![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
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
Posted by kerry B on July 4, 2000, at 6:02:43
In reply to Re: Antipsychotic round-up: kerry B, posted by noa on July 3, 2000, at 11:58:17
> > 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.
Hi noa,
I have posted Cam about what happened today. I had a visit from the health team, a new worker there that was really enthusiastic about my case, then he asked me what traumas I have had in my life and when I told him He exclaimed "you have survived all that!!!!" so he is referring me to the special treatment clinc for therapy, I guess it will be pretty intense but he feels that it needs to be cleaned out so as I can clear my subconscience and try to get on with things which I am willing to do. I mean there has been so much since my childhood it's not pleasant, things that I hadn't remembered before are coming out. Not nice. Anyway, he has put me on zyprexa with the lithium and hopefully it works well together, just makes me really sleepy at the moment but I guess that will pass.
If you want to read Cam's post feel free O.K. I probably explained it better there.
Thanks for your help too. It probably won't be until at least a week until I get into this place, maybe longer, depends, but he called it post tramatic shock syndrome and said that it probably triggered off my illness. I can expect improvement but will need the meds to keep me on keel. I will keep you posted. Thanks......Kerry
Posted by SLS on July 4, 2000, at 7:41:01
In reply to Re: Question for Cam » Oddzilla, posted by Cam W. on July 3, 2000, at 21:27:06
Dear Cam,
I am unclear as to whether or not applying a neuroleptic antipsychotic can *unmask* tardive-dyskinesia (TD).
> > 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.
Cam - You indicated that TD showed up when someone was switched from a combination of a traditional antipsychotic with an anticholinergic to Zyprexa.1. If the anticholinergic were kept on-board, would TD symptoms have appeared? Was it simply the withdrawal of the anticholinergic drug that was responsible for the emergence of symptoms?
2. In the absence of an anticholinergic, can the switch from a traditional neuroleptic to Zyprexa (or other atypical neuroleptic) unmask the TD that had been previously masked by the traditional one?
3. Can atypical neuroleptics fail to mask TD in patients for whom a typical neuroleptic had accomplished this?
4.Zyprexa and Clozaril are sometimes used to "treat" TD. Are these drugs added to the offending neuroleptic or substituted for it?
5. Do atypical neuroleptics act pharmacologically to reduce TD symptoms in a way dissimilar to typical neuroleptics, or is it that they simply lack an offending mechanism? What would such an offending mechanism be?
6. Can the acute application of a neuroleptic immediately exacerbate TD symptoms, or does it always reduce them?
7. Does 5-HT2 receptor antagonism act to reduce TD symptoms? If so, have any other drugs with this property been used to treat TD - nefazodone for instance? Has ritanserin ever been played with for this indication?
This is a test. You have 7 minutes to complete it and submit your answers. Open book is O.K. Good luck.
Thanks.
- Scott
Posted by danf on July 4, 2000, at 8:48:52
In reply to R:danf from kerry B, posted by kerry B on July 4, 2000, at 5:51:55
Kerry, about benadryl for EPS.
Surprised that they don't know about it. As far as I remember it was one of the 2 prototype drugs for treatment of EPS. I have seen it used more in general hospitals as a trial drug when EPS was suspected. The EPS go away for about 6 hrs or so & then come back. pretty good test. after a day or two on benadryl & a good response people are usually switched to a more std AC. Don't recall ever seeing anyone on benadryl long term for EPS.
Pdocs use it some times when people call in with sx that sound like EPS. Since it is OTC lots of people have some around the house. If the benadryl works, then the pdoc calls in a pres for a traditional AC the next day.
Benadryl is not often used now for several reasons. It is multiple effects compared to newer ACs. (Does lots of other things.)
Because it was not designed as a pure or even close AC drug, it may have drug interactions.
The tid to qid schedule is hard to keep up with. This particularly true as many folks that need EPS treatment have memory probs. The newer ACs tend to be longer acting & once a day.
well even so, it works.
