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Doctor Rao
Doctor Rao, Doctor
Category: Mental Health
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Experience:  MBBS,MD,DPM,MRCPsych
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Dear Sir,I would like to discuss with you something very

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Dear Sir, I would like to discuss with you something very important again : Dear Sir, Following are my two Psychological test reports, one from Guwahati Psychiatric Hospital and the other from Apollo Hospitals, Chennai. 1) (Guwahati) ::: The test findings are suggestive of a diagnosis of Schizophrenia with features of severe anxiety and obsession. 2) (Apollo) ::: The neuropsychological report of Mr. xxxxxxxxx shows low average intellectual skills. His memory functions are at a low average level. His personality profile shows features of depression and a co-existent psychotic illness - schizoform with paranoid content. 1) Yesterday, u had advised me to go for Clomipramine cocktail. Sir, my over-all conditions (except Obsessions) are such that ESCITALOPRAM works good for me. Sir, whether Escitalopram can tackle Obsessions ? (Earlier I used to take 20mg Escitalopram per day but it didn't help me in obsessions but it treated my other conditions). Sir, my request to you is, whether you would advise me to go for a higher dose of Escitalopram or do u think the earlier combination of mine (Clomipramine 75 SR, Aripiprazole 15mg, Pregabalin 150mg, Clonazepam on sos) is better for me for all the mentioned conditions ? 2) Sir, do i need Valproate/Lamotrigine too ? If 'Yes', which one is better for me ? 3) I am a very depressed person, i dont like to go out of home out of social fear, i dont at all like taking bath, I dont like to brush my teeth.....Sir, are these 'Negative' symptoms of schizophrenia ? Sir, In the end , I would request you to kindly suggest me your BEST prescription for me which I shall discuss with my local doctor here. Thanks.

Submitted: 2 years ago.
Category: Mental Health
Expert:  mysticdoc replied 2 years ago.
Hello,
Thanks for your question.
You were working with a different expert before.
Currently your question is in medical category.
Are you willing to continue with me and leave a good rating after your questions answered satisfactorily?
Customer: replied 2 years ago.

Sir, My question is under Mental Health Category, are you a Psychiatrist....plz dont mind for asking.

Expert:  mysticdoc replied 2 years ago.
I am an internist trained in psychiatry as well.
Customer: replied 2 years ago.

ok sir, i m willing.

Customer: replied 2 years ago.
Relist: Other.
I am waiting for Dr. Rao (Psychiatrist) to talk to.
Expert:  Camille-Mod replied 2 years ago.

Hi,

My name is XXXXX XXXXX I am the Moderator for this topic. Dr. Rao is not available right now, but I have sent him a message to follow up with you here, when he comes back online. If I can help further, please let me know. Thank you for your continued patience!

Camille

Customer: replied 2 years ago.

Thanks, XXXXX XXXXX been waiting since a long time for Dr. Rao, Please do connect me to Dr. Rao (Psychiatrist) as soon as he comes online, PLease.

Expert:  Doctor Rao replied 2 years ago.
Hi,
Thank you for extra information.I can understand that it might be confusing for you to have what might appear as conflicting psychological reports.But, if we look at the reports the contents of the reports reflects the discussion we have had in the last few days.

Now coming to some of the symptoms you have mentioned might appear like negative symptoms of schizophrenia. It is important to note some negative symptoms of schizophrenia.but, you need to know that some of these symptoms can mimic or confused with depressive symptoms.

The negative symptoms of schizophrenia include(please not that these are only some symptoms and list is not exhaustive).

Find little or no pleasure in life. You may not enjoy things you once enjoyed, such as playing sports or video games or visiting with friends. This is a common symptom of schizophrenia.

Feel like you have no emotions. You may not smile or frown, make eye contact, or use other facial cues that show how you feel. Or you may have emotions that don't make sense to others, such as becoming angry with strangers.

Have a hard time focusing or paying attention. You may not understand how to use information well and feel confused. You may not have whole thoughts.

Not be interested in succeeding or meeting goals.

Not take care of yourself. You may not bother to wash, do laundry, or clean your living space.

Not talk or make only short statements.

Have a hard time starting or finishing tasks. These include everyday tasks such as eating, bathing, or grooming.


Now coming to the medication and management ----The medications you are on are helpful. If you find the escitalopram helpful but not at 20 mg dose, you can not increase more than 20mg. More over you have told me that it wasn't helpful for all your symptoms in the past. Clomipramine is helpful obsessions and low mood.we are also aware that sometime depression can occur following an Schizophrenic episode and clomipramine is helpful. The other medication i have mentioned the rationale why your Psychiatrist have prescribed.I will repeat again here.

1.Aripiprazole dose range can vary from 5 mg to 20 (needs to start low dose with gradual increase) is helpful for some of the thought process you have experienced and also acts as an adjuvant to antidepressant.

2.clomipramine-As i have mentioned above is helpful for obsessive symptoms and depressive symptoms.

3. Pregabalin (dose range from 75 mg to 300mg) --is helpful for your anxiety symptoms.

You were on Lamotrigine which is helpful for depression and mood stabilizer.But as your New Psychiatrist suggested it might be helpful to try 1,2 and 3 first to the therapeutically maximum safe doses first.So, stick to 1,2 and 3 first.

Clonazepam 0.5 mg SOS is helpful in the short term but I would not recommend this on the longterm and if you can avoid this it might be helpful.

So,please stick to one Local Psychiatrist and follow his/her advice. As long as they are qualified and specialized it is better to stick to one Doctor to maintain consistency.

I can appreciate it is anxiety provoking for you but first try 1,2 and 3 for at least few months to see the benefits. If either no or partial response then you can discuss the possibility of adding mood stabilizer like Sodium valproate or Lamotrigine. (please note that both are effective and you have not had any side effects to Lamotrigine)

You might want to exercise some patience and pursue the medication.I know you said CBT did not helped in the past but you might want to get help from online resources like Moodgym (please google MoodGym).

I wish you all the best.

Thank you
Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience: MBBS,MD,DPM,MRCPsych
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