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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Jeroen on September 18, 2012, at 14:29:54
i never tried any TYPICAL ANTI PSYCHOTIC!!!
i'm just stuck with abilify and seroquel XR
any suggestions, Seroquel is the only AP that completely cured the psychosis and depression and cognition and other stuff...
i really need help. I heared about Navane and Perphenazine, but is it same as seroquel to cure the illness ;(
Posted by Phil on September 18, 2012, at 16:32:34
In reply to i never tried any TYPICAL ANTI PSYCHOTIC!!!, posted by Jeroen on September 18, 2012, at 14:29:54
Are you saying that Seroquel did it all now you want to switch? Did you have a bad reaction to Seroquel?
Posted by phillipa on September 18, 2012, at 16:48:19
In reply to Re: i never tried any TYPICAL ANTI PSYCHOTIC!!! » Jeroen, posted by Phil on September 18, 2012, at 16:32:34
Jeroen those you mentioned at typical antipsychotics? Have you ever tried them before? Phillipa
Posted by SLS on September 18, 2012, at 18:11:38
In reply to i never tried any TYPICAL ANTI PSYCHOTIC!!!, posted by Jeroen on September 18, 2012, at 14:29:54
> i never tried any TYPICAL ANTI PSYCHOTIC!!!
>
> i'm just stuck with abilify and seroquel XR
>
> any suggestions, Seroquel is the only AP that completely cured the psychosis and depression and cognition and other stuff...
>
> i really need help. I heared about Navane and Perphenazine, but is it same as seroquel to cure the illness ;(
>
Navane (thiothixene) is a pretty good drug. I would try it before perphenazine. It seems to be stronger. It mixes well with Seroquel. However, I still have my suspicions that Abilify is interfering with your treatment.
- Scott
Posted by jono_in_adelaide on September 18, 2012, at 19:24:32
In reply to Re: i never tried any TYPICAL ANTI PSYCHOTIC!!! » Jeroen, posted by SLS on September 18, 2012, at 18:11:38
Is the Seroquel still working, or has its effect petered out?
Its very hard to ay which drug might suit you best, I'd discuss with your psychiatrist and see what his feelings are.
Like many of these things, its often just a matter of selecting a likely candidate, trying it and seeing if it works, if it does, great, if not, then move on and try a different one
Posted by phidippus on September 18, 2012, at 22:29:16
In reply to i never tried any TYPICAL ANTI PSYCHOTIC!!!, posted by Jeroen on September 18, 2012, at 14:29:54
Start with Haldol.
Eric
Posted by SLS on September 18, 2012, at 23:49:25
In reply to Re: i never tried any TYPICAL ANTI PSYCHOTIC!!! » Jeroen, posted by phidippus on September 18, 2012, at 22:29:16
> Start with Haldol.
What are your reasons for choosing Haldol first?
Just curious.
- Scott
Posted by Jeroen on September 19, 2012, at 3:21:57
In reply to Re: i never tried any TYPICAL ANTI PSYCHOTIC!!! » Jeroen, posted by SLS on September 18, 2012, at 18:11:38
thanks for you advice man, you're a good friend!
now the question is will Navana treat a lamictal induced psychosis????
i am sure glutamate anti psychotics that are under development will treat this condition
Posted by SLS on September 19, 2012, at 5:47:22
In reply to To SLS, posted by Jeroen on September 19, 2012, at 3:21:57
> thanks for you advice man, you're a good friend!
>
> now the question is will Navana treat a lamictal induced psychosis????
>
> i am sure glutamate anti psychotics that are under development will treat this condition
I think it is important to understand the difference between positive, negative (deficit), and cognitive symptoms:http://www.mayoclinic.com/health/schizophrenia/DS00196/DSECTION=symptoms
-----------------------------------------------------
Positive symptoms
In schizophrenia, positive symptoms reflect an excess or distortion of normal functions. These active, abnormal symptoms may include:
Delusions. These beliefs are not based in reality and usually involve misinterpretation of perception or experience. They are the most common of schizophrenic symptoms.
Hallucinations. These usually involve seeing or hearing things that don't exist, although hallucinations can be in any of the senses. Hearing voices is the most common hallucination among people with schizophrenia.
Thought disorder. Difficulty speaking and organizing thoughts may result in stopping speech midsentence or putting together meaningless words, sometimes known as word salad.
Disorganized behavior. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation.Negative symptoms
Negative symptoms refer to a diminishment or absence of characteristics of normal function. They may appear with or without positive symptoms. They include:
Loss of interest in everyday activities
Appearing to lack emotion
Reduced ability to plan or carry out activities
Neglect of personal hygiene
Social withdrawal
Loss of motivationCognitive symptoms
Cognitive symptoms involve problems with thought processes. These symptoms may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms. They include:
Problems with making sense of information
Difficulty paying attention
Memory problems-----------------------------------------------------
Which of these symptom clusters is most prominent in your case?
- Scott
Posted by SLS on September 19, 2012, at 6:52:26
In reply to To SLS, posted by Jeroen on September 19, 2012, at 3:21:57
Navane and Haldol are not in the same class of drug. They come from very different series of molecular structure. Navane is the only thioxanthene available in the US. They also produce nearly opposite effects on brain glucose utilization as seen on PET scans. These differences reflect brain activity in various regions. If you fail to respond to one drug, you might respond to the other.
