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What Causes Schizophrenia?

Posted on Tue, 5 May 2015

Question: I would like a second opinion regarding my 20 year old son.

Answered by Dr. Seikhoo Bishnoi (28 minutes later)

Brief Answer:
Symptoms appear to be due to psychosis

Detailed Answer:
Hello, Welcome to Health Care Magic

I have read the detailed history you provided sad can understand your concern. After reading the history it seems that he started developing his symptoms with anxiety which later progressed to grandiose ideas that he would become millionaire. This worsened in psychotic symptoms like fear, suspiciousness and ideas that govt is after him. Ideas that ghosts has haunted him. These symptoms suggest some psychotic episode more specifically Schizophrenia. As per my opinion he need antipsychotics for his treatment.

Zyprexa is Olanzapine and is safe antipsychotic drug but it is known to cause weight gain, in such case drugs like Aripiprazole can be used. The drug is not known to cause metabolic side effects and can help him. The drug also have efficacy equivalent to Olanzapine.

Few things I would like to know about his symptoms-

If he has shown any violent episode during his illness? Has he landed in any legal problem due to violent episode?

For how long he smoked pot? If he had stopped crack now? Pot or marijuana is known to cause psychosis.

Any other significant symptoms he is showing?

Thanks, please provide the details in follow up so that I can comment with more confidence.

Take care

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

Follow up: Dr. Seikhoo Bishnoi (18 minutes later)

No violence. Occasional pot age 16. Few times weekly age 17-18. Daily and sometimes several times daily in college age 19. Some other drug use in college too but experimentation / not frequent / ecstasy and mushrooms I think. He quit pot 2 months ago. He said it made his thoughts worse. His quality of life seems to be getting worse to me. He doesn't do much for fun and mostly lays around feeling exhausted he says. Thank you so much.

Answered by Dr. Seikhoo Bishnoi (12 hours later)

Brief Answer:
His symptoms doesn't classically fit into Schizophrenia

Detailed Answer:
Hello again and thanks for asking a follow up question

Pot or Marijuana smoking is known to result in paranoid psychosis and it can precipitate acute transient psychotic disorder. His drug use strengthens the fact that he has developed psychotic symptoms. He has never shown violence or violent behaviour which is quite common in patients of bipolar disorder of his age. Over all his whole history points more towards Psychosis and to label it as Schizophrenia detailed evaluation is needed.

He is showing suspiciousness and paranoid feelings which got aggravated after reading conspiracy theories. He is not having any history suggestive of auditory hallucinations which is common in Schizophrenia. So I would like to correct my provisional diagnosis and will keep Schizophrenia as next possibility once Psychosis precipitated by Pot is ruled out. Paranoid psychosis is almost related to Schizophrenia but doesn't fit into classical classification systems.

Continue to give him his medicines or discuss with his psychiatrist to add some metabolically safer drug (as weight gain is one issue) like I have mentioned earlier also as Aripiprazole. This would result in improvement of his symptoms and he would feel better. Continue to give him Effexor as per prescription as this would help in his depressive symptoms like persistent fatiguability, poor social life, poor desire, increased sleepiness, worsening anxiety etc.

I hope this helps you. If you want to clarify more doubts or have some more questions please don't hesitate to ask again in follow up.

Thanks

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

Follow up: Dr. Seikhoo Bishnoi (15 hours later)

Thank you so much. My son confided something to me last night. He said his symptoms of ghosts and fear of haunting began right after trying ecstasy. He also said a friend peer pressured him into taking too much of it at once. I am thinking this will correlate with your opinion.

I am going to discuss with his doctor the medication you mentioned above. We have an appt tomorrow. Do you think the abilify will make him less fatigued or just less appetite?

Do you think he should consider increasing his effexor to boost his energy?

Last question - Do you have an opinion about the chronic pain he has been having since age 16 and why it improved a lot with the antipsychotics?

Thank you so much!

Answered by Dr. Seikhoo Bishnoi (33 minutes later)

Brief Answer:
Ecstasy is known to cause psychotic symptoms.

Detailed Answer:
Hello again and thanks for asking a follow up question

Ecstasy is MDMA and there are several case reports that found use of MDMA associated with psychosis. He has also smoked pot for long and this also has probably precipitated psychosis. MDMA also cause neurotoxicity and this drug should be avoided.

Please sit besides your son and try to advise him to avoid use of these drugs in future. Try to make him learn to say NO in peer pressure.

Talk to him doctor. Abilify would not cause weight gain and he would feel less sedation with that drug. Efficacy of this drug is comparable to Zyprexa.

As per my opinion main concern at this point should be to correct his psychotic features. No need to increase Effexor doses at this time. With improvement of his symptoms his energy level would improve.

His chronic pain improved a lot with anti-psychotics because that pain was somatic pain. Somatic pain occurs in individuals with anxiety and depressive symptoms. Antipsychotics also help to relieve anxiety and this resulted in improvement in his pain.

Thanks, I hope this helps you. Please don't hesitate to ask again for more doubts.

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

Follow up: Dr. Seikhoo Bishnoi (5 minutes later)

Thank you - you are amazing!

