think kerry B needs our help, posted by stjames on July 1, 2000, at 21:11:45
> >
> > Tegretol is an anticonvulsant. What's neulactil? (sounds like it might be one too.)
>
> James here....
>
> Neulactil (brand) is Pericyazine, a Phenothiazines
> which is the class Stelazine and Melleril are in. It's not on the market in the states, ABIK.
> I don't understand why no one perscribed antiparkinson meds to counter side effects. Kerry,
> it seems you only get treatment when things get bad, then you go to the hospital, is this correct ? It might help if you could give us a little more information. The voices started for the first time in 1995 and how old were you then ? Were you abused in any way at any time in your life ? It seems you are not from the USA, would you tell us what country you are from ? Do you have health insurance or do you pay full price for doc's and meds ?
>
>Kerry's e-mail ends with au. So, I'm guessing Australia. Bye for a while.--Abby
Posted by kerry B on July 2, 2000, at 3:46:09
In reply to Kerry B's country--a thought. , posted by Abby on July 2, 2000, at 0:27:09
> > >
> > > Tegretol is an anticonvulsant. What's neulactil? (sounds like it might be one too.)
> >
> > James here....
> >
> > Neulactil (brand) is Pericyazine, a Phenothiazines
> > which is the class Stelazine and Melleril are in. It's not on the market in the states, ABIK.
> > I don't understand why no one perscribed antiparkinson meds to counter side effects. Kerry,
> > it seems you only get treatment when things get bad, then you go to the hospital, is this correct ? It might help if you could give us a little more information. The voices started for the first time in 1995 and how old were you then ? Were you abused in any way at any time in your life ? It seems you are not from the USA, would you tell us what country you are from ? Do you have health insurance or do you pay full price for doc's and meds ?
> >
> >
>
> Kerry's e-mail ends with au. So, I'm guessing Australia. Bye for a while.--AbbyHi Abby,
You've probably gone away by now but you are right, my country is Australia. I don't know if we do things differently over here or not, but I suppose most places are the same.
I lost it big time last night.
I don't know what happened, I was going ok, couldn't stop working all day again.
Later in the night around 11pm I became disorientated, yelling and screaming at my husband who at that moment was ringing the health team. I was hiding behind the lounge with my face covered enjoying the darkness I felt and wouldn't let anyone see my face.
The health team told him to call the police to come and take me but he didn't, he took me to the local hospital where they couldn't help me.
People were staring at me and whispering about me and giving me filthy looks but the doctors thought I was strange.
That's about all I remember. There are probably things I have missed out but I feel so weird, so strange and nobody will listen. I need their help but they just won't do anything!!!!!
I feel desperate. I thought of suicide once again.
I went to work today, somehow, but I wasn't there.
Nothing once again went right, I just wanted to come home and curl up and be left alone.
Tonight I am with the kids and they are really irritating me. It's not their fault. they are just being themselves but it's me.
I am concerned how I am going to manage.
Tomorrow the health team are supposed to be ringing me about phsycho therapy, but I don't see what that will do if I don't get treated by a doctor for my mental health.
It is so hopeless and I feel hopeless. If it wasn't.......my daughter just spilled her milk everywhere!!!!! I'm finding it sooooo hard to stay in control. I shake with rage and anger and mouth off something terrible. They know I'm not well........
Well, if it wasn't for this place I would go over the edge I think......Thanks everyone...........
Posted by Abby on July 2, 2000, at 8:22:08
In reply to Re: Kerry B's country--a thought. , posted by kerry B on July 2, 2000, at 3:46:09
> Hi Abby,
> You've probably gone away by now but you are right, my country is Australia. I don't know if we do things differently over here or not, but I suppose most places are the same.
> I lost it big time last night.
> I don't know what happened, I was going ok, couldn't stop working all day again.
> Later in the night around 11pm I became disorientated, yelling and screaming at my husband who at that moment was ringing the health team. I was hiding behind the lounge with my face covered enjoying the darkness I felt and wouldn't let anyone see my face.
> The health team told him to call the police to come and take me but he didn't, he took me to the local hospital where they couldn't help me.
> People were staring at me and whispering about me and giving me filthy looks but the doctors thought I was strange.
> That's about all I remember. There are probably things I have missed out but I feel so weird, so strange and nobody will listen. I need their help but they just won't do anything!!!!!
> I feel desperate. I thought of suicide once again.
> I went to work today, somehow, but I wasn't there.
> Nothing once again went right, I just wanted to come home and curl up and be left alone.
