Mental Health Anti psycotics for schizo-affective disorder

[Boku_]

I've been on anti psychotics since 2002. In 2008 I went to pysch hospital and changed my meds due to psychosis . Anyone got any tips about taking this kind of medication long term and staying healthy?

 

[MeaCulpa]

Exercise, eat healthy, have labs done once a year to make sure you aren't having metabolic effects like high blood sugar.

There are some other things. If you would ever feel feverish, stiff, and have changes in consciousness, like being very dopey and having no sense of time get to a doctor or an the ED.There is a rare but serious thing that can happen with antipsychotics, called NMS. you'll probably never have to worry about it but if you have those symptoms it's worth getting it checked out.

 

[AlphaMethylPhenyl]

I have schizophrenia too.

The best thing I can say is stay on your meds. If you don't like one, ask your doctor if you can change it. Always stay on your meds though, unless you want to live in a nursing home. That's the hard truth.

The above suggestions are valid too.

I will be back later to give more suggestions.

 

[Brody5150]

Like Ho-Chi-Minh said, please take your meds everyday. There are so many different ones you can switch to if you don't like the one you're taking. I know it can be frustrating trying to find the right one but just remember that everyone's brain is wired differently and that's why it may take multiple switches till you find the right one.

If taking your meds is an issue, Idk if you know this already, but there are some meds that come in a shot that is only administered once a month as opposed to taking a pill everyday. I don't know them all off the top of my head, but a few that i remember are invega sustenna, abilify maintenna, and risperdal consta (that one is every 2 weeks).

I actually met a guy that has schizo-affective d/o when i was interning at a clinic and he allowed me to administer invega sustenna for the first time. He also let me sit in his appointment with the psychiatrist and he said he liked the shot more than the daily pill. I have a friend that has schizophrenia and he takes a shot once a month as well. And today i met a guy with schizophrenia that hates taking his meds cause he takes so many. We gave him the option of taking invega sustenna and with that we were able to discontinue 3 of his meds.

As you probably know already, some antipsychotics cause weight gain. Diabetes can follow as well as all the other complications that come with significant weight gain. I know it gets annoying hearing the same thing over and over but diet and exercise are very important. If you're like me, you probably ignore it anyway and eat what you want lol but my friend that has schizophrenia gained over 100 lbs over the years and I'd hate for that to happen to you so i just want to stress how important diet and exercise is..

I hope this helps and I wish you the best.

 

[MeaCulpa]

1st generation anti-psychotics had a much greater risk of tardive dyskinesia(TD), a pretty hard to treat possibly irreversible movement disorder. During the era where those drugs were the only anti-psychotics available, it was not uncommon to hear advice to make sure you stuck your tongue out every morning when you brushed your teeth. If your tongue was making involuntary, undulating movements it was something to bring up with your prescriber. TD is less of a concern now. I don't suggest doing the tongue test daily but I think doing an occasional check is still a good practice.

Probably the biggest health issue affecting people with schizophrenia spectrum disorders isn't medication related. Its that while the general adult population is about 16% smokers the schizophrenic rate of smokers is close to 90%, and schizophrenics who smoke tend to be very heavy smokers. This likely is due to nicotine receptors helping with focus and concentration for schizophrenic folks. How much an individual psychiatrist is going to be proactive about smoking cessation for patients is going to vary a great deal. If you are a smoker and you are interested in quitting for health's sake do mention it to your provider. They are more likely to make an effort when a patient expresses interest.

I have had periods of binging on psychiatry related literature and had periods where I've not paid much attention at all. There was an idea about ten years ago or so that doing fish oil with antipsychotics tended to enhance their efficacy and might even allow for lower doses. There were studies that supported the idea. I'm not saying anyone ought take fish oil and lower their dose on their own. I'm suggesting one might ask their prescriber about things that help one in staying at the minimal effective dose.

I'm a little bit medically literate, but I don't have the education and experience to really evaluate all the studies about schizophrenia and antipsychotics. My cheat sheet on sorting through medical literature is Cochrane monographs. A Cochrane monograph tends to survey all the studies on a medication or treatment and then the experts start tossing out various studies because they are to small or have methodological flaws. They try to come to an expertise based averaging out of reliable, evidence based sources.

Not saying you need to comb through Cochrane for guidance either. Letting your provider know that you are compliant with medication but want to minimize any possible ill effects might cause him or her to give you a lot more info than they would in a run of the mill patient encounter.

 

[Brody5150]

1st generation anti-psychotics had a much greater risk of tardive dyskinesia(TD), a pretty hard to treat possibly irreversible movement disorder. During the era where those drugs were the only anti-psychotics available, it was not uncommon to hear advice to make sure you stuck your tongue out every morning when you brushed your teeth. If your tongue was making involuntary, undulating movements it was something to bring up with your prescriber. TD is less of a concern now. I don't suggest doing the tongue test daily but I think doing an occasional check is still a good practice.

