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What Causes Fever, Auditory Hallucinations, Depression, Fatigue And Slurred Speech?
Question: Hi, I'm XXXXXXX a 28 yr old female with no previous health concerns. Two years ago on holidays in Paris I became quite sick, had a bad fever for 48 hrs, then started hearing voices and felt so tired I slept for a week day and night. I came back a bit depressed and took antidepressants and sleeping pills, I stopped them suddenly and started hallucinating voices. They put me on ability, Invega then seroquel. All had devastating side effects. I am now 14 kg heavier, chose to go off Seroquel 4 months ago and am going better now off it. (I was sleeping till 11am most days) I have moved energy but these are my symptoms now; constant fatigue, feel like I have a hangover every morning, slow thinking, difficulty talking, slurred speech, uncontrollable mouth movements. And today on a walk in the forest the first half was fine then the more tired I became the more I lost control of my thoughts and leg movements. I felt mentally fatigued but not physically fatigued. In context, I've always been fit and strong and would ride my bike 3 times a week for 14km, now I'm mentally fatigued after a walk. Sometimes my brain will seemingly freeze up where if I'm trying to think, I can not and I just go blank for a minute and sometimes my head drops a little or my eyes shut or I just stare until I come back. This is all bizarre for me as I've been eating healthy and excercising my whole life.
Brief Answer:
It may be EPS(extra pyramidal symptoms) and/or postpsychotic depression
Detailed Answer:
Hi XXXXXXX
I read your query thoroughly.
Hearing of voices is positive psychotic feature. It is one of the symptoms of schizophrenia(considering MRI is normal).
You have been given Abilify(aripirazole), invega(pallipridone) and seroquel(quetipine). All are anti psychotic medicines used in treatment of schizophrenia as well as in bipolar disorder.
These medicines can cause extra pyramidal symptoms(EPS) as side effects. EPS includes tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia.
Seroquel can cause very much sedation as well as weight gain by metabolic disturbance. Your weight gain and excessive sleepiness were because of seroquel likely.
You have been off from seroquel since 4 months and somewhat improved that is good.
Your current symptoms (slow thinking, difficulty talking, slurred speech, uncontrollable mouth movements) are likely suggestive of EPS. They can be treated with anticholinergic medicine trihexiphenydyl(benzhexol-pacitane).
Slow thinking and excessive fatigue suggest postpsychotic depression(in some patient after improvement in schizophrenia, symptoms of depression occurs). Your weight gain also may be responsible for these symptoms. Weight reduction and antidepressant medicines can help in such case.
Thought block and blank mind are likely due to depressive phase of schizophrenia. But again to rule out any neurological cause MRI to be done. You have already undergone second MRI. Hope it will come normal.
With this information please consult your treating doctor, get evaluated and start the treatment.
Hope I have answered your query, I will be happy to answer again if follow up query is there. Revert back to me with latest reports in that case.
Regards,
Dr.Chintan Solanki.
It may be EPS(extra pyramidal symptoms) and/or postpsychotic depression
Detailed Answer:
Hi XXXXXXX
I read your query thoroughly.
Hearing of voices is positive psychotic feature. It is one of the symptoms of schizophrenia(considering MRI is normal).
You have been given Abilify(aripirazole), invega(pallipridone) and seroquel(quetipine). All are anti psychotic medicines used in treatment of schizophrenia as well as in bipolar disorder.
These medicines can cause extra pyramidal symptoms(EPS) as side effects. EPS includes tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia.
Seroquel can cause very much sedation as well as weight gain by metabolic disturbance. Your weight gain and excessive sleepiness were because of seroquel likely.
You have been off from seroquel since 4 months and somewhat improved that is good.
Your current symptoms (slow thinking, difficulty talking, slurred speech, uncontrollable mouth movements) are likely suggestive of EPS. They can be treated with anticholinergic medicine trihexiphenydyl(benzhexol-pacitane).
Slow thinking and excessive fatigue suggest postpsychotic depression(in some patient after improvement in schizophrenia, symptoms of depression occurs). Your weight gain also may be responsible for these symptoms. Weight reduction and antidepressant medicines can help in such case.
Thought block and blank mind are likely due to depressive phase of schizophrenia. But again to rule out any neurological cause MRI to be done. You have already undergone second MRI. Hope it will come normal.
With this information please consult your treating doctor, get evaluated and start the treatment.
Hope I have answered your query, I will be happy to answer again if follow up query is there. Revert back to me with latest reports in that case.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Hi, thank you. Yes i feel it must be from the medication also. If i take the trihexiphenydyl, are there serioud side effects from that medication. And what does it help with?
Even though ive put on 14 kg, im still healthy, i was around 60kg now im 74kg. And 172cm tall.
Does the fatigue in the morning ever go away? I never had it before medication and could always get up early 5 am, 6, or 7 to start my day. Now i always feel like i havent slept and average 8 am-9am. Which is better than on seroquel as that was 11am. Do you think i will regain my energy in the morning? Will the other medication mentioned above cause any drowsy like symptoms? I feel like ive been drowsy/sleepy the whole year on invega and seroquel.
