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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by Kath on January 8, 2007, at 15:42:25
I'll ask on the substance use board also.
I know NOTHING about antipsychotic meds.
22 yr old son hospitalized - paranoid/was suicidal/hearing voices/now on risperdone (sp?) & topping it up as needed with loxopine (sp?) for, let's see, - 10 days now.
he'd been doing cocaine & crystal meth (yes - i tell myself - MY son!!!!)
he's just phoned (is half-way across Canada from me) & say's "Mom, I don't think I'm gonna make it"
is beside himself; thinks the meds aren't going to work
I'M beside myself; what if they don't work? how long do they take to work? will he be flipped into psychosis when he leaves hospital & encounters the locations etc that were part of his psychosis?
If anyone has any input, etc I'd really appreciate it.
Thanks, Kath
Posted by linkadge on January 8, 2007, at 16:23:10
In reply to Drug-induced psychosis; anti-psychotic meds?, posted by Kath on January 8, 2007, at 15:42:25
Is he currently withdrawing from coke and crystal meth or has the psychosis lingered dispite adequate an adequate withdrawl period ?
AP's can sometimes help (or block) the effects of stimulants but, they're not always the best way to treat stimulant psychosis.
He should improve over time, but if he is currently in withdrawl then his outlook will be understanably bleak for the time being.
Linkadge
Posted by notfred on January 8, 2007, at 16:30:17
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by linkadge on January 8, 2007, at 16:23:10
He needs a drug treatment program. Meth and coke (esp. via the IV route) are very hard to kick, in-patient is best as it takes the person away, at least for 30 days, from their setting. Their setting
is full of triggers and sources for doing drugs.
Good luck.
Posted by Phillipa on January 8, 2007, at 17:23:41
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by notfred on January 8, 2007, at 16:30:17
Kath what a great idea. An impatient setting for 30 days is there one in Canada? Love Phillipa
Posted by med_empowered on January 8, 2007, at 17:32:30
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by Phillipa on January 8, 2007, at 17:23:41
you don't necessarily need antipsychotics for drug-induced psychosis...and you certainly wont need them long-term. Once the acute psychosis has passed, he should be good to go in terms of psychiatric meds...they may put him on other stuff, like anticonvulsants, lithium, antidepressants, maybe something for sleep/anxiety but..antipsychotics really aren't necessary long-term.
Posted by Kath on January 8, 2007, at 18:33:50
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by linkadge on January 8, 2007, at 16:23:10
Hmmmmm - thx for your reply.
I'm not sure if he's in withdrawal.
From what I know, he was using over the few weeks before Christmas.
I've told him I posted on a site to see if anyone has any input. I think I'll ask him when he used/how much etc. See if he is OK with telling me.
Thx, Kath
Posted by Kath on January 8, 2007, at 18:35:26
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by linkadge on January 8, 2007, at 16:23:10
PS - how long would withdrawal take?
would it depend on for how long the person had been using?
you mentioned that anti-psychotics are not always the best way to treat drug-induced psychosis...what other ways do you think are good?
K
Posted by Kath on January 8, 2007, at 18:37:31
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by notfred on January 8, 2007, at 16:30:17
Hi thx - I don't think it was IV & I'm not sure for how long he'd been using. From what I know, I suspect that it might have been for 3 to 4 weeks.
thx for your input. I really appreciate all & any.
:-) Kath
Posted by blueberry1 on January 8, 2007, at 18:41:03
In reply to Drug-induced psychosis; anti-psychotic meds?, posted by Kath on January 8, 2007, at 15:42:25
Sounds like a real tough situation. I am very sorry. My heart goes out to you very strongly.
I was a coke addict a couple times and was entering that stage of psychosis/depression. I quit cold turkey both times. The psychosis part faded on its own in about 48 hours. The depression part was severe, almost totally crippling, and took a full 2 weeks to fade away. A month later I was back to where I used to be.
For drug-induced psychosis, I do not believe risperidone is a good choice by the doctors. Or any antipsychotic for that matter. Waiting it out with supportive help such as xanax would have been better in my view.
The problem is that no matter what tips or suggestions you pick up here, what will the doctors think of your requests? Will they cooperate? Will they get defensive and resist? After all, the way they see it is psychosis is psychosis is psychosis and you treat psychosis with antipsychotics. In my mind that is lame.