Probably the biggest health issue affecting people with schizophrenia spectrum disorders isn't medication related. Its that while the general adult population is about 16% smokers the schizophrenic rate of smokers is close to 90%, and schizophrenics who smoke tend to be very heavy smokers. This likely is due to nicotine receptors helping with focus and concentration for schizophrenic folks. How much an individual psychiatrist is going to be proactive about smoking cessation for patients is going to vary a great deal. If you are a smoker and you are interested in quitting for health's sake do mention it to your provider. They are more likely to make an effort when a patient expresses interest.

1st generation antipsychotics aren't as common nowadays due to the EPS (extrapyramidal symotoms) and TD, though I did see Haldol twice recently. 2nd generation antipsychotics are the ones used a lot more now, but no med is perfect, the 2nd generation ones may cause NMS (neuroleptic malignant syndrome). It isn't very common though, the psychiatrist I interned for said she's only seen it once in her entire career. But it is a possibility, so I recommend you always know what drug you're taking. Research the side effects, which ones are the ones you need to look out for. Like a few symptoms of NMS are excessive sweating, difficulty swallowing, rigidity, delirium.. There are more but I can't remember them all off the top of my head.

If course, Idk how I forgot about the smoking.. My friend that has schizophrenia smokes 2 packs a day. I didn't believe it until I saw it with my own eyes. I didn't think it was possible to smoke that much in one day.. I tried the whole "I'll cut down if you cut down" thing with him but within a few minutes he'd start his chain smoking all over again.

 

[AlphaMethylPhenyl]

Yeah lung cancer and obesity definitely lead to a higher death rate for schizophrenics, that and sitting down all the time.

 

[MeaCulpa]

Another unhealthy thing that comes up with schizophrenia, that meds might have a slight bearing on, but is mostly a result of the illness and the aftermath of episodes, is lack of a support system.

Having a fulfilling social life has medical benefits. Better immune system, better longevity-I'll post a link and excerpt

https://bewell.stanford.edu/features/social-ties-good-health

Does research show convincingly that social ties really improve health?
Yes, and there are many studies, but it is difficult to determine the quality of the research unless you examine it closely. Some studies focus on short-term health benefits such as reduced incidence of colds and flu. Other research looks at longevity, alleging that the number of friends correlates with longer life. Still other studies have found that people have better survival rates for diseases when they have social support. Not long ago I heard a cardiologist compare social isolation to smoking, saying that loneliness is the new tobacco.

A significant health challenge for many schizophrenics is isolation. Our behavior in episodes has often pushed others away. Anhedonia and flat affect(which can come from the illness or from medications) can make it hard to engage and connect. Anxiety and paranoic tendencies can make others avoid us and make us avoid other people. Many schizophrenics are authentically needing to be on disability, but disability can be another source of isolation and lack of connection.

I've brought up several things that I have no idea if they pertain to the OPs situation at all like smoking, 1st generation antipsychotics, disability, and isolation. OP, Boku_, it would be good to hear back from you about what your specific concerns are regarding antipsychotics and health. Thanks for starting a thread on a really important topic

 

[Boku_]

Thanks for the replies guys. I stopped smoking in 2009. Best thing I ever did. However I still wear a nicotine patch everyday. I know about trying to be a active and eat well. I always take my meds everyday. Weight gain is the killer IMO.

 

[AlphaMethylPhenyl]

^props on taking meds every day!

 

[paranoid android]

1st generation antipsychotics aren't as common nowadays due to the EPS (extrapyramidal symotoms) and TD, though I did see Haldol twice recently. 2nd generation antipsychotics are the ones used a lot more now, but no med is perfect, the 2nd generation ones may cause NMS (neuroleptic malignant syndrome). It isn't very common though, the psychiatrist I interned for said she's only seen it once in her entire career. But it is a possibility, so I recommend you always know what drug you're taking. Research the side effects, which ones are the ones you need to look out for. Like a few symptoms of NMS are excessive sweating, difficulty swallowing, rigidity, delirium.. There are more but I can't remember them all off the top of my head.

I actually haven't found the old typical anti-psychotics such as Chlorpromazine aka Thorazine aka good ol Largactil, Prochlorperazine (Compazine, Stemetil) or Methotrimeprazine (Nozinan in Canada) to be bad at all. I have only been prescribed them for nausea and vomiting but i have taken them for mania as well and they worked pretty good. Thorazine i didn't find to be bad at all though i only took 100mg's at most at a time. It feels more like a anti-histamine then like a anti-psychotic really. Methotrimeprazine used to knock me out for a good 10 hours just on 10-20mg's. It's only half as potent of a anti-psychotic as Chlorpromazine but it's so sedating it makes Seroquel look like Dexedrine by comparison. It's not used for it's anti-psychotic properties anymore so much as it's used for nausea and vomiting, insomnia and severe anxiety. I have seen tests comparing the old Typical Perphenazine to the atypicals and it worked just as well as most of the atypicals with about the same amount of side effects. Only Clozapine and Olanzapine tested better then Perphenazine.

