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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by xbunny on November 16, 2005, at 9:18:52
Over the past few week I have found the part of my face on either side of my nose between my nose and lips has been twisting on its own making it look like I am trying to impersonate Elvis's sneer. This seems to happen a few times a day usually happening with my face twisting every few seconds for about a minute. I have procyclidine to take for involuntary movements but I have never experienced this before. Its not really bad or anything but is it likely to be the beginning of something more serious? Seems worse before I take my morning dose of flupenthixol and late at night before I goto bed.
<elvis voice> thank ya very much
Posted by med_empowered on November 17, 2005, at 6:33:56
In reply to involuntary elvis sneer!, posted by xbunny on November 16, 2005, at 9:18:52
hi! you're on some old-school antipsychotics, correct? If so...it could be *very* early Tardive Dyskinesia. I'd talk to a doc about it pronto. Have you tried any of the atypicals? I know they have their own side effects--particularly all the metabolic stuff--but the TD risk is a good bit lower than with the older medications, so that's a definite selling point. I don't know what's available in the US, but Abilify is pretty good stuff, I think..its not sedating, but it does control schizophrenia and bipolar pretty well, and the TD risk seems minimal (the weight gain risk is also very small, and there don't seem to be too many blood sugar problems).
If Abilify isn't your bag, you could try Zyprexa (possibly plus Metformin, to prevent weight gain), Seroquel, or Risperdal (Risperdal is kind of like the old-school drugs, so it might be right up your alley if you respond well to the old drugs). Among the old drugs, molindone **seems** to have a pretty low rate of TD; it also seems to have some mood-brightening effects, and some people lose weight on it. Reducing your antipsychotic dosage and adding a mood stabilizer (depkote, tegretol, trileptal..you should probably avoid lithium) and/or a benzo (ativan and klonopin/rivotril are pretty popular) could be helfpul. If you must keep your current regimine as-is, you might want to consider vitamin supplementation, since TD **might** be caused, at least in part, by "oxidative stress" caused by free radicals in the brain; upping your antioxidant intake **might** help.
If I recall correctly, researchers in England recently developed some sort of "shake" that has vitamins and amino acids and other good stuff in it that reduces side effects of antipsychotic mediction...maybe something like that could help? You could google it and bring it up with your shrink. Also, check gnc.com and other places online...they have checklists that offer suggestions for what supplements to add to certain medications...that could prove useful.
Personally, when I was on antipsychotics I always took a C+E combo pill 2X daily, plus a multivitamin and selenium..the supplements were really cheap, and I think they may have helped some.
Good luck...don't worry too much, but please do contact your doctor or nurse promptly, and make sure they understand the urgency of the situation. Good luck!
Posted by ed_uk on November 17, 2005, at 14:58:11
In reply to involuntary elvis sneer!, posted by xbunny on November 16, 2005, at 9:18:52
Hi Buns,
It could be an acute dystonia/dyskinesia or it could be early tardive dyskinesia. There's also a possibility that it's not related to your medication. Procyclidine is usually very effective in suppressing acute neuroleptic-induced dystonias but it does tend to aggravate the symptoms of tardive dyskinesia. Try taking some regular procyclidine eg. 2.5mg three times a day and see what effect it has on your symptoms. Whatever you do, speak to your psychiatrist ASAP.
>Seems worse before I take my morning dose of flupenthixol and late at night before I goto bed.
Do you take your flupenthixol as a single daily dose in the morning?
I'd recommend that you start taking vitamin E (as mixed tocopherols). Vitamin E may help to prevent TD.
A switch to clozapine might possibly be necessary at some point in the future. I believe you've tried all the other atypicals??? Is that right?
The major atypicals available in the UK:
Amisulpride (Solian)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Aripiprazole (Abilify)Kind regards
Ed
Posted by ed_uk on November 19, 2005, at 9:22:03
In reply to involuntary elvis sneer!, posted by xbunny on November 16, 2005, at 9:18:52
Bunny,
Please reply. We will support you here :-)
Ed
Posted by xbunny on November 21, 2005, at 7:23:27
In reply to Re: involuntary elvis sneer! » xbunny, posted by ed_uk on November 17, 2005, at 14:58:11
> Hi Buns,
Hi Ed, sorry about the delay in getting back to you! How are you?
> Whatever you do, speak to your psychiatrist ASAP.
I dont have an appt until next March, they downgraded my care plan, no CPN, one psychiatrist appt a year!
>
> >Seems worse before I take my morning dose of flupenthixol and late at night before I goto bed.
>
> Do you take your flupenthixol as a single daily dose in the morning?Yes though usually I am busy so take it about 1pm
>
> I'd recommend that you start taking vitamin E (as mixed tocopherols). Vitamin E may help to prevent TD.I thought vitamin E supplements were linked to lung cancer? as a smoker this is a concern to me.
>
> A switch to clozapine might possibly be necessary at some point in the future. I believe you've tried all the other atypicals??? Is that right?
>
> The major atypicals available in the UK:
>
> Amisulpride (Solian)
> Quetiapine (Seroquel)
> Olanzapine (Zyprexa)
> Risperidone (Risperdal)
> Aripiprazole (Abilify)
>I havent tried quetiapine or aripiprazole yet.
I am very reluctant to change my med regiem since its the best one I have had and I have had such poor results from atypicals. A switch to clozapine is very far off I hope as it would require a stay in hospital and it has such nasty side effects.
Found another curious thing about the sneer, if I have a steady supply of caffeine it seems greatly reduced. Those days when I am out of pepsi its worse (and my daytime sedation is much worse). Could this be a caffeine withdrawl effect and nothing to do with my meds?
Buns
Posted by ed_uk on November 21, 2005, at 16:09:02
In reply to Re: involuntary elvis sneer!, posted by xbunny on November 21, 2005, at 7:23:27
Hi Buns
>Hi Ed, sorry about the delay in getting back to you!
No prob :-)
>How are you?
I'm ok thanks :D
>Yes though usually I am busy so take it about 1pm
You could try taking it in two divided doses per day. If this reduces your symptoms, TD is a possibility. TD symptoms tend to be worse when the level of antipsychotic in your blood is low ie. shortly before you take your next dose. Taking the med in two divided doses might keep your blood level of flupenthixol more constant and reduce symptoms.
You could also try a few doses of procyclidine to see what effect it has. Procyclidine tends to aggravate the symptoms of TD.
>I dont have an appt until next March
Will you make an earlier appointment? It might be a good idea.
>I thought vitamin E supplements were linked to lung cancer?
That was vitamin A/beta carotene.
Vitamin E should be taken in the form of 'mixed tocopherols' for example....
http://www.enerex.ca/products/gamma_e.htm
>Could this be a caffeine withdrawl effect and nothing to do with my meds?
I really don't know!
Kind regards
Ed
This is the end of the thread.
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