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.