If it is long lasting or lifetime psychosis, then I favor safer strategies such as depakote or benzodiazepines. If they don't work, then go to zyprexa. Not risperdal. And if depression is an ongoing issue, an antidepressant may be needed. The choices are staggering, but I would limit the field to zoloft, prozac, lexapro, effexor.
In the antipsychotic arena when one is really needed, it is my opinion based on observations here and studying clinical research that zyprexa should be the number one choice. Forget risperdal.
If they wanted to see him improve rapidly, like within a week or two, they should have given him prozac+zyprexa and maybe xanax to back it up. The drugs they have him on now have nowhere near that kind of clinical efficacy or speed.
Posted by Kath on January 8, 2007, at 18:45:03
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by Phillipa on January 8, 2007, at 17:23:41
Yeah Phillipa,
there are long-term drug treatment places but as far as I know you can't necessarily get in at a snap of the fingers.Right now, I suspect he'll be in the hospital for at least 2 more weeks. He's already been in for about 10 days & before that he was drug free for at least 4 days; probably 'way more.
He wants to come back to Ontario once he leaves hospital there. Apparently the psych ward is very geared to drug users as Vancouver is SOOOO bad in that way. So the doctor who I spoke with said that they'll give the patient a 1/2-hour pass to go out & see what cravings they have or basically how they do. Then they'll help them deal with it; give them a longer pass etc before letting them out to stay.
Right now, my son doesn't WANT out - in fact will ask to be put in the "quiet room" so they can lock it & he'll know nobody can hurt him. He's also saying that he never wants to do ANYthing again - even weed. THAT is HUGE!!!!!! Weed to him was like - hmmm - maybe AIR to most people!
Anyway, I know that once he's feeling better the addiction part will kick in, but he knows he needs to go to rehab for a LONG time to help him deal with that.
I've got an appointment tomorrow with the head of the psychology dept at the local hospital. She also does counselling, so I'm going to see her & ask her about resources, etc. As it happens, my son used to go to her years ago, when he was about 13.
Kath
Posted by Kath on January 8, 2007, at 18:47:10
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by med_empowered on January 8, 2007, at 17:32:30
THAT's good to hear.
There's a part of me (& I know a BIG part of him) that is afraid the voices won't stop. The doctor told him that schizophrenia can surface from 15 to 25 yrs, but that he does think in this case it's from drugs.
K
Posted by notfred on January 8, 2007, at 18:51:21
In reply to Re: Drug-induced psychosis; anti-psychotic meds? » notfred, posted by Kath on January 8, 2007, at 18:37:31
> Hi thx - I don't think it was IV & I'm not sure for how long he'd been using. From what I know, I suspect that it might have been for 3 to 4 weeks.
>
> thx for your input. I really appreciate all & any.
>
> :-) KathI would not expect psychosis in a early user of meth and coke. Unless they were up for 3 weeks. I realize the psychosis is troubling but coke and meth are hard core drugs. This is the big league
now, psychosis is just a bump on the road.
Posted by Kath on January 8, 2007, at 18:51:47
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by blueberry1 on January 8, 2007, at 18:41:03
Yikes! You're right as to how would the doctors react...and with me being half a country away it makes it hard & also that my son IS 22.
I was told Risperdone - is that the same?
I'm going to keep all this info that I'm getting - particularly the specific stuff about meds, for when he gets back. I might also ask his doctor re meds if it 'feels' OK.
I know nothing about anti-psychotic meds (or many of them at all really) but it sounds like anti-psychotic ones have heavy-duty side effects.
thx for your support.
Kath
Posted by Kath on January 8, 2007, at 19:02:37
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by notfred on January 8, 2007, at 18:51:21
He used coke big-time in Ontario before he left for out there in July.
I know he had at least one 'slip' with coke in about September.
He visited here in October & I suspect he used E or at least something during that visit as he went to a Rave on the last day & was messed up the next day.
Then when he went back it took him a while to get a job (& MONEY)
So as to a new user. As far as coke goes, there was a break in between.
When he was about 17 he was in Vancouver living for a while & was heavily into meth. He came back about 6 months later & as far as I know didn't do it out here, but his mind WAS messed up for a while. No psychosis, but concentration problems etc.
