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Verhaltenstherapeut
Verhaltenstherapeut, Dr. Med.
Kategorie: Psychiatrie
Zufriedene Kunden: 1990
Erfahrung:  Arzt und Psychotherapeut
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I am writing because there is a disagreement between the doctors

Kundenfrage

I am writing because there is a disagreement between the doctors that are treating my mother and I hope to find here another opinion. 7 years ago she had a severe psychotic episode (she spoke incoherently, couldn't recognize anyone). She was treated with different drugs, but in the end, after 5 months (!) of staying in this confused state, a maximum dose of zyprexa daily got her out of the crisis (diagnosed with atypical schizophrenia for almost 20 years now). For the last 7 years, she took the same crisis dosage of zyprexa and was back on track. Last friday, she had a new crisis and the treating doctor gave her solian 400mg in addition to zyprexa 30 mg, for 5 days now. We see no real improvment (maybe less agitation-physically, but confusion is unchanged). My question is: how long shall we wait with this combination before seeing results? when is it a good moment to declare she is not responsive? what is the average duration of an episode? What are the dangers of longer episodes? dank
Gepostet: vor 7 Jahren.
Kategorie: Psychiatrie
Experte:  Verhaltenstherapeut hat geantwortet vor 7 Jahren.
The medication takes about 2 to 3 weeks to work Zyprexa is fine for psychotic disorders related to common schizophrenia. Atypical psychotic disorders are difficult to handle. It is a good idea to combine to atypical neuroleptics. Another option would be to give lorazeoam (Tavor) and or a typical neuroleptic drug (e.g. haldol) to handle the acute state and try to switch back to the old zyprexa dose after the acute episode.

So you have to wait about 1 month to 8 weeks to see the results of the treatment.

After this period the doctors will change to another medication option. There is no average duration of an episode. It really depends on the individual response and the kind of psychotic problems (e.g. schizoaffective disorders are rather hard to treat).
There is a risk of negative symptoms related to long episodes and a state called "residuum" with permanant chronic symptoms of psychotic problems. But if your mother responded in earlier episodes there is a good chance right now
Kunde: hat geantwortet vor 7 Jahren.

thank you for your answers.

One last question,

the dosage has now increased to 40mg zyprexa in combination with 600 mg of solian. Is this a safe dosage? Is it standard practice (her treating doc is very young)?My mother looks stiff (muscular stiffness) and is still in acute psychotic crisis (incoherent, agitated, sleeps one out of two nights and wakes up more confused and restless, and the results of the treatment are not visible at all). I understand that it take up to 8 wks efore we see results (meaning thinking clearly again), but not even a smaller improvment (like sleeping all nights) before these 8 weeks?

thanks

Experte:  Verhaltenstherapeut hat geantwortet vor 7 Jahren.
It is a safe dosis but a very high one. Where does your mother live ?
Usually zyprexa has a side effect of tiredness. But if the anti-psychotic effect is not strong enough one should consider to see a qualified psychiatrist or go to a psychiatric hospital.
Kunde: hat geantwortet vor 7 Jahren.

Thank you for your reply.

 

My mother is treated by a qualified psychiatrist who works in the Psychiatric hospital of Bucharest, Romania, where she lives . Without a psychiatrist?s prescription, it would have been impossible to even obtain (or know about) this meds. She is her treating psychiatrist for the last 7 years (before my mother was treated by the psychiatrist s mother, now retired), but is very young, around 35 and I doubt about her experience (not her good will).

 

Because it is Easter, we will hospitalize my mother from Tuesday on when all the activities/staffing will be normal. Indeed, my worry is that this high dosage might be safe at a hospital with all necessary facilities for a quick intervention in an emergency, but unsafe for home treatment as my father and myself do currently (although we communicate daily by phone with her treating doctor, who is on holidays, I still believe this kind of dosage should be monitored better).

 

We did not give her yet this dosage, but if your opinion, together with her own psychiatris?s is that it is safe, we will proceed this evening. My mother looks slightly better- although still totally confused, her eyes look clearer and her agitation is (maybe because of her zyprexa-introduced tiredness) reduced . Thank you

Experte:  Verhaltenstherapeut hat geantwortet vor 7 Jahren.
Well, to be very honest : The European recommodations for Olanzapine (Zyprexa) recommend not to go over 20 mg PER DAY. I don´t think it is a big risk to go higher, but I would not recommend to do this at home. So you are right to hesitate and I would not recommend to give her 40 per day if you have not done this. But I also understand the doctor. He has to get a solution for a very difficult patient and this requires methods that are not "usual".
Kunde: hat geantwortet vor 7 Jahren.

Thanks again.

 

To her treatment:

a second doctor would recommend instead of her current combination,

30mg zyprexa per day and instead of solian one orifiril long 500

one pill plus abilify 1 pill every evening, would this be better?

 

what would be the early signs indicating her treatment is adequate ? (for example, does less agitation and a few hours of sleep per night mean we are going the right direction with the treatment or is it just the disease”s evolution?).

 

Experte:  Verhaltenstherapeut hat geantwortet vor 7 Jahren.

There are two possible risks with zyprexa : First hight blood sugar levels with severe problems and second state of confusion.

 

30 mg would be o.k. It is also an option to quit solian if it doesn´t improve the status and go for a trial with abilify (another neuroleptic drug). Orfiril long is a kind of mood stabilizer (and an antiepileptic drug). It is also used for mixed psychotic states and schizoaffective disorders.

 

There are always different treatment options. In my opinion it is best to trust the local psychiatrist but have different options of treatment in mind.

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