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Extreme Confusion, Restlessness. Suffered Stress Induced Psychiatric Break. Prescribed Olazapine, Lithium, Tegretol. Is Tegretol Causing Restlessness?
Question: My wife, suffered a stress induced psychiatric break on sept 04 2011. She was prescribed olanzapine 15 mg twice a day,(no prior diagnosis or history of psychiatric disorder) she had to be forcibly admitted to a psychiatric facility on three seperate occasions within a six month period. I am thinking she was sufffering from NMS, in addition to Olonzapine she was given Invega sustaina and a hodge podge of mood stabilizers, Lithium, carbamezipine etc. We have gradually reduced her medications to just ziprasidone 60 mg once daily, and Tegretol 400 mg twice a day. She has been expieriencing episodes of extreme confusion and intense restlessness lasting about 4 hours, on a bi weekly basis. I think this is catatonia brought on by ??? We have been prescribed loazepam to counter these episodes, which does work, but I would like to eliminate them, I suspect the Tegretol. What do you think? Her doctor has been fairly supportive of reducing the levels of meds she was receiving in the board and care, Three months ago she was on 600mg tegretol twice daily, an
Hello
Welcome to Health Care Magic
You wife has a sudden onset episode of behavioral change and psychiatric symptoms in September 2011. She was then started on Olanzapine 30 mg per day. She was forced to get admitted at Psychiatric hospital. She was given long acting injection of Paliperidone (Invega sustaina) and mood stabilizers as Lithium and Carbamazepine. Later her medicines has tapered to Ziprasidone 60 mg per day and Carbamazepine 400 mg per day. Now she has been experiencing episodes of confusion, restlessness for about 4 hrs on biweekly duration.
From the available history and description I have reached to conclusion that most probably she is suffering from Bipolar disorder. Because mood stabilizers especially Lithium are given in Bipolar illness and usually not used in Psychosis or Schizophrenia.
Now coming to your questions-
- The episodes of confusion and restlessness she is having are definitely not due to Catatonia. Catatonia present with different features.
- It may be just the flare up of her psychotic symptoms which may present as restlessness.
- Second possibility, the restlessness may be due to Ziprasidoene. She is on 60 mg Ziprasidone and this dose is a little higher dose (probably required to control her symptoms). Ziprasidone is known to cause Extrapyramidal side effects and akathesia or restlessness occurs in a number of patients receiving this drug. Usually it is continuous restlessness but it may present in different pattern.
- Tagretol or carbamazepine is a mood stablizer and it is a comparatively safer drug but side effect of decrease blood count and serious skin rash has been reported with it. It don't cause akathesia or restlessness. It causes sedation, nausea, dizziness but restlessness at 400 mg doses is not so significant.
For relief of this restlessness Beta Blockers as Propranolol are found to be useful. I will advise you to visit her doctor and discuss again about her problem.
Hope I cleared your doubt, if you have more questions you can ask again.
Thanks
Dr. Seikhoo Bishnoi MD
(Consultant Psychiatrist)
Welcome to Health Care Magic
You wife has a sudden onset episode of behavioral change and psychiatric symptoms in September 2011. She was then started on Olanzapine 30 mg per day. She was forced to get admitted at Psychiatric hospital. She was given long acting injection of Paliperidone (Invega sustaina) and mood stabilizers as Lithium and Carbamazepine. Later her medicines has tapered to Ziprasidone 60 mg per day and Carbamazepine 400 mg per day. Now she has been experiencing episodes of confusion, restlessness for about 4 hrs on biweekly duration.
From the available history and description I have reached to conclusion that most probably she is suffering from Bipolar disorder. Because mood stabilizers especially Lithium are given in Bipolar illness and usually not used in Psychosis or Schizophrenia.
Now coming to your questions-
- The episodes of confusion and restlessness she is having are definitely not due to Catatonia. Catatonia present with different features.
- It may be just the flare up of her psychotic symptoms which may present as restlessness.
- Second possibility, the restlessness may be due to Ziprasidoene. She is on 60 mg Ziprasidone and this dose is a little higher dose (probably required to control her symptoms). Ziprasidone is known to cause Extrapyramidal side effects and akathesia or restlessness occurs in a number of patients receiving this drug. Usually it is continuous restlessness but it may present in different pattern.
- Tagretol or carbamazepine is a mood stablizer and it is a comparatively safer drug but side effect of decrease blood count and serious skin rash has been reported with it. It don't cause akathesia or restlessness. It causes sedation, nausea, dizziness but restlessness at 400 mg doses is not so significant.
For relief of this restlessness Beta Blockers as Propranolol are found to be useful. I will advise you to visit her doctor and discuss again about her problem.
Hope I cleared your doubt, if you have more questions you can ask again.
Thanks
Dr. Seikhoo Bishnoi MD
(Consultant Psychiatrist)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks.
Its my pleasure to answer you. Please review if you are satisfied with answer.
Thanks
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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