![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Novelagent on September 13, 2012, at 16:06:28
Forgive me, this is long, but may be of interest to those into diagnosis...
I had a psychotic episode where I saw people that weren't there (and I knew it as I saw them--I had a lot of insight).
It was probably induced by benzodiazepine withdrawal-- I was without klonopin for 2 weeks after I had a bottle of it fall beneath an oven in my apartment. I was also manically walking in the rain (and yes, even at one point hysterically laughing in the heavy downpour). Despite this, I was not diagnosed with mania, because I slept a lot in the hospital. But during my episode, I hadn't slept the prior night, yet didn't fail in walking through three cities (about one hour apart each).
I knew I was psychotic, but attributed it to my klonopin withdrawal, so went to the hospital knowing I'd be put back on klonopin there.
I stopped seeing people once I entered the hospital at night (12 hours from first onset) but I continued to hear voices. I was transferred the next day from the ER, which gave me klonopin, to a rehab hospital (the regulat psych wards were full). At the rehab hospital, I insisted on seeing a doc first thing, and a doc was called in at night to see me. I told him I was hearing voices and he rx'd me xyprexa. About 2 days later, I stopped hearing voices and was fine.
After my stay, I asked to be switched to Risperdal Consta biweekly injections. Later, I would switch to Invega Sustenna once-monthly injections. I've been on am antipsychotic ever since my episode, and have never relapsed.
I have no negative symptoms, either, which leads me to think I do not have schizophreniform, but can be instead classified as once having a brief psychotic episode.
Gabitril once made me psychotic for two hours, until I went to sleep and woke up and was fine. It is known to case psychosis, and may indicate I am prone to psychosis when my GABA levels go wary, as they did from my klonopin withdrawal.
I was also taking dexedrine at doses that were more than prescribed (although I now take Adderall, and no longer do this). It was probably the combination of dexedrine, stopping my fish oil that I took for years because I then couldn't afford it, and my klonopin withdrawal.
But the question is this: how likely is it that I have schizophreniform (schizophrenia that is shorter than 2 months, in my case, 1 day)? I have no negative symptoms. My chart claims I have social withdrawal, but this isn't true. I have a pre-existing social anxiety disorder, and engage socially despite it being painful to me now that my current doc doesn't believe in klonopin.
Posted by jono_in_adelaide on September 13, 2012, at 18:02:34
In reply to Was it brief psychotic episode, or something more?, posted by Novelagent on September 13, 2012, at 16:06:28
I'd say it was as you say, likely to have been a combination of the benzodiazepine withdrawl, and the use of amphetamines at highish doses, but I'm only making a guess
Posted by Christ_empowered on September 13, 2012, at 19:34:17
In reply to Re: Was it brief psychotic episode, or something more?, posted by jono_in_adelaide on September 13, 2012, at 18:02:34
I'd say try a very gradual taper or at least dosage reduction and see.
Posted by Novelagent on September 15, 2012, at 10:16:05
In reply to Re: Was it brief psychotic episode, or something more?, posted by Christ_empowered on September 13, 2012, at 19:34:17
> I'd say try a very gradual taper or at least dosage reduction and see.
>i'd say I'm going to stay on them for 3 years (it's been a year and a half)-- but I don't know if I should be staying Sustenna, because I take Adderall for ADHD.
Is there any research on the relapse of brief psychotic episode? Does it have a chance of converting into schizophrenia?
Posted by Christ_empowered on September 15, 2012, at 10:20:46
In reply to Re: Was it brief psychotic episode, or something more?, posted by Novelagent on September 15, 2012, at 10:16:05
I don't know man. Your case sounds complicated. Personally, I'd try to low dose the Invega (maybe switch to tablets?) and watch it with the amphetamine. Just a thought.
Posted by brynb on September 15, 2012, at 14:01:28
In reply to Was it brief psychotic episode, or something more?, posted by Novelagent on September 13, 2012, at 16:06:28
NA,
I don't know anything about psychosis and/or Schizophrenia, but I used to be a heavy benzo user/abuser. For what it's worth, I did several medical detoxes (inpatient) for benzos, and when I was coming off of really high doses (like 150-200mg of Valium daily), I wasn't psychotic, but I was out of control. (I was at a well-known rehab in the tri-state area where they had to give me Thorazine when I checked-in.)
I eventually managed to get off of them by working with an addiction psychiatrist who used Valium and we tapered the dose over four or five months. He's affiliated with Bellevue, and told me that a very high percentage of psych ER cases and psychosis were from benzo withdrawal. Add in stims, and it gets messier.