Answered by Dr. Seikhoo Bishnoi (4 minutes later)

Brief Answer:
Thanks for your appreciation.

Detailed Answer:
Hello again

Thanks for appreciation. Please contact again if you want more help to if you want to clarify more things. Wish you and your son a good health.

Thanks

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

Follow up: Dr. Seikhoo Bishnoi (22 hours later)

Hello again, I hope it is ok that I write another question. Also, thank you for the advice regarding peer pressure. I will definitely work on this with him. We had the appointment with his psychiatrist today. I mentioned switching to Abilify and his doctor felt it was too closely related to the latuda, which was the third drug he tried. My son developed akathesia (?spelling) from this drug and could only tolerate it for 3 days. The doctor also mentioned he wasn't sure Abilify would be strong enough and he was also hesitant to make another drug change since he is relatively stable. We go back in 2 weeks to see his colleague, who he said may have a different opinion.

I am wondering if you think my son will have akesthesia from Abilify given his response to Latuda?

Drug history -1. seroquel - took 4 months - couldn't increase dose high enough to be very therapeutic because of constant sleeping. 2. Risperdone - took 4 days but hot flashes, dizziness, and tachycardia/heart racing did not improve after 4 days and my son didn't want to take any more. 3. Latuda - took 3 days but had intolerable feelings of inner restlessness. 4. Current med - 25 lb weight gain, increased LFTs (monitoring again in a couple of weeks) and excessive fatigue.

Should I try to address Abilify with the new doctor in 2 weeks?

Thank you!!

Answered by Dr. Seikhoo Bishnoi (44 minutes later)

Brief Answer:
Aripiprazole is known to cause akathisia

Detailed Answer:
Hello again and thanks for asking a follow up question

Abilify and Latuda both belong to same group of drugs. These drugs are thought to be safer drugs in terms of metabolic side effects. Akathisia can occur with Abilify but it can be managed easily with drugs like Propranolol.

Your son has already been to three different drugs because of side effects so I would like to correct my opinion. Zyprexa can cause significant weight gain but the drug is a good drug. He is showing response with the drug as you have mentioned. So as per my opinion continue to give him 5 mg doses of drug.

Now regarding Akathisia with Aripiprazole. Aripiprazole is known to cause akathisia but that is usually controllable. Aripiprazole cause dose dependent akathisia and this is seen with high doses only. He is on 5 mg Olanzapine and this is not very high dose so he would not need high dose of Aripiprazole, and even he developed akathisia with Latuda still I don't think he would develop serious akathisia with Aripiprazole.

Don't think to change his doctor. This may worsen his clinical situation. So for some time continue to give him Zyprexa.

Thanks. I hope this helps you.

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

Follow up: Dr. Seikhoo Bishnoi (3 days later)

Thank you for the response. I had to think about it for a couple of days. We go to the doctor every two weeks. His current doctor is leaving the practice for one year, so we have to see his partner next time. My son's level of functioning seems to be declining. He hasn't done any college home work for several weeks. he told me yesterday he doesn't think he can work such long shifts at work - he works two 8.5 hour shifts per week! He has been going to classes and says he is passing, but I'm not sure. he takes 3 classes. His doc increased his Effexor from 75mg to 150 mg and it isn't helping his energy and motivation. My son sits home laying around on couch even on Friday and Saturday night. He used to be a very high functioning high school student - driven and motivated. He now says he thinks this is his last semester of college. He wants to make money by doing things that aren't realistic and it is making me very angry. I try not to show him how angry I am because I know how sick he is. He spends his spare time lately writing a children's book because he saw someone make a lot of money online by doing this. He gets ideas that are unlikely to happen and he has no interest in a college education. I don't know what to do. Thank you so much. Do you get paid each time you respond because I feel guilty asking so many questions. Sincerely, XXXXXXX

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
Keep patience and give him proper drugs and he would improve

Detailed Answer:
Hello again and thanks for asking a follow up question

I can understand your situation, it is very common to see change in behaviours and perception towards patients in close caregivers of psychotic patients. Due to his changed behaviour and poor performance your anger is justified but please try to control it in front of him. Try not to show your anger in front of him because this may worsen the situation. You may loose the rapport in front of him and he might not confide in you. Please handle this situation in a balanced manner.

He has smoked pot, ecstasy and these drugs can precipitate paranoid psychosis in patients. Chronic cannabis use is also known to cause amotivational syndrome like condition in which individuals remain tired, fatigued and start to miss their daily routine. But with proper doses of medicines and proper drugs these symptoms would reduce. He is on 150 mg Effexor and this is high dose of drug. As per my opinion wait for a couple of weeks and if condition remain same then consult the doctor for change in medicine or to supplement the medicine with some other drug.

His abnormal behaviour like writing a story book, skipping classes etc is due to psychosis. Continue to give him his antipsychotic drugs and wait for some time, he would come out of his symptoms. Please keep patience.

Also please don't hesitate to ask questions at any time, and don't feel guilty for questions. A usual question is associated with two-three free follow up questions and you can ask questions without any hesitation.

Thanks, Take care.

Note: For further guidance on mental health, Click here.

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