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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by D minor on March 9, 2005, at 16:24:23
Hey guys,
after about a month of being symptom free I've started hallucinating again. And sometimes its really scary. I am so tired of this. I'm on 5mg Abilify and my pdoc recently upped my Seroquel to 600mg. Why is it that nothing seems to work? I supposedly have Bipolar with psychotic features, but I'm wondering if schizoaffective might not be a better fit. Is there any difference in the treatment of the two?Any input is appreciated,
thanks,
dm
Posted by med_empowered on March 9, 2005, at 18:04:58
In reply to More Hallucinations: When will this end!, posted by D minor on March 9, 2005, at 16:24:23
Schizoaffective is a slippery diagnosis. Some docs think of it as more in the schizophrenia spectrum, some think of it as between bipolar and schizophrenia, some think of it as psychosis-heavy bipolar disorder...personally, when I see it used it seems the doc really doesn't have a grasp on what's going on. Treatment of schizoaffective isn't that different from schizophrenia or Bi-polar, but depends on your doc. Some docs treat schizoaffective like schizophrenia, complete with the long-term use of anti-psychotics, sometimes with mood-stablizers and/or anti-depressants. Others use anti-psychotics as needed,then withdraw them, and rely more on mood stabilizer and anti-depressants. With the growing popularity of atypical antipsychotics, it seems more and more docs are using antipsychotics long-term in schizophrenia, schizoaffective, and bi-polar disorders.
In terms of your treatment...when was your Seroquel increased? Keep in mind that antipsychotics take about 6 weeks to kick in (this is true of dosage increases as well), so give it a little time. What kind of hallucinations are you having? Mood-stabilizer, ESPECIALLY LITHIUM AND DEPAKOTE, seem to help hallucinations in both schizophrenia and bipolar disorder. Some studies have found mood-stabilizers alone to be effective in refractory schizophrenia and bipolar with psychotic features. Obviously, benzos, such as Klonopin and Ativan, calm people down during mania/psychosis; in addition, some studies seem to indicate that benzos alone have some antipsychotic properties, which makes sense given their dopamine-dampening effects. Good luck!
Posted by D minor on March 9, 2005, at 23:22:10
In reply to Re: More Hallucinations: When will this end!, posted by med_empowered on March 9, 2005, at 18:04:58
> In terms of your treatment...when was your Seroquel increased?
-My Seroquel was increased a few days ago. But the increase was not for hallucinatios but for the derealization that sometimes happens with me.( I don't really understand why an increase in AP will help with that.) So it hasn't been long enough for it to do any good, but I had been stable for a while at 400mg.
What kind of hallucinations are you having?- Mostly I hear my cell phone beeping or ringing when it shouldn't. The scary ones are voices speaking too softly or quickly for me to catch the words. Sometimes people calling my name.
Mood-stabilizer, ESPECIALLY LITHIUM AND DEPAKOTE, seem to help hallucinations in both schizophrenia and bipolar disorder.- Maybe that's my problem. I stopped taking my mood stabilizer (Topamax) about, oh, a month ago. I hated it and I refuse to take it anymore. I like feeling a little up every now and then, I've never been truely manic. My parents say I'm more pleasant off of the Topamax. I've tried Depakote, but gained 20 lbs on it. Maybe I should try Lithium? But I hear the side effects of that are pretty bad to. Will pdocs prescribe lithium for BPII?
I'm not really psychotic in the sense that I lose touch with reality. I just hallucinate every now and then, and have a few strange thoughts. Like for instance, here's a funny one. I've never told ANYONE this before, but every now and then I think that Johnny Depp look-alikes are following me. I dunno. I'm crazy I guess. Thank you for writing to me.
dm
Posted by med_empowered on March 10, 2005, at 0:40:24
In reply to Re: More Hallucinations: When will this end!- med, posted by D minor on March 9, 2005, at 23:22:10
hey! You don't sound like the typical "psychotic patient," in the sense that you seem to know when you are and are not hallucinating, and you also seem to have hallucinations without a terribly developed delusional system that supports them and makes them "real". You're not "crazy" by any stretch. Anyway, with regards to mood-stabilizers...when you're talking BP II, prescribing habits differ wildly. That said, Lithium seems to be a favorite, given the long history of use and all the data that's been collected on it. Usually, BP II involves lower doses of Lithium than BP I, but this isn't always the case. In addition, everything else that's RX'd for BP I is RX'd for BP II--lamictal, tegretol, trileptal, depakote, anti-psychotics-- with the primary difference being that docs generally don't need to resort to "extraordinary measures" (i.e., hospitalization, high-dose anti-psychotics, high-dose Lithium, etc.) with BP II. 600mgs of Seroquel is quite a bit...what exactly is it being RX'd for? I was once BP II, but after hallucinations popped up, the dx was changed to BP I or BP NOS. Since I hate anti-psychotics I refuse to take them, so my hallucinations are controlled by better mood-management...basically, as long as my Trileptal dose is high enough to prevent a mixed-episode and low enough so as not to contribute to depression, things are pretty good. I also take adderall (ADHD, but also helps with depression), anti-depressants (these change regularly), anti-anxiety med(s) (again, subject to change), and the occasional sleeping pill (helps with overall stability...I usually only take if I've been without sleep for a day or two). Anyway, long story short, I've found that using meds to help me avoid severe mood-swings effectively ends any psychosis problems, which in turn helps eliminate the "need" for anti-psychotics. Therapy also helps, as does self-help. Good luck!
