How to handle a schizoaffective disorder patient?

Hi,

Welcome to icliniq.com.

I read your query with keen interest and understood your concern about the poor response of your brother to the current antipsychotics.

First of all, I feel Aripiprazole will make the best choice as he is also having hypertension and gallbladder issues. Almost all the available newer antipsychotics increase blood pressure in the long run except Aripiprazole. Even Quetiapine and Risperidone are also included among the blood pressure and weight-increasing medications, and I feel that they should be avoided if possible. We also need to understand the tolerability of the drug while choosing the medication for him. Considering poor response with Quetiapine and difficulty in tolerating Risperidone, I feel Aripiprazole should be considered. The other options include Lurasidone and Ziprasidone if his psychiatrist has some valid reasons against Aripiprazole.

The dose of Aripiprazole ranges between 10 to 30 mg, and I think 10 mg can be tried initially for two weeks before increasing the dose further. The medication is available in many brand names Abilify, Arpizol, Aspiro, and Arzu, from leading pharmaceutical companies. Consult your specialist doctor, discuss with him or her, and take medicine with their consent.

Regarding the diagnosis, I feel his correct diagnosis is schizoaffective disorder, as there are symptoms to indicate an affective disorder in addition to schizophrenia symptoms.

Regarding further management, the first thing is no more experimentation should be allowed. He needs regular medication, and any attempt to stop the medication in the future should be avoided other than emergency situations.

It is also important to support the patient in his tough time, and the environment should be non-hostile. There is good research data that indicates the possibility of relapse if the patient gets critical feedback, and I think critical comments should be avoided as far as possible.

I hope this answers you. Feel free to write back to me if you have more questions. I will be glad to assist you further. Thanks and regards.

Hi,

Welcome back to icliniq.com.

I am sorry to know that despite the use of 600 mg of Quetiapine, you are finding it difficult to manage him on most days. Ideally speaking, hospitalization is the need of the hour, as it is never easy to manage a patient with the acute symptoms of schizophrenia, including aggression. If admission is not possible due to some reasons, I will recommend the following things:

• Never argue with the patient.
• Try to distract the patient to some other neutral topic if there are some reasons for the aggression.
• Engage the patient in any of the activities as far as possible.
• You can try an injection of Haloperidol 10 mg combined with an injection of Promethazine 50 mg. It should be done under the supervision or guidance of a local doctor or psychiatrist. (This is often done during the hospitalization at the first stage. It was found to be very effective).

Regarding treatment for auditory hallucinations, electroconvulsive therapy is the most effective, followed by antipsychotic medications. rTMS (repetitive transcranial magnetic stimulation) and other brain stimulation techniques are of limited help, provided there is no response or inadequate response with the other modes of treatment.

Regarding the cure, I am sorry to inform you that nothing cures it, although treatment is possible. (Cure means eliminating the disease, which is not possible to date). Naturopathy and yoga will help. But, they are not the mainstay of treatment. There is no use for repeated testing. They are just for research purposes and to rule out other possibilities.

Aripiprazole dose will be increased, and Quetiapine dose will be decreased. It ultimately depends on the discretion of the treating doctor and should be done under his or her guidance only.

I suggest 10 mg Aripiprazole and waiting for two weeks before increasing it further. If there is an inadequate response, then I will increase 10 mg after two weeks and continue it in a similar pattern. At the same time, I keep the Quetiapine dose at the same level for two weeks and then start reducing 100 mg every two weeks. However, this differs from doctor to doctor, and no such guidelines exist.

I hope this answers you further. Thanks and regards.