He's been doing drugs since he was 14; fairly brain-damaging ones since he was about 15 (acid/K/E) - so being that he's 22 now, his poor brain has really been taxed during it's developing stages!
The way I look at it is: he & his GF went out there to get clean (him from cocaine, her from - I don't know, maybe E) - he had a slip; felt bad, etc. & then ends up using METH - 'scuse me?!!! That's addiction bigtime & as you say, the right now part is just a blip as far as what needs to happen for him to conquer this very serious huge problem that he has!
Oh boy!
Thx for your straight-from-the-hip talking.
Kath
Posted by med_empowered on January 8, 2007, at 20:05:21
In reply to Re: Drug-induced psychosis; anti-psychotic meds? » notfred, posted by Kath on January 8, 2007, at 19:02:37
I think blueberry is right...docs tend to see psychosis as psychosis as psychosis regardless of the source (depression, mania, schizophrenia, PTSD, drugs...whatever), so they automotically dope people up with neuroleptics. Risperdal is pretty rough, and the loxapine on top...well, loxapine is an older drug, and its arguably better than some of the other older ones, but its still rough stuff. Hopefully, they'll either withdraw these meds soon or your son can come home soon and get some form of *help*, b/c his drug combo right now looks more like *punishment*.
If he usually goes for stimulants, he may be self-medicating; some people have depressive disorders and what not that respond to stims..since not everyone's doc will give them stims, lots of people get it on the street and go crazy with it. You might want to see about getting him on something stimulating, but legal, like Provigil (I think its Alertec in canada) and certain antidepressants.
Also, some docs will rx stimulants (including amphetamines) to former users. I think the reasons are 1) they are probably self-medicating, so controlled dosages could prove helpful and 2) given high relapse rates, you're probably better off giving them safe, controlled access than cutting them off and then punishing them when they relapse. I know its counter-intuitive to do this, but if you know of or can find any docs who do this near you...it might be a good idea.
Good luck!
Posted by notfred on January 9, 2007, at 0:04:45
In reply to Re: Drug-induced psychosis; anti-psychotic meds? » notfred, posted by Kath on January 8, 2007, at 19:02:37
"He's been doing drugs since he was 14; fairly brain-damaging ones since he was about 15 (acid/K/E) "
Well there is no proof after all these years that
acid causes brain damage. The evidence that E causes brain damage is not at all proven. Given that millions have taken it. But:"- so being that he's 22 now, his poor brain has really been taxed during it's developing stages!"
I would say not taxed, quite the opposite. there is a huge amount of psychological development that
does not take place if you are high all your teenage years. It is a big deficit. You end up with a 20 something adult who has none of the emotional maturity or depth one gets by growing up
and seeing and experiencing life with a clear head.I agree with the others, drug abuse is most times not a primary condition. It is secondary to a bigger problem; it is a sign of a big problem but not the problem itself.
Of course the psychosis needs to be delt with and he needs to detox and get off drugs. But none of that will really get at the why. Why does he need to be high ? Once he can work on these core issues
there can be hope for recovery. But this work cannot start till he is more mentally stable and not using.
Posted by blueberry1 on January 9, 2007, at 5:02:12
In reply to Drug-induced psychosis; anti-psychotic meds?, posted by Kath on January 8, 2007, at 15:42:25
My first post was on the way out the door to work. I had time to think about you at work. Now I'm home 8 hours later with some more thoughts.
First, the drugs he is on absolutely suck. If he is feeling bad, there is a high probability those drugs are making him feel even worse. Not in terms of psychosis, but in terms of depression. Since you don't know much about antipsychotics, the one with high efficacy and tolerable side effects and also benefit for depression is zyprexa. It is actually WIDELY prescribed for anxiety, as a sleep aid, and is dished out like candy to everyone including senior citizens. I was on it for 10 years and it was a good med, especially considering I am sensitive to meds. So that speaks well for its tolerability and acceptability. Risperidone does not come close to fitting that profile. Why they chose that one I have no idea. Bad choice. Keep zyprexa in mind. Second line right behind it would Abilify.
I suspect a deeper problem here though. And that is depression. He has likely been doing drugs to treat depression, though he didn't know that's what he had or that's what he was doing. People seek to get high for a reason, and often the reason is underlying depression.