> Tonight I am with the kids and they are really irritating me. It's not their fault. they are just being themselves but it's me.
> I am concerned how I am going to manage.
> Tomorrow the health team are supposed to be ringing me about phsycho therapy, but I don't see what that will do if I don't get treated by a doctor for my mental health.
> It is so hopeless and I feel hopeless. If it wasn't.......my daughter just spilled her milk everywhere!!!!! I'm finding it sooooo hard to stay in control. I shake with rage and anger and mouth off something terrible. They know I'm not well........
> Well, if it wasn't for this place I would go over the edge I think......Thanks everyone...........Kerry,
I saw your message to Rick E. I just checked in, but this is my last message. I doubt very much that people were looking at you as much as you think. "Filthy looks" sounds a teeny bit paranoid to me. That's not a judgement call. Everybody's been a bit paranoid at times
The differences are with how health care is paid for. In the U.S. people without private insurance have a very difficult time, and even those, who do, often have managed care problems. UK---the sclerotic National Health,Canada--government insurance. Different places will pay for different things.
Call the health team on Monday. Explain to them that it is an emergency and that your local hospital has been unable to help. Good luck. ---Abby
Posted by SLS on July 2, 2000, at 11:23:10
In reply to Re: stjames---any other ideas?, posted by stjames on July 1, 2000, at 18:40:27
Hi Kerry.
Are your doctors confident in their diagnosis of schizo-affective disorder? I am just asking - I have no reason to think otherwise.If Depakote has not been tried yet, I think it might be a good choice to put a lid on any manic counterpart, if there is one. In the mean time, perhaps Klonopin or Ativan would help settle things.
EPS are not common with Zyprexa. I am surprised that you are having a problem with it. Have the dosages of these drugs been kept as low as possible? Clozaril (clozapine) might be the next step. It may be necessary to use an antipsychotic regardless of side effects, and aggressively treat the EPS with a combination of drugs in addition to Cogentin (benztropine). I hope not. Your doctors should be able to prescribe an algorithm for doing this. I would like to hear Cam W. comment on what strategies are currently used to manage EPS.
I don't think taking antidepressants is a good idea right now. An SSRI might be making the psychosis and/or EPS worse.
Kerry - What are *all* of the drugs you are currently taking - psychotropics and otherwise?
You sound pretty good. Hang in there.
- Scott
Posted by Cam W. on July 2, 2000, at 12:28:19
In reply to Antipsychotic round-up: to Cam, posted by Abby on July 2, 2000, at 0:12:47
Kerry (Abby, James & Scott) - I really don't know Kerry's case from outside this thread, but the initial post by Abby summarizing Kerry's med experience makes me wonder if the Risperdal &/or Zyprexa were causing an EPS reaction. Did the doctors say that it was EPS?
Both traditional antipsychotics and lithium can cause types of movement disorders, but they are different. Tremors caused by lithium are rapid and fine in amplitude, whereas EPS tremors are more course or jerky. Was it the Zyprexa and Risperdal causing the EPS or was it lithium causing a pseudo-EPS?
Another variable that could be factored into this equation is that the Zyprexa could "unmask" EPS or TD caused by previous traditional antipsychotic use. I have seen this on a number of occasions where Zyprexa has been blamed for causing TD (tardive dyskinesia) within the first week of it's use. This seems to occur rarely when a person is taken off a traditional antipsychotic and an anticholinergic (for the EPS) and placed on one of the atypical antipsychotics. The traditional antipsychotic and anticholinergic are masking the TD and when these drugs are taken away the TD becomes noticeable. Since the Zyprexa was the last drug started before the appearance of the TD it gets blamed for causing the TD. I have also seen this happen when someone was switched to Risperdal and even to Clozaril.
Scott is right. Your next step may be Clozaril, but I would be inclined to try a low dose of Zyprexa again without the lithium. Perhaps the Zyprexa with another mood stabilizer (eg Depakote, Lamictal, Topamax) may be a strategy. This is just a guess.
It is really difficult to guess what to do when we do not know all of the particulars in a case and didn't see the reactions to the medications. So, I would not make any definitive recommendations in this case, as this is too complex to give any kind of blanket advice.
Scott - As for treating EPS. My personal choice is to always drop the offending antipsychotic and use one of the new atypicals. Of course, this is the action that should be taken in a perfect world. Sometimes there isn't the option of switching for several reasons. Other than that, the anticholinergics are really to only effective therapy that I can think of at the moment. There are several anticholinergics on the market and it may be prudent to try another if one is causing too many side effects.