Both Navane and Haldol are very potent dopamine D2 receptor antagonists; Navane being slightly more potent than Haldol. I don't know if there is a difference in the risk of EPS between these two drugs. Very little has been written about this. One study from 1984 reported Haldol having a higher rate of producing akathisia EPS than Navane. However, one source claimed that Navane was somewhat more likely to produce movement EPS. Either way, the incidence of tardive dyskinesia for these drugs is about 5 percent per year of exposure. Over a lifetime, the incidence is close to 50 percent.
I guess you could rationalize using Haldol or Navane as a temporary bridge until novel antipsychotics become available. Perhaps administering one of these drugs for a short period of time would undo what Lamictal did to you, allowing you to function without them. Some people stay well after discontinuing their antipsychotic treatment. This represents a small minority, though.
http://www.ncbi.nlm.nih.gov/pubmed/22121861
Then again, yours is an atypical case. You might want to attempt discontinuation at some point if you achieve remission. I know I would. I would probably wait a year, though. If I were to relapse, I might then attempt a crossover to Seroquel or some other second generation antipsychotic (SGA) before going back to a first generation antipsychotic (FGA).
- Scott
Posted by jono_in_adelaide on September 19, 2012, at 19:18:39
In reply to Re: To SLS » Jeroen, posted by SLS on September 19, 2012, at 6:52:26
There is realy no means of predicting which drug will be right for you other than trial and error, apart from the fact that Narvane is very sedating, and Haldol is more or less non sedating.
Some people do well on a combo of a typical and an atypical at the same time, taking a lower dose of each - might be worth considering
Posted by SLS on September 19, 2012, at 19:49:56
In reply to Re: To SLS, posted by jono_in_adelaide on September 19, 2012, at 19:18:39
> There is realy no means of predicting which drug will be right for you other than trial and error, apart from the fact that Narvane is very sedating, and Haldol is more or less non sedating.
>
> Some people do well on a combo of a typical and an atypical at the same time, taking a lower dose of each - might be worth consideringGood to know. Thanks.
I hope Christ_empowered sees this.
- Scott
Posted by jono_in_adelaide on September 19, 2012, at 21:27:59
In reply to Re: To SLS » jono_in_adelaide, posted by SLS on September 19, 2012, at 19:49:56
It seems that choosing psychiatric drugs is still more of an art than a science
Posted by phidippus on September 20, 2012, at 9:19:13
In reply to Re: i never tried any TYPICAL ANTI PSYCHOTIC!!! » phidippus, posted by SLS on September 18, 2012, at 23:49:25
Firstly, Haloperidol's neglible affinity for histamine H1 receptors and muscarinic M1 acetylcholine receptors yeilds an antipsychotic with a lower incidence of sedation, weight gain and orthostatic hypotension
Its a 5HT1A Agonist (Ki 1927nM), a 5HT7 antagonist (Ki 377.2nM)and Dopamine D3 inverse agonist (0.74nM). All of which should help with both negative and positive symptoms of schizophrenia.
It also seems to have a wide variety of applications and seems more flexible than a lot of other antipsychotics.
Haloperidol is also considered indispensable for treating psychiatric emergency situations-it seems offered in every ER.
Drawbacks include Depression, severe enough to result in suicide, is quite often seen during long-term treatment. Also the incidence of extra pyramidal symptoms is on the high side
Eric
Posted by Jeroen on September 20, 2012, at 9:36:03
In reply to Re: To SLS, posted by jono_in_adelaide on September 19, 2012, at 21:27:59
more an art then science, it sure is.. :(
Posted by SLS on September 20, 2012, at 10:25:48
In reply to Re: i never tried any TYPICAL ANTI PSYCHOTIC!!! » SLS, posted by phidippus on September 20, 2012, at 9:19:13
Isn't it funny how with modern technology and new data, old drugs can seem new again?
The Ki values for 5-HT1a and 5-HT7 receptors represent fairly low potency. My guess is that these effects do not contribute to the therapeutics of Haldol, especially at the dosages used. However, the potent inverse agonism of D3 receptors comes as a surprise to me. Perhaps this contributes to its efficacy to treat positive symptoms. I wonder, though, if it also is responsible for the depression that you describe.
- Scott
> Firstly, Haloperidol's neglible affinity for histamine H1 receptors and muscarinic M1 acetylcholine receptors yeilds an antipsychotic with a lower incidence of sedation, weight gain and orthostatic hypotension
>
> Its a 5HT1A Agonist (Ki 1927nM), a 5HT7 antagonist (Ki 377.2nM)and Dopamine D3 inverse agonist (0.74nM). All of which should help with both negative and positive symptoms of schizophrenia.
>
> It also seems to have a wide variety of applications and seems more flexible than a lot of other antipsychotics.
>
> Haloperidol is also considered indispensable for treating psychiatric emergency situations-it seems offered in every ER.
>
> Drawbacks include Depression, severe enough to result in suicide, is quite often seen during long-term treatment. Also the incidence of extra pyramidal symptoms is on the high side
>
> Eric
>
>
>
Posted by phillipa on September 20, 2012, at 20:42:48
In reply to Re: i never tried any TYPICAL ANTI PSYCHOTIC!!! » phidippus, posted by SLS on September 20, 2012, at 10:25:48
Also used for intractible hiccups. Phillipa
This is the end of the thread.
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