Don't think you guys are behind at all. Just a different system. Most of the Aussie pdocs are trained based on the Brits psych theories & there are some differences from The US. So different meds may be chosen for treatment.
Glad it helped
Posted by Cam W. on July 4, 2000, at 21:03:19
In reply to Re: Question for Cam - This is a test. » Cam W., posted by SLS on July 4, 2000, at 7:41:01
Scott
> Cam - You indicated that TD showed up when someone was switched from a combination of a traditional antipsychotic with an anticholinergic to Zyprexa.
>
> 1. If the anticholinergic were kept on-board, would TD symptoms have appeared? Was it simply the withdrawal of the anticholinergic drug that was responsible for the emergence of symptoms?•No, I believe that it is the traditional antipsychotic that masks the TD. James has seen papers on this phenomenon.
>
> 2. In the absence of an anticholinergic, can the switch from a traditional neuroleptic to Zyprexa (or other atypical neuroleptic) unmask the TD that had been previously masked by the traditional one?•I have seen it once. A person taking 8mg of Orap (pimozide) daily with no anticholinergic was switched to Zyprexa and within 2 weeks he developed the classic tongue movements.
>
> 3. Can atypical neuroleptics fail to mask TD in patients for whom a typical neuroleptic had accomplished this?•I believe that iy is the lower level of D2 binding that minimizes the movement disorders when taking the atypicals. This, or 5HT-2 blocade, is possibly why atypicals fail to mask TD.
>
> 4.Zyprexa and Clozaril are sometimes used to "treat" TD. Are these drugs added to the offending neuroleptic or substituted for it?•These are substituted for the traditional antipsychotic. I haven't seen Zyprexa used as successfully as Clozaril in treating TD. Clozaril does work for TD, but it takes at least 6 months of high dose Clozaril (700-900mg/day) before you see any significant improvement (usually). I think some people with TD give up on Clozaril treatment too early. This may also be the reason why Zyprexa doesn't seem to work that well for TD (too much weight gain with no noticeable improvement in less than six months may cause people to stop therapy).
>
> 5. Do atypical neuroleptics act pharmacologically to reduce TD symptoms in a way dissimilar to typical neuroleptics, or is it that they simply lack an offending mechanism? What would such an offending mechanism be?•Interesting question. I wonder if that is how it works. I can't think of the theories behind why it works, but I think that I did read about it once.
>
> 6. Can the acute application of a neuroleptic immediately exacerbate TD symptoms, or does it always reduce them?• I don't know if acute application would exacerbate or mask symptoms. I think that either of these would be typically seen with long term therapy.
>
> 7. Does 5-HT2 receptor antagonism act to reduce TD symptoms? If so, have any other drugs with this property been used to treat TD - nefazodone for instance? Has ritanserin ever been played with for this indication?•I really don't think it is the serotonin, but decreased D2 blockade in the limbic system (?).
>
> This is a test. You have 7 minutes to complete it and submit your answers. Open book is O.K. Good luck.
>
•I don't know if all my answers are totally correct, but hey, it's only a test and there is no need to get 100% to pass. Also, I didn't have any notes at home to use as open book. - Cam
Posted by kerry B on July 4, 2000, at 22:09:55
In reply to Re: danf to kerry B, posted by danf on July 4, 2000, at 8:48:52
> Kerry, about benadryl for EPS.
>
> Surprised that they don't know about it. As far as I remember it was one of the 2 prototype drugs for treatment of EPS. I have seen it used more in general hospitals as a trial drug when EPS was suspected. The EPS go away for about 6 hrs or so & then come back. pretty good test. after a day or two on benadryl & a good response people are usually switched to a more std AC. Don't recall ever seeing anyone on benadryl long term for EPS.
>
> Pdocs use it some times when people call in with sx that sound like EPS. Since it is OTC lots of people have some around the house. If the benadryl works, then the pdoc calls in a pres for a traditional AC the next day.
>
> Benadryl is not often used now for several reasons. It is multiple effects compared to newer ACs. (Does lots of other things.)
