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Suggest treatment for schizophrenia,drug induced parkinson and low BP?

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Practicing since : 2005
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hi doctor my father age 60 years is suffering from schizophrenia since 13 year.after taking medication for such a long time he is suffering from tremor in left hand and leg.he has now drug induced parkinson.he stopped taking medicine due to side effect.we consulted one physician he advised us to start medication again.he prescribed illosue(Iloperidone) 4mg. after taking that his bp got suddenly decreased and got stiffness in whole body.please advice us.
Posted Tue, 18 Mar 2014 in Schizophrenia
Answered by Dr. Manisha Gopal 16 minutes later
Brief Answer: He needs medical attention and blood test. Detailed Answer: hello and welcome to HCM! I have read your question and can understand that your father needs some medical attention. You have mentioned that he is 60 yrs old, and has extra pyramidal side effects along with Parkinson's symptoms, (due to drugs use). currently he is having rigidity and fall in BP (after taking illosure). The dosage is not mentioned in query. From my clinical experince I can say that this position can be either due to drug itself ( rare side effect of this drug as it is relatively weak and mild chemical). OR due to Parkinson's itself... I would recommend that he shoud be taken to a specialist, and get his BP and electrolytes monitored. This rigidity can be a sign of catatonia, which is seen in schizophrenia and is considered an emergency. please maintain adequate hydration and get his routine blood test, pressure, temperature, oxygen concentration and electrolytes monitored. once this rigidity is resolved, he can be shifted to some other drug. Hope the reply is useful please feel free to ask more question for clarifictaion Dr. Manisha Gopal MD Psychiatry
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Follow-up: Suggest treatment for schizophrenia,drug induced parkinson and low BP? 34 minutes later
Hello Mam thaks for your answer. he has stopped medicine 7 months back and only taking paciten 2 mg 3 times a day.we have consulted neurologist regarding tremor after 3 to 4 months he said us to meet psychiatrist.We moved to specialist then he prescribed illosure-4mg at night and Arip MT-15mg.after first and one dose of illosure he got low BP and whole body stiffness.He is also complain that after taking illosure he has problem in speaking and feeling like drug(nasha).before stopping medicine he was taking 1/4th part of olinzapin-2mg,beacuse he is not even able to move to washroom at night. Please tell me is any other therapy or option because he is not agree to take this medicine as after taking this is not able to speak effectively and feel like drunked(nasha).Where can have treatment for catatonia.we live near nagpur.
Answered by Dr. Manisha Gopal 9 hours later
Brief Answer: May go to GMC/IGMC Nagpur Detailed Answer: Hello, Your father has been on drugs ( I guess- mostly on typical antipsychotics for initial part of his illness) from past many years. These typical antipsychotics are notorious to cause tremors, increase salivation, reduced blinking, etc. To crub these side effects we give pacitane. Your father is on 2mg TDS pacitane now but has stopped all other drugs. It is seenthat by long standing use of typical antipsychotics, the tremors might not completely vanish even after stopping the culprit agent or by using pacitane. Your neurologist had tried all what he could and referred you back to a psychiatrist. Arip MT is also seen to give rise to this presentation ( not very uncommon in clinical setting). It might be that not illosure, but Arip MT in combination with illosure lead to this picture.. However, for now the most important thing is to take the patient to medical care and manage him well. You may take him to GMC Nagpur, or to IGMC. In private there is a doctor ( psychitrist) at Dhantoli - Dr. XXXXXXX he might be able to help you / guide you properly but sorry, I donot have his number. # you have said that he was taking 1/4 of 2 mg alnazapine previously. It is strange that he developed so may side effects in this drug..may be its his age plus demetia/ Parkinson's. I think you may need to get his MRI Brain also after some time when he stabilises. Hope this information helps you. Please ask more questions for clarifictaion Dr. Manisha Gopal MD psychiatry
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Follow-up: Suggest treatment for schizophrenia,drug induced parkinson and low BP? 2 days later
Hi Doctor, Thanks for your suggestion as i have told earlier that he has stopped taking medicine of schizophrenia for 7 to 8 months because after taking that he feels like he has taken drug(nasha) not able to go washroom at night and also trouble in speaking or swallowing mounth.I think his body is not accepting this type of antipsychotics drug. Can schizophrenia come back again.My father is doing well,he can do all types of work.Please let me know is it necessary to start antipsychotics drug. Problem is with tremor.what best we can do regarding his tremor(drug induced parkinson).If we visit to psychiatrist he will again write some antipsychotics drug and again this all thing will happen.We are afraid to give him this antipsychotics drug by seeing his condition last time. I have read that antipsychotics drug reduces dopamine level in the brain and paciten increases dopamine level.Dr who prescribed us illosure-4 and arip MT-15, he said that he we to increase dopamine level from the areas in the brain which are responsible for hand and leg movements and reduce from the area which are responsible for talking etc. Is there any cure in Ayurveda i have read about Dr. paneri in ahemadabad regarding parkinson decease.
