san

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Hi there ( anybody with psych experience)

I have got a real case here with a difficult situation.

This is somebody who recently developed Paranoid delusions with episodic depressive( emptiness/ lonliness to be more precise) features. She was started on Olanzapine 5mg, and within 6 months all psychotic features have disappeared but still she is abit withdrawn wanting only the close family around her.

I am wondering what the long term outlook is like in her case ??

Thanks in advance
 

Anai Rhoads

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Hi San,

Olanzapine is generally prescribed for those suffering from schizophrenia (for those who are reading this and are not aware). The typical starting dose is 10 mg. Olanzapine blocks conditioned avoidance at lower doses than those inducing "catalepsy". It produces few extra-pyramidal side effects and reduces positive and negative symptoms of schizophrenia as well as if not greater than Clozapine.

I would assume this person is having the onset of side effects (although I must admit her symptoms do not fall in the category of side effects provided by Lily) and needs to level out on her 5 mg dose or request the 10 mg dose.

Clearly the Olanzapine has done it's job, by removing her psychotic episodes and paranoia. But I wonder (as I mention above) if her dose is too low.

The avoidance behaviour she is exhibiting can be from generalised/social anxiety. Without a doubt, treatment of this behaviour with cognitive therapy now will prevent or lessen chances of Agoraphobia in the future.

Keep me posted on her progress.

Best,

Anai Rhoads
 
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san

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Thanks so much, at least knowing that we are on the right track.

She is gradually opening up to face more people ( I mean known people ), last whole week had been a real drama, she just insisted that she would spend the time only with the 3 closest people she is most close to, and we were scared to leave her home during the day fearing for the " just in case outcome" so
we took turns to stay home around the clock.

This weekend she agreed to visit a couple of other friends she knew of, so I am very impressed and positive.

Thanks again for your valuable input..
 
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Anai Rhoads

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San,

It must be very difficult to see someone you know change like that.

I am very happy to hear that she is showing signs of becoming social again. It will take time, but do look into her dose.

If you see her developing a set back, do not be discouraged. Things will work out once her dose is customised.

Thank you for sharing the positive news on her progress, much appreciated!

Best,

Anai Rhoads
 
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san

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Anai Rhoads

Just wanted to give a bit of follow-up info on this girl.

She just went to see a psychiatrist ( new one ) because the old one was interstate where her parents are and he is the who started her on Olanzapine 5 mg when she went back to live with her parents.

She is very happy with the long consultation which lasted about an hour. The specialist brought up a number of new issues which she really wanted to talk about and started her on Paroxetine 10 mg mane for now, and will review her again in 10 days. He has reduced her Olanzapine to 2.5 mg and will gradually stop .

My only concern is will she revert to previous state ? ( Paranoia)
Like you clarified before she is very anxious, agraphobic. ( still not depressed from my assesment atleast )

How do you explain this generalised anxiety, Could this be a sequele of previous Psychotic illness/ Olanzapine A/ E.

I am just hoping she will do well without an Antipsychotic because otherwise it will be a bit too soon for her and all of us close to her to go through the same period again.
 

Anai Rhoads

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San,

I share your disappointment and your concerns.

The new psych should have transfered her file from the previous psych. This disruption may cost your friend progress. Was there no way that the old psych could continue her prescribing Olanzapine?

Some psychs allow medication visits/phone consultations when the medication therapy is effective. When there is an issue or for regular upkeep, there is a scheduled time to catch up and resolve an issue.

Lowering her dose and eventually removing her from the Olanzapine can cause a setback. It is not often that the first therapy given works so well. On average patients go through several different medications to find a tailored combination or single medication that works for them.

This doctor (assuming) was told by her that she has schizophrenia along with paranoia/delusions? And he still insisted on lowering her dose. I feel this is very irresponsible on his part and someone should express this directly to him. If he says that he cannot discuss her treatment with you, make sure you mention that this woman likely cannot make a clear decision and may require help from family/friends with regards to her treatment.

You ask about her generalised anxiety. Chances are if she did not exhibit avoidance behaviour prior to the medication, then the medication itself may have been the source for encouraging the anxiety.

This is not to say the medication was ineffective, but possibly carried a side effect that would have evaporated eventually.

Agoraphobia is treatable, and more so when caught in its early stages. The avoidance behaviour begins with the place where an attack occurred. The attack being an anxiety or full scale panic attack.

