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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by xbunny on September 29, 2006, at 5:30:14
I have a feeling this will be a) a long post because Im not quite sure what I want to say and b) that very few people will reply to it (just my gut feeling).
I have a diagnosis of undifferentiated psychotic disorder, this has been various schizophrenias in the past. My principal symptoms are hallucinations (visual, auditory and olfactory) of a non delusional nature, occasional delusional episodes, thought disorder probably, social and occupational withdrawl, anxiety and occasionally depression.
With the help of my psychiatrist we are trying to find a good resolution for this after many years of what seems like somewhat aimless medication experimentation my GP, previous psychiatrists and myself. Until recently I was reasonably stabilized on two low doses of typical antipsychotics. Despite that I had plateaued in terms of regaining normal functionality and symptom control and felt that my life was still being greatly held back by this illness whatever it may be.
My psychiatrists strategy was to increase my medication to what he considers a normal dosage of the antipsychotics for a psychotic illness, this wasnt a great move side effect wise and did little to improve my symptoms. It also resulted in an increase in my anxiety and OCD like symptoms which we both suspected where due to the antipsychotic medication (ie some type of akathisia).
The new strategy was that I should stop my medication for two weeks so we can get some kind of a baseline and then probably start quetiapine. Since stopping meds my OCD type anxiety has all but dissapeared, instead I have an intense general feeling of anxiety. My hallucinations have greatly increased and my mind feels extremely disjointed. I have also started experiencing episodes daily lasting a few hours and then stopping of becoming severely suicidally depressed.
Getting around to the point, the NICE guidelines for antipsychotics say if you have had an unsuccessful result from two or more antipsychotics one of which is an atypical then clozapine should the drug of choice. I have taken several atypical antipsychotics and several typical antipsychotics all with unsatisfactory results in one way or another. So do you think clozapine would be a valid choice for me? I have always discounted it because it seemed like too much of an undertaking ie weekly blood tests, hospital stay to get started, potentially nasty side effects. But am I being unrealistic about treating my illness? I understand I will probably have good periods and bad periods and I have had better periods in the past without needing to resort to such drastic mesaures, but perhaps is it time for me to take the plunge and try it. Or maybe I should take seroquel, I dont know. At what point would you consider clozapine?
Thanks for reading my message, all replies are welcome even if they are just I dont know lol
Best regards, Bunny
Posted by Basia on September 29, 2006, at 6:56:36
In reply to at what point would you consider clozapine?, posted by xbunny on September 29, 2006, at 5:30:14
Hi Bunny
I am sorry to hear you have been having a hard time. I was put on Clozapine temporarily after many attempts at regulating my psychosis in BPD with atypicals and older APs. It was a horrendous experience of feeling dizzy, ill, depressed to the point of suicide and utterly flaked out and exhausted with no will or personality. I stopped after two months (maybe not long enough to give it a fair trial but who wants to feel like that for six months??).
I went back to a higher dose of Sulpiride, which is the only AP that has really worked for me. I think it acts on different receptors in the brain. But you may have tried it. Have you tried PRN (occasional AP use as needed)?
I am wary of Clozapine as I also know people who, in spite of regular blood tests, have ended up with the dreaded high white blood cell count and been rushed to hospital.Good luck!
Lyn
Posted by fca on September 29, 2006, at 12:26:17
In reply to at what point would you consider clozapine?, posted by xbunny on September 29, 2006, at 5:30:14
I do not know if it would be a valid choice but it is an legitimate option. I am sorry you have had this ongoing struggle--keep on working . I have seen patients do extremely well and the the problem with white cell count is very unusual if med compliance and monitoring is faithfully followed. my best fca
Posted by Phillipa on September 29, 2006, at 12:38:36
In reply to Re: at what point would you consider clozapine?, posted by fca on September 29, 2006, at 12:26:17
A friend I e-mail with is in the same poition scared to try clozaril but has used the others haldol now. Good luck with your decision. Love Phillipa
This is the end of the thread.
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