Thursday, May 03, 2007

Medication Update

It’s been a while since I have written a full update on how Mr Man is doing and recent appointments and such. At the beginning of October I wrote how Mr Mans Risperdal (Risperidone) had been changed to Abilify (Aripiprazole) which he now takes in addition to the Clozaril that he has been taking since 2003. The change over period was a bit shaky, with Mr Man becoming quite paranoid and delusional, believing that our visitors were spies and questioning whether he was really ill or not. I had to keep a closer eye on him than usual for a little while, especially at medication times, as once he starts down that slippery slope of paranoia and delusion he is likely to start skipping medication secretly, which then of course leads to all kinds of problems.

It’s quite hard to gauge how much the Abilify has helped with Mr Mans positive symptoms as the changes have been gradual over a period of 7 months now. Also, for the two months before the switch these symptoms had worsened due to being on his own for two nights when there were no beds at the respite home, so to compare fairly with the Risperdal I would have to think back to over 9 months ago, which is quite difficult. It’s very obvious that the negative symptoms have improved now though and he has fewer side effects than before; he is usually more alert and less drowsy now, and his concentration is much better. In fact over the last 6 months or so he has accomplished a great deal and generally seems more motivated to engage in his hobbies. He has even talked about working again, and is keen to start his own web design business, although only if he can work from home and never leave the house!

I would also say that he is starting to interact better with more people now. Although he still can’t really cope with too many people all at once, he is definitely more willing to have company now and the list of individuals that he feels comfortable with is slowly growing.

One thing that the medication change hasn’t helped with is Mr Mans growing levels of anxiety. It’s difficult to say whether or not this problem still would have continued to worsen if he had stayed on the Risperdal, but the anxiety in itself isn’t a new problem. As I mentioned previously, Mr Mans CPN is taking this problem much more seriously now and last time he visited we talked about it at length. If only we had known more about anxiety when Mr Mans problems first started to escalate. We were using gradual exposure when we first started to tackle this issue, probably back in 2004, but Mr Mans anxiety suddenly and dramatically increased while he was out of the house on his own one day, and since then he hasn’t had the confidence to try it again. What we didn’t realise at the time though is that this experience is common and is known as the “anxiety burst”. Apparently, what we should have done is continue with the exposure, but at the time I didn’t know this and I was worried about pushing Mr Man too much and causing a relapse of his symptoms.

We saw Mr Mans Psychiatrist recently and discussed this ongoing anxiety problem. She decided to introduce an antidepressant called Citalopram, which is an idea that has been on the cards for a long time for various reasons but she felt that Mr Man needed to be more stable on his other medications first. Citalopram is the antidepressant that I take myself, and is well known for helping to control anxiety. Also, his Psychiatrist mentioned that it can help with “compulsive tendencies” as she called them, which is another problem that Mr Man has been suffering from. The most intrusive compulsive thought that he has, which is compounded by the voices, is that he feels he needs to continually add numbers together, such as 1 and 1 is 2, 2 and 2 is 4, 4 and 4 is 8, and so on, until he reaches 65,536. He always stops at that number and then starts all over again. When I asked him why, he said that there are 65,536 numbers that can be represented by 16 bits in binary. Now, binary is a concept way over my delicate little brain cells, but apparently it begins at 0 (zero) and the highest number in 16 bit binary is 65,535, which is 65,536 numbers in total including zero. I still don’t really see the connection myself, but it all makes perfect sense to him, and the more I said I didn’t understand the more detail he went into which confused me even more.

I can see why people say there is a fine line between genius and madness.


slurry said...

Thats quite a mix of meds, but glad they are working and helping Mr Man with the symptoms.
I was on clozeril many years back well 5, but it did not agree with my heart at all, so was decided to stop before it did any real damage.
Cipramil I think is quite a good med, I never had any problems with it, but then as usual they fussed with my meds and changed me to venelafaxine which is the worst thing in the world to be on, then more recently on to Zispin which again isnt a bad med, just makes people fat, like every other medication used in this area.

Sandi said...