Its only been 4 months off medication. Do you think my body will readjust over time or is EPS permanent?
Even though ive put on 14 kg, im still healthy, i was around 60kg now im 74kg. And 172cm tall.
Does the fatigue in the morning ever go away? I never had it before medication and could always get up early 5 am, 6, or 7 to start my day. Now i always feel like i havent slept and average 8 am-9am. Which is better than on seroquel as that was 11am. Do you think i will regain my energy in the morning? Will the other medication mentioned above cause any drowsy like symptoms? I feel like ive been drowsy/sleepy the whole year on invega and seroquel.
Its only been 4 months off medication. Do you think my body will readjust over time or is EPS permanent?
Brief Answer:
No serious side effect of trihexyphenydyl
Detailed Answer:
Hi XXXXXXX
Thanks for follow up. I can understand your concern for side effect of drugs.
There is no serious side effect of trihexyphenydyl.It is also not going to cause drowsiness rather it can decrease it in some patients. It will help you to reduce/stop slurring of speech, difficulty in talking, unwanted mouth movements and may also fatigue.
Yes, fatigue in the morning will go for sure.Continuing regular exercise, healthy low fat diet, reduction in weight to premorbid level and use of anti depressant medicines will help for the same. You can regain your morning energy by maintaining healthy lifestyles.
Seroquel and invega have caused metabolic changes and some neurochemical changes which are responsible for fatigue and lack of energy.
Your body will surely readjust over time.How much time it will take that I cant say right now. Duration of recovery depends on your efforts to maintain healthy life style and efforts by treating doctor in terms of phrmacotherapy and counselling.
Wishing you early recovery and good health.
Regards,
Dr.Chintan Solanki.
No serious side effect of trihexyphenydyl
Detailed Answer:
Hi XXXXXXX
Thanks for follow up. I can understand your concern for side effect of drugs.
There is no serious side effect of trihexyphenydyl.It is also not going to cause drowsiness rather it can decrease it in some patients. It will help you to reduce/stop slurring of speech, difficulty in talking, unwanted mouth movements and may also fatigue.
Yes, fatigue in the morning will go for sure.Continuing regular exercise, healthy low fat diet, reduction in weight to premorbid level and use of anti depressant medicines will help for the same. You can regain your morning energy by maintaining healthy lifestyles.
Seroquel and invega have caused metabolic changes and some neurochemical changes which are responsible for fatigue and lack of energy.
Your body will surely readjust over time.How much time it will take that I cant say right now. Duration of recovery depends on your efforts to maintain healthy life style and efforts by treating doctor in terms of phrmacotherapy and counselling.
Wishing you early recovery and good health.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks for your response.
I find it difficult to exercise because sometimes what i tell my legs to do does not always happen. I cant concerntrate on running anymore, where before imwould just do it and barely think about it. Now it tkes all my mental strength and my legs lose coordination and kind of go sideways after a while... Yestereday on a hike it was the same, the forst 3-4km i was fine then my mind became severly fatigued and my legs started walkming mildly sideways. My left leg would walk first not both evenly, and i just couldnt tell my XXXXXXX to tell my legs to go any faster.... They just slowed down... Today i just went shopping with a friend and it was similar, complelty tired fter a good 8 hrs sleep, then we just went to church, had coffee then walked around the shops. By midday i was so mentally tired i felt like it was 11:30-12 midnight... I also found that when i think i cnt just respond quickly to people, it takes force to get the words out. Where before it ws just natural, think and respond. Today it was like think nd i couldnt retrieve thoughts and my mouth felt like it was frozen shut and i had to force my lips open to say what i was thinking.
I eat really healthy, and always excercised, but it seems i can only powerwalk now. Due to the fatigue. I bought a fitbit flex so im tracking how much i do and i try and hit 10,000 steps a day. I know i really need to excercise to lose weight though. But mentally is the challenge, not even physically. My body cn handle it. I feel like if there was some sort of imaginary clamp its clamping around my brain and blocking thoughts and easy thought procceses.
To get my energy back do you think the main thing is that mediction, and excercise. Is there anything in particular you think is a minimum?
I find it difficult to exercise because sometimes what i tell my legs to do does not always happen. I cant concerntrate on running anymore, where before imwould just do it and barely think about it. Now it tkes all my mental strength and my legs lose coordination and kind of go sideways after a while... Yestereday on a hike it was the same, the forst 3-4km i was fine then my mind became severly fatigued and my legs started walkming mildly sideways. My left leg would walk first not both evenly, and i just couldnt tell my XXXXXXX to tell my legs to go any faster.... They just slowed down... Today i just went shopping with a friend and it was similar, complelty tired fter a good 8 hrs sleep, then we just went to church, had coffee then walked around the shops. By midday i was so mentally tired i felt like it was 11:30-12 midnight... I also found that when i think i cnt just respond quickly to people, it takes force to get the words out. Where before it ws just natural, think and respond. Today it was like think nd i couldnt retrieve thoughts and my mouth felt like it was frozen shut and i had to force my lips open to say what i was thinking.
