Re: Please Help Scott

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?

> 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.

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.

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

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

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