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Have bipolar disorder, taken Divalproex and Oxazepam. Have muscle cramps, blurred vision, trickling urine. What should I do?

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Psychiatrist
Practicing since : 2004
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bipolar disorder treatment
maintainace after maniac episodes
detail query already written in detail
Posted Sun, 26 Aug 2012 in Mental Health
 
 
Answered by Dr. Ashish Mittal 10 hours later
Hello,
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     28 year old female
•     Known case of Bipolar disorder under treatment
•     Complaints of: flight of ideas, get distracted to odd things, seeing people/colour, irritation from inside, black magic, sleep difficulty without Oxazepam, confusion
.
You case is interesting and but difficult too. I will try to give my best effort to help you in this problem.

Lets discuss your queries one by one.

What should I do now regarding medications?
Ans: You should continue medicines in same doses. Manic episode is severe problem which require intensive treatment as you are receiving in form of Divalproex Sodium ER 1000mg, Paliperidone 6mg, procyclidine XXXXXXX 2.5mg twice, Oxazepam 30mg. I understand your distress for having so much medicines and side effects but same time you need to understand that it is necessary to keep you well.

What alternative I have after I stop medications?
Ans: For bipolar disorder mood stabilizers like Divalproex Sodium or Lithium or second generation antipsychotics are best for long term management.

Should these medications be tappered?
Ans: Medicine should continue in same doses as you already having many symptoms. To change medicine doses mental status examination by psychiatrist is must. So, it is good that you are on regular follow up with your psychiatrist.

Do you suggest any alternate medication?
Ans: I feel you already receiving good treatment.

When can I stop medication and consider disease remission?
Ans: Stopping medicine is complex decision. In Mania, Loss of insight is the first symptom of the illness. Because of that treatment records, mental status examination finding during interview and information from family members regarding total numbers of episode and inter episodic functioning, plays significant role in decision making regarding treatment duration. But with current information, I can tell minimum duration: 1 year. Maximum duration may be 2-5 years or life long depending on above factors.

What precautions should I follow in future?
Ans: Avoid stress, regular medicines, regular follow up with psychiatrist, maintaining sleep wake cycle and structured routine.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,
Above answer was peer-reviewed by
 
Follow-up: Have bipolar disorder, taken Divalproex and Oxazepam. Have muscle cramps, blurred vision, trickling urine. What should I do? 1 hour later
Sir since last 5 days I am taking
Thioridazine hydrochloride-10mg twice a day
oxcarbazepine-300mg twice
trihexyphenidyl hydrochloride-2mg
Oxazepam-15mg
citicoline-500mg
lorazepam-1mg
propranolol hydrochloride-10mg + alprazolam-0.25mg
promethazine hcl-25mg

What are the common side effects (those that do not usually cause problems)?
What side effects should I report if I experience them?
How will I know that the medicine is helping?
Will it interact with other medicines or other medical conditions?
Are there any other medicine or treatment options?
 
 
Answered by Dr. Ashish Mittal 22 minutes later
Hello again,
Thanks for follow,

There is long list of side effects: you name and it is present. But side effects are essential part of every medicines. More important is side effects experience by you.

Some of the side effects you already mentioned in primary query as experienced by you. Other side effects are which occur commonly: weight gain, Diabetes, rigidity, tremor, nausea, headache, restlessness, excessive sleep, sedation etc.

You should report every side effects to your psychiatrist so that he/she can take appropriate step according to management plan.

Effects of medicine in mania is known by:
-report of family members regarding improvement in behavior
-interview by psychiatrist.

Every medicine usually have interaction with other medicines but it usually taken care by physician. So, inform your physician regarding use of existing medicines before stating new medicines.

Treatment option: For bipolar disorder mood stabilizers like Divalproex Sodium or oxcarbazepine or Lithium or second generation antipsychotics (alone or in combination) are best for long term management.

Wish you good health,
Regards,
Above answer was peer-reviewed by
 
Follow-up: Have bipolar disorder, taken Divalproex and Oxazepam. Have muscle cramps, blurred vision, trickling urine. What should I do? 20 minutes later
Sir. Sorry to disturb you again but few more queries

1. Actually I am patients husband asking query on behave of patient. Patient does not know anything of her disease and why all this is happening to her. Should I let patient know about her disease in detail.

2. She is cleanliness freak and gets irritated if anything is not in order at home or in kitchen. Therefore during the acute time of episodes she was anti to her mother in law. Latter she was well after the medications.
Since last 5 days she is with her own mother. Should I bring her back to our home around XXXXXXX or wait for more time.

3. What is Cognitive Behavior Therapy! how it is done. Will it be helpful in her case. How much time this treatment takes.
 
 
Answered by Dr. Ashish Mittal 1 hour later
Hello again,

1. Actually I am patients husband asking query on behave of patient. Patient does not know anything of her disease and why all this is happening to her. Should I let patient know about her disease in detail.
Ans: Yes, after improvement in current episode you can tell her about her illness.

