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Have high bp, feeling cold and mentally disturbed. Prescribed oleanz. Is this safe?

Dec 2014
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Practicing since : 2007
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Oleanz 2.5mg is prescribed to my brother when we explained his problem to a psychatrist. Dr asked to take 2.5 mg for a week, then 5 mg for 2 weeks and he will be ready to consult a doctor. Read suicide chance is high in these ppl especially when age below 30 & higher IQ(exceptionally good in academics). He gets cold often & has little bit now, is it safe to take? Also he had high BP, now seems to be normal though we didn't check today.

Brief about his problem, discontinued studies 2 years back, says he loved one girl but she cheated him. He stopped speaking to friends and initially very angry with family. Didn't take up any job. From past 4 months he is friendly with family and we recognized his problem at that time. He is telling many ppl around him try to create issues for him, they are recording his conversation and also some ppl are trying to create trouble for his close family members. Now he is telling he will continue his studies and will take up job and wrote an exam for that and waiting for result in another 4 days. Since he is not recognizing that he has some problem, he is not ready to consult dr. when we met a doctor, he said, don't know how he is going to react if he is not scoring good in that exam. (He says he has done well, but Dr doubt whether he has done so). He talks normally to us most of the time, but sometime tell something of this kind. Once he told me that, all r trying their best to create trouble for me & i am ignoring but even i ready to die.

Please share your views asap.
Posted Wed, 3 Apr 2013 in Mental Health
Answered by Dr. Seikhoo Bishnoi 49 minutes later
Welcome to Health Care Magic

Dear friend your brother is 29 year old, and he developed the problem (or noticed by some one) about 2 year back, with chief complaints of
-sudden unexplained discontinuation of studies. Although he claimed to be cheated by some girl, but it has to be confirmed by any of his colleague as he might be under delusional state.
- social withdrawal (stopped to interact with friends and family members)
- occupational dysfunction (didn't pick any job)
- he is continuously telling that people are trying to create issues and trouble for him (suspiciousness in technical terms)
- not able to accept his problem and illness
- irrelevant talks some times

These symptoms suggest two main type of problems-
- first thing we can think of is Any psychotic disorder or Schizophrenia Paranoid type. He is having suspiciousness, social and occupational dysfunction, delusions, suspiciousness, not taking medicines etc. These symptoms are main features of schizophrenia.

- second possibility although less chances is Bipolar illness mainly manic type. In patients of mania irritability, delusions may be seen. But they are not much symptoms suspiciousness. Instead patient remain happy, over social and have tall claims.

So most likely he is having symptoms of Schizophrenia. Schizophrenia is a psychotic disorder, if treated properly and in time improvement is observed in patient. Treatment options are-

Medicines like- Antipsychotic drugs as Haloperidol, chlorpromazine, olanzapine, qutiapine, resperidone etc. As he has been given 2.5 mg of olanzapine for one week then 5 mg for next 2 weeks and he became a little ready for medicines. As per my opinion for this symptomatology the dose should be a little high like 10 mg equivalents of olanzapine. Olanzapine is a safe drug, no major side effects on movements, only side effect is increased sleep and increased appetite. So if he continues to take this drug so I advise you to give him diet with plenty of fibers, low fat diet, also daily light exercise will help. Risk of suicide is over all higher in this disease as compared to normal person. But with olanzapine risk do not increase.
Also for your information if he refuse to take this drug you can purchase melt in mouth preparations which are available with different brands and are tasteless and odorless and can be mixed with food or even with tea.

- Proper psychological support is must for this disease. Try to understand that he is ill, some times he may doubt on you or any family member, but never get stressed due to this. Give him proper care and he will definitely improve.

- Motivate him to join some job as soon as he gets improvement as proper vocational rehabilitation is cornerstone in improvement.

so please visit a good psychiatrist along with your brother and take opinion regarding his symptoms, he really need treatment.

Thanks, hope I solved your query, I will be happy to answer your query (if any) again.

Dr. Seikhoo Bishnoi
Above answer was peer-reviewed by
Follow-up: Have high bp, feeling cold and mentally disturbed. Prescribed oleanz. Is this safe? 27 hours later
Thanks very much for the quick response. We (me & my father)have already met a doctor and explained about my brother and according to him we started oleanz. Though we asked my brother many time, he is not ready to XXXXXXX doctor. Our worry is whether he take some extreme steps(suicide etc) when he realizes that he has some problem or even after 3 weeks, what to do if he is not ready to go to doctor.

In order to understand the problem better & hence proper diagnosis, i am detailing his condition in the sequence which occured. Please go through this in detail and help us to move in the correct direction.

