Psycho-Babble Medication Thread 1096736

Shown: posts 1 to 6 of 6. This is the beginning of the thread.

 

Please Help Scott

Posted by andrewb on January 27, 2018, at 8:50:50

Scott,

This is your old friend from Psychobabble. I hope you receive this and can help. I have a dear friend who had dropped out of society a number of years back due to his increasing paranoia. He quit his job because he thought the mechanics were out to get them and isolated himself from his family and friends due to the same type of fears. Though he is a bipolar according to his psychologist daughter, he has never sought or received any treatment.
However, there is a sliver of hope now as he was recently hospitalized with a brain aneurysm (which seems to have miraculously caused no damage), and the hospital will insist he stays another 3 weeks I think. During the first week there they put him on Haldol for his psychotic paranoia (they are trying to kill me). According to his daughters his change has been miraculous, their old father is completely back! However, the psychiatrist stopped the Haldol yesterday, thinking, according to his daughter, that his psychosis may have been induced solely by his aneurysm. We would hate to lose this opportunity for him to live inner world without fear.
Scott, do you have any suggestions. Specifically,
1) What can be said to the psychiatrist in order that she can pursue a suitable medication for him.
2) What can his family and friends say to him to let him know what he needs to do to have a life not dominated by fear.
3) What specific medication might be effective and have a suitable side effect profile, so he might actually stay on it. Do you think Saphris (asenapine) should be considered here.
4) Also, he likes pot, which exacerbates his symptoms. Any suggestions here.

I hope your health acceptable. Ive always had nothing but best wishes for you and am grateful for all the help you have provided myself and others overs the many years.

Andy

 

Re: Please Help Scott

Posted by SLS on January 28, 2018, at 8:21:37

In reply to Please Help Scott, posted by andrewb on January 27, 2018, at 8:50:50

> Scott,
>
> This is your old friend from Psychobabble.

It is great to see your name appear on Psycho-Babble again. Your knowledge and understanding were greater than mine. I also admired your objectiveness and deliberative approach. I liked the way you comported yourself. I'm sure you have retained these traits. Are you still at the email address you gave me in 2000?

The presence of psychosis can be a symptom of aneurysm from what I've seen in the medical literature. However, my impression is that it is not at all common. This has been reported with ruptured aneurysms, not unruptured aneurysms, although I imagine it's possible.

At what age did the psychotic paranoia symptoms first appear? How old is he now?

Where in the brain was the aneurysm?

> 1) What can be said to the psychiatrist in order that she can pursue a suitable medication for him.

It might be the doctor's intent to see if the psychosis returns upon the discontinuation of the Haldol and resume antipsychotic treatment if it does. It would be a sort of rechallenge. If this is the plan, I would request of the doctor that your friend remain in the hospital while this is done. I imagine it would be difficult to convince a paranoid person to accept taking psychiatric medication for fear of being intentionally poisoned.

> 2) What can his family and friends say to him to let him know what he needs to do to have a life not dominated by fear.

After being presented with the relevant information, how does your friend feel about discontinuing the Haldol and be without psychiatric treatment? Perhaps with a clear mind, he would ask the doctor to keep him on the Haldol upon discharge and follow up with a psychiatrist.

> 3) What specific medication might be effective and have a suitable side effect profile, so he might actually stay on it. Do you think Saphris (asenapine) should be considered here.

Saphris is a good choice, and is about my favorite antipsychotic. It has been my doctor's experience that it is particularly effective for paranoid psychosis. The drug also demonstrates antidepressant effects. I see few, if any side effects. That was my experience and that of a good friend of mine. She gained weight with Seroquel and Abilify and was unable to lose it while on those drugs. She lost all of the gained weight once they were discontinued and had them replaced with Saphris. She also takes Navane (thiothixene). Abilify and Seroquel were without robust effect. Navane did a good job with most of her paranoid symptoms, but things didn't come together until Saphris was added. Now, she goes to school and has a job. She does not isolate.

> 4) Also, he likes pot, which exacerbates his symptoms. Any suggestions here.

