Brief Answer: He needs medical attention and blood test. Detailed Answer: hello and welcome to HCM! I have read your question and can understand that your father needs some medical attention. You have mentioned that he is 60 yrs old, and has extra pyramidal side effects along with Parkinson's symptoms, (due to drugs use). currently he is having rigidity and fall in BP (after taking illosure). The dosage is not mentioned in query. From my clinical experince I can say that this position can be either due to drug itself ( rare side effect of this drug as it is relatively weak and mild chemical). OR due to Parkinson's itself... I would recommend that he shoud be taken to a specialist, and get his BP and electrolytes monitored. This rigidity can be a sign of catatonia, which is seen in schizophrenia and is considered an emergency. please maintain adequate hydration and get his routine blood test, pressure, temperature, oxygen concentration and electrolytes monitored. once this rigidity is resolved, he can be shifted to some other drug. Hope the reply is useful please feel free to ask more question for clarifictaion Dr. Manisha Gopal MD Psychiatry

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Brief Answer: May go to GMC/IGMC Nagpur Detailed Answer: Hello, Your father has been on drugs ( I guess- mostly on typical antipsychotics for initial part of his illness) from past many years. These typical antipsychotics are notorious to cause tremors, increase salivation, reduced blinking, etc. To crub these side effects we give pacitane. Your father is on 2mg TDS pacitane now but has stopped all other drugs. It is seenthat by long standing use of typical antipsychotics, the tremors might not completely vanish even after stopping the culprit agent or by using pacitane. Your neurologist had tried all what he could and referred you back to a psychiatrist. Arip MT is also seen to give rise to this presentation ( not very uncommon in clinical setting). It might be that not illosure, but Arip MT in combination with illosure lead to this picture.. However, for now the most important thing is to take the patient to medical care and manage him well. You may take him to GMC Nagpur, or to IGMC. In private there is a doctor ( psychitrist) at Dhantoli - Dr. XXXXXXX he might be able to help you / guide you properly but sorry, I donot have his number. # you have said that he was taking 1/4 of 2 mg alnazapine previously. It is strange that he developed so may side effects in this drug..may be its his age plus demetia/ Parkinson's. I think you may need to get his MRI Brain also after some time when he stabilises. Hope this information helps you. Please ask more questions for clarifictaion Dr. Manisha Gopal MD psychiatry

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Brief Answer: We can try without drug till he is keeping good Detailed Answer: hello, Furstly- Schizophrenia is a life long illness, and there are all chances that it may come back. However, when we have such a case where side effects are problematic and patient is keeping fine for many days without medicine -we may just keep a close watch on him without giving any drug and if there are any emergence of symptoms, then start treatment. So, for time he is keeping fine, able to take care of himself and there are no psychotic symptoms seen, just keeping a close watch can be tried. Tremors, as I said earlier are difficult to manage in long standing cases. In such cases we have few choices- 1. increase the dose of pacitane - upto 10 mg -12 mg. ( in divided dose three times a day) 2. treat like Parkinson's - syndopa ( but this may bring back psychotic symptoms , so care is required ). Secondly, Im sorry but I am not aware of avurvedic treatment for this problem. However, if there is anyone qualified in Ayurveda, you can consult him. There is no problem in discussing with a qualified doctor of any domain, provided patient is benefited. thirdly, when I have such a case in my clinic, I go with the following medicines ( they are relatively mild and free of major side effects) --- 1 quetiapine ( but it has sedation-- can be managed by giving dose in early evening hours and this effect weans away in some days) 2. Amisulpride ( this is also very good and usually donot cause sedation, tremors, increase in saliva etc., can be given at one time in a day) If you can pursuade your father to take them, you can discuss them with the doctor. Hope the reply is useful Please ask more questions for clarifictaion If you are satisfied, please close the query and arête the answer Dr. Manisha Gopal MD psychiatry

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Brief Answer: It is due to illness and not because if age Detailed Answer: Hello, The usual starting dose of Amisulpride is 25 mg twice a day, after meals, and it is increased by 25 mg every third day or so after monitoring the response. the dosage is build upto 200-300 mg peer day as needed. There are formulations available which can be given once a day, preffrably at night. Quetiapine is can be given once a day ( night time) in dose of 25-50 mg, increased by 25 mg or 50 mg every third or fourth days...build upto 150-300 mg, as needed. Your doctor would also know about them. The symptoms of over activity, sleeping less, and getting angry easily when things donot go his way, point towards possibility of influence of his illness. So, it will be best to give him some medicine regularly. These symptoms are not due to his age as he is just 60 yrs, so, it is due to schizophrenia only. Donot worry about sleep, as with above medicines it will also improve. Hope the answer helps you please feel free to ask more questions for clarifications if you need Dr. Manisha Gopal MD Psychiatry

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