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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by nellie7 on September 12, 2006, at 14:40:27
Hi,
Does anyone know if people suffering from psychosis but who have some ability to doubt their delusions and to question their judgement can benefit from CBT or some form of "thought training" in order to gain increased ability for reality testing? Could this possibly help such people if they cannot tolerate side effects of APs?
TIA,
Nellie.
Posted by Phillipa on September 12, 2006, at 19:05:27
In reply to psychosis and AP substitutes, posted by nellie7 on September 12, 2006, at 14:40:27
What type of psychosis and what's your diagnosis .I would think it would depend on that and your ability to process information. Love Phillipa
Posted by yxibow on September 13, 2006, at 1:35:13
In reply to psychosis and AP substitutes, posted by nellie7 on September 12, 2006, at 14:40:27
> Hi,
>
> Does anyone know if people suffering from psychosis but who have some ability to doubt their delusions and to question their judgement can benefit from CBT or some form of "thought training" in order to gain increased ability for reality testing? Could this possibly help such people if they cannot tolerate side effects of APs?
>
> TIA,
> Nellie.Yes, there are non-medical psychotherapy routes for psychotic disorders. And even antipsychotics may not block out things fully, as the math virtuoso John Nash has experienced although his psychosis has lesseneed in later life as some people with schizophrenia have experienced.
But it would depend on the intensity of your psychosis and your absolute willingness to return to an emergency room or your doctor when you felt any self-harm or other thoughts (I don't know your particular disorder) and return to medication.
I assume you have been through all the atypicals and some of the less active at D2 typical antipsychotics? Have you tried amoxapine ? Have you been through clozaril or decided that wasn't a route would be able to give a trial and manage?
Probably by 2008-2009 there will be several new ones on the market but I can understand that EPS is unpleasant, I do take Seroquel but not for a psychotic disorder. Akathisia is usually the most prevalent and intense EPS for me with the ascending order of D2 activity of medications.-- tidings
Jay
Posted by med_empowered on September 14, 2006, at 14:16:06
In reply to Re: psychosis and AP substitutes » nellie7, posted by yxibow on September 13, 2006, at 1:35:13
yup..you dont necessarily need an AP. You can try CBT with other meds or alone. Alternate meds include: benzos (apparently, mid-to-high dose valium has shown helpful in managing schizophrenia flare-ups, without APs), anticonvulsants (depakote, trileptal, etc.), or lithium. I imagine there are others, too.
If youre really anxious, you might want to try a benzo to help you calm down...but you should be able to do CBT without antipsychotics.
Posted by yxibow on September 15, 2006, at 3:33:57
In reply to Re: psychosis and AP substitutes, posted by med_empowered on September 14, 2006, at 14:16:06
> yup..you dont necessarily need an AP. You can try CBT with other meds or alone. Alternate meds include: benzos (apparently, mid-to-high dose valium has shown helpful in managing schizophrenia flare-ups, without APs), anticonvulsants (depakote, trileptal, etc.), or lithium. I imagine there are others, too.
>
> If youre really anxious, you might want to try a benzo to help you calm down...but you should be able to do CBT without antipsychotics.
Yes, I have heard of the issues around Valium and schizophrenia. Which is probably why my argument for switching to Valium rang more true -- not that I have schizophrenia or a psychotic disorder, I am compos mentis, just trapped inside an unpleasant anxiety disorder, but the somatiform nature sometimes takes on a parapsychotic angle.
Posted by nellie7 on September 15, 2006, at 6:35:41
In reply to Re: psychosis and AP substitutes » nellie7, posted by Phillipa on September 12, 2006, at 19:05:27
> What type of psychosis and what's your diagnosis .I would think it would depend on that and your ability to process information. Love Phillipa
Hi Phillipa,
I probably suffer from schizoaffective disorder. Could that be the same as psychotic depression? Antidepressants help me a lot, but I still have problems with delusional thinking.
Best wishes,
Nellie.
Posted by nellie7 on September 15, 2006, at 6:37:46
In reply to Re: psychosis and AP substitutes, posted by nellie7 on September 15, 2006, at 6:35:41
Posted by nellie7 on September 15, 2006, at 6:50:15
In reply to Re: psychosis and AP substitutes » nellie7, posted by yxibow on September 13, 2006, at 1:35:13
Hi Jay,
Thanks for all the info and suggestions.
I haven't tried all the atypicals but am feeling so weak and "slow" right now that taking any drug with a depressive effect is out of the question. So I guess for now managing the delusions with ADs and non-medical means is the only option.
Best wishes,
Nellie.
Posted by nellie7 on September 15, 2006, at 6:54:32
In reply to Re: psychosis and AP substitutes, posted by med_empowered on September 14, 2006, at 14:16:06
Thanks, med-empowered. It is reassuring to know that APs are not the only solution.Best wishes,
Nellie.
Posted by SLS on September 15, 2006, at 7:44:35
In reply to Re: psychosis and AP substitutes, posted by nellie7 on September 15, 2006, at 6:35:41
> I probably suffer from schizoaffective disorder. Could that be the same as psychotic depression? Antidepressants help me a lot, but I still have problems with delusional thinking.
Does the delusional thinking follow a manic episode or is it part of a depressive episode?
- Scott
Posted by SLS on September 15, 2006, at 7:58:51
In reply to Re: psychosis and AP substitutes » yxibow, posted by nellie7 on September 15, 2006, at 6:50:15
> I guess for now managing the delusions with ADs and non-medical means is the only option.
