[MirageXD]

My diagnosis: paranoid schizophrenia
My age: 27 (having it 3 years)

Medical history:
- olanzapine - caused weight gain and cortical disarthria (difficulty speaking) after a year
- quetiapine - also causes disarthria and on higher doses even heart arrhythmia
- sulpiride - no serious side effects, just some blurred vision
- amisulpride - insomnia
- ziprasidone - didn't work, psychosis returned
- zotepine - strong drowsiness and orthostatic hypotension
- sertindole - nausea, impotence and disarthria
- aripiprazole - some transient side effects and disarthria

Most antipsychotics I tried caused disarthria. I never figured out why, but my doc thinks it has to do with dopamine blockade, but I'm not sure about that, because all antipsychotics block dopamine receptors and some don't cause it (mainly selective dopamine blockers).

I did try some anticholinergics (biperiden and procyclidine) to help me with disarthria, but it didn't work.

Currently, I take the following combination of medications:
- 800mg of sulpiride - almost no side effects, great
- 6mg of quetiapine - such low doses block mainly histamine and alpha receptors, and I use it as an alpha blocker.. causes disarthria

Why do I take quetiapine? When I go off it, I get some increased lacrimation and my body shakes all day. For that reason, I'm trying to convince my doc to replace quetiapine by a proper alpha blocker, which should be safer, and no more disarthria. He's gonna tell me how he decided next week.

Other than that, I have some cognitive problems, because I was on 400mg of sulpiride for a very long time, and it was not enough.

So, my question is: Can an alpha blocker serve as a quetiapine replacement in my case?

Cheers,
Mirage

[spiritual_emergency]

Hello Mirage,
I wasn't certain what dysarthria was so I googled it. If I understand correctly, it's a form of tardive dyskinesia. That may be a term that more people are familiar with.

The mechanism of TD is still unknown despite extensive research. However, it is generally believed that long-term blocking of dopamine D2 receptors (which is what all antipsychotics on the market do) causes an increase in the number of D2 receptors in the striated region of the brain (which controls muscle coordination). This "up-regulation" of D2 receptors may cause spontaneous and random muscle contractions or movements throughout the body, but particularly in the peri-oral and facial muscles.

Source: NAMI: Tardive Dyskinesia

The NAMI site says that people do not develop TD until years have passed but my child began experiencing symptoms within days of being treated with Haloperidol. This was accompanied by a high fever and loss of bladder control -- symptoms of neuroleptic malignant syndrome. Some people are more sensitive to effects of medication. You appear to be one of them. I have read that the trace mineral manganese can help prevent or reverse tardive dyskinesia but I've not spoken with anyone who claims personal experience.

Why do I take quetiapine? [Seroquel] When I go off it, I get some increased lacrimation [excess tears] and my body shakes all day. For that reason, I'm trying to convince my doc to replace quetiapine by a proper alpha blocker, which should be safer, and no more disarthria. He's gonna tell me how he decided next week. ... Can an alpha blocker serve as a quetiapine replacement in my case?

I can find very little information on the net in relation to alpha blockers as a form of treatment for schizophrenia. However, I did find this in reference to alpha blockers and post traumatic stress disorder...

A final note on adrenergic agents
Although there are clear research data that alpha- and beta-adregernic blockers can be useful adjuncts in the treatment of post traumatic stress, the investigations to date have been limited to case reports, open trials, and a handful of controlled trials with very few subjects. The data suggest that beta-blockers may be helpful in treating those individuals who suffer from intense symptoms of hyperarousal, while alpha-blockers may be most helpful in those with intractable sleep disturbances and nightmares. ...

Source: Principles of Trauma Theory

The paragraph immediately below that one also contains a blurb regarding anti-psychotics, dopamine and tardive dyskinesia. Meantime, there is an increasing focus on the relationship between trauma and psychosis with a causal link having been established...

... The results are entirely consistent with many previous retrospective studies showing high levels of childhood abuse and trauma among schizophrenia patients. By relaxing the outcome criteria from a diagnosis of schizophrenia to the presence of any of a broad category of symptoms, the researchers were able in this study to prospectively and convincingly link trauma to a later psychotic state. A handful of other studies have recently used similar designs and along with this report, the results are starting to show a consistent pattern between trauma and psychosis, particularly hallucinations (reviewed in Read et al., 2005). It remains to be seen, however, if the association between trauma and psychotic symptoms also applies to psychotic disorders, including schizophrenia.

