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Suggest Treatment For Late Onset Psychosis
Question: "My Father, Age: 58 is a Bank Employee. From One month he started having a feeling that something was going wrong in the bank. From 2 weeks that feeling has increased a lot. He thinks all the other employees are conspiring against him by taking his bank password and robing the bank. But nothing of this sort happened. He is not able to accept that fact. He is thinking that everyone including some of the family members is part of this. He is getting suicidal tendencies.
Sometimes he stops thinking about bank after all his friends explained that nothing is wrong is going on. If it’s not the bank then there is something else bothering him. He gets depressed for other issues thinking that something bad is going to happen. He can’t rest and always thinks very negative about something or the other issue.
We have taken him to a local psychiatrist he said it could be:
1. Provisional diagnosis: - late onset psychosis
2. Differential diagnosis- severe depression with psychotic symptoms, dementia with psychosis. He has given the following medication.
Please suggest alternate medication or changes for the current schedule and the course and duration of the medication. Can this condition be cured? If so how much time will it take to get to normal.
Sometimes he stops thinking about bank after all his friends explained that nothing is wrong is going on. If it’s not the bank then there is something else bothering him. He gets depressed for other issues thinking that something bad is going to happen. He can’t rest and always thinks very negative about something or the other issue.
We have taken him to a local psychiatrist he said it could be:
1. Provisional diagnosis: - late onset psychosis
2. Differential diagnosis- severe depression with psychotic symptoms, dementia with psychosis. He has given the following medication.
Please suggest alternate medication or changes for the current schedule and the course and duration of the medication. Can this condition be cured? If so how much time will it take to get to normal.
Brief Answer:
Late onset psychosis is likely diagnosis
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
From the available description it appears that late onset psychosis is likely diagnosis as there is no evidence of depression and dementia mentioned as alternative diagnosis.
I am not sure why you want change in medication or schedule as quetiapine is good molecule for this age group, In fact in my personnel practice I prefer the quetiapine for elderly population with similar complaints.
Regarding cure I must inform you that more than two third patient become asymptomatic within a period of two to three months and few patient fail to respond with single drug necessitating add on therapy.
Quetiapine 400 mg is effective dose for an averagely built 58 year male and I hope he will start showing improvement in period of two to three weeks but complte cure will take time.
If this is the first episode for him the medication need to be continued for at least six to nine months according to response pattern.
Hope I am able to answer your concerns.
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
Dr Ashok Kumar
Late onset psychosis is likely diagnosis
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
From the available description it appears that late onset psychosis is likely diagnosis as there is no evidence of depression and dementia mentioned as alternative diagnosis.
I am not sure why you want change in medication or schedule as quetiapine is good molecule for this age group, In fact in my personnel practice I prefer the quetiapine for elderly population with similar complaints.
Regarding cure I must inform you that more than two third patient become asymptomatic within a period of two to three months and few patient fail to respond with single drug necessitating add on therapy.
Quetiapine 400 mg is effective dose for an averagely built 58 year male and I hope he will start showing improvement in period of two to three weeks but complte cure will take time.
If this is the first episode for him the medication need to be continued for at least six to nine months according to response pattern.
Hope I am able to answer your concerns.
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
Dr Ashok Kumar
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for quick reply.
Shall i continue giving him CLONAZEPAM - 0.5 in the afternoon?
Also the doctor I consulted here has given Olarc 10 mg (Olanzapine) to be taken in the night. My father gets uneasy when he takes this medicine (Olarc 10). Should this be continued along with Quetiapine or should I stop this.
Shall i continue giving him CLONAZEPAM - 0.5 in the afternoon?
Also the doctor I consulted here has given Olarc 10 mg (Olanzapine) to be taken in the night. My father gets uneasy when he takes this medicine (Olarc 10). Should this be continued along with Quetiapine or should I stop this.
Brief Answer:
You can stop olanzapine after due discussion
Detailed Answer:
Hello,
Thanks for reverting back to me.
Continuing clonazepam is ok but there is no rationale for using olanzapine with quetiapine.
I like to inform you that both Olarc and quetiapine work in almost similar fashion and one drug is enough for majority of individuals. Even all standard guidelines recommend use of single antipsychotic and caution against use of multiple antipsychotics as the chance of side effect is increased..
You can discuss with your psychiatrist to stop Olanzapine with this piece of information. Other than guidelines patient is not tolerating olanzapine well and it will be wise decision to stopping olanzapine.
Hope this is clear to you.
If you have any questions now or in future feel free to write back to me.
Thanks and regards
You can stop olanzapine after due discussion
Detailed Answer:
Hello,
Thanks for reverting back to me.
Continuing clonazepam is ok but there is no rationale for using olanzapine with quetiapine.
I like to inform you that both Olarc and quetiapine work in almost similar fashion and one drug is enough for majority of individuals. Even all standard guidelines recommend use of single antipsychotic and caution against use of multiple antipsychotics as the chance of side effect is increased..
You can discuss with your psychiatrist to stop Olanzapine with this piece of information. Other than guidelines patient is not tolerating olanzapine well and it will be wise decision to stopping olanzapine.
Hope this is clear to you.
If you have any questions now or in future feel free to write back to me.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor for your detailed reply.
My last question. My father was taking clonazepam .5 mg for 3 years and can not sleep without that. Does he has to go any de-addition treatment.
Could this condition be hereditary. because i personally overthink many things and doctor has given me a routine of daxid 50 mg and prothiaden 75mg routine for 2 months in the past. How can i prevent this happening to me. My age is 30
My last question. My father was taking clonazepam .5 mg for 3 years and can not sleep without that. Does he has to go any de-addition treatment.
Could this condition be hereditary. because i personally overthink many things and doctor has given me a routine of daxid 50 mg and prothiaden 75mg routine for 2 months in the past. How can i prevent this happening to me. My age is 30
Brief Answer:
No deaddiction is required with stable dose
Detailed Answer:
Hello,
Welcome back to Healthcaremagic.
I do not think deaddiction is required. If he is on stable dose for last three years that indicates that he is using it for medical purpose and that is not abuse.
If this is the requirement for his sleep he can continue with Clonazepam.In case there is any side effect than you can ask your doctor to prescribe one of the Z drug as they are safer in compare to Clonazepam.
Currently Zolpidem and Zopiclone are available Z drugs in XXXXXXX
Around 50 % of patients have some other family member suffering with other psychiatric disorder and so it can be said there is equal contribution from genetics and environment.
Having a healthy life style and healthy diet is formula to prevent them happening to you. You can practice yoga and meditation as they are helpful to anybody including you.
Hope this helps you.
Thanks and regards
Dr Ashok Kumar
No deaddiction is required with stable dose
Detailed Answer:
Hello,
Welcome back to Healthcaremagic.
I do not think deaddiction is required. If he is on stable dose for last three years that indicates that he is using it for medical purpose and that is not abuse.
If this is the requirement for his sleep he can continue with Clonazepam.In case there is any side effect than you can ask your doctor to prescribe one of the Z drug as they are safer in compare to Clonazepam.
Currently Zolpidem and Zopiclone are available Z drugs in XXXXXXX
Around 50 % of patients have some other family member suffering with other psychiatric disorder and so it can be said there is equal contribution from genetics and environment.
Having a healthy life style and healthy diet is formula to prevent them happening to you. You can practice yoga and meditation as they are helpful to anybody including you.
Hope this helps you.
Thanks and regards
Dr Ashok Kumar
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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