>
> Because it was not designed as a pure or even close AC drug, it may have drug interactions.
>
> The tid to qid schedule is hard to keep up with. This particularly true as many folks that need EPS treatment have memory probs. The newer ACs tend to be longer acting & once a day.
>
> well even so, it works.
>
> Don't think you guys are behind at all. Just a different system. Most of the Aussie pdocs are trained based on the Brits psych theories & there are some differences from The US. So different meds may be chosen for treatment.
>
> Glad it helped
Hi dan,
How are you so knowledgable? You must have done alot of research!! That's great!!!!
I like to know all there is about what I'm on etc, it makes me feel better knowing.
Now after all that, I am not on stelazine anymore, I am on zyprexa as of yesterday when the health team guy came around, finally. He was great, I could actually talk with him and he understood exactly where I'm at.
Now on this one I am so whacked and tired, I don't like it very much but Cam said it will last only a week or so. I don't like it but if it's going to do the job, that's O.K.
I have my first post trauma appointment on the 14th July as my health worker said that is what brought on my illnes, so if I can get all the junk cleaned up, I might feel better.
I know it's going to be hard but what the heck!!!!
Anything is better than what I've been going through lately.
Thanks for your post,
Bye for now,
Kerry
Posted by noa on July 5, 2000, at 6:06:05
In reply to Re: To danf from kerry B, posted by kerry B on July 4, 2000, at 22:09:55
Kerry, I am glad the visit went well. I hope the med change helps.
As for the posttraumatic stress syndrome, if you have a lot of trauma in your past, then it does make a lot of sense.
My advice: Don't try to uncover too much at once, ie, more than you can handle. There is a reason you have covered up some memories--they are very difficult, no? Make sure to work on building support systems, and learning how to gauge when you are ready to talk about things, especially the nastier stuff.
Keep us posted as best you can.
Posted by Oddzilla on July 5, 2000, at 16:35:00
In reply to Re: Question for Cam - This is a test. » Cam W., posted by SLS on July 4, 2000, at 7:41:01
Hi Scott- I was just looking at the chapter on Schizophrenia in the Merck Manual at the link James posted. This caught my eye and I thought you might be interested:
Spontaneous movement disorders may develop in patients who have severe negative symptoms and cognitive dysfunction, even when antipsychotic drugs are not used.
Are the same drugs that are causing the TD also causing the negative symptoms (in people who are taking them? Are people with more pronounced negative symptoms more likely to get TD than people with fewer negative symptoms to begin with? What a price to pay.I was just wondering-no urgent need to reply. I admire your ability to think things through. Since I cut down my effexor I can read again but I still can't think:)
Hope things are going as well as possible for you. O.
Posted by stjames on July 6, 2000, at 2:16:04
In reply to Re: Question » SLS, posted by Oddzilla on July 5, 2000, at 16:35:00
>
> Spontaneous movement disorders may develop in patients who have severe negative symptoms and cognitive dysfunction, even when antipsychotic drugs are not used.
>
>
> Are the same drugs that are causing the TD also causing the negative symptoms (in people who are taking them? Are people with more pronounced negative symptoms more likely to get TD than people with fewer negative symptoms to begin with? What a price to pay.
>
James here....B4 the Phenothiazines were invented in the 50's (?) you saw these movement and other disorders.
Things like "waxy flexability" the ability to stay in one posture, often uncomfortable, for long periods of time. Repeatative movements and repeating the same word(s) over and over all day long.In a sad irony, the meds that made the insane sane, allowed much greater level of functioning, and emptyed the psyco wards also created a large portion of our homeless persons. Persons w/o a support structure (friends and family) tend to fall thru the cracks and stop taking their meds.
The gov. says it can't be there 365 days a year
to make sure 1/2 of 1% of the total population takes their meds and track them down if they don't. Scitzophrenia occurs in the general population at the rate of 1%. I would guess half of these are not identified or undermedicated.james
Posted by Oddzilla on July 6, 2000, at 10:20:08
In reply to Re: Question, posted by stjames on July 6, 2000, at 2:16:04
> >
> > Spontaneous movement disorders may develop in patients who have severe negative symptoms and cognitive dysfunction, even when antipsychotic drugs are not used.
