[Victoria'smom]

Last weeks general consences ( by 3 MH pro.) is that I'm currently psychotic outside of a mood swing. So currently were messing with meds and our appointments are staggered. Plus walk ins were very clearly suggested. My H's T wants me IP , my t wants me on AP, and pdoc tried to convince me that its effecting my quality of life but wants to avoid AP as long as possible. I'm not willing to argue that I'm sane but how will I know when I've become sane again? Especially when I only trust T right now. I only have 6 more t appointments before I'm on my own.

[pegasus]

Hi, I'm not sure what AP is but certainly your T needs to extend the therapy for longer. Psychosis is a complete loss of reality, hallucinations etc, is this coming and going for you right now? It is possible for this to be managed without going IP, the meds need to be monitored obviously. Oh hugs

[Curiosity77]

I think it would be hard to tell if psychosis is gone on your own because it can feel so real. Are there people around you that you can trust to check your thoughts to see if they are real? Your therapist is a good person for now, and hopefully the psychosis will have cleared with the AP before your 6 sessions are up. How about your pdoc? Can you trust them to check your thoughts? Your husband? If there is no one then post here and see what people think. I hope that helps.

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[Victoria'smom]

AP - antipsychotic

I can't extend therapy for longer because I leave July 8th but for 6 weeks and 2 wks later I move states. I do have intake at the new state sept. 9th and I'm going to ask to see her right when I come back from the 6 wks. Its been here for a good month maybe month and a half. Apparently having half hearted parinoia and very occational small visual hallusinations count as psychosis. So if my reality is a bit "off" when do I know that it has returned to normal?

[pegasus]

It's a difficult one to judge yourself when you are in the middle of it. Try to keep stress to a minimum as much as possible and an antipsychotic might be useful for a while, doesn't mean you need to be on it forever.

[Silent Void]

It's been my experience that psychosis doesn't completely go away. I'm medicated, but still hear voices and think the TV is talking to me.

If anything, you become more aware of your deficiencies as you "come out of it".

[moremi]

MM I am like you. Dont use AP or mood stabilizer. I can tell you in the past Thorzine has brought me out of some craziness. I used it as needed not routinely. Its just a suggestion. It usually helped a little immediately then I would take for a couple of days and it would bring me back to normal. It is rather sedating but works. I have called my dr requesting to get a script myself.

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[Victoria'smom]

I'm not trusting my husband at this point, and he finds it funny. I don't see my t until the 5th but my in-laws are coming from the 3rd-11th like all 8 of them. Usually I really don't care but as time goes on I do. ( stupid therapy). I don't have time for this!

[nummy]

What's your drs reasoning on the avoidance of ap? I'm on Abilify low dose age and it snapped me into reality (a healthier version, anyway), within 3-4 days.

I'm really sorry that you're struggling at the moment Miguel'smom Are they going to change your diagnosis to schizoaffective then? That's how I got mine originally.

Originally Posted by Miguel'smom

Apparently having half hearted parinoia and very occational small visual hallusinations count as psychosis.

Really?! I clearly have no idea when psychosis starts or finishes then...

I really hope that the trip with your parents goes well, as does your move, but I really would consider the regular AP. I know the side effects suck, but you are clearly about to go through a stressful period (travelling and moving) and you're not doing well...I just don't want to see you end up IP admitted against your will (idk what it''s called in the US, but it's 'sectioned' here).

All the best

*Willow*

[Victoria'smom]

He doesn't want me on anything sedating or that decreases gray matter. He avoids APs in genral. Plus that be med #4.5 If psychosis is a dopamine overdose then lowering my SNRI should work. He left it up to me because only I can decide how afraid I am and how much things are bothering me. He wouldn't even tell me what he would do, he always tells me what he would do when I ask. With my aprehention about AP and current paranoia I'm pretty sure he seems to be stepping very carefully (as is everyone on my psy team). As this has been stress related not mood or med related. He also worries I'll drop meds if I'm on many.

[Victoria'smom]

Are they going to change your diagnosis to schizoaffective then? That's how I got mine originally. they may have already. I'm going to ask t on the fifth. I doubt they'll change my DX giving the time I have left here.

[Sometimes psychotic]

Originally Posted by Miguel'smom

Last weeks general consences ( by 3 MH pro.) is that I'm currently psychotic outside of a mood swing. So currently were messing with meds and our appointments are staggered. Plus walk ins were very clearly suggested. My H's T wants me IP , my t wants me on AP, and pdoc tried to convince me that its effecting my quality of life but wants to avoid AP as long as possible. I'm not willing to argue that I'm sane but how will I know when I've become sane again? Especially when I only trust T right now. I only have 6 more t appointments before I'm on my own.

