Brief Answer: Both drugs and therapy Detailed Answer: Hello & welcome to HCM! I have read your question and it says that you want to know about the treatment of OCD. (Cure is by treatment only- many times even drugs are stopped and patient may remain well thereafter: especially when treatment is started at early stage of illness). OCD is a psychiatric disorder, which is treated by two lines of management. 1. Medicines eg. - fluoxetine, fluvoxamine etc.. 2. Therapy (usually- exposure and response prevention). Depending on the patient's condition, one is able to decide how to proceed with the treatment line. Many times the patients has a long standing OCD & no insight into the illness:-- at that time it is not possible to go with therapy at all. In such cases, the treating doctor starts the drugs and then with response one may initiate the therapy as well. ### From my clinical experience can say that many times the patients get completely well with medicine only, so there is no need to go about with therapy process at all. #### In OCD, it is better to diagnose the condition in its beginning itself and start the treatment. It becomes difficult to treat as the years pass by. Hope this answers your query Please feel free to ask more questions for any clarification If you are satisfied, please rate the answer and close the query. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Medicine will help a lot, please move ahead Detailed Answer: Hello, It's well understandable that you have severe anxiety, may be OCD is your self diagnosis after reading symptoms over internet. From the description you have given now, your case is more like of severe anxiety with may be OCD symptoms as well. -- I must tell you that even the most severe patients have very good respons with in few days of starting medicines. There is not just reduction in anxiety and fear but also mental relaxation and boost in confidence. Your sleep and daytime activities will also improve significantly. I would advice that you should take an appointment and go along with a family member or close friend. There you may talk to the psychiatrist and discuss the symptoms in detail. From my clinical experince I can say that initially you should only be put on anti anxiety medicine and later when there is atleast 50 -60% response , one can initiate therapy sessions. Please meet a psychiatrist: as one must interview you in person to start accurate treatment. # I know this anxiety appears very distressing to you but I can assue that you will become good with in a few days of starting drugs. Hope the reply is useful Feel free to ask more questions for clarification If you are satisfied, please rate the answer and close the query. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Please read below Detailed Answer: Hello, The name of drugs given by you in the last question -abilify, and trihexphenydly with Xanax are not very usual treatment options of anxiety disorder. You may be having some other baseline diagnosis and over that you have anxiety, restlessness, agoraphobia etc. The way the question was put initially did not reflect symptoms but later in second question the description was more in favour of anxiety ...however, abilify is an antipsychotic and not used / not very effective in this disorder. Trihexphenydyl is used to counter the side effects of Abilify, nothing more.. Xanax is helpful in reducing anxiety temporarily, it does not help in curing the illness. You have not mentioned the name of the natural ingredient which seem to suit you ..But from my clinical experince I can suggest you that do not take the decision to stop your medicine in hurry, you must consult your doctor before taking such step. You donot know if the supplement can actually replace the necessity of drugs or not. It may happen that the illness comes back with more speed and strength. ### Switching to clonopin is not a good option to me , as it has addiction potential and it's effect weans over with time...you may take it on SOS basis ..moreover, Xanax is already serving the same purpose which clonopin would do...so, why to shift? ## Please ask your doctor about your complete diagnosis, and if it is anxiety you can discuss why is he giving you abilify and not an anti anxiety drug as a first line managment? He will be able to clear the doubts. # also get your thyroid levels and serum B12 leves done, they might be altered. Corrceting them always help in reducing the illness. Hope the reply is useful for you Please feel free to ask more questions Dr. Manisha Gopal MD Psychaitry

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Brief Answer: I suggest to add/ change the medicine Detailed Answer: Hello Now the things are clear as the diagnosis is paranoid schizophrenia. It is commonly seen that such patients develop anxiety along with the main illness. ### From my clinical experince I would suggest you that donot even try to stop abilify or Trihexphenidyl on your own ever. No supplement has ever been reported by any good medical research organization which can replace proper medicines. If any of my patients with similar diagnosis (as ours ) develops significant anxiety, I go for following options:- 1. add some anti anxiety drug to the existing regimn- paroxetine, escitalopram etc. 2. or may shift him to another medicine which has both anti anxiety and anti psychosis effect - like: amisulperide, or quetiapine, etc. 3. and give Xanax or clonazepam to be taken on SOS basis. So, it will be good for you to talk to your doctor about the above mentioned approaches and medicines. Do not try to do drug changes on your own, it might lure you but you are too young to risk your life with this.. ## I have seen that many times when the psychosis is not controlled sufficiently, the patients develops anxiety. Here, only by increasing the dose of antipsychotic ( abilify in your case) solves the problem. Your case however reflects that there is a separate diagnosis of anxiety and one needs to add the drug or change the medicine altogether. I hope that the reply helps you in handling your problem Please ask more questions for any clarification if you need. If you are satisfied, kindly close the query and rate the answer Wish you good health Dr. Manisha Gopal MD. Pscyhiatry

