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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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my son went into hospital with slight hypomania and start of

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my son went into hospital with slight hypomania and start of manic episode..He was put on high doses of seroquel and risperdal along with ambiem to sleep ..he continued his lithium and lamectal treatment he was on but sadly within a few days he was escalating and ended up fully psychotic and we thought it was the risperdal so they stopped that and increased seroquel..discharged fully psychotic and ended back in after 5 days totally out of his mind...took him off seroquel and put him on latuda which made him manic...he has stayed on his lithium and lamectal.Was released after 7 days and it was a nightmare since then he was manic and psychotic...6 days later he was hospitalized again fully psychotic and hypomanic..We tried ambiem with benadryl and nothing. A couple of days before the outpatient dr. put him on risperdal 2mg am and 2mg pm and was weening of Latuda. He did not make it so we ended up in the hospital on the 14th and was put on 3mg risperdal am and 3mg risperdal pm. He was so psychotic and was not sleeping with ambiem I realized the ambien was making him not sleep and psychotic..stopped it and gave him temazepal which helped him sleep. He has come down from mania and now a bit psychotic just reading into things or words but no voices, hallucinations or delutions beginning to understand what he went through and surprised so coming to reality. The last 4 days of treatment he was hurting so bad and even though they are giving him the congentin he is in pain restless, can't sit still , feels his skin is crawling, totally drugged out and says he can't stand the way he feels inside makes him want to die cause it is miserable...He started waking up at night again with panic and confused and scared and I told the dr. that in the past they risperdal worked to bring him down but then they had to start reducing cause it was affecting him more negatively..He agreed to lower the bedtime dose by 1 mg so 2mg bedtime and 3 day time. He slept through the night soundly and woke up feeling better until he took his am meds and the anxiety and resltlessness confusion depressed sad all started within an hour and a half or so.. He just got released today and it was horrible he has been sleeping trying to fight off the inner anxiety and restless ness he has been crying saying he can't take it or live like this..it feels horrible inside and he only has a bit of tuning into things or people but he is aware it is not real...The dr. had agreed to lower the day dose by 1 mg to make it 2 mg bedtime and 2 mg am but because my son is flipping out I want to reduce the bedtime to 1 mg or 1.5 he has been at 2 mg for two nights now..then I can reduce the am tomorrow to 1 mg or 1.5 mg What do you think? this happened last time in 2010 he as on an 25 mg injection plus 2 mg am and 2mg bedtime and it was so sad how he was hurting I had him refuse to take that med and within 3 days he was much better when the dr. came back he was angry but the nurses had noted the difference so he could not argue. We agreed to discontinue the shot and lower the dose which he did to 2 mg am and 1 mg bedtime and then 2 days later he was discharged on 1mg am and 1 mg bedtime. That was a big shift and improvement by lowering his dose.5 days later the outside dr. lowered it to .50 am and .50 pm and it was good. Well it be safe to lower to 1 mg from 3 in am or go to 1.5? and is it safe to go from 2mg that he has been for two nights to 1mg or 1.5mg. My son also had a similar reaction with abilify and almost made his suicidal from the inner discomfort. Help
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Vikas replied 1 year ago.

Dr Vikas :

Hello ! Thank you for your question, I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you today.

Dr Vikas :

The usual dose range of Risperdal is from 2-6 mg per day. We sometimes increase or decrease dose depending on the clinical response.

Dr Vikas :

As such there is no harm in reducing the dose by 1 mg in my view.

Customer:

Yes please I want to lower the risperdal..he has been in a nightmare of treatments the last 40 days with 3 hospitalizations and all improper dosage or med...now he is hurting so his clinical response was good for bringing him down from psychosis and mania but now we have the opposite

Dr Vikas :

however the only problem in doing this is that his symptoms may become worse.

Dr Vikas :

has be been screened for Risperdal induced side effect like Akathisia?

Dr Vikas :

are you there?

Customer:

It was reduced by 1 mg at bedtime since he was waking up feat, anxiety, panic etc..that was 2 nights ago . Today the dr. was going to start tolower the am dose tomorrow by 1 mg so he would be on 2 am and 2 bedtime mgs. but it is severe . He had not been tested. He wants to stop all meds if he is going to feel like this.

Dr Vikas :

please go through the link I have given above

Dr Vikas :

do you think that his symptoms are matching as those mentioned in that article.

Customer:

That is exactly what he has and it is bad...today he was flipping out with discomfort and inner pain. His mind is better but the other is worse now.

Customer:

This happened in 2010 and they reduced pretty quickly after that within a few days he was down to 1mg am and 1 mg bedtime and 5 days later to 1 mg per day. much better after that.

Dr Vikas :

See, it is possible that he is experiencing this typical side effect which is commonly reported by many patients taking antipsychotics.