Hope this makes sense (if not, tell me and I will try again) - Cam
Posted by kerry B on July 2, 2000, at 20:30:28
In reply to Re: Antipsychotic round-up, posted by Cam W. on July 2, 2000, at 12:28:19
> Kerry (Abby, James & Scott) - I really don't know Kerry's case from outside this thread, but the initial post by Abby summarizing Kerry's med experience makes me wonder if the Risperdal &/or Zyprexa were causing an EPS reaction. Did the doctors say that it was EPS?
>
> Both traditional antipsychotics and lithium can cause types of movement disorders, but they are different. Tremors caused by lithium are rapid and fine in amplitude, whereas EPS tremors are more course or jerky. Was it the Zyprexa and Risperdal causing the EPS or was it lithium causing a pseudo-EPS?
>
> Another variable that could be factored into this equation is that the Zyprexa could "unmask" EPS or TD caused by previous traditional antipsychotic use. I have seen this on a number of occasions where Zyprexa has been blamed for causing TD (tardive dyskinesia) within the first week of it's use. This seems to occur rarely when a person is taken off a traditional antipsychotic and an anticholinergic (for the EPS) and placed on one of the atypical antipsychotics. The traditional antipsychotic and anticholinergic are masking the TD and when these drugs are taken away the TD becomes noticeable. Since the Zyprexa was the last drug started before the appearance of the TD it gets blamed for causing the TD. I have also seen this happen when someone was switched to Risperdal and even to Clozaril.
>
> Scott is right. Your next step may be Clozaril, but I would be inclined to try a low dose of Zyprexa again without the lithium. Perhaps the Zyprexa with another mood stabilizer (eg Depakote, Lamictal, Topamax) may be a strategy. This is just a guess.
>
> It is really difficult to guess what to do when we do not know all of the particulars in a case and didn't see the reactions to the medications. So, I would not make any definitive recommendations in this case, as this is too complex to give any kind of blanket advice.
>
> Scott - As for treating EPS. My personal choice is to always drop the offending antipsychotic and use one of the new atypicals. Of course, this is the action that should be taken in a perfect world. Sometimes there isn't the option of switching for several reasons. Other than that, the anticholinergics are really to only effective therapy that I can think of at the moment. There are several anticholinergics on the market and it may be prudent to try another if one is causing too many side effects.
>
> Hope this makes sense (if not, tell me and I will try again) - Cam
Hi Cam,
Thanks for all that info. I am going to put it to my doctor or health team. Still waiting for them to contact me. I am using the public health system but have never had this much trouble with them before. They have always been prompt. Maybe they have overload. Private Psychs are soooo expensive and I am not really in a position to be able to afford it at the moment. Scripts cost the earth.
Scott asked what exactly the meds I am on at the moment: Lithium 1,000mg and lately stelazine 8mg and the valium, i only take 2.5mg as I don't like it.
I have also been on pimozide in the past but don't really remember. There is so much I don't remember. I felt like some sort of guinea pig at the beginning as they were always trying out different drugs, to which most of them I had the side effects, EPS, TD and dystonia? so maybe I just have a low tolerance to these drugs, I have told them repeatedly but they seem to shrug it off.
It's been a nightmare lately and I just don't know where to turn. They are sure that the diagnosis id right, schizoaffective as that also includes Bipolar and the schizo part of it.
I have never been up on this stuff even though I have been going through this for a few years, onset 1995. Nobody ever really explained to me what was going on, they'd just put me in hospital and try out all this stuff. It's noy until now, with the help from all of you that it is sinking in. Thanks. I will wait for them to contact me today. I am going to be very disappointed if nothing is done. I can't stand what I'm going through at the moment, moods, psychosis and the rest. I will wait...................kerry
Posted by kerry B on July 2, 2000, at 23:29:51
In reply to Antipsychotic round-up: to Cam, posted by Abby on July 2, 2000, at 0:12:47
> > >
> > > Tegretol is an anticonvulsant. What's neulactil? (sounds like it might be one too.)
> >
> > James here....
> >
> > Neulactil (brand) is Pericyazine, a Phenothiazines
> > which is the class Stelazine and Melleril are in. It's not on the market in the states, ABIK.
