Dr. Seikhoo Bishnui
Psychiatry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
The problem started in 2010. 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 point to? The prescriptions are lost in transit. No medicines are being taken.
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 depression. 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: How did the symptoms start? What were your initial symptoms? What were the aggravating factors? Did you consult a doctor for initial symptoms? If yes, what were the medications? Did you take treatment or discontinued it? Why do you not want to consult a doctor now? Thanks. Take care.
Patient's Query
Hello doctor,
Thanks for replying. I was asking for my son. Let me explain. My son disliked to study, and he loved to play football. But, my wife and I forced him to study. After passing his high school exams, he denied 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.
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 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. Take care.
Patient's Query
Thank you doctor,
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 advice.
Hello,
Welcome back to icliniq.com.
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 to1000 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.
Patient's Query
Hi doctor,
I propose my son to 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 than XR 600 and Olanzapine 5 mg and increased to 10 mg unless it is tough to feed medicine in time. Please advise.
Hello,
Welcome back to icliniq.com.
Yes, you can give him Oxetol 300 than 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 in bipolar disorder patients to show such type of behavior. Do not feel bad about that. Thank you.
Patient's Query
Hi doctor,
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 doctor talked to my son, prescribed Arpizol 10 mg further in the next month Arpizol 5 mg.
Hello,
Welcome back to icliniq.com.
Arpizole or Aripiprazole also a good drug used for stabilization of mood. The drug is free of metabolic side effects like weight gain, increase in blood sugar levels, etc. So, it is a safe drug. If he is stable on 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 a very safe and even on high doses the drug will not cause any severe side effects. The drug is a good drug for bipolar disorder. Thank you.
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