My husband takes a Geodon and Seroquel cocktail. Along with zoloft and lithium.

I have heard so much about abilify..but have been hesitant to have him try it, just because med changes are soooo difficult.

We will have to talk to his doctor about it again.

Slurry said...

Sandi, hows does your husband get on with the Geodon? I have just started on it. I tried the abilify but found I needed a shed load of lorzepam to deal with the climbing the walls feeling it gave me.

Sandi said...

slurry, he does well on it as long as he has the small amount of seroquel added in. When they tried to remove the seroquel completely it didn't work nearly as well. So they added it back in.
In the beginning he had a problem with insomnia but that cleared up as he adjusted to it. I think it was probably about a month or so.

I wish you luck on it! :)

rosie said...

I just recently met my ex whom I have been together with 2 years, by the time already through a diagnose of schizophrenia, several months of "treatment" in an asylum, and he is again, not looking good. I have not much idea how to help him as he has this idea of coming down from medication, that is, being "healthy", "drug free". But everytime that happens, he starts seriously smoking weed as a part of his lifestyle, and the condition worsens and the inability to work, the hallucination and the weird ideas re-occur. He spent during this time again three months in above institute. That so called treatment consists of having him tied to the bed upside down, the "caretakers" burning cigarettes on his back, allowing other patients torturing him and themselves torturing him, playing around with his medication, experimenting how much he can "take". It is just so terrible. He can barely talk about it. As this whole is happpening in Roumania there is no way to take legal action whatsoever, if you know the situation in that country. He would do anything to avoid this but every time some passes he feels better and nothing on earth can stop him from believing that the pills are all against him and put them down. I do not have much influence on his life any more but I was his first and last girlfriend ever (he is now 33) and I am trying to find at lease something to say to him in my e-mails that could stop this vicious cycle. He has no insurance in this country but every time somebody calls the ambulance on him (he stops eating and going to work, and starts doing irrational things like starting to drive all the way south and then running out of fuel, then walking on until he faints), because of his records he is being taken back to Roumania where he gets beaten up, humiliated, not fed, drugged with sedatives, his belongings taken away, tortured but of course visitors not allowed... but the scars and the look in his eyes just speak for everything. I am not in love with him any more but I am terribly concerned about him and see no way out. Sorry for the ranting, but if you have any advice (though I don't feel any email I could write him would have any power over what is happening) just don't hesitate, especially with convincing him that even though marijuana is widely used for recreational goals by people his age, it is not for him and he should stop doing it. It is devastating to see this man go down like this.

Mr Mans Wife said...

Thanks Slurry, I am relieved that things are improving for Mr Man, although it seems to have been a long search. It’s only 3 meds really, and only twice a day, which seems like nothing in comparison to what he used to take. What do you mean by “the climbing the walls feeling”?

I agree Sandi, sometimes you’re better off sticking to what you know. Medication changes for Mr Man always make me nervous, but thankfully it has worked out pretty well.

Rosie, thank you for your comment and welcome to my blog. I am really sorry to hear about all the problems your ex has had with his health. I agree that it is very difficult to help someone when they feel that the medication is being used to control them. It’s strange though that he should want to be “healthy” and “drug free” and then smoke marijuana! It really is important that he stops smoking it though, as there is evidence that smoking marijuana can actually cause mental health problems, and obviously worsen problems that already exist. I’ve seen this happen to at least two people that I know (not Mr Man).

I really can’t comment on the “treatment” he receives from his “caretakers” as I have no knowledge of mental health services in other countries. On one hand Schizophrenia can make people believe that they are being persecuted when they are not, but on the other hand persecutors of the mentally ill rely on the fact that no one will believe them because they are “insane”. Are you completely sure that his scars are not self inflicted? The look in his eyes won’t mean that what he says about the torture is true – only that he believes it is true.

I wish I knew what advice I could give you. I agree that if he stopped smoking marijuana it would be a start. Thank you for leaving a comment Rosie. I hope the situation improves soon.

Does anyone else have any advice that they could offer Rosie?