> > I don't understand why no one perscribed antiparkinson meds to counter side effects. Kerry,
> > it seems you only get treatment when things get bad, then you go to the hospital, is this correct ? It might help if you could give us a little more information. The voices started for the first time in 1995 and how old were you then ? Were you abused in any way at any time in your life ? It seems you are not from the USA, would you tell us what country you are from ? Do you have health insurance or do you pay full price for doc's and meds ?
> >
> > My impression is that you only get to a doc in crisis and I think it would be better to see someone outside of the hospital who could re-think your dignossis. Anytime someone has such adverse reactions it can be a sign the wrong condition is being treated. Have you ever had a scan of your brain or checks for other non-pych conditions that could cause this ?
> >
> > In the mean time, if you are not on meds to counter act the side effects you mentioned, start
> > taking Benydryl, which is often used for this problem. Call your doc Monday and ask for a medication to counter the side effects.
> >
> > james
>
> Cam-- what do you know about different antipsychotics? Kerry got EPS on both Risperdal and Zyprexa. Do you have any suggestions?--Abby
Hi again Cam,
I replied to you in another follow-up but not sue which one, this-morning. Sorry, having trouble concentrating today. My memory feels like it is deteriorating rapidly!
I just read your post in this one and I will try to tell you all I can.
I was on pericyazine (neulactil) for about a year with tegratol at the same time. They felt I was going alright on the even though I developed TD. I eventually went off all medication with the advice from a private psych I was seeing, but a few months later, I was aback in hospital. This was early last year. Since then I have only been on lithium after trying risperdal & zyprexa where I developed distonia? I think it's called so they took me off all those and left me with the lithium.
I am from Australia and I think I mentioned in the other post to you, I am going through the public system which is not at all good at the moment. We do have health insurance but it does not cover this type of doctoring nor the medications.
Yes, I do only get treated when things are really bad, I have a local G.P but she is not up on all this and goes by the psychs. I can be fine for ages but then it all hits me and off I go again, crying out for help, but this time everything is taking sooooo long and I don't think I can take much more.
I was abused from the age of 17 when I married a very violent man. He used to bash me for breakfast, lunch & dinner and sometimes in between that as well.
I was 33 years old in 95 when my menatal health troubled began so that makes now the ripe old age of 38.
I have had numerous brain scans and other tests, one I really remember was with a psychologist and I had to sit and answer 367 questions on paper, that was tough!!
They are certain that I am schizoaffective because of all the different psychological signs I show.
So, I had contact with the health team a while ago and someone is coming out to see me tomorrow.
I hope that has filled you in on more about me, if I have left anything out please let me know.
I hope this post makes sense, it is hard to concentrate lately. Thankskerry
P.S I have started taking benadryl for my side effects from the stelazine. I think James put me on to that. Thanks James
Posted by danf on July 3, 2000, at 10:51:34
In reply to Re: Antipsychotic round-up: to Cam, posted by kerry B on July 2, 2000, at 23:29:51
kerry,
has the benadryl helped with the symptoms ?
Posted by noa on July 3, 2000, at 11:58:17
In reply to Re: Antipsychotic round-up: kerry B, posted by danf on July 3, 2000, at 10:51:34
> kerry,
Were any of the scans positive for head injury (I am thinking of the abusive first husband)?Can you try to draw up a timeline of symptoms, medications, and adverse effects, so that you can present the info succinctly to the docs you see? It seems you have probably had to deal with so many different docs over time. Gathering the info into a timeline form might help you feel more on top of the info, which is good to help you feel some more power as a mental health services consumer.
Posted by noa on July 3, 2000, at 12:00:13
In reply to Re: Antipsychotic round-up: kerry B, posted by noa on July 3, 2000, at 11:58:17
Kerry, I also wonder if there is any kind of mental health organization that you give you some support, or guide you to someone who could serve as a kind of advocate for you as you try to get appropriate care within the public system?
Posted by Oddzilla on July 3, 2000, at 17:48:59
In reply to Re: Antipsychotic round-up, posted by Cam W. on July 2, 2000, at 12:28:19
Cam- this is very interesting. Has it been written up somewhere or is this your personal observation? Will the TD go away again? I didn't know TD could be masked. What does that mean exactly? Thanks O.
>
> Another variable that could be factored into this equation is that the Zyprexa could "unmask" EPS or TD caused by previous traditional antipsychotic use. I have seen this on a number of occasions where Zyprexa has been blamed for causing TD (tardive dyskinesia) within the first week of it's use. This seems to occur rarely when a person is taken off a traditional antipsychotic and an anticholinergic (for the EPS) and placed on one of the atypical antipsychotics. The traditional antipsychotic and anticholinergic are masking the TD and when these drugs are taken away the TD becomes noticeable. Since the Zyprexa was the last drug started before the appearance of the TD it gets blamed for causing the TD. I have also seen this happen when someone was switched to Risperdal and even to Clozaril.