So here is my take....the way you describe your hallucinations and paranoia it sounds minimal....lots of people have more than this even on meds but if you are in a personal level bothered at all then take the meds. In cases studying early intervention often a very low dose is effective if you catch things soon enough thus minimizing side effects but also leading to better functional outcomes and perhaps even prevention of chronic conditions. Still Even if you feel OK With the level of hallucination you have I would ask for a prescription in case things get really bad just to have around. If things get really bad it won't be a question of should I take the meds so much as somebody else threatening to take you to the Hospital if you don't take them. This might save you a trip to the ER. You might get bad enough that you want to take them because things have gotten unbearable....getting the pills in hand gives you a lot more options especially if you are away from care.

So if you decide to take the meds be aware that you are likely to lose some things right away...probably some level of cognition and emotional expression. Both of these are restored when you quit the meds. You do lose a certain amount of brain tissue it occurs at roughly twice the rate of normal age related degeneration so it's not a ton. If you get on the meds you're going to have to taper off due to the possibility of rebound psychosis so make sure you have enough to get you though without discontinuation. They are not the best things in terms of side effects but if you are being tortured by your own mind you will take them and be thankful they exist.

TL;DR: get them and take them only if you get to the point of mental pain from the hallucinations/paranoia...

[nummy]

How do you know?

I've had a few episodes where I felt...not quite myself. Family said I was off my rockers (or close). When I went on meds, I could tell I was better when I could look back at the episode and saw it through their eyes. Almost...dispassionately? I wasn't triggered into being scared, and it seemed ludicrous that I could be. Plus, ones closest to me said I sounded less rambling....? And I felt ...good. That's how I know when I've turned the corner. Part of me still feels injured, but it's like by brain feels sprained, not broken. It's useable, and it feels good. For me, If I have to ask if I'm better, I'm not.

[nbritton]

Originally Posted by Miguel'smom

Plus that be med #4.5 If psychosis is a dopamine overdose then lowering my SNRI should work.

Can you expand on this more please? What SNRI are you on, and why does he feel the SNRI you're on will influence dopamine?

[Victoria'smom]

So explaining science with pdoc: anti-psychotics block dopemine. So he feels to much dopimen causes psychosis. SNRI increase dopemine and norepinephrine. I'm currently on 75 mg sr 1x day of welbutrin which is a SNRI.

He doesn't want me off the welbutrin because it saved my life but he doesn't care for a side effect of psychosis but can't be sure its a side effect or responds to stress.

[nbritton]

Originally Posted by Miguel'smom

He doesn't want me on anything sedating or that decreases gray matter.

Latuda (lurasidone) is mildly sedating about 1 hours after taking it and then it goes anyway a few hours later. I take it at night to help me get to sleep. Come morning it's sedating effects have completely worn off.

If you give rats a brain toxin called MK-801, they will become forgetful, as measured by rat activities such as navigating mazes. In preclinical trials, lurasidone did a better job of reversing MK-801-induced memory impairment in rats than risperidone, olanzapine, or quetiapine (Enomoto T et al, Behav Brain Res 2008;186(2):197–207).

Also in rats, lurasidone was shown to upregulate BDNF(brain derived growth factor) in the prefrontal cortex (Fumagalli F et al, Int J Neuropsychopharmacol 2011:14(1):1–12). Since BDNF is decreased in both schizophrenia patients (Weickert CS et al, Mol Psychiatry 2003;8(6):592–610) and animal models of schizophrenia (Fumagalli F et al, Eur J Neurosci 2004;20(5):1348–1354; Roceri M et al, Biol Psychiatry 2004;55(7):708–714), a drug that can upregulate BDNF has theoretical appeal.

But what about lurasidone’s cognitive effects in humans? Thus far, two human studies have examined the question. One administered lurasidone 80 mg or placebo to 180 patients with schizophrenia for six weeks, and showed a small (-2.1 vs -0.5) but significant (p=0.0015) improvement in the cognitive subscale of the PANSS versus placebo (Nakamura M et al, J Clin Psychiatry 2009;70(6):829–836).

That sounds impressive, but the study did not compare lurasidone with other medications. Also, the cognitive subscale of PANSS does not really measure cognitive dysfunction per se, but rather thought patterns common in schizophrenia, such as stereotyped thinking, lack of abstract thinking, and lack of judgment and insight.