Customer:

He had the same thing with abilify and wanted to die

Dr Vikas :

in such cases, simply adding some medicines like benzodiazepine or trihexyphenidyl or propranolol by his doctor should be enough in controlling these symptoms.

Dr Vikas :

see, for acute psychotic symptoms, patient may require higher dose of Risperdal to control his or her symptoms however few patient may start experiencing drug induced side effects like akathisia at higher doses. In such cases, simply adding the above mentioned medicine may help in controlling the side effects and patient start improving rapidly.

Dr Vikas :

it is possible that he experiencing akathisia with abilify also which is usually not very common

Dr Vikas :

you can discuss with his doctor about adding the above mentioned medicines and hopefully he will improve very soon.

Dr Vikas :

for acute psychotic symptoms, the dose of Rispedal is usually kept at 3-4 mg per day. However this varies from patient to patient. Some may tolerate lower dose better.

Dr Vikas :

waiting for your response

Customer:

He is a very difficult person to medicate. He started with depression at 17 and given prozac which made him manic. can't take antidepressants and meds work at lower doses for him. in reading your link it says they can stop the use of the medication. Can I lower it safety to 2 to 2.5 mg per day and see...? He is not that psychotic it was induced by the heavy doses of seroquel and ambiem.

Dr Vikas :

I don't think there is any harm in reducing the dose to 2 or 2.5 mg per day provided he is not acutely psychotic and his symptoms won't flare up because of reducing the dose.

Dr Vikas :

in addition to this, just discuss with his doctor about trying any one of the above mentioned medicines also in combination with Risperdal.

Dr Vikas :

In patients who are very sensitive to side effects, we usually prescribe Risperidone (Risperdal) in combination with trihexyphenidyl to prevent side effects like akathisa and most patients are able to tolerate the higher dose well.

Customer:

I do have some ativan that they gave to him when he was anxious with the latuda I can perhaps give him one of those for now.

Dr Vikas :

well, in my view, for akathisia, trihexyphenidyl is a much better choice.

Customer:

they gave himbenztropine 1 mg 2 times per day

Dr Vikas :

ok, and what was the response

Customer:

it is not helping or if it is I can't imagine how bad it must really be..he was exactly what was described in your article you sent me

Dr Vikas :

OK, then benzodiazepines or propranolol can also be tried by his doctor.

Dr Vikas :

don't worry, he will respond to any one of these medicines if it is indeed akathisia he is experiencing right now

Customer:

oops that was benztropine 1 mg two times per day as he takes the other. is this benzotropine like the one you mentioned

Dr Vikas :

it is not similar to benzodiazepine or propranolol

Customer:

why is it not working? should he take something else with that?

Dr Vikas :

but is is also used for akathisia.

Customer:

He has taken the propranolol before and it was not working either...must be more severe

Dr Vikas :

discuss with his doctor about trying benzodiazepine like Clonazepam in addition to using low dose of antipsychotic.

Customer:

I can try to give it to him again along with the benztropine mesylate tab

Dr Vikas :

clonazepam is a long acting benzodiazepine and can be useful in his case.

Customer:

Oh is clonazepam like klonopin

Dr Vikas :

yes

Customer:

ok I can try that. I am going to try to lower it to 2 mg in am and give a little klonopin and then tonight give him the 1 mg tonight How does that sound?

Dr Vikas :

Can be tried but please make sure that his doctor is aware of all the modification you are making in his treatment.

Dr Vikas :

I am not aware of his physical condition so can't comment from here.

Dr Vikas :

I hope you understand my limitations

Customer:

I will leave him a messsage tonight and we are supposed to be on 2 mg bedtime and 2 mg am tomorrow so I will lower the bedtime one and leave the 2 mg for tomorrow as he lowered it to. Then I will give the Klonopin to Dillon who is in good physicial condition until now..

Customer:

Yes, dr. I understand your limitations and it makes it tough but your insight and experience and knowledge have helped me more than you can imagine.

Dr Vikas :

Thanks a lot

Dr Vikas :

reducing the dose to 3 mg from 4 mg per day can be tried in my view.

Customer:

Thank you I feel good about that and it will not be drastic until his dr. can continue to lower...you have been great.

Dr Vikas :

you are most welcome.

Dr Vikas :

I really enjoyed working with you – please feel free to request me again when you come back to ask another question. You can Bookmark my profile link in your browser. ( http://www.justanswer.com/mental-health/expert-drvikas/ )


 

Dr Vikas :

do you have any other question to ask

Dr Vikas :

My goal is to provide you with excellent service and I hope I’ve provided the information you were seeking, if not, please let me know so that l can continue to help you. If you need more help, please use the reply tab to continue our conversation. If you do not require further assistance,please rate one of the positive ratings (3,4,5 / smiley faces) as this is the only way how we are compensated for our time and expertise.



Please take a moment to rate the answer.



