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Is it possible to feel irritated and constipated during schizophrenia treatment?

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Published At May 6, 2023
Reviewed AtDecember 6, 2023

Patient's Query

Hello doctor,

My sister has been under the treatment for schizophrenia for the past many years. She has been taking the following medicines right now for the past few years with slight modifications.

(1) Amisulpide 200 milligrams twice daily.

(2) Clozapine 100 milligrams once daily.

(3) Clonazepam 2 milligrams once daily.

(4) Quetiapine 300 milligrams once daily.

Her food intake is normal but her sleep is slightly disturbed. My concerns are,

(1) Her blood pressure is low at times.

(2) There is constipation trouble for which she takes Ayurvedic medicine.

(3) She is lost in her own thoughts. She does not participate in household chores and feels irritated sometimes. But she is able to take care of herself.

I am very worried.

Please help.

Hello,

Welcome to icliniq.com.

I went through your query and understood your concern.

It seems your sister is suffering from schizophrenia. It is a chronic disorder that leads to cognitive impairment.

1) Your sister is on Clonazepam (benzodiazepine) 2 milligrams which is a sedative. if she does not have any sleep problems, then there is no need to give it to her. It is better to give it at night otherwise, you can taper it off and stop it.

2) Clozapine (atypical antipsychotic) causes constipation. There is no option for it. Clozapine is one of the best medications for schizophrenia. Ask her to drink more water and go for walk or exercise daily for 30 to 45 minutes. It will help her to deal with constipation. You can also give her Ayurvedic medication.

3) She may have a cognitive impairment which leads to her work impairment. Sometimes, she may have auditory hallucination which keeps her engaged in her thoughts.

I hope this has helped you.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for the reply,

I hope you remember my consultation with you on the health of my sister. Based on your inputs and my follow-up with the doctor treating her, these are the latest medicines she takes:

(a) Joykem (Sulphide) 200 mg two times a day in the morning and night.

(b) Azep (Clonazepam) 1.5 mg in the morning daily.

(c) Clozapine 100 mg 1/2 (half) tablet in the morning daily.

[b and c were reduced after my last consultation with you one medicine at a time. Around a month has passed since then].

(d) Quetiapine 300 mg 1/2 (half) tablet in the night daily.

(Quetiapine dose was cut to half before my previous consultation with you due to low urine output).

Since about a month back tablet Azep has been reduced from 2 mg to 1.5 mg and Clozapine has been reduced from 100 mg to 50 mg.

Bowel movement has improved a lot since the earlier consultation and now it is almost on alternating days. Now she can pass stool with lower effort. Her condition is stable and even better as her anxiety levels (irritating mood) have come down. The only point is sometimes her thoughts wander on her hallucinations before she gets back to her senses once again.

I am unable to attach any blood report as she refuses to take blood tests. Kindly understand it.

Now my concerns are as follows:

I suspect that there is fluid buildup in the stomach and urine output is also lower in the morning even though she passes urine with ease at night. She weighs 132.2 lbs and her stomach looks bulgy suggesting fluid retention. She also feels thirsty especially while taking food almost frequently. She takes sufficient water. Please advise on this.

She feels sleepy. For that, I understand tablet Azep should be tapered out gradually. Our previous efforts to cut down tablet Azep were not successful as she had relapse syndrome. (At that time she also took Quetiapine 300 mg; urine output was low and she regularly felt abdomen pain). Now I understand that her relapse is principally due to a reduction in the tablet Azep. This time I want to cut it very gradually. Please advise on dose reduction and frequency.

I also want to know whether this tablet can be tapered first or if any other tablets should be tapered beforehand before tapering tablet Azep. In the evenings I take her for a regular walk out. She walks very slowly. I want her muscle movements to be better. Please advise. The last time when we went for an eye check up ophthalmologist told me that her eyesight is weak. Do any tablets she takes exert an influence on her eye health? I also want to taper one tablet at a time and wait for around 20 days before attempting another one. In this way, I hope I can better observe her and take corrective steps.

Thanks.

Hi,

Welcome back to icliniq.com.

Thank you for taking help from a psychiatrist. I know your sister's case. I am glad to know that she is doing fine with the medications.

1) It may be due to tablet Clozapine. You should do USG abdomen and pelvis to rule out any problem (regarding urine or fluid accumulation). If possible switch Clozapine at night. It will be better.

2) Tablet Clozapine is also responsible for sleep in the daytime. You can taper off tablet Clonazepam 0.5 mg every four weeks. I mean that you can give her tablet Clonazepam 1 mg for four weeks then give her 0.5 mg for another four weeks then give her 0.25 mg for another four weeks then give her alternate day another four weeks then stop it. You first taper off tablet Clonazepam. You should try to switch the Tablet Clozapine at night from the daytime.

3) It is due to antipsychotic medication. She walks with a stiff body. She may have fine tremors or salivation at night. You can add a tablet of Trihexyphenidyl 2 mg daily in the morning for it. It will help her.

4) There is no effect of medication on eyesight, but if she has diabetes due to medication then it may affect her eyesight.

5) You have to wait for taper-off medications. It takes months for it. First, taper off the tablet Clonazepam then you can try to taper the tablet Quetiapine.

You must wait for at least four weeks to reduce the dose of one medication and wait for six months to change or stop another medication. Do not try to taper off Sulphide and Clozapine tablet without proper evaluation and doctor guidance.

I hope that you get my point.

Please let me know if you want some help.

Thank you.

Investigations to be done

The investigations include RBS (random blood sugar), USG (ultrasonography) abdomen and pelvis.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Vishal Anilkumar Gandhi
Dr. Vishal Anilkumar Gandhi

Psychiatry

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