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Suggest treatment for agressive behavior due to schizophrenia

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Posted on Wed, 20 May 2015
Question: HI Doctor, gud afternoon, my father is a patient of Schezophernia. his age is 73 years. from the past one year he is on medication like Olianze, stalopam & parkin (sometimes take alprex also). but it seems medicines is not helping him anymore. He has started beating my sister (who is handicapped and 45 years old) on the pretext that in the nite someone is coming to her room for meeting her , which is actually not true.yesterday also he had beaten by sister with scissors. and when we tried stopping him, he said that he will murder her ,she is not a gud girl. sir, I need advise, if medicine needs to be changed , my father even refused to see a doctor, please help
doctor
Answered by Dr. Chintan Solanki (36 minutes later)
Brief Answer:
increase olanzapine for a while, other medicines are as below

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us. I can understand your concern.

If your father is confirmed case of schizophrenia at present it is acute exacerbation likely.
He is on 5 mg oleanz. It is good anti psychotic medicine to control anger and to sedate the patient. Optimum dose is 20 mg per day and in some cases it can be given up to 30 mg. At present you can increase the dose up to 20 mg by giving 5 mg in morning 5 mg in noon and 10 mg at night.This will help. Later on when feasible consult his treating doctor , inform about increasing the dose and discuss about other option which I am mentioning below.

If he can not be controlled with oleanz, round the clock cover of benzodiazepine like clonazepam should be added. After stability it can gradually be decreased.
Another option is to add mood stabilizer like valproate which can control such anger.
If I were treating his doctor I would like to add trifluoperazine if he has no possibility of extrpyramidal symptoms.This is good drug to treat suspiciousness which is likely cause of his anger.

If his condition is so much worsened that he can harm to himself or someone the best option is to get him admitted forcefully with help of other relatives/police.
You can ask his psychiatrist for home visit and evaluation also.

Hope I have answered your query, I will be happy to help further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (37 minutes later)
Dear Doctor,
thank you so much for your advise. wanted to know, can we continue giving stalopalm and parkin along with Oleanz. request if u can just give a descrption which medicine to give and at what time please.

We will try giving him the medicine as per your advice
right now he is taking:

Oleanze - 2.5 mg in nite
stalopam -5mg
parkin-2 mg
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
Yes continue stalopam and parkin as mentioned below

Detailed Answer:
Dear XXXXXXX

Thanks for follow up. Thanks for clarification about dosage.

Give Satlopam 5 mg and parkin 2 mg in morning. Oleanz 2.5 mg in morning , 2.5 mg in noon and 5 mg in night for 2 days. If improvement is there in one day continue the same for 5 days and by the time consult his treating psychiatrist.
If no improvement is there increase oleanz up to 15 mg by adding more 2.5 mg in morning and night dose.
If you have clonotril available right now you can give 0.5 mg at night for sleep for a day or two.
I am helping you for acute management.
But you should consult his treating doctor who is aware about his detail history.

Feel free to ask if you have any doubt yet.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest treatment for agressive behavior due to schizophrenia

Brief Answer: increase olanzapine for a while, other medicines are as below Detailed Answer: Hello XXXXXXX Thanks for writing to us. I can understand your concern. If your father is confirmed case of schizophrenia at present it is acute exacerbation likely. He is on 5 mg oleanz. It is good anti psychotic medicine to control anger and to sedate the patient. Optimum dose is 20 mg per day and in some cases it can be given up to 30 mg. At present you can increase the dose up to 20 mg by giving 5 mg in morning 5 mg in noon and 10 mg at night.This will help. Later on when feasible consult his treating doctor , inform about increasing the dose and discuss about other option which I am mentioning below. If he can not be controlled with oleanz, round the clock cover of benzodiazepine like clonazepam should be added. After stability it can gradually be decreased. Another option is to add mood stabilizer like valproate which can control such anger. If I were treating his doctor I would like to add trifluoperazine if he has no possibility of extrpyramidal symptoms.This is good drug to treat suspiciousness which is likely cause of his anger. If his condition is so much worsened that he can harm to himself or someone the best option is to get him admitted forcefully with help of other relatives/police. You can ask his psychiatrist for home visit and evaluation also. Hope I have answered your query, I will be happy to help further.