* He got top ranks in entrance exams, best student in school and highest score in school & college. (14/15 yrs back)
* Exceptionally good in Maths & paintings.
* His achievements surprised everyone
* Worked 3 years in a MNC after campus placement. (In 2004/2005)
* Joined for higher studies (good score in selection exam)
* Lot of friends, very jovial, good humor sense.
* Lot of movie collection, watches english movies a lot.
* Technically very good.
* Interested in Facebook, found lot of time spending in fb. Sitting long time, even before brushing, entertaining everyone, writes nice jokes and funny comments.
* Noticed a mentality to advise everyone. Long time conversation with others, little bit arguing mentality.
* Gradually noticed he getting angry when his parents or me ask things about him.
* Stopped studies with out telling anyone of us. Came to knw after he finished the formalities to discontinue studies. (In 2010)
* Same time, he said he was in love with a girl, one of our distant cousin and asked my parents to talk to her parents as she is waiting for that. When my parents asked her parents, she said she considered him as a brother. But few fb messages he showed to my parents which we can't completely agree to her statement. (In 2010).
* Gradually he stopped speaking much, he gets angry, don't pick up calls. But he was very friendly with visitors & friends.
* Though he took a room, paying rent for that, but he started staying with us. Became close to our flat neighbors. Very friendly with one family, spent most of the time with them and come for food to my flat etc. He won't talk to us, will be very angry if we ask something. If we ask why u do this, he says, earlier i thought you ppl r good, but you too are selfish. My perception for ppl have changed now etc.
* He was not doing anything for more than a year & half after stopping the studies. He started his painting and was telling he will build a career out of this. He did few paintings for others, sold some, did an exhibition etc.
* Since he was very rude to us and always a fighting mentality, we asked him to move to his room as it was creating uncomfortable days for him & us. Above that i was pregnant & it was creating stress for me. We didn't have any idea that something strange(psychiatric disorder) is happening with him. We believed he is angry with us for some reason.
* He left our place with anger. Almost completely stopped answering to our calls, picks up sometime when my parents call.
* During this time my parents came here and he came 1 or 2 times.
* He came to hospital during my delivery and stayed with us. We all were very happy. After a month, when things settled he asked whether do we need his help or do he need to go.
* We asked him to stay with us, but it became messy as he gets irritated when someone come to our flat. Also there was less space and he was not getting free time for his studies as he was preparing for an exam to continue the studies he stopped. My father asked him to move near to our place, & he did that. He come to my place everyday for food and spent some time here. Reading paper etc.
* Now he says he will join studies, work parallel and look after my parents etc. Earlier he didn't tell like that, he was in a state, like even with 5000 i will live. That make us to think that whether his condition improved or not.
* Then we asked why u did all these, he didn't have a proper answer. He said, "now i came to u since i know, some ppl r trying to create problem for you, they are after me & you"( me & my parents). He is even doubting my husband. ( 2 1/2 months back). Then we realized that he has some problem.
* From that time we are trying to convince him that, nobody is trying to create problem for us. No one is bad, your thinking has some small problem, lets us sort it our with the help of psychiatrist. He says, he doesn't have any problem, if you have any information share with me, i will be able to help u etc. Once i said, i will take u to a psychiatrist, he said, "i haven't given u authority to do that".
* The ppl who create trouble(almost everyone except me & my parents) make fun of him thru Facebook. But according to my knowledge, he is just watching others, not responding back. Once he responded to my in-laws, but when said, why u r angry with him he said he will not repeat.
* Other than doubting others, correlating things (no where related), he does everything perfectly.
* He is not talking anyone, not even picking up phone calls from close friends. Right now he is close to my father and speaks to me & mom and plays with my kids.