Sandi said...

rosie.. I don't have any advice, but that is appalling. It sickens me that people are treated that way.

I am very sorry.

Catherine said...

I am glad the Abilify is definitely helping with at least some of the symptoms. The best outcome would be to have all symptoms under control, correct? Is that possible? Or maybe the changes have already happened, but have been so gradual that you haven't noticed them (like you mentioned). Am I making any sense at all?

Was also very impressed to read that he was thinking of starting his own business. Go Mr Man!

Mr Mans Wife said...

Thanks Catherine. Yes, to have all symptoms under control would definitely be the best outcome, but I don't know if that is really possible. On the other hand I didn't expect Mr Mans symptoms to ever be as under control as they are now, so I should never give up hope. I really think his anxiety is the last hurdle now; his other symptoms vary, but are mostly under control.

Catherine said...

I know what you mean about not giving up hope. Have I accepted having bipolar? I suppose in a way; I mean, I do take my meds when I am supposed to (most of the time) and go for my appts as necessary.

But am I able to live with the fact that I could have it for the rest of my life and never have it fully under control? To be honest, no I am not. I am not ready to stop fighting. For me, fighting is what keep my hope alive. And if I couldn't fight for myself, I would be thankful to have someone like you fighting for me.

So maybe you are also part of the reason Mr Man is getting better. He sees that you are supportive instead of judgemental, that you believe in him. Yes, the meds are doing their job, but so are you by showing Mr Man that you value him.

*Sigh* Once again, I hope what I am saying makes sense. I've been kinda loopy lately, lol

Catherine said...

Mr Mans Wife: You asked what the "climbing the walls" feeling was like, and even though you addressed slurry, I feel like I can relate.

I too took Abilify. I felt restless, like I had to be moving constantly; however, even moving around didn't make it go away entirely. I would try to lie down for a bit, but within a short period of time I would be back on my again, pacing or tapping or even chanting out loud - anything to reduce the internal agitation.

Slurry said...

Catherine has got it down to a T about what I feel the climbing the walls feeling is, its like you want to run a marathon and you get to the end, and run back, just the constant internal aggitation, very nasty feeling the abilify gave me that as the worst side effect it had, even worse than Stelazine, but apart from that it was quite good. The Geoden, I feel is a huge step forward in regards to medication, so far no side effects, sleeping better at night and getting up at a reasonable time, allmost feeling like I would imagine I would feel if all things had been equal and I didnt become ill, which i never thought was possible. of course its all subject to change and I could wake up in the morning thinking invasion is iminant, by beings not of this planet!

Mr Mans Wife said...

Hmm… something strange going on here – I usually get email notification when someone leaves a comment, but they don’t seem to be coming through properly, so my apologies if I miss someones comment or reply late.

Thank you Catherine. Yes, what you say makes a lot of sense, and without wishing to blow my own trumpet I’m sure you’re right. I have to stress though that the support I offer Mr Man has not been all one sided; he is brilliant about my own health problems. Actually I often wonder if having to care for me was one of the extra burdens that made him so ill in the first place. Maybe I should write about that in more detail; I’ve never actually written about the guilt I sometimes feel…

Slurry I understand what you mean now about the “climbing the walls” feeling. It sounds a lot like how I was affected by Prozac. Poor Mr Man – there he was in the depths of depression, in need of some patience and understanding, and there I was with my non stop chatter whilst juggling balls because I couldn’t sit still!

I’m really glad that the Geoden seems to suit you so well. (Although sitting in the garden in a haze sounded pretty good to me as well!)

rmacapobre said...

my friend (qui j'aime) is taking zyphrexa something. its making him sleepy and disoriented. and unable to function normally at work. hes thinking about loosing his job over it. and also recently he had small suicidal thoughts. i try to cheer him up all the time and he does say it helps. but i wonder. he asked his doctors to lower the dosage and he is much control now ..

Mr Mans Wife said...

Hi there Rmacapobre, thank you for your comments.