>
Posted by kerry B on July 3, 2000, at 17:50:27
In reply to Re: Antipsychotic round-up: kerry B--PS, posted by noa on July 3, 2000, at 12:00:13
> Kerry, I also wonder if there is any kind of mental health organization that you give you some support, or guide you to someone who could serve as a kind of advocate for you as you try to get appropriate care within the public system?
Hi noa,
Hooray, today I am having a visit from a heath team worker and hopefully, if I can explain all that's been happening and how I feel, something might be done, well, they should do something.
As I told Rick, I find it extremely hard to vocally talk about my feelings, I write things which makes it so much easier. I have a small piece that I wrote in my journal, the last entry when I felt suicidal so I'll show him that and hopefully that will be enough.
Also, this guy coming today has access to the psych doctors so maybe he might be able to get me in today to see one quickly as today is the day that they see people that are not in the hospital, but probably not. You usually have to be booked in ahead, but who knows.
These side effects are getting a little too much too handle, I finished my bottle of Benadryl (as James suggested) and it worked so I will tell this guy about it, I really don't think our docs are up on that one!!!!!
Well, I think I'm raving a bit now so I won't put you through that. I will let you know what they say today and I hope that it will be a positive thing!!!!!!!!!!!! Thanks!!!!!!!!!!!Kerry
Posted by Noa on July 3, 2000, at 18:23:06
In reply to Re: To noa from kerry B, posted by kerry B on July 3, 2000, at 17:50:27
When I first started therapy years ago, it was hard for me to verbalize my feelings in person. So, I used to write my therapist letters to broach subjects and share my thoughts, which made talking about them in person much much easier. I hope you can find a doc who will take the time to read what you have written, as it seems to be a good mode of communication for you.
Good luck and keep us posted.
Posted by Cam W. on July 3, 2000, at 21:27:06
In reply to Re: Question for Cam » Cam W., posted by Oddzilla on July 3, 2000, at 17:48:59
Oddzilla - The unmasking of TD was an observation of mine, but when I had mentioned it to the pdocs and pnurses they seemed to already know this. I don't know if it has been written up anywhere. "Masking of TD" was used by a couple of our docs and the couple that I talked to about it. They said that the switch to atypicals seem to bring out the TD. It could be that the anticholinergic was covering some of the tremors, I don't know.
No, the TD doesn't go away. Once you get it, you've got it. Clozaril does seem to help in some of the severe cases, but it does take about 6 months to notice any difference. Nitoman (tetrabenazine), a monoamine depleting agent which was made to help TD, doesn't seem to work that well. I have only seen Nitoman used in a couple of cases and it didn't really seem to help. - Cam
Posted by stjames on July 4, 2000, at 3:05:05
In reply to Re: Question for Cam » Oddzilla, posted by Cam W. on July 3, 2000, at 21:27:06
> Oddzilla - The unmasking of TD was an observation of mine, but when I had mentioned it to the pdocs and pnurses they seemed to already know this. I don't know if it has been written up anywhere. "Masking of TD" was used by a couple of our docs and the couple that I talked to about it. They said that the switch to atypicals seem to bring out the TD. It could be that the anticholinergic was covering some of the tremors, I don't know.
>James here....
The "masking" and "unmasking" of TD by antipsychotics is written about in medical
journals and publications on the net and I have known about it for some time as I did some research about TD in the middle 80's. The Merck Manual mentions it and that raising the dose of an AP will mask TD, though this is not the recomended way to deal with TD.james
Posted by kerry B on July 4, 2000, at 5:51:55
In reply to Re: Antipsychotic round-up: kerry B, posted by danf on July 3, 2000, at 10:51:34
> kerry,
>
> has the benadryl helped with the symptoms ?Hi Dan,
It's amazing! I did take the benadryl and it did help! I actually told my health team gut today about it and he was amazed!!!!!
He thought it was a great idea. Somehoe I think we are very much behind you over here which is a shame really. I have been put on zyprexa today and no more stelazine thakn goodness. I have posted Cam about what happened today if you care to read it feel free.
Thanks so much for the tip about benadryl. It will be something I can pass on to others thanks to you, even our medical staff over here!!!
Thanks again!!!!!Kerry
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