Patient's Query
Hello doctor,
The problem started 10 years ago. Social withdrawal, isolation, inability to continue at a job, negative talk, jealousy, lack of initiative, low self-esteem, and fickle-minded behavior. What could these points point to? The prescriptions are lost in transit. No medicines are being taken.
Please advise.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
The symptoms of withdrawal from society, loneliness, difficulty in continuing the job, negative thoughts, lack of motivation, indecisiveness, etc., could be due to some severe underlying mood disturbance. Since the symptoms are persistent and are resulting in impairment, they should be evaluated properly.
It could be either depressive disorder or bipolar disorder. Depressive disorders or bipolar depression can be treated properly with medicines. Most of the newer medicines are safe to use and have no serious side effects. These medicines have great efficacy. So, taking proper treatment would solve your issue.
Please describe your symptoms in detail, right from the beginning of the illness:
Kindly revert.
Thanks.
Take care.
Patient's Query
Hello doctor,
Thanks for replying.
I was asking for my son. Let me explain. My son disliked studying, and he loved to play football. But my wife and I forced him to study. After passing his high school exams, he refused to take up any further education. He became aggressive and threw things around.
He used foul language, argued a lot, and masturbated excessively. We consulted some psychiatrists from time to time. They prescribed some medicines. But he never took the pills regularly. He joined work once, five years ago, but did not continue it.
A psychiatrist we consulted took images of his brain and said that there was nothing wrong there, and prescribed him two medicines. I do not recall the names. Now the condition has deteriorated. He only keeps to his room. He refuses to go to the doctor. I am a pensioner. I cannot bear such expenses.
Please suggest what can be done about this.
Hello,
Welcome back to icliniq.com.
I understand your concern.
The symptoms you have mentioned clearly point towards bipolar disorder. Most probably, he developed the first symptoms when he refused to study further and became aggressive. He had hypersexuality, violent behavior, and was abusive, and these are clearly symptoms of bipolar disorder with mania. His symptoms persisted despite the use of medicines.
Regarding the psychopathology and course of bipolar disorder, it runs in episodes of mania with or without depression. The treatment should be continued for long periods of time. With proper treatment and good compliance, patients can function normally.
Mood stabilizers like Valproic acid in a dose of 750 to 1000 mg should help control these symptoms. Antipsychotics like Olanzapine or Risperidone should also be added to his prescription. Olanzapine in a dose of 10 to 20 mg per day in the evening hours will aid him in sleeping well and also stabilize his mood. If he takes these medicines regularly, he will definitely recover.
I hope this helps you.
Take care.
Patient's Query
Hello doctor,
Thanks for replying.
Just to update you, my wife seems to remember the names of the two medicines our son took. They are Oxetol 300 and Nexito Plus. Should he stick to the same?
Please advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Oxetol (Oxcarbazepine) is a mood stabilizer. The drug is started at a dose of 300 mg per day and can be increased to 600 to 900 mg per day. This should help in the stabilization of the mood. Since my provisional diagnosis is bipolar disorder, giving Nexito or Escitalopram might increase the risk of a manic switch and could worsen his symptoms.
In place of this drug, a low dose of Olanzapine, like 5 to 10 g, can be used for some time. If he fails to respond to these drugs then mood stabilizers like Sodium valproate in a dose of 750 to 1000 mg can be used. This will help in controlling his mood swings. So yes, Oxetol can be started again with 150 mg twice a day, and after about two weeks, the dose can be increased to 300 mg twice a day. This will help in mood stabilization.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thanks for replying.
I propose that my son take medicine as you advised last time, Oxitol 150 twice a day for two weeks, and then 300 in twice a day and Olanzapine 5 mg to 10 mg. But he disagrees to take twice, and he takes only once at night.
Can I give at night alone? Oxitol XR 450 first and then XR 600 and Olanzapine 5 mg, and increased to 10 mg if it is tough to feed medicine on time.
Please advise.
Thank you.
Hello,
Welcome back to icliniq.com.
Yes, you can give him Oxetol 300 instead of 450, and then it can be increased to 450. No need to worry. You can give him Olanzapine 10 mg after dinner. It is common for bipolar disorder patients to show such type of behavior.
Do not feel bad about that.
Kind regards.
Patient's Query
Hello doctor,
Thanks for replying.
After talking with you, I visited a psychiatrist because my son agreed to go to a doctor. I showed a print of your advice, and the doctor talked to my son, prescribed Arpizol 10 mg for the next month, and Arpizol 5 mg.
Please advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Arpizole or Aripiprazole is also a good drug used for the stabilization of mood. The drug is free of metabolic side effects like weight gain, an increase in blood sugar levels, etc. So, it is a safe drug. If he is stable on a 5 mg dose, then that is good; otherwise, the dose should be increased again to 10 mg.
Try to reassure him that the drug is very safe and that even on high doses, the drug will not cause any severe side effects. The drug is a good drug for bipolar disorder.
I hope this helps you.
Thank you.
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Answered byDr. Seikhoo Bishnui
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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