> >
> >
> > Are the same drugs that are causing the TD also causing the negative symptoms (in people who are taking them? Are people with more pronounced negative symptoms more likely to get TD than people with fewer negative symptoms to begin with? What a price to pay.
> > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>Hi James-I think I took my quote out of context and didn't make myself clear. I was talking about movement disorders that appeared spontaneously after years of (untreated) negative type schizophrenia. I was wondering if this was the same as TD and if the drugs were speeding up the natural course of the disease rather than actually causing it. I also thought it was interesting that the new atypical antipsychotics which have a lower (2% vs 5%) incidence of TD relative to the phenothiazines are at least somewhat useful in treating negative symptoms while the older drugs are not useful at all (for negative symptoms). I really don't understand enough to even frame a question.Anyway thanks for posting the link to the Merck manual.
I absolutely agree with you about the lack of social support for schizophrenics and others in the community.
Best wishes O.
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> James here....
>
> B4 the Phenothiazines were invented in the 50's (?) you saw these movement and other disorders.
> Things like "waxy flexability" the ability to stay in one posture, often uncomfortable, for long periods of time. Repeatative movements and repeating the same word(s) over and over all day long.
>
> In a sad irony, the meds that made the insane sane, allowed much greater level of functioning, and emptyed the psyco wards also created a large portion of our homeless persons. Persons w/o a support structure (friends and family) tend to fall thru the cracks and stop taking their meds.
> The gov. says it can't be there 365 days a year
> to make sure 1/2 of 1% of the total population takes their meds and track them down if they don't. Scitzophrenia occurs in the general population at the rate of 1%. I would guess half of these are not identified or undermedicated.
>
> james
Posted by kerry B on July 6, 2000, at 16:32:36
In reply to Re: To noa from kerry B » kerry B, posted by Noa on July 3, 2000, at 18:23:06
> 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.
Hi noa,
Just a quick reply before everybody wakes up. I get up early now so as I can read my posts and reply without the noise of the day interfering!
I was thinking to write down all the traumas I've had in my life, the actual event, the year and whatever else I can remember about it, that way I won't go in there umming and ahhhing about them.
It's going to be tough talking about them but if it makes ones mind better in any sort of way, it's worth it.
I'm just wondering how long this is all going to take? I spoke to the therapist on the phone and she sounds really caring, guess she would have to be like that in her job so that makes me feel much better.
Sort of can't wait until next Friday. I will let you know how it goes.
Hope you are feeling well and healthy!!!!!
Thanks again,Kerry
Posted by SLS on July 6, 2000, at 17:05:57
In reply to Re: Question » SLS, posted by Oddzilla on July 5, 2000, at 16:35:00
Dear O,
Thank you for your flattering, although probably undeserved comment.
I appreciate that you thought of me enough to have posted the material you found.
> Spontaneous movement disorders may develop in patients who have severe negative symptoms and cognitive dysfunction, even when antipsychotic drugs are not used.
I was aware of this, but I don't know very much about it.
I can't answer with surety the questions you ask. They are all good ones. If I scrape up the energy, I am interested to look into them.
> Are people with more pronounced negative symptoms more likely to get TD than people with fewer negative symptoms to begin with?
Yes. If this was simply a guess on your part, neuroscience could use you right now.
> What a price to pay.
I can't even go there.
> Since I cut down my effexor I can read again but I still can't think:)
Your questions betray your clarity of thought.
> Hope things are going as well as possible for you. O.
I really appreciate the sentiments. Thanks for your concern. Things aren't going very well, but I can imagine them being worse. This sort of thinking helps to get me through the day sometimes. I am trying not to count on my new drug, sulpiride, to work for me, as I too easily become optimistic. I really need it bad, though.
Thanks again.
- Scott
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.