The other study in humans was a randomized double-blind three-week trial of lurasidone 120 mg (n=123) versus ziprasidone 80 mg twice daily (n=111) (Harvey PD et al, Schizophr Res 2011;127(1–3):188–194). Two outcome measures were used. One was a subset of tests from the MATRICS Consensus Cognitive Battery (MCCB), which is an interviewer-rated measure of cognitive function.

This showed a small but significant improvement in the lurasidone group, but not the ziprasidone group, which was consistent with a “practice effect.” It’s not clear why the ziprasidone group did not equally benefit from the practice effect, but several other antipsychotics have shown the effect in other studies.

The other outcome measure was the Schizophrenia Cognition Rating Scale (SCoRS). This is a structured 20-question interview of both the patient and an informant that is not susceptible to practice effects, because it measures functionality. The lurasidone group showed statistically significant improvements over three weeks on these measures, whereas the ziprasidone group did not. However, in direct comparisons between the two drugs, lurasidone did not show a statistical benefit over ziprasidone.

So—is lurasidone pro-cognitive, or isn’t it? The jury is still out. All antipsychotics appear to improve cognition to some degree, but the improvements are thought to be either artifacts of practice, or reflections of improvement in general psychotic symptoms (see Dr. Balt’s article in this issue for details). At this point, all we can say for sure is that in trials designed by Sunovion, lurasidone’s manufacturer, lurasidone appears slightly more pro-cognitive than one particular comparator, ziprasidone. Given the proven ability of companies to manipulate study design to make their drugs look better than their competitors’, we will have to await non-sponsored data before drawing clear conclusions.

Here is a study about Latuda and Modulation of BDNF expression by ... [Int J Neuropsychopharmacol. 2012] - PubMed - NCBI

[Sometimes psychotic]

Originally Posted by Miguel'smom

So explaining science with pdoc: anti-psychotics block dopemine. So he feels to much dopimen causes psychosis. SNRI increase dopemine and norepinephrine. I'm currently on 75 mg sr 1x day of welbutrin which is a SNRI.

He doesn't want me off the welbutrin because it saved my life but he doesn't care for a side effect of psychosis but can't be sure its a side effect or responds to stress.

So why not just back down a little in the Wellbutrin...I didn't realize that was the AD you were on it's for sure known to induce psychosis....if you add an AP it won't even matter whether you are taking Wellbutrin or not the effects will be blocked at the dopamine receptor by the AP so the signal won't get through. There is typically 80-90% receptor occupancy for the D2 antagonists so people taking them don't get anywhere near the normal level of dopamine signaling even when the receptor numbers increase to compensate for the blockade. Often we will develop blunted affect ie not smile etc as a result of the drug. If you are really worried about losing the beneficial effects of Wellbutrin an AP is not going to help you....it's roughly like Wellbutrin turns on the faucet so the water is flowing but an AP is the stopper in the sink so none of that will make it downstream.

The only one you might try is abilify because it's a partial agonist at dopamine but it's still going to block any Wellbutrin effect unless it's acting by D1 or some other non D2 receptor.

[Curiosity77]

SNRI's work on serotonin and norepinephrine. At high doses there is some secondary action on dopamine, but that is not the main action. Wellbutrin is an NDRI, which works in norepinephrine and dopamine.

There is a benefit to taking wellbutrin with an AP, even though AP's primarily block dopamine. There are multiple pathways for the neurotransmitters, so it is not as simple as blocking or increasing, meds can do a little of both. Wellbutrin can help with blunted affect caused by APs, although it hasn't worked that well for that in me. Wellbutrin's antidepressant effects may be reduced by an AP, but they are not totally canceled out.

If you have psychosis an AP is important because the longer the psychosis goes, the more difficult it is to treat.

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[r010159]

I honestly do not understand something here.

How can an AP be taken PRN? Isn't the whole point to avoid psychosis? How can you remember to take it in the middle of a psychotic episode, a paranoid delusion for example? By then I would think its too late. Don't APs take awhile to work, like on the order of half a day or more? How would this play out at work?

I am glad I do not have this happen to me!

[Victoria'smom]

I know messing with meds aren't good but he would have don't this anyway. Maybe it's a sign of unwellness but **** it.

So here's what I did:
I increased my welbutrin back to 100 mg
Added 2.5 mg abilify

I'm sensitive to meds so I just did 2.5 mg. If anything messes up I'll take my PRN and walk in.

[Victoria'smom]

Double post sorry.