2. She is cleanliness freak and gets irritated if anything is not in order at home or in kitchen. Therefore during the acute time of episodes she was anti to her mother in law. Latter she was well after the medications.
Since last 5 days she is with her own mother. Should I bring her back to our home around XXXXXXX or wait for more time.
Ans: On XXXXXXX it is better if she celebrate with her brother. But take care of her medicines.

3. What is Cognitive Behavior Therapy! how it is done. Will it be helpful in her case. How much time this treatment takes.
Ans: Cognitive Behavior Therapy is a treatment in form of counseling. It is helpful in Depression phase of bipolar illness and Treatment non compliance. But, it is not a substitute for drug treatment on Mania.

Wishing her good health,
Regards,
Above answer was peer-reviewed by
 
Follow-up: Have bipolar disorder, taken Divalproex and Oxazepam. Have muscle cramps, blurred vision, trickling urine. What should I do? 6 days later
Sir,

From around 23rd of last month my wife is taking medicines regularly i.e.
Thioridazine hydrochloride-10mg twice a day
oxcarbazepine-300mg twice
trihexyphenidyl hydrochloride-2mg
Oxazepam-15mg
citicoline-500mg
lorazepam-1mg
propranolol hydrochloride-10mg + alprazolam-0.25mg
promethazine hcl-25mg

But we see again a slight increase in symtoms like lack of sleep only 5 hours in a day, more thoughts in mind, see sings vauge songs without any meaning, Heaing loudly, there is distraction & flight of many ideas at a time, New symtom that arose is confusion or short term memory mixing of two different things and saying mixing 2 things. She also give negative remarks to her relatives.
She is well in front of guests and others cannot sense abnormability. Futher we feel the some of the symtoms occur in episodes.

The Dr. has changed the medicines a bit since yesterday as under
Thioridazine hydrochloride-10mg twice a day
oxcarbazepine ER-300mg thrice
aripiprazole 10mg
trihexyphenidyl hydrochloride-2mg
citicoline-500mg
lorazepam-1mg
tri hexyphenidyl-2mg

Now since we feel increase in symtoms

1) Should we switch either back to Valpoate or should start with lithium?
2) Vis-a-vis present medications what major side effect does lithium has? Can it be prevented or reduced by some medicines or precautions?
3) Is there any need of any health check up or tests?
4) Looking to the symtoms you please suggest about the current medications and is there any better medical help we can give.
5) Is the additional symtom of Confusion, mixing of 2 thing a side effect of any medicine or a symtom of bipolar.
6) How is elipsy different from bipolar. Looking to the history what you would diagnose.
7) Can we have a telephonic talk in regards to the patient. We will be obliged if you would share your phone No. and comfortable time of calling.

 
 
Answered by Dr. Ashish Mittal 10 hours later
Hello again,

1) Should we switch either back to Valpoate or should start with lithium?
Ans: If she was well on valproate or lithium then you can request your psychiatrist for change in medicine.

2) Vis-a-vis present medications what major side effect does lithium has? Can it be prevented or reduced by some medicines or precautions?
Ans: Lithium is not advisable with current medicine because of neurotoxic effects of oxcarbamazepin with lithium.

3) Is there any need of any health check up or tests?
Ans: Test like: FBS, CBC, LFT and Serum TSH are advisable.

4) Looking to the symtoms you please suggest about the current medications and is there any better medical help we can give.
Ans: Medicine should continue in same doses as she already having many symptoms. To change medicine doses mental status examination by psychiatrist is must. It is not good for patient perspective to change medicine in online forum.

5) Is the additional symtom of Confusion, mixing of 2 thing a side effect of any medicine or a symtom of bipolar.
Ans: From your description, It appear symptom of bipolar to me.

6) How is elipsy different from bipolar. Looking to the history what you would diagnose.
Ans: It is bipolar from current history.

7) Can we have a telephonic talk in regards to the patient. We will be obliged if you would share your phone No. and comfortable time of calling.
Ans: Physical consultation with psychiatrist is always better than telephonic call. If you want to talk to me, you can visit Gurgaon or take help of XXXXXXX help of Call a Doctor facility.

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have bipolar disorder, taken Divalproex and Oxazepam. Have muscle cramps, blurred vision, trickling urine. What should I do? 2 days later
: Lithium is not advisable with current medicine because of neurotoxic effects of oxcarbamazepin with lithium.

Sir, but the physician has started lithium carbonate and also continuing old medicines including
Oxcarbamazepin. What can be after effects. Should we ask physician to change oxcarbamazepin.
Lithium is given 300mg twice.
In 1 day only we see slight improvement.
What precautions must be taken to minimise side effects of lithium.
Sleep has also improved slightly after lithium.
Can any particular diet help.
 
 
Answered by Dr. Ashish Mittal 16 hours later
Hello again,

As oxcarbamazepin with lithium have neurotoxic effect, one medicne from both of them is better to stop. As she is responding better for lithium, you can ask your psychiatrist regarding possibility of tapering oxcarbamazepin.

For Lithium regular serum level need to check to assure adequacy of dose and to prevent lithium toxicity.

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Regards.
Above answer was peer-reviewed by
 
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