Anyway, I used Invega successfully for a while when discontinuing Klonopin (several years ago). Thought I'd share if it helps at all.
-b
Posted by Novelagent on September 16, 2012, at 7:04:50
In reply to Re: Was it brief psychotic episode, or something more?, posted by Christ_empowered on September 15, 2012, at 10:20:46
> I don't know man. Your case sounds complicated. Personally, I'd try to low dose the Invega (maybe switch to tablets?) and watch it with the amphetamine. Just a thought.
>i guess it sounds complicated diagnosis wise, but prognosis wise, I'm completely fine. Which is why I don't understand why docs make such a big deal about taking on psychotics. I've tracked down a whopping 5 psychiatrists in all of my state that see psychotics at all. Assuming they accept new patients, none accepts insurance, and one charges $500 just for the first appointment. Growing up, I had the strange belief seeing crazy people was what psychiatrists did for a living. Turns out, they're all too good for it.
Posted by Christ_empowered on September 16, 2012, at 14:11:58
In reply to Re: Was it brief psychotic episode, or something more? » Christ_empowered, posted by Novelagent on September 16, 2012, at 7:04:50
nothing against people with "milder" problems, but its true: shrinks, at least in the US, have largely given up care of the severely mentally ill. And therapists and counselors...well, since they started mass producing those a few decades ago, there has been very little research (at least in the US) on using therapeutic techniques to help psychosis. European mental health seems more focused on first managing severe mental problems and then employing non-medical techniques to get people into society in some capacity. I guess when you have a nationalized health system, you just don't have time or fund$ to spend on mild depression, cyclothymia, etc.
Public health? They obviously won't give you amphetamines. Around here, I think they either cannot give controlled substances, or there are strict rules on it. I think I knew one guy on Ritalin, but that was a low dose and he had brain damage.
You could just get oral atypical tablets off the net. That's where my Abilify comes from...an online Indian pharmacy. #30ish monthly for 30mgs tablets, #30. Shipping isn't too bad either, although it take a minute to get it. Risperdal is ridiculously cheap from India. Invega...probably more expen$ive, assuming its even available yet.
I hope you can figure something out. Have you considered Seroquel+amphetamine? I knew someone on that little combo...she liked it, and it helped her reduce her opioid use. Then again...seroquel isn't for everyone. I hated it. I just thought, you know..its more sedating, you can make dosage adjustments easily, helps take the edge off amphetamine...just thinking out loud.
Posted by Novelagent on September 17, 2012, at 18:55:06
In reply to walking wounded..., posted by Christ_empowered on September 16, 2012, at 14:11:58
I have a public psych, but she's a pediatric psychiatrist, so she's more inclined to rx stimulants. Evenso, they were very hesitant, and it took a year of whining every week at appointments about. What ultimately helped was mentioning Henry Nasrallah led a successful Phase II trial of Vyvanse for schizophrenia. It's eventually going to get approved for it, and blow the minds of public psychs once it does. Nasrallah gave a ground rounds to the hospital my doc is affiliated with a few months ago.He's the most respected doc on schizophrenia in the world, Shire must be paying him a fortune. Shire put up the study results online in a press release.
> nothing against people with "milder" problems, but its true: shrinks, at least in the US, have largely given up care of the severely mentally ill. And therapists and counselors...well, since they started mass producing those a few decades ago, there has been very little research (at least in the US) on using therapeutic techniques to help psychosis. European mental health seems more focused on first managing severe mental problems and then employing non-medical techniques to get people into society in some capacity. I guess when you have a nationalized health system, you just don't have time or fund$ to spend on mild depression, cyclothymia, etc.
>
> Public health? They obviously won't give you amphetamines. Around here, I think they either cannot give controlled substances, or there are strict rules on it. I think I knew one guy on Ritalin, but that was a low dose and he had brain damage.
>
> You could just get oral atypical tablets off the net. That's where my Abilify comes from...an online Indian pharmacy. #30ish monthly for 30mgs tablets, #30. Shipping isn't too bad either, although it take a minute to get it. Risperdal is ridiculously cheap from India. Invega...probably more expen$ive, assuming its even available yet.
>
> I hope you can figure something out. Have you considered Seroquel+amphetamine? I knew someone on that little combo...she liked it, and it helped her reduce her opioid use. Then again...seroquel isn't for everyone. I hated it. I just thought, you know..its more sedating, you can make dosage adjustments easily, helps take the edge off amphetamine...just thinking out loud.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.