The sleepiness that you describe in your friend is very common with anti-psychotic medication. It can be difficult for doctors to find a balance between controlling symptoms and side effects, especially at the beginning. I’m glad to hear that your friend is coping better now that his medication has been reduced.

You are a good friend to him, and you obviously worry about him. If his suicidal thoughts continue make sure he mentions it to the doctor.

Thanks again for your comments.

marlena rivers said...

wow. you are a really wonderful partner, so supportive and it's nice to see that you try to understand what's going on in your husband's head. i find one of the most supportive thigns my boyfriend does is to be ok with and engage with the weird things that go on inside my head, which can be challenging for the other person as the imagery is scary and can be violent...
i also wonder if the numbers thing you were talking about, does your husband find it soothing to go through that whole chain of numbers or is it oppressive and he is kind of "forced" to do it. it's weird how the stuff in my mind can be both oppressive and at the same time soothing, like sitting on the subway having all kinds of weird images go through my mind like a sequence in a horror movie can feel ok. i think the anxiety can be worse than any of the other things that go on in my brain as it sort of amps up everything else and is more exhausting that the crazy thinking. does your husband do any meditation or breathing/relaxation exercises for anxiety? i highly recommend it. it could be soemthing you could do together...

Roy said...

Re: the counting in binary thing...
Sometimes, folks who realize they are losing some of their faculties will do things like this just to help them feel like they still "have it". It may also be a way to maintain their concentration or to help them focus.

BTW, love the blog.

Mr Mans Wife said...

Thank you Marlena, I do try to be supportive, although I don’t always do it well.

You bring out so many good points that I know I really need to write about in more detail, but I’m trying to tell our story in order (although I haven’t actually got any further than the day he was admitted so far!)

You say that your boyfriend is “ok with, and engages with” the weird things that go on inside your head? Can you explain a bit more what you mean by that? I remember when Mr Man was on home leave from hospital; at the time he believed that little side plates could protect him from the “beams” that were directed at him from the “company” trying to steal his thoughts. At that time he was so anxious about it that I let him put little plates on the floor all around our bed at night. Although I didn’t want to reinforce his beliefs, I would have gone along with anything to make him feel safer at that time. Is this what you mean by “engages with”?

Mr Man has also suffered from violent imagery, and still does sometimes. The voices used to tell him to kill me and chop me up into pieces, and he would “see” it happening. You can imagine how distressing that was for him, but one of the nurses on the ward suggested that these were actually his own desires and told him that he can’t blame the voices for his own actions! As if he was planning on doing it and thinking he could “get away with it” by saying “the voices told me to do it”!

As regards the numbers, yes, he feels forced to do it, and it actually causes him a lot of anxiety. He doesn’t find it soothing at all, and he finds it very difficult to think about anything else.

It’s strange how your “crazy thinking” doesn’t seem to cause you anxiety, but I’m glad that this is the case for you. I agree; anxiety is exhausting. Mr Man has done about a billion anxiety management courses, but actually I have already asked about doing one myself so that I know how to help him, and this is being looked into for me.

Thanks again for your comments Marlena.

Roy, thank you for your comment. That’s a very interesting point, but as explained above, Mr Man feels forced into this counting thing, and it actually has a bad affect on his concentration because he can’t think about anything else.

I’m glad you are enjoying the blog. Thank you. :)

The Fly said...

There is a fine line between genius and psychosis!!! It is never spoken about in a clinical setting, seems like only on the Internet! From my view point, the Mental Health System does not know how to handle the genius in us persons with schizophrenia. Here in Canada, namely Montreal, the Hospital started to invest in my genius slant through the arts....times do slowly change for the better!!!....Doctor Goober Modesty...and proud of my schizophrenia!

Mr Mans Wife said...

Hey Goober! Great to see you commenting.

You raise some very interesting points, and this is something I have wanted to write about for quite some time, so bear with me while I write a post on the subject.

Thanks for your comment.

Anonymous said...

Hi i was reading about Mr Man and
schizophrenia. i know nothign about it, and it must be difficult to understand i do hope Mr MAN is a littel better on madication..
good luck and god bless ..