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What causes psychosis in a patient with typhoid fever?

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Posted on Wed, 18 Nov 2015
Question: My son (aged 21) was treated for typhoid psychosis. He was admitted and discharged. He was initially prescribed a course of tegretol and olanzapine (10mg) for sixty days. Chlorpromazine was later added because he wasn't sleeping well, but after some time, his sleep became normal and he discontinued taking it because of the lethargy he would feel the next day. As of now, his thinking is very normal, but he has some memory problems

What are the long term effects of these drugs, and how long should such treatment last?
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Answered by Dr. Chintan Solanki (12 minutes later)
Brief Answer:
need to reduce the dose of olanzapine gradully

Detailed Answer:
Hello,

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

Psychosis is common during or after typhoid fever. In that anti-psychotic medicines are used. It is good that chlorpromazine has been stopped. You did not mention the dose of tegretol. It should be decreased or stopped if he has no agitation. Olanzapiine can be reduced to 7.5 mg and gradually reduced to 5 and 2.5 mg at every month interval if he is completely fine and then stopped. 10 mg for olanzapine is not needed for 60 days in such cases as it can cause sedation and drowsiness and due to that memory problem. Discuss this aspect to his treating doctor and if psychiatrist is not consulted consult the same once.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Chintan Solanki (41 minutes later)
Thank you. That is helpful.
Mentally, my son seems to be doing fine, aside the memory loss, but he is very resistant to taking the drugs (especially chlorpromazine) because of the dulling effects. Also they are expensive.

His initial 60 day prescription of both the tegretol and olanzapine are almost finished (four days left). What are the implications for stopping the olanzapine without reducing the dosage over time?

I don't understand this sentence: "Discuss this aspect to his treating doctor and if psychiatrist is not consulted consult the same once."

Our discussions with the doctor have not been too helpful. He is a doctor of the old school who doesn't want to be asked any questions. He wanted to extend the prescription and add chlorpromazine (100 mg) back in, even though it had not been part of the initial prescription and when it was prescribed it was at 50mg dosage. So I became concerned and wanted a second opinion.


I've been concerned also because his leg has had some problem with swelling, which I've read can be a side effect of olanzapine.
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Answered by Dr. Chintan Solanki (9 hours later)
Brief Answer:
sudden stopping olanzapine may cause sleep disturbance

Detailed Answer:
Hello,

Thanks for follow up and sorry for delayed response.

Sudden stopping of 10 mg of olanzapine may cause sleep disturbance, fatigue, lethargy and decrease appetite. In some cases psychotic features may reappear if drug is stopped suddenly. If he is completely fine he can stop within a month by reducing 2.5 mg dose every 10 days. I always recommend stopping slowly.

If you are in XXXXXXX Chlorpromazine is one of the cheapest drug in psychiatric problems and in olanzapine Tolaz is the cheapest.

His treating doctor is not psychiatrist and olanzapine and chlorpromazine have been given by physician I suggest visiting a psychiatrist will help to discuss and use these drugs effectively.

I do not recommend that olanzapine should be continued in same dose after 2 months in first psychotic episode after typhoid. And there is no need of chlorpromazine at all as with 100 mg it only helps in sleep. You can change the doctor if you wish.

Swelling in one leg cannot be caused by a medicine. If it is on both sides we need to check for drug. However with 2 months of use olanzapine no significant weight gain is there. Better to go for physical examination by a doctor and liver function tests for his swelling of limb.

Feel free to discuss further.

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

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Practicing since :2007

Answered : 2406 Questions

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What causes psychosis in a patient with typhoid fever?

Brief Answer: need to reduce the dose of olanzapine gradully Detailed Answer: Hello, Thanks for writing to us. I can understand your concern for your son. Psychosis is common during or after typhoid fever. In that anti-psychotic medicines are used. It is good that chlorpromazine has been stopped. You did not mention the dose of tegretol. It should be decreased or stopped if he has no agitation. Olanzapiine can be reduced to 7.5 mg and gradually reduced to 5 and 2.5 mg at every month interval if he is completely fine and then stopped. 10 mg for olanzapine is not needed for 60 days in such cases as it can cause sedation and drowsiness and due to that memory problem. Discuss this aspect to his treating doctor and if psychiatrist is not consulted consult the same once. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.