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Have schizo affective disorder. Taking Solivan, Invega and Avanza. What dosage would be ideal?

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Practicing since : 2004
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My son XXXXXXX
XXXXXXX was born in October 1981 in Australia. He was diagnosed when he was 19 with Schizo Affective Disorder. Since then he has been treated with various drugs to control his depression and psychosis including Prozac and resperadone at the start. Over the past four years he has been treated with
Solian 400 mg, Invega 9 mg and Avanza 60 mg per day. These dosages have been periodically altered to arrive at the current dosage above. However these values may not be ideal. XXXXXXX has never presented with chronic depression or chronic psychosis but a low level mix of the two. Over the past three years I have noticed a marked inability for him to hold down any job. This has been because of his presentation to others of illogical or incoherent speech at times, and rambling speech when he is relaxed and by himself. He has an excellent memory (learnt by heart) but this is marred by his inability to concentrate for too long and his inability to carry out three, four or five instructions consecutively.
The loss of losing several jobs has made him even more despondent with the occasional comment of just giving up. He has recently turned to smoking and I would hate to think that he may contemplate suicide if he can’t improve. XXXXXXX is an affable person but he has no friends and even though he has tried to make them he is always rejected , possibly due to his illogical speech at times and his inability to say the right thing or raise the appropriate question. He is currently studying Horticulture on which his exam performance has been excellent. He lives with my wife and I and we help him with his study and give him much love and consideration.
I have a few questions that perhaps you could answer –

1.     What dosages would be ideal for Schzo Affective disorder ?
2.     In this instance should Solian be given with Invega or removed from the equation ?
3.     Is the current drug choice and dosage the best that can be administered ?
4.     Should one contemplate giving Clozapine ?
5.     Do you need any further information ?

Sincerely
XXXXXXX Wright
University of WA
1st Sept 2012

Posted Sat, 22 Sep 2012 in Mental Health
 
 
Answered by Dr. Ashish Mittal 55 minutes later
Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     31 year old male
•     Known case of Schizo affective disorder
•     Currently on: Solian 400 mg, Invega 9 mg and Avanza 60 mg per day
•     Complaints of: rambling, illogical or incoherent speech, poor concentration and inability to hold job.

Although it is sad but I should tell you schizo affective illness one of the severe psychiatric illness. It frequently give challanges to treating psychiatrist due to its chronicity, residual illness in spite best treatment, treatment effects of medicines, poor social/occupational outcome and relapse of symptoms.

In adequately treated cases 33% patient recovered fully, 33% improved partially (like your son) and 33% are improved minimally.

There is no standard dose regimen for treatment. Drugs usually give in their effective range which is wide. Drug doses usually titrated according to treatment response.

Clozapine given in treatment resistant cases and it is reserved drug for such cases. Your son may be candidate for it if he had received more than 2 antipsychotics from 2 groups (invega, solian and risperidone belong to same group: atypical antipsychotics) in adequate doses and sufficient duration (4-8 weeks).

I can help you better, for all your question, if you tell me your son weight.


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

Wishing good health for your son,
Regards,
Above answer was peer-reviewed by
 
Follow-up: Have schizo affective disorder. Taking Solivan, Invega and Avanza. What dosage would be ideal? 11 minutes later
Re XXXXXXX Wrights case. His weight is 92 kgs

Thankyou for your valued opinion.
XXXXXXX Wright
 
 
Answered by Dr. Ashish Mittal 14 hours later
Hello again,

Thanks for follow up,

1. What dosages would be ideal for Schzo Affective disorder ?
Answer: doses are highly individualized. It is titrated according to treatment response.

2. In this instance should Solian be given with Invega or removed from the equation ?
Answer: Usually one antipsychotic should (Invega in his case) at one time during treatment. But low dose solian (upto 200mg) has good effects on negative symptoms of schizophrenia (like amotivation, decrease talk, decrease interest etc) which is resistant to other medicines. I would favor 200mg solian in his case.

3. Is the current drug choice and dosage the best that can be administered ?
Answer: At this time broadly treatment appear to be right. As his weight is already 92kg. I would not like to prefer Avanza 60mg in his case due to side effects of weight gain with Avanza. It is better to gradually stop Avanza and replace with other antidepressants like Bupron SR 300mg per day.

Illogical or incoherent speech (Known as Formal thought disorder), poor concentration and inability to hold job indicate partial treatment response and residual symptoms. I would like to increase Invega dose to 12 mg per day for better response.

Rambling speech may be due extrapyramidal side effect of Invega for that Trihexiphenidryl 2mg two times a day can be try for 2-3 weeks to see response. If he respond then it can continued further.

4. Should one contemplate giving Clozapine ?
Answer: No. As explained in primary reply.

All medicine dose related changes should be done under supervision of treating psychiatrist as we are advising only from the information available to us.

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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