I have the following doubts in my mind,
* How Oleanz help him to realize the he has a problem he will be ready to XXXXXXX doctor?
* How he responds when he realizes that he has a problem?
* Currently he is expecting good result in the exam he wrote, if it is not good, will create more trouble? Once he told, i have written the exam well, but if those ppl(those who is trying to create problems for him) do something, i don't knw. Will he take some extreme steps ?
* Currently he is staying alone in a house near to our us, do we ask him to stay with us? He is staying in that place for studying etc since in our flat many friends comes now & then and place is less. Also these days, he is finding issues if others come here as think they are coming with some intensions to trouble us.
* Is there any use in supporting him when he says these unwanted things, like let us find out the recording stuff and search with him? What we (family side) can do to improve his condition
* As we are giving the medicine dissolved in food without his knowledge, and he is sleeping a lot these days, he will be thinking why he is sleeping this much ?
* He is sleeping more with 2.5 mg , will he sleep more time if it is increased to 5 mg?
* What could be the situation which leads to think about suicide etc, can we do something to avoid those situations ?
* What could be the step, even if he is not ready to consult doctor even 3 weeks completion?
* Will it help, if i ask him whether we both together start some business etc, or say i am with u always ?
* I am in contact with one of his close friend, but didn't tell him about this psychic disorder. We think that, we should keep it secret, so that when he recover, it will be easy for him to interact with people. Will it help if tell this close friend and get some help to do the treatment. What is your opinion on this?
* From the above details, do u think his condition is improved or worsened? Can this disorder eliminated completely or only controlled?
* Please suggest doctors in Bangalore/Kerala who helped patients to get rid of schizophrenia. Or good doctors you think who can help him/us to come out this disease. We just met one(2 days back), but would like to move to a different one if there is a better option).
Answered by Dr. Seikhoo Bishnoi 7 hours later
Hello again,

You have described his clinical condition in detailed manner. After reading this I would like to correct myself, the clinical picture you have mentioned in your question is pointing to Bipolar Illness with episode of mania. It's good that we are keeping Schizophrenia as second possibility and not first. It's really difficult to treat a Schizophrenia patient than Bipolar Patient.

Before coming to answer part I would like to explain a brief clinical history of him-

He was exceptionally good in his academic and occupational carrier, he used to love a girl and who allegedly left him (and it has been proved to some extent by Facebook messages). This is a significant life event which may precipitate already present sub clinical illness.
He was a very social person with humorous personality. (Cheerfulness)
He has been a person of arguing nature, he used to advise others, or we can say he used to intrude in others life. (Intruding nature)
He stopped studies and he has become close to neighbours. (Over sociality)
He is did nothing for one year and then did painting and also exhibition of painting. (Risk taking behaviour, grandiosity to some extent)
He became rude with others, started fighting with family members, moved in different room again. (Irritability)
Now he is saying he will join studies, will look after parents and also will work part time. (Tall claims)
Doubting even your husband, your in-laws

Most of the features point to the episode of Mania, but I would like to tell you to check whether he has ever become silent? Whether you have seen him sitting alone in room and muttering some words or talking to self? Whether he ever complained that he is seeing some persons or hearing voices that are distressing?
The answer to these questions should be negative.

Now coming to your questions part:

- Oleanz or Olanzapine is an Anti psychotic drug, and it is also used as a mood stabilizer. In low doses olanzapine works as a good mood stabilizer. Mood stabilizers are main stay of treatment in Bipolar illness with mania.

- When he will take medicines for some time (even without his knowledge), and also with spontaneous remission of episode, he will be able to realize his problem.

- Usually people of Bipolar Illness with Mania don't take extreme step. But as they are impulsive so any threat should not be ignored. But the risk is not very high as compared to other illnesses.

- For some time he should be at same place where he is presently living, as when he will move to your place it will affect your normal life, and you will be under extreme stress, and you are the only proper care giver of him.

- Don't ever reject his sayings out rightly, instead after some time of any demand try to negotiate with him. If he will start to believe you, it will be easy to administer medicines to him.

- He is sleeping more only because of Oleanz and this is good for him. But use high secrecy in giving medicines to him, as by any means if he will come to know about medicines then there will be a huge problem. He will stop to confide in you.

- Warm supportive care is must for his condition. Try to talk to him, or negotiate with him. Like you can say '' brother you have huge potential but due to anger you can't use it productively, you should shed your anger. We can also go to a doctor for some medicines of anger" I mean proceed in steps during negotiation

- For now don't tell his friends as in future this may affect his social life.

- He is presently in episode of mania. Bipolar illness is an episodic illness, and it is characterized by episodes of either Mania alone or mania and depression. Spontaneous remission of episodes usually occurs in 3-4 months, but episodes tend to reoccur. Proper treatment is must because if not treated properly patients go in chronic mania state, and their work, education, social life start deteriorating.

- The disorder can be controlled with medicines. Medicines like Mood Stabilizers as Sodium Valporate, Lithium carbonate, Carbamazepine, Oxcarbamazepine etc. are used. Low dose antipsychotics as Olanzapine, Qutiapine, Resperidone etc. are also useful in controlling episode.

- You can visit NIMHANS Bangalore, for his problem. Special OPD for bipolar illness is there in NIMHANS. Or if you don't want to visit a government institute then there are a lot of good Psychiatrists are available in Bengaluru as well as in Cochin.

