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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 Danielj on December 1, 2013, at 10:54:39
My son is 26 yrs he has been living alone for 1 year in a 1 br apt. He has been taking a combination of Zyprexa now 15mg and Zoloft now 100 mg. for 10 yrs.
2 years ago he started to relapse. He hasn't been really stable since then.
He has been to a care facility 2 times this year, the most recent time for 3 weeks. His memory is bad, he mouths words and gestures as if conversing with some invisible person.
The one time they tried Haldol on him at the care hospital he seemed to suddenly rally, they had him taking 10 mg i think. I think my wife panicked because she heard bad things about Haldol but for certain people from what I have read in reviews, it can work really well. I would appreciated any advice you could give. thanks
Posted by Phillipa on December 1, 2013, at 11:44:44
In reply to Thoughts on Haldol for schizoaffective?, posted by Danielj on December 1, 2013, at 10:54:39
Hi Daniel I do remember about your Son. If the Haldol worked can he take something like Cogentin with it to keep the side effects at bay? Phillipa
Posted by ed_uk2010 on December 1, 2013, at 12:37:37
In reply to Thoughts on Haldol for schizoaffective?, posted by Danielj on December 1, 2013, at 10:54:39
Haloperidol (Haldol) can sometimes work just as well as newer antipsychotics. Some pts respond better to it.
The issue with haloperidol is that the risk of movement disorders is very high. Young people such as your son are particularly at risk of sustained involuntary muscle contractions (dystonia) and physical restlessness (akathisia). These side effects can develop after the first dose on otherwise early in treatment. Like Phillipa said, many pts require additional medication to reduce these side effects. They are sometimes prescribed in advance in case they are necessary (there are several to choose from).
Older pts on haloperidol often develop slowness of movement and tremor (Parkinsonism) and involuntary repetitive twitching movements, especially around the face (tardive dyskinesia). Tardive dyskinesia is usually the only side effect which can be permanent. Other side effects generally disappear on stopping or reducing the dose. Parkinsonism is much less common in young people on haloperidol, as is tardive dyskinesia. The risk of tardive dyskinesia increases with the duration of treatment; it is very rare after short-term use.
All of the above side effects can occur with other antipsychotics, but they are more common with haloperidol.
Haloperidol causes much less weight gain than most other antipsychotics. Apart from movement disorders, other side effects are generally milder than related meds.
In order to minimise the risk of adverse effects, the minimum effective dose should be found. Like you say, 10mg worked before, and will probably work again, but a lower dose could be tried eg. 5mg. Close monitoring is important for the purpose of monitoring efficacy, side effects and dose adjustments.
Posted by Christ_empowered on December 1, 2013, at 12:59:19
In reply to Re: Thoughts on Haldol for schizoaffective?, posted by ed_uk2010 on December 1, 2013, at 12:37:37
Hey. Sorry about your situation.I have a form of bipolar I with psychotic features, so I have to take a high dose (30mgs/day) of Abilify, sometimes with a little bit of Risperdal on top for agitation.
I used to be EXTREMELY sensitive to neuroleptics. Then, I discovered Orthomolecular. Not only do the meds work better, I get fewer side effects.
Haldol has a high rate of TD. Weirdly enough, Abilify might, also (lucky me, right?). If nothing else, consider some taurine, about 4+ grams daily, to reduce the risk of TD and help stabilize mood. Additional antioxidants (C, E, high dose B3 and B6) can help, too.
www.doctoryouself.com
Also, I'd personally think about switching out the zyprexa for a high dose of Abilify with the Haldol. Less sedation, weight gain, fewer metabolic issues (usually...). The cool thing about Abilify is that you can high or low dose it, depending on the needs at the present time.
My best (rudimentary) guess is that your son has been on zyprexa so long that he's now got a little tardive psychosis going on. That just means that the same drugs that treat psychosis can increase vulnerability to psychosis. I read somewhere that an anticonvulsant can help in those situations. I'd vote for trileptal or lamictal, once the psychosis is under control (trileptal would be better for agitation and aggression, but wouldn't help depression as much as lamictal).
Good luck!
Posted by Phillipa on December 1, 2013, at 20:50:42
In reply to Re: Thoughts on Haldol for schizoaffective?, posted by ed_uk2010 on December 1, 2013, at 12:37:37
Ed perfect answer and it is all true. Listen to Ed Phillipa
Posted by ed_uk2010 on December 2, 2013, at 12:20:13
In reply to Re: Thoughts on Haldol for schizoaffective? » ed_uk2010, posted by Phillipa on December 1, 2013, at 20:50:42
> Ed perfect answer and it is all true. Listen to Ed Phillipa
Thanks PJ. Haloperidol CAN work well, but it can also cause many side effects (but so can Zyprexa etc). Personally, I would generally recommend trying a range of different atypicals before going on haloperidol long term eg. Abilify, Seroquel, Risperdal etc. In countries where is it available, amisulpride (Solian) is also a very useful option. Clozapine (Clozaril) is usually the most effective antipsychotic of all, but required tonnes of blood tests and is used more in schizophrenia than schizoaffective. Still, it remains a possibility which can sometimes work wonders.
With respect to trying Risperdal, be careful with the dose. It's often very tolerable at low doses and very intolerable at high doses!
A similar but possibly somewhat 'milder' drug similar to haloperidol is perphenazine, which may suit pts who respond well to haloperidol. Here in the UK, pts who do well on old antipsychotics often go on a 2-4 weekly long-acting injection, but this is only recommended if the drug is well tolerated and tablet taking erratic, more commonly in schizophrenia than schizoaffective disorder.
I hope you find something that works well with minimal side effects. One good thing is the increasing number of choices which are available.
Chris_empowered mentioned using supplements. One supplement which may be useful in depressive and psychotic disorders is omega-3 fish oil capsules. It might be worth a visit to the health food store.
Take care
ed_uk
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