Posted by DanielJ on March 10, 2005, at 8:09:56
In reply to More Hallucinations: When will this end!, posted by D minor on March 9, 2005, at 16:24:23
It could be that the anti psychotic med dosage is too low. My son has schizophrenia, he really didn't start to stabilize until he was on 20 mg of zyprexa. Abilify made him worse, he couldn't sleep and had nightmares and hallucinations. Zyprexa taken about 8:00 pm eventually fixed that
agitation and anxiety were eventually controlled by 75 mg of Zoloft. After a year we cut back on the zyprexa but initially he required the higher amount. He never took topomax but if it is the anti seizure med, I have heard the side effects can be bad. When you have mood swings do you have anger, elation, compulsive behaviour etc. or is it more between depression and normalcy?
Posted by ed_uk on March 10, 2005, at 9:22:00
In reply to Re: More Hallucinations: When will this end!- med, posted by med_empowered on March 10, 2005, at 0:40:24
Hi Med!
>Since I hate anti-psychotics.
Have you had personal bad experiences with antipsychotics? I'm just curious because you mention them a lot. The only APs that I've ever taken are prochlorperazine and chlorpromazine. I had a very bad reaction to chlorpromazine. The prochlorperazine didn't really do anything because the dose was almost homeopathic.
Regards,
Ed.
Posted by SLS on March 10, 2005, at 9:51:30
In reply to More Hallucinations: When will this end!, posted by D minor on March 9, 2005, at 16:24:23
Hi.
> after about a month of being symptom free I've started hallucinating again.
What is the nature of your hallucinations?
> I'm on 5mg Abilify and my pdoc recently upped my Seroquel to 600mg
Seroquel might not be the right drug for you, but I have seen it used at dosages of 800mg and above. 5mg is a small dosage of Abilify. I am wondering if perhaps you can do without it. How long have you been taking it? How do you know that it was helping? Either try going up to 20mg or scrap it. Are you using Abilify as an antidepressant?
Schizoaffective disorder might be a fit if you experience schizoid symptoms in the absence of mood symtoms for at least a two week period.
A friend of mine always gets hypomanic first before becoming psychotic. Her manias are triggered by stress and lack of sleep. The mania would seem to trigger a psychosis that qualified as schizophrenic. During this time, her mania subsides, leaving her in a schizoid state. The trick with her is to prevent the mania from developing in the first place. Believe it or not, using Xanax as a PRN in combination with Risperdal, Effexor, and Neurontin keeps her well. She also suffers from bouts of depression that I haven't payed enough attention to as to when it precipates relative to her other psychiatric states. For some people, the schizoid state is precipitated during a depressed state.
Look at this, and tell me what you think:
http://www.mentalhealth.com/dis1/p21-ps05.html
Pay particular attention to the criteria for schizophrenia.
- Scott
Posted by D minor on March 10, 2005, at 13:56:26
In reply to Re: More Hallucinations: When will this end! » D minor, posted by SLS on March 10, 2005, at 9:51:30
Hey, thanks all for writing.
> What is the nature of your hallucinations?
- I mostly hear my cell phone beeping when it shouldn't. But every now and then I hear voices, and they scare me. Usually I can't make out what they are saying. More rarely I will see something, like people moving out of the corner of my eye.
> Seroquel might not be the right drug for you, 5mg is a small dosage of Abilify. I am wondering if perhaps you can do without it. How long have you been taking it? How do you know that it was helping? Are you using Abilify as an antidepressant?
- I dont' think Seroquel does JACK for the hallucinations. I was once at 700mg and still hallucinating. The side effects were unbearable at that dosage. The Abilify seems to be the only thing that helps. But even at low dosages of 10-15mg it gives me crazy akathisia. So I'm taking the Seroquel to calm me down enough to be able to take the Abilify. I've been on both for over a year.
> Schizoaffective disorder might be a fit if you experience schizoid symptoms in the absence of mood symtoms for at least a two week period.
- I don't even know if I truely get hypomanic. I only get hyper every now and then, but no racing thoughts. And it never lasts longer than a day. My pdoc and psychologist seem to think that these symptoms are enough to warrent the BP diagnosis. But mainly I get depressed, and I don't think I've been truely depressed for a month. Certainly not within the past two weeks. Though I was a little hyper for a few hours yesterday.
> Look at this, and tell me what you think:
> http://www.mentalhealth.com/dis1/p21-ps05.htmlHmm, well I don't meet the time criteria for hypo mania, though I may once have had a mixed state. As far as the criteria for schizophrenia, I think I only have halluniations and rarely delusions. Like once I thought the stone cats sculptures at the mall were watching me. Or I'll feel like people are following me. But all of these things happen infrequently, like once every other day or once a week I'll have a hallucination.
So what do you think???
dm
Posted by SLS on March 10, 2005, at 21:30:01
In reply to Re: More Hallucinations: When will this end!, posted by D minor on March 10, 2005, at 13:56:26
Hi.
If what you are experiencing are genuine hallucinations, and have been experiencing them in the absence of depression, I think that makes a strong case for schizoaffective disorder as opposed to psychotic depression. This would probably argue in favor of using both a mood stabilizer and antipsychotic, along with an antidepressant if necessary.
- Scott
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