- Just have faith in treatment, and provide proper care to him, he will be alright.

Hope I cleared your doubt, I will be happy to answer your queries any time, again.

Take care

Dr. Seikhoo Bishnoi M.D.
(Consultant Psychiatrist)

Above answer was peer-reviewed by
Follow-up: Have high bp, feeling cold and mentally disturbed. Prescribed oleanz. Is this safe? 2 days later
Few things to detail,
* Over sociality is true. He was not mingling with many ppl when he was a school student. I noticed him more interacting when was around 23/24(not very sure). But he was having many good friends. With Facebook, his friend circle increased, he was chatting with many family members as well. They were telling we never thought he is this much funny & jovial.
* He was/is(according to me) not having intruding nature. Noticed this advising thing around 2/3 years back which is going on still(only to me & my parents).
* I feel, currently he is trying to get back to his old state. For that he prepared & wrote exam. He got good result now. He is just telling that, i want to take care of parents and trying for that.
* I have seen him sitting silently for a long time, thinking something, while reading books, he will thinking, when asked, he says " i am recollecting what i read" . But i haven't seen him speaking alone or muttering. He didn't tell that he is seeing people or hearing voices
* He gets cold often.
* He is a very truthful person. I haven't seen him telling a lie to anyone. I felt, he might be expecting the same truthfulness from others as well. When he realized that ppl are not that faithful he got frustrated (this is just my thought)
* BP was high, last few checking showed normal values
* He became lean, when asked why u r nt taking food, he says "doing yoga, thats why"
* Earlier (3/4 yrs back) was ready to help anyone to XXXXXXX extend. But now not ready to do a small help also. Says, "i did so much for others, none has gratitude".

* Few examples of his current situation and wild imagination,
* Some sound from top floor(we can also hear the sound, but we ignore usually), he says, it is purposely done to trouble us.
* Someone duplicated his house key and reading his diary, record his snoring and upload in FB.
* He withdrawn his PF, didn't get full money. His old colleague played behind this
* When asked who does all these, it point finally to that girl with whom he had affair. He says, "now she wants to create a bad picture about him, so grouping with other ppl(few other bad minded) they do that.
* Those ppl,whose secrets are with him, trying to create a bad pic so that others will not listen to him. But he is not reacting to those ppl back. Once he said, if it becomes severe i will respond.
* In this recent exam he wrote, he got very good result, but as per him he was expecting some more grade(according to the answer key). So he says someone played behind this.
* Currently apart from this wild imagination and correlating things(ppl who don't each other get together & fight against him), everything is normal. Sometimes he agrees that what he thinks could be an assumption but sometime he is sure about that. (Quite confusing for us too sometimes)
* Couldn't understand the point u wrote, - "When he will take medicines for some time (even without his knowledge), and also with spontaneous remission of episode, he will be able to realize his problem."
Answered by Dr. Seikhoo Bishnoi 1 hour later
Hello again

Most of the symptoms are of the Bipolar Illness with mania. Apart from bipolar illness symptoms he is having suspiciousness as main feature. Although it is more common in Psychotic episode but in a lot of cases of Bipolar suspiciousness can be seen. The wild imagination, correlating things is nothing but suspiciousness. It's good that he doesn't have self taking or muttering

I was trying to tell you that, as he is not ready to take medicines; so we have to give medicines either by mixing with food or by mixing in tea or coffee. Our main target is to bring him to such state that he become ready to take medicines by his own and becomes ready to consult a Psychiatrist.

Mania usually continue for about 3-4 months then spontaneously patient becomes better (remission), but episodes tend to reoccur.

Hope it is clear now.

Thanks, I will be happy to answer you again. If you are satisfied with conversation kindly rate.

Dr. Seikhoo Bishnoi
Above answer was peer-reviewed by
Follow-up: Have high bp, feeling cold and mentally disturbed. Prescribed oleanz. Is this safe? 2 days later
Thank you so much for the help.
One more question since he is able to get very good result in this exam, is this disease really harming him?
He gets cold very often and it last for long days, is there a relation?
Answered by Dr. Seikhoo Bishnoi 8 minutes later
Hello again,

The results can only be predicted by seeing him. He may or may not have good result. Usually in productive mania results are good.

The disease may hamper in his social and occupational functioning. So quick treatment is needed.

There is no relation between recurrent cold and this illness. Probably he has allergic rhinitis.

Thanks, if you are satisfied with answer please review.

Dr. Seikhoo Bishnoi
Above answer was peer-reviewed by
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