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Brief Answer: please answer following questions.. Detailed Answer: hello, You have asked if it will be OK that you add paxil to the current medicines. Well, this is one of the commonly used methods to treat severe anxiety associated with any psychotic illness. However, to be sure of what will be best to do (adding a drug or changing to a new drug ) depends on other factors as well. Tell me if - 1. your psychotic symptoms are well controlled with current medicines? 2. how is your sleep? 3. for how long have you been on abilify? 4. from how much time do you have had this "severe anxiety", NOT just "some fleeting anxiety"? From the reply to above questions I would be genuinely be able to suggest the most helpful way to proceed. * try to reply about the psychotic symptoms clearly. Please feel free to ask more questions for any clarification. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Shifting to new drug would be better Detailed Answer: Hello, 1. abilify 5 mg is very low dose. It is good that psyhcotic symptoms are controlled on it. But I cannot understand why are you on Trihexphenidyl ( THP) ? At such low dose of abilify: it is very uncommon to have side effects which need THP. THP is usually given along with resperidone etc which are notorious to lead to side effects. Do you really need it now? 2. Secondly, your prior medicine combination had Ativan , which again is used for sleep or to reduce anxiety. Now also you have complaint of disturbed sleep. So, there are two things - a- That if any time in future if you ned to increase the dose of abilify, it will not possible as already it is giving you side effects at a very low dose 5 mg (as you are taking THP to treat them). b- & that there has been consistent sleeping problem which is not managed properly 3. Looking at the above two points, I would not like to add Paxil to the current regimn, but would like to shift such a patients to a drug which can: # give you sleep and reduce/ treat anxiety along with controlling psychotic symptoms ## not give side effects so that we can look towards stopping THP ### if needed, we may add something for panic attacks for some time in the begining I have seen very good response to quetiapine in such cases. This molecule has an intrinsic property of sedation, so it is preffrably given at night. It is also used in cases of severe anxiety, and I have seen very good response in such patients. It would also not cause you side effects most probably, and therefore we may not need THP. I'm positive about this new drug (as your symptoms are well controlled on a very low dose of abilify), this signifies that illness is not severe. So, quetiapine can be used safely without any major risk of relapse. I think you should discuss these points with your treating doctor. He would know how to go about the gradual change in medicines. Please ask more questions for clarifications I hope the reply is informative for you Dr. Manisha Gopal MD Psychiatry

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Brief Answer: I think the new drug will be better..be hopeful Detailed Answer: Hello, You are right in saying that Xanax should be avoided, as it has some addiction potential. That is the same reason why I want that you should switch the medicine altogether. The other doctor ( it looks like that he is a psychiatrist ) has mentioned almost the same drugs which I have advised, like - seroquel , which is the brand name of quetiapine only. Paxil ( paroxetine )- however may be used if seroquel( quetiapine ) alone will not be able to handel the anxiety component. But at least one may tryit alone initially! Many times my patients have significant relief with it in their anxiety as well. And also, seroquel - is good as it will give you a mush needed sedation. Your impatience, nervousness all are a part of anxiety spectrum. With proper and adequate medicines I am very hopeful that you will be able to take your life and health ahead in a positive mode. ## look jobs will come and go all the life....only living people have problems. So, problems are sign of life!! Everyone has them, we just donot know other people part of problems....So, NEVER EVER give up in life... You have made so much efforts in putting down the questions, explained all the issues in such beautiful detail that I am able to help you from a long distance...you have a beautiful mind, we just need to calm it down!! nothing else..it is simple... ## I can assure you that you are amongst the simple patients in psychiatry....there are so many which have hell lot of issues, comorbidities and other factors which hinder the treatment process. Please meet a psychiatrist and discuss about the possibility of switching to quetiapine...he will know how to do so. If you have any issues, please feel free to discuss them with me. If you feel satisfied, then you may close the questions and rate the answer Wish you good health! Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Thank you too! wish you good luck Detailed Answer: Thank you too! You do have a beautiful mind ( as I have said earlier) and anyone who is observant enough would come to know this easily.. that's why your friend say so! You may do the following things when you visit your doctor next- 1. make a list of your problems which you want to discuss with him 2 apart from medicines, ask him about some dietary changes which may help you, Or may be just read on net and discuss with him 3. ask your councillor how to reduce your public speaking anxiety/ phobia of going out.. 4. and some breathing exercise if possible. #In India we have some very good yogic exercises which help in healing and calming the brain. You may see them on internet ( videos) and then try to practice them. ##You may also try to run!! Yes, it is a quite simple but highly effective mean for relaxing ones mind. Running secrets endorphins--> leading to happiness--> means reducing anxiety and fear!! ### You are good in silent writing communication, but this is not enough...you are extrovert and you will be happy talking to the people in face to face...so, Go ahead..everyone has capacity..we just need slight push and determination! I hope you get well soon Please ask more questions if you have, I will be pleased to answer them. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Please read below. Detailed Answer: Hello, Yes, you are right in the treatment approach according to my clinical point of view.. And the symptoms of not feelng comfortable in crowds, feeling restless on red lights, and buildings, have difficulty in driving far off places away from home: are mainly reflective of Agoraphobia and claustrophobia. Thes are part of anxiety spectrum and all of these resolve with the drug which will reduce the anxiety. So, you will not need anything additionally for such symptoms. ## I'm sure that you will get well. Please take care of one important thing- you are very young , so, never try to stop the treatment even when you are 100% good. Always take advice of a psychiatrist before planning to do so (I'm sorry to say, but even a trained councillor, if he is not a psychiatrist, cannot guide you for this matter and should not be consulted for such things....as it is related to medicine and they are only trained in therapies). Good luck! please ask more questions for any clarifications if you have. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Explained below.. Detailed Answer: Hello You want Side effects of seroquel and clonopin. Clonopin is sedative and this is both effect and side effect!! ( when more sleep is there ),. and may be addiction potential,..but you are mature enough to watch it out yourself.. Seroquel- it can cause weight gain, but so would any antipsychotic ( however it is comparatively less )). One may prevent that too by : --being more active, --- taking regular walks, ---and of course keeping a check on what you eat. ### And no one gets fat without eating, so, just be alert of what you eat. Eat healthy, -more of salad, --fruits and ---less or no junk food,---- low oil food,----- best will be homemade stuffs. Moreso, I don't think you will have this weight gain problem , as your symptom profile and history of having good response with verb low dose of abilify suggest that you will have improvement with low dose of seroquel as well...so, it will be weight neutral. Don't worry so much, this will be helpful. move ahead positively so that your body also listens and helps you. All the best!! Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Keep ur self active and anxiety free! Detailed Answer: Hello, It is not just a great way to handle weight gain issue , but the most suitable and smart way. I have seen my patients who are on one or other antipsychotic--only the ones who are lazy and careless about their life style and donot work out, they gain wieght. I have never seen anyone who does workout regularly, or is a field worker, farmer, etc..such conscious people never gain weight. So, look forwars to kill your anxiety and getting better. Donot fear weight gain..keep motivation level high and check what you eat!! Wish you all the best. Dr. Manisha Gopal MD psychiatry