I eat really healthy, and always excercised, but it seems i can only powerwalk now. Due to the fatigue. I bought a fitbit flex so im tracking how much i do and i try and hit 10,000 steps a day. I know i really need to excercise to lose weight though. But mentally is the challenge, not even physically. My body cn handle it. I feel like if there was some sort of imaginary clamp its clamping around my brain and blocking thoughts and easy thought procceses.
To get my energy back do you think the main thing is that mediction, and excercise. Is there anything in particular you think is a minimum?
Brief Answer:
Accept the challenge and you will win, medicine & exercise both needed
Detailed Answer:
Dear XXXXXXX
I can understand your feelings and situation. I appreciate your attitude that you are trying physically though your brain is not helping.
From clinical point of view it is really good that you are aware about your situation.
Psychotherapy can help you to continue your efforts and maintain motivation to become energetic again.
Role of your doctor and rapport with your doctor matters in that case.
If you can accept mental challenge and continue the efforts, you will win.At present your problem seems to be moderate to severe.
Medication can help for sure without affecting weight.
Drugs will remove that imaginary clamp and fasten your thought process.
After medication you can put efforts more easily than at present and later on medication can be stopped .
In conclusion I think both medicines and exercise are necessary.Initially role of medicine is important and later on role of healthy lifestyle.
Hope I have answered your query. If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback so I can improve my service. In future you can contact me directly if you wish with this link: http://bit.ly/drchintansolanki
Accept the challenge and you will win, medicine & exercise both needed
Detailed Answer:
Dear XXXXXXX
I can understand your feelings and situation. I appreciate your attitude that you are trying physically though your brain is not helping.
From clinical point of view it is really good that you are aware about your situation.
Psychotherapy can help you to continue your efforts and maintain motivation to become energetic again.
Role of your doctor and rapport with your doctor matters in that case.
If you can accept mental challenge and continue the efforts, you will win.At present your problem seems to be moderate to severe.
Medication can help for sure without affecting weight.
Drugs will remove that imaginary clamp and fasten your thought process.
After medication you can put efforts more easily than at present and later on medication can be stopped .
In conclusion I think both medicines and exercise are necessary.Initially role of medicine is important and later on role of healthy lifestyle.
Hope I have answered your query. If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback so I can improve my service. In future you can contact me directly if you wish with this link: http://bit.ly/drchintansolanki
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks yes i will do my best... What do you think the slow leg movements are from. Sometimes im fine and can walk at pace with strength but other times like i mentioned i feel they go slower under my body than im telling my brain and so,etimes my body will cause my left leg to walk first and be on a slight diagonal as i walk. It only happems every now and then. But sometimes it will be a sudden drop, ill always be able to catch myself bt then i walk funny.? Is that all a part of the EPS? It was more severe the first 2 weeks i stopped the medication where i could only walk at a shuffle and no matter what i told my legs to do rhey would onlh walk slow?
When im on the treadmill, my head completly looses it after a minute or two and its like i can only control one. Either all my focus on my thoughts away from distrscting thoughts or if i concerntrate on running then i loose my mental control... And my head moves around a bit.. Thats why im worried i cant commit to as much excercise as i used to. Ill try running my driveway though, its 1km long and has one big hill in it.
When im on the treadmill, my head completly looses it after a minute or two and its like i can only control one. Either all my focus on my thoughts away from distrscting thoughts or if i concerntrate on running then i loose my mental control... And my head moves around a bit.. Thats why im worried i cant commit to as much excercise as i used to. Ill try running my driveway though, its 1km long and has one big hill in it.
Brief Answer:
Likely due to EPS,possibilities of anxiety or nutritional deficiency
Detailed Answer:
HI Jenni,
Welcome again.Sorry for delayed response.
You narrated that problem was more severe in first two weeks of stopping medication. After that it decreased but not stopped.
From your narration it seems that it is likely due to EPS.
AS problem is not persistent and sometime you can walk up to some extent without problem suggests there should be no neurological cause.
Considering your history of treatment,there might be possibility that it is due to anxiety also or your anxiety is increasing baseline EPS problem.
There is possibility of some nutritional deficiency of vitamins and minerals specifically vitamin B12 and D3. This may lead to some neuropathy and causing walking difficulty.
To reach to specific conclusion physical and mental status examination are must.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Likely due to EPS,possibilities of anxiety or nutritional deficiency
Detailed Answer:
HI Jenni,
Welcome again.Sorry for delayed response.
You narrated that problem was more severe in first two weeks of stopping medication. After that it decreased but not stopped.
From your narration it seems that it is likely due to EPS.
AS problem is not persistent and sometime you can walk up to some extent without problem suggests there should be no neurological cause.
Considering your history of treatment,there might be possibility that it is due to anxiety also or your anxiety is increasing baseline EPS problem.
There is possibility of some nutritional deficiency of vitamins and minerals specifically vitamin B12 and D3. This may lead to some neuropathy and causing walking difficulty.
To reach to specific conclusion physical and mental status examination are must.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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