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Suggest Medication For Aggressive Behavior And Severe Anxiety
Question: Have been unsuccessful to control aggressive behaviour on 7.5 mls aripiprazole, now palliative care, high anxiety levels well controlled on lorazepam 2mg up to in 24 hours
have a just in case box. GP says midazolam will control the anxiety and aggressive behaviour. Will it? if not what could replace the aripiprazole as high dose led to sleepiness and in ability to function ie eating drinking. The aripiprazole is this contributing to the lack of ability to take fluids as this is problematic since starting the aripiprazole. palliative care, have just in case box hallucinations causing aggressive behaviour plus plus periodically
have a just in case box. GP says midazolam will control the anxiety and aggressive behaviour. Will it? if not what could replace the aripiprazole as high dose led to sleepiness and in ability to function ie eating drinking. The aripiprazole is this contributing to the lack of ability to take fluids as this is problematic since starting the aripiprazole. palliative care, have just in case box hallucinations causing aggressive behaviour plus plus periodically
Brief Answer:
I will prefer sertraline in this scenario
Detailed Answer:
hello,
Thanks for using Healthcaremagic.
I gone through all the details provided by you and understand the concerns. Although I must acknowledge that there is no right or wrong medication in this situations as every medication somehow interacts with one or another and with multiple disorders problem becomes more acute and challenging.
After thoughtful consideration my first choice to control agitation will be Sertraline which is an antidepressant and found be useful in aggression or BPSD symptoms secondary to dementia. My second choice will be quetiapine but it is likely to cause sedation. In case it suits him than the dose can be increased gradually to the optimum level.
I must inform you that I tried midazolam in three-four patients and did not found much use. Although there is literature supporting its use but three of my patients landed in more confusion with use of midazolam to control aggression.
This is my personal recommendation and not binding. This also need to take other consideration and treating physician is best judge as he is taking care of all aspects.
I hope this helps you.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
I will prefer sertraline in this scenario
Detailed Answer:
hello,
Thanks for using Healthcaremagic.
I gone through all the details provided by you and understand the concerns. Although I must acknowledge that there is no right or wrong medication in this situations as every medication somehow interacts with one or another and with multiple disorders problem becomes more acute and challenging.
After thoughtful consideration my first choice to control agitation will be Sertraline which is an antidepressant and found be useful in aggression or BPSD symptoms secondary to dementia. My second choice will be quetiapine but it is likely to cause sedation. In case it suits him than the dose can be increased gradually to the optimum level.
I must inform you that I tried midazolam in three-four patients and did not found much use. Although there is literature supporting its use but three of my patients landed in more confusion with use of midazolam to control aggression.
This is my personal recommendation and not binding. This also need to take other consideration and treating physician is best judge as he is taking care of all aspects.
I hope this helps you.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The physicians have been most unhelpful. They have ignored the fact that he cannot swallow well, very poor indeed.
They ignored the fact that for 3 weeks they failed to treat his aggression and distress due to the hallucinations.
They failed to treat constipation for 2 weeks. They failed to recognise he dislikes the aripiprazole and spits it out causing more distress and uncontrolled hallucinations. It increased risk of aspiration.
Does sertraline treat hallucinations? is it an antidepressant? thank you.
They ignored the fact that for 3 weeks they failed to treat his aggression and distress due to the hallucinations.
They failed to treat constipation for 2 weeks. They failed to recognise he dislikes the aripiprazole and spits it out causing more distress and uncontrolled hallucinations. It increased risk of aspiration.
Does sertraline treat hallucinations? is it an antidepressant? thank you.
Brief Answer:
It is an antidepressant
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I feel sorry for what you are experiencing and inability to have control over situations.
Although sertraline do not act directly on hallucinations but it treats its underlying cause to a significant extent and helps in aggression. In vascular dementia I found it very useful and even helpful in resistant cases.
I must make it clear that choice between sertraline and quetiapine depends on the pressing symptoms which need more acute treatment.
Sertraline is antidepressant while quetiapine is an anti psychotic which is directly involved with control of hallucinations.
At the stage of palliative care doctors as well as physician need a collaborative plan to tackle the situation. The understanding between treating team and family members is of utmost importance. I feel lack of communication should be addressed first so other issues can be resolved.
While communicating to physician you can discuss what I opined so he can take a better call to understand the situation.
I hope this assists you to some extent.
Thanks and regards
It is an antidepressant
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I feel sorry for what you are experiencing and inability to have control over situations.
Although sertraline do not act directly on hallucinations but it treats its underlying cause to a significant extent and helps in aggression. In vascular dementia I found it very useful and even helpful in resistant cases.
I must make it clear that choice between sertraline and quetiapine depends on the pressing symptoms which need more acute treatment.
Sertraline is antidepressant while quetiapine is an anti psychotic which is directly involved with control of hallucinations.
At the stage of palliative care doctors as well as physician need a collaborative plan to tackle the situation. The understanding between treating team and family members is of utmost importance. I feel lack of communication should be addressed first so other issues can be resolved.
While communicating to physician you can discuss what I opined so he can take a better call to understand the situation.
I hope this assists you to some extent.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your informative information a to an awful, long on-going problem with the local health services that have contributed significantly to the mental and physical decline of the patient. Inducing unnecessary pain and suffering and stress for him and the family.
I am unable to star rate due to my browser but will rate you on your profile page with top star rating. Bless you and many thanks.
I am unable to star rate due to my browser but will rate you on your profile page with top star rating. Bless you and many thanks.
Brief Answer:
Your satisfaction and health of patient is more important than rating
Detailed Answer:
Hello,
Glad to know that information was useful for you.
Rating can be done later on and not essential.
I will be more happy to know that information was useful for you.
Feel free to ask me direct in future if any need arises at the following link
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Your satisfaction and health of patient is more important than rating
Detailed Answer:
Hello,
Glad to know that information was useful for you.
Rating can be done later on and not essential.
I will be more happy to know that information was useful for you.
Feel free to ask me direct in future if any need arises at the following link
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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