Question: Dear Sir/Madam,
I am writing about my mother who is 55 years of age. Some two months ago, she started saying that people in the apartment,where we live, talk bad about our family. She said that they are conspiring to harm us. She said it with such confidence that initially we also believed it until one day when she said that “listen persons living on the above floor are saying that I am a bad person, they are abusing me” and we didn’t hear anything at all, then we realized that she is suffering from auditory hallucination. She also cries when she feels that we don’t believe her.
(She had also suffered from very high fever of 102 degree as well prior to the start of auditory hallucination episodes.)
Then we took her to the doctor who gave her REXIPRA 10 for one time, Clonotril 1 mg and Inderal 10mg.
But her problems did not show sufficient improvement. She was not sleeping well and her heart palpitation was also not under control. Then the doctor increased the REXIPRA 10 for two times, Etizolam0.5 mg for one time in the night,Migrabeta-TR 40 (Propranolol Hydrochloride Sustained Release Tablets) for one time to control her heart palpitations.
Now the palpitations are under control, but she still says that people are talking bad about her from the above floor. When she says these things there is a strange restlessness in her eyes. She was not sleeping well before Etizolam 0.5mg but with this medicine she showed improvement for two days and on the third day again she didn’t sleep well. For last 10 days she is having the changed medicines. Now her sleep is showing improvement but not on regular basis. One day she sleeps well but again on the other she has problem sleeping.
She always says that change the house, I will not feel this way once I am in a different house. But one day she had gone to market and she heard things there as well. Sometimes she feels irritated and agitated for changing the house. But we try to calm her down by saying that “O.K..O.K we will change.”
She has been under depression and stress all her life due to some family problems. She also became a high blood pressure patient in the age of 35. She has been on Atenolol 50mg (two times to control her blood pressure) for last several years.
Thus for last 1 and half months she says everyday that people are talking bad about her. Now what I want to ask is that is there any other medication that she needs to control her auditory hallucinations? Please advice.

Dear Sir,

I started olanzapine 5mg. od on 22nd night and gave her on 23 and 24th of october in the morning. Now she is sleeping very well. Yesterday, she said for only one time that "look they are still talking". But her sentence didn't have any confidence and it was not strong either. Her face didn't have any signs of panic either. Today, she has not said anything of that sort. And she sleeps very well in the day time as well.

For last one and half month she was not sleeping at all even after having clonazepam 1mg, she was restless.And this restlessness was evident in her eyes. Now her eyes also look healthy.

I consider these signs of improvement and seek your opinion.

I want to ask that after how many days can we increase the dosage of olanzapine from .5mg od to 10 mg and more.

I thank you from bottom of my heart sir for your very precious advice, we were really very hassled for last 1.5 months. And thanks for your kind and encouraging words as well.

Please advise us on future course of action.

Dear Sir,

I have given the review.

I want to inform you about one more thing. After I submitted my reply to you, my mother woke up and for the first time in so many days she said that she has slept really well and it seems that some load has gone off her head. And on the hearing front she said that "she is hearing very less things". Her face and eyes seemed also relaxed.

Thanx a million sir! It is only because of you that this diwali could bring happiness in our family.

I will keep you informing about her situation.

Happy Diwali to you and your family sir.

Dear Sir,
As told by you, I am writing about my mother’s condition after observing her for two weeks.

My mother said in last week on four alternate days that she was hearing things. And in this week she is saying on all three days that she is hearing things.

During last week she used to say only one time in a day that she heard things. On Monday and Tuesday in this week, she said once that she heard things,but since yesterday she has said 3-4 times that she has heard things.

The medicine response in the last two weeks is that she has not cried once. Otherwise earlier she used to cry while saying that people are talking bad about her. Earlier she used to listen things all round the clock, but now it has reduced to some small time slots of the day.

Her sleep was otherwise good, it has just got interrupted since yesterday and that might be one reason as well that she is saying again that she is hearing things.

Since yesterday, I have observed increase in her restlessness while she says that people are saying bad things about her and there is little panic on her face as well.

I think that perhaps this is time for the increase in dosage of Olanzapine for her, I seek your advice.

She complains of weakness as well, could you please prescribe some vitamins for her?

There is a lot of improvement in her since the start of the medicine otherwise it was like a nightmare for us, your advice certainly controlled that nightmare and we are sure that you will delete this nightmare from our life forever.

I understand that there would be relapses in her condition and for that I seek your advice.

Hello Sir,
For last two days we have started Olanzapine 10 mg twice a day and in these two days she said only one time of hearing things and she is sleeping well as well for last two days.

One more positive thing has happened after we started medicine( Olanzapine) advised by you and that is that she has regained her interest for eating. Otherwise earlier she had totally lost her interest for eating. And she used to say that she didn’t have any appetite. But now she has started eating well.

Actually, I want to ask you one question about her other medicines:
1)     Can we stop Rexipra 10? She complains of burning sensation in her stomach when she takes this tablet and anyways it was of no help at all in controlling her auditory hallucinations. But I will follow your advice.

Regards,
XXXXXXX XXXXXXX

Hello Sir,
One thing is happening with my mother after Onlanzapine 10 mg two times has started.

Actually sir my mother complains of restlessness after having the medicine. She is not being able to sleep properly either.

For first two days we thought that it could be the effect of the increased dosage and her body would adjust and that is why I didn’t tell you about this in my earlier mail. But gradually her problem also increased. After having medicine she stays restless for 5-6 hours.

For last three days her heart palpitations have also increased.

While having the Olanzapine 5 mg one time she didn’t complain of restlessness and heart palpitation but after the increase in the dosage from 5 mg to 20 mg in a day ,she is complaining of restlessness on regular basis.

She also feels thirsty all the while. Her lips are also dry whole day.

Though her hearing problem has reduced but her restlessness has increased.

Actually she is also the patient of high blood pressure. As I have already mentioned. She is on Atenolol 50 mg two times.

Do we need do decrease the dosage?

Sir Please Please help!