Answered by Dr. Manisha Gopal 11 hours later
Brief Answer: We can try without drug till he is keeping good Detailed Answer: hello, Furstly- Schizophrenia is a life long illness, and there are all chances that it may come back. However, when we have such a case where side effects are problematic and patient is keeping fine for many days without medicine -we may just keep a close watch on him without giving any drug and if there are any emergence of symptoms, then start treatment. So, for time he is keeping fine, able to take care of himself and there are no psychotic symptoms seen, just keeping a close watch can be tried. Tremors, as I said earlier are difficult to manage in long standing cases. In such cases we have few choices- 1. increase the dose of pacitane - upto 10 mg -12 mg. ( in divided dose three times a day) 2. treat like Parkinson's - syndopa ( but this may bring back psychotic symptoms , so care is required ). Secondly, Im sorry but I am not aware of avurvedic treatment for this problem. However, if there is anyone qualified in Ayurveda, you can consult him. There is no problem in discussing with a qualified doctor of any domain, provided patient is benefited. thirdly, when I have such a case in my clinic, I go with the following medicines ( they are relatively mild and free of major side effects) --- 1 quetiapine ( but it has sedation-- can be managed by giving dose in early evening hours and this effect weans away in some days) 2. Amisulpride ( this is also very good and usually donot cause sedation, tremors, increase in saliva etc., can be given at one time in a day) If you can pursuade your father to take them, you can discuss them with the doctor. Hope the reply is useful Please ask more questions for clarifictaion If you are satisfied, please close the query and arĂȘte the answer Dr. Manisha Gopal MD psychiatry
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Follow-up: Suggest treatment for schizophrenia,drug induced parkinson and low BP? 2 days later
Hi Doctor, Could you please tell me how many mg of dosage is required of above mentioned drug. One thing i want to mention is that he after stopping antiphyscotic drug he is talk active some times if things not go according to him, he gets angry .Means he is moody.behaviour is agitated and over enthusiastic.also he dont have particular routine.problem in sleep.sometimes sleep at 4 am sometime 12 am and some times in day only for 3 to 4 hours.By the way he is good in all social and other things. Dont know that it is a symptoms of early schyzhophernia or it is casual because of older age.
Answered by Dr. Manisha Gopal 1 hour later
Brief Answer: It is due to illness and not because if age Detailed Answer: Hello, The usual starting dose of Amisulpride is 25 mg twice a day, after meals, and it is increased by 25 mg every third day or so after monitoring the response. the dosage is build upto 200-300 mg peer day as needed. There are formulations available which can be given once a day, preffrably at night. Quetiapine is can be given once a day ( night time) in dose of 25-50 mg, increased by 25 mg or 50 mg every third or fourth upto 150-300 mg, as needed. Your doctor would also know about them. The symptoms of over activity, sleeping less, and getting angry easily when things donot go his way, point towards possibility of influence of his illness. So, it will be best to give him some medicine regularly. These symptoms are not due to his age as he is just 60 yrs, so, it is due to schizophrenia only. Donot worry about sleep, as with above medicines it will also improve. Hope the answer helps you please feel free to ask more questions for clarifications if you need Dr. Manisha Gopal MD Psychiatry
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