Brief Answer:
Proper evaluation and change in prescription is needed

Detailed Answer:
Hello thanks for asking from HCM for your health related queries

I have read the attached files and I can understand your concern. The blood report you have uploaded is normal report with Lithium in normal therapeutic range. The blood sugar is slightly elevated but that is not in diabetes range.

The clinical symptoms you have mentioned in uploaded file like thinking that others can read your mind, visualising and hearing things exclusively, thoughts that mother directing to do things remotely, abnormal behaviour like getting naked suggest more towards some psychotic illness more specifically Schizophrenia. Though as you are taking the treatment since long and now of almost 60 years age so the classical clinical symptoms have been reduced. Other possibility is bipolar disorder but this needs evaluation to make proper diagnosis.

Coming to the drugs you are taking. You have mentioned that you are on Valance OD 250 mg (Divalproate sodium), Oleptal DT 150 (Oxcarbazapine), Amisulpiride 50 mg, Tremnil 2, Lithium 400, Haloperidol 1.5, Sizodon (Risperidone) 1 mg, Telmesartan 40 and Atorvastatin 10.

If we consider this prescription then Valance OD 250, Oleptal 150 and Lithium 400 all are mood stabilisers. Amazeo 50, Nedol 1.5 and Sizodon 1 mg all are anti psychotics. Though I have not seen you personally and have no detailed history but I beg to differ from this prescription. I don't find this prescription a right prescription for your symptoms. Using 3 different anti psychotics and 3 different mood stabilisers that too in insufficient doses is of not use. In my either one or two antipsychotics can be used but that should be used in good doses. Dose of Sizodon 1 mg is very low, same for Nedol and Amazeo. If I have to prescribe the drugs to you then I should have discontinued Nedol and should have increased the dose of Amazeo to 100-200 mg per day and Sizodon to 2-3 mg per day. Increase in dose would help in better symptom control.

Similarly either of Oleptal or Valnce should be discontinued and one drug should be used for mood stabilisation in good doses. Dose of Valnce can be increased to about 1000 mg per day as your liver enzymes are in normal range. Discontinuing Oleptal and increasing the dose of Valnace to 1000 mg along with Lithium will make a good prescription for mood stabilisation.

The drugs Telvas and Stator are fine and are for high BP and lipids. Continue to take these drugs as per prescribed doses. Tremnil has been added to prevent side effects of antipsychotics and is in right doses. Please talk to your psychiatrist and ask for dose adjustments I have mentioned. This will help in better functioning.

Thanks, I hope this helps you. Please don't hesitate to ask again for more doubts.

Take care

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Brief Answer:
Repeat the serum Lithium levels at 6 months interval.

Detailed Answer:
Hello again and thanks for asking a follow up question

In the new report you have uploaded the serum Lithium levels are below therapeutic levels and in my opinion increasing the dose of Lithium would bring the levels in therapeutic range. Get the repeat test done for Lithium level from any good lab because the report is of last year. No need to get more tests done. HDL cholesterol is in lower range and in my opinion daily exercise would help to bring this in normal range. The other lipid parameters are normal.

No need to get tests done at specific intervals. Just go for serum lithium levels and TLC (total leucocyte count, differential count) then repeat the tests in about 6 months.

Thanks, Still have more doubts left please ask again. Take care

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