Going forward, I would keep 3 things in mind: 1)zyprexa for depression and psychosis; 2)prozac for depression and because it marries well with zyprexa; 3)a stimulant such as Provigil that is going to give him a little of that energy feeling he liked, some more antidepressant action, but without the probability of psychosis.
I hope this helps. I wish there was some way you could get them to do these drug swaps right now, because he could be feeling a lot better real fast. The road he is on now with those drugs they're giving him is just torture.
Posted by fca on January 9, 2007, at 10:21:33
In reply to Re: Drug-induced psychosis; anti-psychotic meds? » Kath, posted by blueberry1 on January 9, 2007, at 5:02:12
I am not familiar with how services work in Canada but I familiar with the US and UK--they may well be using these drugs first as part of the requirements of their formulary. That does not mean they are the best drugs but must be used before some of the newer APs are used. Regardless, this is a very very difficult situation--hard to manage clinically, hard for the patient and extremely difficult for loved ones and family. This will probablt take a long time with many disappointments and much hope. Do not give up, do not abandon him but you can not manage his care and recovery. I hope you visit here often for support and information--there are some very knowledgeable people her--but remember--none of us know the situation as well as your son and the medical professionals now working with him fca
Posted by naughtypuppy on January 9, 2007, at 10:49:08
In reply to Re: Drug-induced psychosis; anti-psychotic meds? » Kath, posted by blueberry1 on January 9, 2007, at 5:02:12
> My first post was on the way out the door to work. I had time to think about you at work. Now I'm home 8 hours later with some more thoughts.
>
> First, the drugs he is on absolutely suck. If he is feeling bad, there is a high probability those drugs are making him feel even worse. Not in terms of psychosis, but in terms of depression. Since you don't know much about antipsychotics, the one with high efficacy and tolerable side effects and also benefit for depression is zyprexa. It is actually WIDELY prescribed for anxiety, as a sleep aid, and is dished out like candy to everyone including senior citizens. I was on it for 10 years and it was a good med, especially considering I am sensitive to meds. So that speaks well for its tolerability and acceptability. Risperidone does not come close to fitting that profile. Why they chose that one I have no idea. Bad choice. Keep zyprexa in mind. Second line right behind it would Abilify.Zyprexa is not covered by BC PharmaCare unless the physician has special permission. It's just a matter of cost.
>
> I suspect a deeper problem here though. And that is depression. He has likely been doing drugs to treat depression, though he didn't know that's what he had or that's what he was doing. People seek to get high for a reason, and often the reason is underlying depression.
>
> Going forward, I would keep 3 things in mind: 1)zyprexa for depression and psychosis; 2)prozac for depression and because it marries well with zyprexa; 3)a stimulant such as Provigil that is going to give him a little of that energy feeling he liked, some more antidepressant action, but without the probability of psychosis.
>
> I hope this helps. I wish there was some way you could get them to do these drug swaps right now, because he could be feeling a lot better real fast. The road he is on now with those drugs they're giving him is just torture.
Posted by Kath on January 9, 2007, at 14:54:45
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by notfred on January 9, 2007, at 0:04:45
Thx - yes - and the good news is that he's had a few conversations with his 'bio'-Dad out there, talking about issues he needs to deal with in addition to the addiction thing.
He & I haven't talked about this stuff yet, but we have talked very briefly about dealing with the issues that led to him using drugs to deal with his feelings in the first place. I'm thankful that he is realizing that.
Kath
PS - Hopefully his brain isn't damaged from the drug use over the years...and yes, I know what you mean about a 22 yr old who hasn't had the experiences that have helped him mature emotionally & who has way fewer healthy, positive means of coping that a 22 yr old who didn't use drugs to 'cope'.
Posted by Kath on January 9, 2007, at 15:00:17
In reply to Re: Drug-induced psychosis; anti-psychotic meds? » Kath, posted by blueberry1 on January 9, 2007, at 5:02:12
Yikes - it makes me feel so helpless!!
I'm going to be speaking to his doctor today hopefully & I will try to bring it up. Jay had been on Paxil as well & had wanted to stop it because he said it made him feel "speeded up inside" something like Celexa had done years ago when he tried it for probably a couple of weeks.
I'm not sure how his doctor is going to like me questioning the drugs Jay is on. On the other hand, it wasn't this particular doctor who started him on them.
Is it that zyprexa has fewer side effects? Or in what way would the current ones make him feel crappy?
