Posted by Sunnely on August 18, 2000, at 20:28:19
In reply to Psycosis and relapses, posted by silva bonvicini on August 16, 2000, at 1:59:13
Hi Silva,
> 1 - It's possible my daughter suffers from bipolar desorders?
I am not sure. However, she does exhibit some symptoms that are indicative of bipolar disorder, manic type with psychotic features (agitation, being "nervous," poor concentration, less need for sleep, hallucinations, confusion, and even delusions). I'd venture to say that she may even meet the criteria for a bipolar disorder type II (history of depression, now in hypomanic state). Other supporting features include her own history of depression, and a family history of a mood disorder (twin sister with depression). Euphoria, although a common feature of bipolar disorder, does not always have to be present to satisfy this diagnosis.
Her acute relapse could have been triggered by several recent and ongoing stresses such as family arguments, financial debts, working hard to pay debts, car accident, worry about her depressed twin sister. Of course, all these stresses no doubt affect her sleep pattern which in turn contributed to the development of a manic state. For your information, sleep deprivation is a top trigger to manic relapse. Therefore, a major part of her treatment should include adequate sleep and restful nights.
==============================
> 2) - My impression is that the association of two antidepressants provocates
> a speed to mood provoking one psychotic crisis (maniac). It may be
> possible?It is possible. In fact, antidepressants are known to trigger mania or worse, rapid cycling episodes, especially in women with bipolar disorder. Rapid-cycling is the occurrence of at least 4 or more manic or depressed states in a year. If antidepressant treatment becomes an absolute necessity for a bipolar disorder patient, he/she should be adequately covered with a mood stabilizer.
Your daughter is on Tegretol (carbamazepine) which is a mood stabilizer. This should be continued and make sure that blood level is within "therapeutic" range. Other mood stabilizers that are also equally effective include valproic acid or valproate (Depakote, Depakene) and lithium. Newer drugs with potential mood stabilizing effects (secondary choice) include gabapentin (Neurontin), lamotrigine (Lamictal), and topiramate (Topamax).
================================
> 3) - Quetiapine is " an atypical " antipsychotic: what does it means? In
> which it's different from the Haloperidolo (Haldol)? Can Quetiapine
> have therefore insufficient effect on my daughter, so to provocate the third
> relapse in psychosis?For lack of a better term, and to distinguish them from the older ones, the newer generation of antipsychotics have been called "atypical antipsychotics" (sometimes called "novel antipshotics.")
Atypical antipsychotics simply means antipsychotics that have minimal extrapyramidal symptoms or EPS (muscle rigidity, motor restlessness, parkinsonism, tardive dyskinesia) at antipsychotic dosages. It was hypothesized that the minimal EPS with atypical antipsychotics is due to their ratio of blockade of the serotonin receptors (5HT2) and dopamine receptors (D2), favoring the former. Atypical antipsychotics that are available in the U.S. include clozapine (Clozaril, Leponex), risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). Ziprasidone (Zeldox), another atypical antipsychotic, will soon be available in the US market.
Quetiapine supposedly has similar antipsychotic effectiveness for the positive psychotic symptoms as haloperidol. (Its effectiveness for the negative symptoms has been questioned, however. But don't mention that to the Zeneca people.) The optimal antipsychotic dosages for quetiapine is between 300 to 500 mg/day. The maximum dose is 800 mg/day. It has a short half-life, and must be given 2 or 3 times daily.
I can't tell you for sure if quetiapine had an insufficient effect on your daughter. However, before it (or other antipsychotic) could be considered ineffective as antipsychotic, it must be first tried in adequate dosage and duration. Also, remember that different individuals respond to medications differently. Quetiapine may be effective for one person but ineffective for another. This holds true with the other antipsychotics.
====================================
> 4) - The " crises " have been manifested to the distance of approximately
> fifteen days , (always in the weekend) .May it have a meaning for her
> disease?Sorry, I don't know if there is a connection.
===========================================
> 5) - Are the two successive relapses caused by a not adapted therapy or
> by an aggravation?It could be either one or both. However, I do believe that the stressors (aggravation) she is going through play major roles in her relapse. For your information, relapses have been known to occur in stable bipolar disorder patients but experiencing major stressors, even though they are religiously compliant with their medications and therapy.
=========================================
> 6) - Can be useful psicoterapy of support of psicoanalisis?Definitely, but must be in conjunction with pharmacotherapy.
==========================================
Hope the best for you and your daughter.
poster:Sunnely
thread:43039
URL: http://www.dr-bob.org/babble/20000811/msgs/43267.html