Many people with schizophrenia self-medicate with tobacco and marijuana. I don't know - maybe your friend would consider avoiding marijuana once he is thinking with a clear head. Other than that, I have no idea how marijuana addiction is treated.

> I hope your health acceptable.

It really isn't. I am currently taking six drugs to treat severe bipolar depression. The combination helps with mental energy, but not with anhedonia, loss of interest, and amotivation. I am still in a sort of brain-fog and do not think nearly as clearly as I have during periods of remission. I have been on Parnate for quite a few years. It is obvious to me that it represents a dead end. I asked my doctor to discontinue the Parnate to allow me to try serotonergic drugs. He wants to try Trintellix (vortioxetine) first. I had been leaning towards adding high-dosage Effexor. This won't happen for another few weeks. The doctor would like things in the brain to settle down since my bout with appendix rupture and peritonitis, which included respiratory and kidney failure among other things. He thinks it possible that there is some inflammation in the brain that might complicate things.

> Ive always had nothing but best wishes for you and am grateful for all the help you have provided myself and others overs the many years.
>
> Andy

As usual, you are kind and generous with your compliments. Thank you.


- Scott

 

Re: Please Help Scott

Posted by andrewb on January 28, 2018, at 10:40:34

In reply to Re: Please Help Scott, posted by SLS on January 28, 2018, at 8:21:37

Thanks Scott,

Some great info. and suggestions!
The friend apparently will refuse to continue Haldol because it makes him feel anxious. Suggestions?

Sorry about your health issues. Interested in the inflammatory/immune system component of BP. What do you know about that? You might be interested in the just released results of the Phase 2 study of aspirin/minocycline for BP, as you have responded to minocycline (https://www.ncbi.nlm.nih.gov/pubmed/29362444). Also note that there is a form of curcumin that is able to cross the BBB and tampen inflammation in a different manner than aspirin and likely minocycline. Let me know if your interested in looking into that.
But really, ideally, it helps to investigate which components of the immune system might be contributing or mitigating your condition, and, if possible, why. For example, this study is provocative and promising (https://www.ncbi.nlm.nih.gov/pubmed/28025071) as T cell components are relatively easy to manipulate in some aspects without medication required (e.g. changing the components and relative abundance of the gut microbiome). You might consider not only getting the blood test that gives you your white blood count profile but go further and get a t-cell breakdown (e.g. t-regs, th17).
Also know that my email address has not changed, so you can reach that way also.

 

Re: Please Help Scott

Posted by SLS on January 28, 2018, at 13:53:49

In reply to Re: Please Help Scott, posted by andrewb on January 28, 2018, at 10:40:34

Hi Andrew.

> The friend apparently will refuse to continue Haldol because it makes him feel anxious.

It could be akathisia. However, it would be difficult to evaluate someone for this condition if the patient remains in bed, as many of the symptoms depend on observing motor activity while sitting or standing (rocking back and forth in a chair, pacing, shifting weight from one foot to the other). If the patient describes extreme restlessness, having an urge to move, and a feeling of "crawling out of their skin, akathisia is likely present. This side effect can be treated with Cogentin (benztropine), a potent anticholinergic. Ugly.

Unfortunately, anxiety (not akathisia) is a common reaction more often seen with the older neuroleptics. I think I read that trifluoperazine is the worst antipsychotic with respect to anxiogenesis. I'm not sure, though. The anxiety side effect is often treated with a benzodiazepine. Ugly.

Haldol is a heavy-duty drug. It binds to dopamine receptors with high affinity, and isn't terribly selective (D1-D4). This might be the reason why the risks of developing dystonias and tardive dyskinesia is so high. For this reason alone, I would not make Haldol the first choice for maintenance treatment.

One of the defining characteristics of atypical antipsychotics that the first generation antipsychotics lacks is their ability to block 5-HT2a receptors. This is good for anxiety.

I'm sure you already know these things.

> Suggestions?

Does your friend acknowledge that treatment with Haldol effectively mitigated his paranoid delusions? Is he willing to switch to another drug? You can explain to him the differences between Haldol and the newer atypical antipsychotics for which the risks of akathisia and anxiety are greatly reduced.