Maybe I'll say that since he seems to be needing to take a LOT in order for them to help, could we look at him trying something else?
K
Thx for your support!!!!!
Posted by Kath on January 9, 2007, at 15:04:28
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by med_empowered on January 8, 2007, at 20:05:21
In what way are these drugs bad? like - what kinds of effects would they have that would make him feel badly?
I think you're right about self-medicating. He was diagnosed with ADD years ago (Grade 9 I think) & at that point, he was using weed & the doctor said that ADD kids often self-medicate with weed.
At that time, she prescribed I think dexidrine or something (long time ago) & after a while he decided to stop taking it - that was after he'd gotten extremely drunk & his friends had called me to get him & instead I took him straight to Emerg. The fact that he stopped taking it then made me think that he'd been getting a buzz from it & was afraid of abusing it.
It's been a LONG trip !
Kath
Posted by Kath on January 9, 2007, at 15:06:30
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by fca on January 9, 2007, at 10:21:33
A teary thanks!!!!!!!
Some posts, I print out & carry with me, as reading them calms me & helps me carry on.
thank you. Kath
Posted by Kath on January 9, 2007, at 15:09:59
In reply to Re: Drug-induced psychosis; anti-psychotic meds?, posted by naughtypuppy on January 9, 2007, at 10:49:08
>> Zyprexa is not covered by BC PharmaCare unless the physician has special permission. It's just a matter of cost.
Wouldn't you know it! I wonder how the physician gets the special permission? I bet they have to try other things first.
I wonder how long they would consider a reasonable amount of time to try a med? 2 weeks?
Kath
Posted by blueberry1 on January 9, 2007, at 16:40:07
In reply to Re: Drug-induced psychosis; anti-psychotic meds? » blueberry1, posted by Kath on January 9, 2007, at 15:00:17
Hi Kath,
The whole psychiatry thing is so complicated. Individual response to medications varies bigtime from person to person. I'm only suggesting things that have a high likelihood of working on ALL his symtpoms...depression and psychosis and anxiety and sleep and any hidden bipolarness, based on...real world experiences of people here over the years, real world experiences of people at remedyfind.com that rate their drugs, reviewing clinical trials, and things that are FDA approved. Zyprexa+prozac meets all of those criteria. Risperidone does not.
Zyprexa's side effects are fairly tame compared to others. That is probably one reason it is handed out like candy these days. Risperidone is not. Another popular one is Seroquel, but it is used more often for insomnia or anxiety. They all have longterm risks, but longterm risks of not being treated are probably worse (suicide, return to street drugs, more hospitalization).
Though it is complicated to explain, risperidone does have decent antidepressant action but only at low doses. A high doses it blunts all emotions and creates some that are similar to depression.
The key with zyprexa (in this case) is to not use it alone, but use it with its FDA approved partner prozac. They have offsetting side effects. If he felt speeded up on other antidepressants, prozac alone would probably do that too. Zyprexa and prozac work in harmony on all the symptoms and zyprexa blocks that speeded up feeling of the antidepressant.
You might just tell the docs, "look, zyprexa is the most popular antipsychotic out there and I want my son on that one. Risperidone isn't used much. Zyprexa according to clinical studies and the FDA works better with prozac so make sure he takes both. I'm merely asking for something with strong clinical proof, strong anecdotal proof, and FDA approval." Maybe???
I have been hospitalized for depression. All the doctors I saw walked around with a sense of arrogance. But you know what? Working in a hospital is just part of the step on the way to going into private practice. Hospitals are where they get their first opportunity to practice what they learned from textboos. In other words, most of the hospital psychiatrists are newbies! The ones that aren't are usually involved more with academic administrative stuff. Another thing. They are only looking to treat short term emergencies. They are not looking at the longterm welfare of your son. They don't have experience in treating things longterm. They have no idea how their treatments turned out after the patient is discharged. So they can keep making the same mistakes over and over and never realize it.
I speak in general terms. My opinions to not apply to all doctors or all hospitals or all drugs. It is a common saying around here, "mileage varies". With that in mind, I try to shoot for things with the highest potential for good mileage. Zyprexa+prozac in your particular situation fits that. Risperidone does not. I usually frown at antipsychotics. I am a longtime veteran with them. But when they are really needed, I am all for them. But it is important to choose the best.
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