CBT and other psychological tools and therapy can help, but I find them of only mild to moderate benefit when treating the more severe biologically-driven illnesses if used exclusively. It can be a critical component of the recovery process, though. It can affect biology positively. I do believe that psychosocial stress plays an important part in the induction and persistence of these illnesses. This is where the psychological approach is targeted to provide coping tools and produce positive change to reduce this stress.
Have you tried Wellbutrin?
- Scott
Posted by med_empowered on September 15, 2006, at 11:45:38
In reply to Re: psychosis and AP substitutes » nellie7, posted by SLS on September 15, 2006, at 7:58:51
hi! Some people will get better without neuroleptics. For a lot of people, psychotic episodes tend to be self-limiting, especially when they occur in the context of a mood disorder.
I think a good therapist could help tremendously...however, I also think something to relieve tension (benzos, exercise, hobbies, whatever) would help a whole lot, too.
Posted by nellie7 on September 16, 2006, at 12:41:02
In reply to Re: psychosis and AP substitutes » nellie7, posted by SLS on September 15, 2006, at 7:58:51
Hi Scott,Thanks for your response.
My delusional thinking is usually part of a depressive episode, though I have suffered from some kind of manic episodes in the past.
I haven't tried Welbutrin but it would probably make things worse because of its dopaminergic effect.
Developing coping tools, as you mentioned, would help in any case.
All the best,
Nellie.
Posted by nellie7 on September 16, 2006, at 12:46:53
In reply to psychosis treatment w/o neuroleptics, posted by med_empowered on September 15, 2006, at 11:45:38
>For a lot of people, psychotic episodes tend to be self-limiting, especially when they occur in the context of a mood disorder.
Do you know if that's also the case in schizoaffective disorder?
> I think a good therapist could help tremendously...however, I also think something to relieve tension (benzos, exercise, hobbies, whatever) would help a whole lot, too.
You are right about that :)
Thanks,
Nellie.
Posted by flip-floppy on September 18, 2006, at 5:42:11
In reply to psychosis and AP substitutes, posted by nellie7 on September 12, 2006, at 14:40:27
Fluvoxamine alone in the treatment of delusional depression
F Gatti, L Bellini, M Gasperini, J Perez, R Zanardi and E Smeraldi
Istituto Scientifico H. San Raffaele, Department of Neuropsychiatric Sciences, University of Milan, Italy.OBJECTIVE: The aim of this study was to evaluate the efficacy of fluvoxamine in the treatment of delusional depression. METHOD: Fifty- nine inpatients who met the DSM-III-R criteria for major depression with psychotic features were treated with fluvoxamine for 6 weeks. Patients were assessed at baseline and weekly thereafter with the Hamilton Depression Rating Scale and the Dimensions of Delusional Experience rating scale. RESULTS: Of the 57 subjects completed the trial, 84.2% (N=48) recovered. The index episodes of the patients who did not respond to fluvoxamine were of significantly longer duration than those of the responders. CONCLUSIONS: Fluvoxamine has a response rate similar to that of the currently most efficacious treatments for delusional depression, including antidepressants plus antipsychotics and ECT.
Posted by nellie7 on September 18, 2006, at 13:55:23
In reply to Fluvoxamine for delusional depression, posted by flip-floppy on September 18, 2006, at 5:42:11
Interesting! Thanks for this message.
Are you considering trying an SSRI?Nellie.
>Fluvoxamine alone in the treatment of delusional depression
>
> F Gatti, L Bellini, M Gasperini, J Perez, R Zanardi and E Smeraldi
> Istituto Scientifico H. San Raffaele, Department of Neuropsychiatric Sciences, University of Milan, Italy.
>
> OBJECTIVE: The aim of this study was to evaluate the efficacy of fluvoxamine in the treatment of delusional depression. METHOD: Fifty- nine inpatients who met the DSM-III-R criteria for major depression with psychotic features were treated with fluvoxamine for 6 weeks. Patients were assessed at baseline and weekly thereafter with the Hamilton Depression Rating Scale and the Dimensions of Delusional Experience rating scale. RESULTS: Of the 57 subjects completed the trial, 84.2% (N=48) recovered. The index episodes of the patients who did not respond to fluvoxamine were of significantly longer duration than those of the responders. CONCLUSIONS: Fluvoxamine has a response rate similar to that of the currently most efficacious treatments for delusional depression, including antidepressants plus antipsychotics and ECT.
>
Posted by flip-floppy on September 18, 2006, at 14:11:30
In reply to Re: Fluvoxamine for delusional depression » flip-floppy, posted by nellie7 on September 18, 2006, at 13:55:23
Hi Nellie,
Yes, I think fluvoxamine sounds really promising, so I want to start on it as soon as possible.
Hug from flip-floppy!
Posted by Phillipa on September 18, 2006, at 19:47:23
In reply to Re: Fluvoxamine for delusional depression » nellie7, posted by flip-floppy on September 18, 2006, at 14:11:30
You do mean luvox? Love Phillipa
Posted by flip-floppy on September 19, 2006, at 3:31:55
In reply to Re: Fluvoxamine for delusional depression » flip-floppy, posted by Phillipa on September 18, 2006, at 19:47:23
Posted by nellie7 on September 19, 2006, at 13:33:36
In reply to Re: Fluvoxamine for delusional depression » nellie7, posted by flip-floppy on September 18, 2006, at 14:11:30
Good luck Flip-floppy!Hug in return from Nellie.
This is the end of the thread.
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