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Brief Answer: Please read below Detailed Answer: Hello, I had understood the reason why you were on THP with abilify, it is most commonly aka thesis only ...one who develops this gets irritated by this side effect. and usually we have to switch the drug, as akathesia incerease with increasing the dose. Akatheisa is a feeling of moving your leg continuously, one may put it in a way that it is a desire to move around unnecessarily. You can rule out OCD from it as- --this will start after staring abilify and not from the beginning. - not much response with anti anxiety drugs on this - THP reduces it - in OCD patient makes any movement to satisfy some need / thought of fear...here, in akathesia there is nothing related, it is just a sense to move legs.. ### One may boost motivation by having motivational enhancement sessions with councillor ( as you are in touch with one, so you can take his help) Or, by making a dairy of motivation, witirting what good you did each day and how more you want to improve Or by putting good motivational quotes in your room, home, where they are visible to you all time. .they do work! Or one may put good posters of ones favourite celebrity and feel posiistive You can join walk / yoga / gym groups, socialise with positive people, people who understand you and are communicative. You are extrovert by nature as you mentioned, so this is not going to be a major task for you at all. What you need is to reduce the anxiety of going out..then everything will be done. Hope this helps you out.. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Your real self will remain the same. Detailed Answer: Hello, You have said that you feel yourself to be an introvert person. But the points that - 1. you like to talk to people, 2. want to roam around ... Suggest the possibility of some extrovertism or may be normal going person, not an introvert. you only like to have few friends, which I think means having few good ones! And that is an intelligent thing to do. one who had few good true friends is better off compared to one who has many friends but none to rely on. What ever it may be, the medicines never change your real self but just give you back what you have been prior to illness. So, need not have any fear for the same. You may injoy your peace being alone if you are an introvert or enjoy with crowd if you happen to be an extrovert..once you get better!! # though it is never good to be ill but psychiatric illness makes one more sensitive to other people feelings and emotions. you donot take life for granted anymore.. Hope this helps you Feel free to ask more questions for clarifications. If you are satisfied, please rate the answer and close the query. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Always be positive and courageous! Detailed Answer: Hello, First- you are right in saying that " take one day at a time", this is a very intelligent thought and easy to apply also. When we have to cover long distance, or achieve some big goal: we should take one step at a time, and take one day at a time.. Second- you are already a good person, young and are aware that you need some help...your councillor and doctors will give you what ever genuine help they can...rest is your efforts, which I'm sure you will definitely put up! With medicine you will be able to do relaxation exercise, follow the daily activities as told by your councillor / doctor. This will bring about the complete mental and physical well being. Always be positive and welcome life...we get double of what we give to universe...so, always try to be positive and have courage. wish you best of health ! Dr. Manisha Gopal MD psychiatry

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Brief Answer: Good luck Detailed Answer: Thank you and Good luck Please feel free to ask more questions in future. Dr. Manisha Gopal MD psychiatry

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Brief Answer: follow my earlier suggestions Detailed Answer: Hello, Please follow my earlier suggestions. I have tried my best to help you. I will be out of town for some time and will not have access to the internet. Hence, I request you to close this discussion and write a positive review for me. Thank you and take care!

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