Not long after, when attacks surface while the patient is in other places, the avoidance behaviour continues until the patient is restricted in their home from fear of having an attack outside of the house.

The sooner the treatment, with cognitive therapy, the quicker the behaviour can be corrected.

In her case, her anxiety is compounded by her medication - and psychologically, anyone branded as schizophrenic becomes fearful too. It is that constant worry that leads the patient to wonder if they are making the right decisions. They do not seek the comfort of their family and friends, but rather retreat for fear of embarassment. It becomes a "what if I say this or do this" sort of scenario.

If at all possible, ask her to tell her new psych that she would like her old records faxed/mailed over for review. There are release forms she can sign to get this accomplished.

I appreciate that you posted to me as you have. I do hope you will keep me posted. I will check this board often to look for you.

Best,

Anai Rhoads
 
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san

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I appreciate your feed- back, what you said about retreating from anything unfamiliar is very very true in her case, and I sometimes lose patience. She insists on seeing me the moment I return from work ( hospital), while I have already made arrangements for her to spend the day with a friend of ours who stays home with her 2 liitle babies. She tells me she will go there the next day, but at the end I realise It hasn't happened.

The new Psychiatrist thing, I do'nt know what to say. But initially I thought she will be getting some follow up by somebody with good experience while she is here.

One thing, I don't know If I mentioned before, but her Paranoia has totally dissapeared about 3 months after commencing Olanzapine therapy. I realise your view is that she might revert without Olanzapine in the long run, Am I right there ?
 

Anai Rhoads

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San,

Yes, she will get worse unless she is stabilised on her medication therapy.

I hear how you this is disrupting your life, I couldn't imagine.

Ask her new doctor to grab the old files. It is important that her life is not turned upside down over this new doctor's theories on therapy.

Keep me posted...

Anai Rhoads
 
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So, are you suggesting that she will need Olanzapine ( or anything similar ) lifelong, it makes me think " Why does this has to happen to her" .

She was doing Telemarketting job for the last 2 yrs, recently wanted to try out a totally new area ( Admin), couldn't cope- thats when developed these paranoid delusions predominantly her office co-workers laughing at her etc. So she just resigned after about 3 wks of starting the job. So my Question is If not for this job do you think she wouldn't have developed this condition ?

My Medschool learning says " If one is prone to it , they will get it anyway, may be a bit later " Does this theory still apply ?

BTW, we are trying to get in touch with the old Psychiatrist, it is a bit hard, her mother did not want her to go to a new Psych here, the Family Physician in here clearly said he would like a Psych person to monitor her progress while she is here. I thought probably there is nothing to lose, but anyway, we are working on it.
 
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Anai Rhoads

One more thing - How does one go about cognitive therapy (on private basis) Could going to a Psychologist help ??
 

Anai Rhoads

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San,

Yes, a psychologist can help with cognitive therapy just as well as a pyschiatrist.

Cognitive therapy works best alongside of medication in most cases... but it is not necessary. It is a therapy that molds and changes cognitive thinking.

Our brains are capable of re-wiring themselves through this therapy, allowing for a more normal life. Changing perceptions is key to altering a negative or abnormal state.

You can ask her doctor to begin the therapy. If he is determined to stop her medication, she will need the cog. therapy to cope.

Keep in mind, with certain conditions - those chemical, medication is most important. Please urge this doctor to keep her on the Olanzapine. Its seems very unfair that he would remove something that is benefiting her.

Keep me posted.

Best,

Anai Rhoads
 
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san

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Hi Anai Rhoads

Just wanted to let you know, she has gone back to her mom's place - where she was since the diagnosis until 2/3 wks ago.

Atleast we all tried our best to help her out, and there is only so much we all could stretch ourselves as well. Her mom works part-time until 11 am, so by the time she wakes up mom will almost be home.

I only hope she will recover soon, and be able to function on her own as an adult.

I thank you from the bottom of my heart for all your valuable input, it meant a lot to us.
 

Anai Rhoads

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San,

I am sorry to hear she is going back. Will she see another doctor now?

You did an amazing and selfless thing by attempting to care for her as you have. It is not an easy job to care for someone with mental illness. The patience alone is taxing.

Thank you for sharing her story with me. If you have access to her progress, please keep me posted. She sounds like such a sweet woman, and you a good friend.

Feel free to e-mail me too if you like.

Best,

Anai Rhoads
 
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