Kind regards



Vikas

Customer:

where can I see you to treat my son in person :) He has been sleeping all afternoon and evening is that ok?

Dr Vikas :

I am sorry, but I am not from USA.

Dr Vikas :

Risperdal is a sedative medicine and most likely after reducing the dose he may become more active.

Customer:

Too bad now wonder you are so good. :) I will wake him up shortly to give him his night meds and hopefully he can still sleep through the night if he has an issue can I give him a benadryl?

Dr Vikas :

if he is feeling sedated then try to avoid any medicine which can cause further sedation.

Customer:

More active might be good since he could not walk outside or do anything else than sleep all afternoon and evening. Got up and ate and fell sleep again.

Dr Vikas :

probably because of sedation caused by Risperdal

Customer:

What about his night dose of risperdal 1 mg (instead of 2 mg) ?

Dr Vikas :

can be tried.

Customer:

This is why I want to reduce cause he is heavely sedated and with Akathesia (from memory on spelling now). He does not require much.

Dr Vikas :

but please note that abruptly reducing the dose by 2 mg in a day is not a very good idea.

Dr Vikas :

however reducing by 1 mg per day can be tried at present.

Dr Vikas :

but only once

Dr Vikas :

we usually taper down by reducing .5 mg every 3-4 days if we want to reduce the dose significantly.

Customer:

Two days ago they dropped the night one by 1 mg to 2 instead of 3 mg and as of tomorrow he was going to drop the am to 2 mg instead of 3 mg. If I drop tonights to 1 mg that will be another 1 mg reduction after 2 days and then tomorrow ams reduction to 2 mg would be 1 mg reduction for tomorrow. How is that?

Dr Vikas :

always better to reduce the dose slowly because abruptly reducing the dose can lead to worsening of psychotic symptoms.

Dr Vikas :

however if he is able to tolerate it then can be tried.

Customer:

Ok then I can reduce tonights to 1.5 and keep the am at 2 mg as we are supposed to. Then we will use klonopin tomorrow if needed and hopefully reach the doctor.

Dr Vikas :

sound reasonable to me. As I mentioned before also, if a patient is taking 4 mg per day, the dose can be reduced to 3 mg per day the very next day, however drastic reduction in dose for example reducing the dose to 1 or 2 mg per day straight away from 4 mg per day should be avoided.

Dr Vikas :

are you there?

Customer:

yes, I went and cut the dose so I can give him the 1 .5 mg tonight so that means today he will have had 4.5 mg causer they gave him 3 mg this am

Dr Vikas :

see, as such it does not matter if you reduce the dose by .5 or 1 mg specially when a patient is on high dose like 4, 5 or 6 mg per day.

Customer:

tomorrow he starts on the 2 mg am and then if it works out we can keep the 1.5 mg at night . Depending how he does we can then drop the am dose to 1.5 mg the next day and see and hopefully within a couple of days bring him to 1 mg am and 1 mg bedtime which is what he was released from the hospital in 2010 and within 5 days they dropped him to 1 mg per day.

Dr Vikas :

just discuss with his doctor about the probability of akathisia in his case.

Dr Vikas :

If he responded to lower dose earlier, this time also he will respond well to low dose of Risperdal

Dr Vikas :

I hope I’ve provided the information you were seeking, if not, please let me know so that l can continue to help you. If you need more help, please use the reply tab to continue our conversation. If you do not require further assistance,please rate one of the positive ratings (3,4,5 / smiley faces) as this is the only way how we are compensated for our time and expertise.



Please take a moment to rate the answer.



Kind regards



Vikas

Customer:

do u think that I should drop him to 1 mg tonight then. He had 3 in the am and he had been on 5 for the last two days.That would make today a total of 4 mg and tomorrow we can do 2 am as ordered and 1 bedtime dropping it for that day to a total of 3 mg. How is that?

Dr Vikas :

see, we are discussing the same thing again and again.

Dr Vikas :

yes, it can be tried.

Dr Vikas :

since he is on a comparatively high dose

Customer:

based on your answer thast the .5 does not make a difference :)

Dr Vikas :

so reducing by 1 mg can be tried in my view.

Dr Vikas :

:)

Customer:

Yes....I will do that tonight :) Thank you so much for your words and encouragement. That just means we reduced today to 4 mg and tomorrow we will be at 3 ...very simple now ;) I can be slow...

Dr Vikas :

of course with his doctor consent. :)

Customer:

I will leave him a message now..thank you sooooo much..you have given me peace of mind since that is what my gut instinct told me to do. plus the information to speak to the doctor with wisdom and clarity about it.

Customer:

Thank you againa d I will give you all the happy faces I can and I will really be in touch in any other matter as a second opinion..a very valuable second opinion.

Dr Vikas :

most welcome again.

Dr Vikas :

Please take a moment to rate the answer.



Kind regards



Vikas

Customer:

good night Dr. Vikas

Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
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