> Sorry about your health issues.

Thank you. The ruptured appendix and septic shock were not much fun.

Thanks for the information regarding inflammation and curcumin. I tried minocycline. At first, it helped quite a bit. After 1.5 years, I began to develop hyperpigmentation of my feet and shins. At that point, I discontinued it. However, I did not experience a worsening of depression. Perhaps its benefits waned over time so gradually that I didn't notice it.

> Interested in the inflammatory/immune system component of BP. What do you know about that?

Gosh, that's a big subject. Microglia cells in the brain release pro-inflammatory cytokines which modulates the immune system. Evidence for the involvement of inflammation in mental illness is mostly empirical. People with mood disorders have higher levels of inflammatory markers than healthy people. The question I have is which came first, the depression or the inflammation. I think it possible that depression comes first. This might then provoke microglia to produce pro-inflammatory cytokines. I imagine arguments can be made for the reverse, though. However, Duke University found that the levels of inflammation increase with each successive depressive episode. I see this as being consistent with the first explanation. Whichever be the case, I think a positive feedback loop is set up for the perpetuation and/or worsening of the depressive state. I don't know. Maybe damaged cells resulting from glutamate excitotoxicity is the provocation for the induction of the immune system. C-reactive proteins are also elevated in depression. But I ramble. Suffice it to say that brain inflammation is associated with mood disorders.

I look at the Bipolar Network News (BNN) frequently. Here is what came up on a search:

http://bipolarnews.org/index.php?s=inflammation

Be well.


- Scott

 

Re: Please Help Scott

Posted by andrewb on January 28, 2018, at 15:35:31

In reply to Re: Please Help Scott, posted by SLS on January 28, 2018, at 13:53:49

Wow, thanks Scott!
Concerning the inflammation issue I will make some further speculations/observations on this issue, but this will be all I have to offer you since I am just another guy posting who happens to have received a new immune system not so long ago and some of the issues may overlap. In no particular order:
1) You can't rule out issues a systemic inflammatory environment that is being activated by leaky barriers. Most common culprits are: periodontal disease and increased intestinal barrier permeability. The gut wall permeability issue is especially big after a long course of full spectrum antibiotics. In other words, get some guidance on repopulating your gut flora. This is good science speaking here, honest. Has the effectiveness minocycline in BP as an antibiotic, rather than an antiviral, been ruled out? Could the loss loss of effect be due bacterial resistance being developed? Just a thought.
2) Another issue is viruses. Viruses once in the body never go away, lying latent until times of immune system weakness, for example, from stress. Viral activation can wreak havoc on the brain also. Refer to a '13 study that found: a 4-month course of the oral antiviral agent valacyclovir boosted cognition in herpes simplex virus-1seropositive patients with bipolar disorder and cognitive impairment in a randomized, double-blind placebo-controlled clinical trial.
Also a virus can cause harmful immune reactions in the latent state. We are just learning what it might mean to have latent toxoplasmosis virus in the brain.
Also issues with blood brain barrier permeability complicates things further.
3) The term autoimmune reaction can perhaps be a lazy term, as constant low grade bacterial leakage or in some cases viruses will induce what may described as an autoimmune event (e.g. an elevated /Th17 profile). It is perhaps much more commoo than thought.
4) Anyway, my point is, if we watchful for these immune threats to systemic health, perhaps brain health may improve/stabilize also. Or put another way, if we put good shoes on a horse, maybe it won't fall and hurt its head!

 

Re: Please Help Scott

Posted by linkadge on January 28, 2018, at 16:27:45

In reply to Re: Please Help Scott, posted by andrewb on January 28, 2018, at 15:35:31

I find ginger root (in the same family as turmeric) is very effective for some mood related symptoms. It has anti-inflammatory effects, calcium channel inhibition, mild MAOI effects and 5-ht3 antagonism.

While I have used both turmeric and ginger root, I find ginger root a bit more broad spectrum. It almost acts like a mood stabilizer.

Linkaddge


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