More work will be necessary to sort out the mechanisms by which trauma increases the risk of psychosis, but several likely hypotheses exist. Childhood stress affects early brain development, and changes the sensitivity of the hypothalamic-pituitary-adrenal (HPA) axis. This could contribute to the dopamine abnormalities seen in psychosis. It is also possible that traumatic experiences early in life could directly affect dopamine pathways.

In any case, the study reveals childhood trauma as an often-hidden factor that could explain much of the burden of psychosis that occurs outside of major mental disorders. But what about the psychosis of schizophrenia? As van Os and colleagues have written (Read et al., 2005), the practice of classifying psychotic symptoms as PTSD whenever there is clear evidence of trauma may have led clinicians astray and hindered studies on the possible role of trauma in raising the risk of schizophrenia-like disorders. The current work bolsters the case for taking a symptom-centric view of stress-related mental illnesses, especially in light of the fact that different diagnoses, including post-traumatic stress disorder and schizophrenia, involve common psychotic hallmarks like hallucinations and paranoia.

Source: Schizophrenia Research Forum

If your doctor consents to the alpha blocker trial it would be interesting to know how it goes for you.

[MirageXD]

Hello again spiritual_emergency,

I'm glad you are not trying to convince me to go off the medication for a change.

I know that everybody who takes antipsychotics is affraid of tardive dyskinesia (TD), but this is not what I have. As you noted, it exhibits itself by random body movements. In my case, I just have some difficulty speaking, and it's not even so bad, but very annoying, and I have to think about it every time I open my mouth. You just cannot get used to it.

I'm more concerned about your child though. You say she/he has been treated with Haloperidol which is a typical antipsychotic (1st generation). I know that it is still being used in double blind studies of medications just to demonstrate how bad are 1st generation antipsychotics compared to the new antipsychotics. I'm not kidding, and I didn't think that it is still being prescribed. Basically, these old antipsychotics have the following problems: NMS, extrapyramidal symptoms (EPS) and increased chance of developing TD.

You said you think that your child developed TD, but TD develops after at least a month, so it wasn't TD. More likely it was one of the extrapyramidal symptoms which (unlike TD) can be treated pretty well using antiparkinsonian agents (anticholinergics).

I would suggest to tell your child's doctor to use one of the atypical antipsychotics which have a much better profile.

BTW, I'm not more sensitive to side effects, because this is pretty normal with antipsychotics. They all suck.

As to alpha blockers, it's just another experiment of mine. I hardly think it can help anyone else, because it's specific to my condition. I know a bit about them: mainly they treat hypertension (high blood pressure) and can improve cognitive deficit (yay).

Cheers,
Mirage

[spiritual_emergency]

Mirage: I'm glad you are not trying to convince me to go off the medication for a change.

Mirage, I would think that most people would be able to read through that thread and recognize that I never was. I was speaking from my own experience.

As for my child, we got a lawyer and we got them out of that hospital. You may recall that I had already noted they were working with some better professionals.

Good luck with your treatment Mirage.

[spiritual_emergency]

lol. I may have found a place where you'll be comfortable, Mirage. It is verboten to speak of recovery there, and any talk of recovery without meds, any talk of psychological treatments... there is a punishment for that.

It's called crazyboards.org and right now, they're having a field day running me into the ground. You could go join them.

And to think you said I hadn't offered you anything helpful.

[MirageXD]

Finally! Some crazy site where people are not affraid to express their true feelings! What's more, you can use free vocabulary.

But if I leave, who's gonna fight you here?

[spiritual_emergency]

I'm sorry Mirage but I think you'll find the quality of moderators here are substantially superior to the type of moderating that is offered in that community. If fighting is what you want to do, I suspect you're going to be disappointed. That kind of behavior would never be tolerated here, from moderator or member alike.

By the way, when I said I was aware of places on the net where psychological treatments were never discussed... I wasn't referring to this site. But I think you could probably find the oasis of peace you were looking for at that site. Clearly, there will be no toleration of any sort of discussion related to treatment approaches that are anything but medication. It sounds like your kind of place.

[MirageXD]

Clearly, you have no sense of humor.

Let us stay on topic, people.