As for the atypicals i find Zyprexa to be the best and most tolerable. I have had Quetiapine both the IR and XR (i didn't care much for the XR), Risperidone and Olanzapine in tablets and Zyprexa Zydis which are the wafers. The wafers are by far the best for controlling a mixed state or manic state.

 

[Boku_]

Thanks guys for the replies and information. My mother gets me fish oil tablets however since I first posted this topic I had a mini nervous breakdown and had to go to the mental hospital to change medication. It all went smoothly but for the first week after I was discharged I was having withdrawal symptoms from stopping one of my anti psychotic meds. You know insomnia and paranoid feelings while feeling suicidal. It got gradually better over 2/ 3 weeks. That was back in June this year but I am back to normal now.

All I'll say if the meds work I work

 

[Hilary]

I know I sound like a broken record. Cannabinoids (CBD oil) work for Schizophrenia. They are all-natural and don't have any side-effects - other than helping people to sleep better. Your body already has an endocannabinoid system and already produces small amounts of cannabinoids to protect your nervous system, but not enough to keep up with the stresses of modern living.

http://www.medicaljane.com/2013/08/30/cannabidiol-cbd-may-reduce-psychotic-symptoms-of-schizophrenia/

http://www.medicaljane.com/2015/02/28/a-brief-overview-of-the-endocannabinoid-system/

I buy concentrated CBD oil. It's made from industrial hemp. It helps me with joint pain, peripheral neuropathy, stress, and sleep problems.
Other helpful items for nervous system health:
Fish oil (omega 3 fatty acids)
Niacin
Magnesium Citrate dissolved in water or juice
B complex vitamins
Reduce stress
Reduce caffeine
stay hydrated
Vitamin C (natural, not ascorbic acid)
Vitamin D3 and Sunshine
Healthy Diet
Exercise

Check out the thread on "Getting off Invega-Sustenna"

 

[SixBuckets]

One thing that's not mentioned very often is the possibility of elevated prolactin levels if you're taking risperidone or amisulpride. High prolactin levels can affect your bone health and fertility. This can be monitored with a simple blood test every now and then.

 

[iridescentblack]

One thing that's not mentioned very often is the possibility of elevated prolactin levels if you're taking risperidone or amisulpride. High prolactin levels can affect your bone health and fertility. This can be monitored with a simple blood test every now and then.

Just found out, Monday, my prolactin levels are even higher than they were last time I went in to see my psychiatrist. She decided to prescribe abilify to hopefully bring the prolactin down. I was sitting there looking at her, thinking, "You had me on invega sustenna for a year! How did you not fucking anticipate this?"

Or maybe she did and she's just trying to make extra money with the abilify she prescribed.

 

[SixBuckets]

Just found out, Monday, my prolactin levels are even higher than they were last time I went in to see my psychiatrist. She decided to prescribe abilify to hopefully bring the prolactin down. I was sitting there looking at her, thinking, "You had me on invega sustenna for a year! How did you not fucking anticipate this?"

Or maybe she did and she's just trying to make extra money with the abilify she prescribed.

A lot of psychiatrists and patients - myself included - make the informed decision that a risk or occurance of high prolactin is a reasonable pay off for stability. My current medication combo stabilises me very effectively - I work and study, have a very happy and functional marriage, and haven't had an episode of any kind in over five years. This has been unachieveable on any other medication. Unfortunately, my prolactin levels are through the roof, but my medical team and I have decided that (at least for the moment) I'm willing to accept the health risks/ramifications of that in order to maintain my current mental health status. I guess I've got my fingers crossed that another option presents itself within the next ten or fifteen years, before it really starts affecting my bones.

That said, this should be an INFORMED decision - while it's a reasonable risk to take if you have all the information and the medication is highly effective for you, your doctor should have let you know that this was a possible outcome of your prescription and explained what it meant. I'm constantly horrified by how little engagement most psychiatrists do with their patients about side effects.

 

[Miss Tecal]

Just found out, Monday, my prolactin levels are even higher than they were last time I went in to see my psychiatrist. She decided to prescribe abilify to hopefully bring the prolactin down. I was sitting there looking at her, thinking, "You had me on invega sustenna for a year! How did you not fucking anticipate this?"

Or maybe she did and she's just trying to make extra money with the abilify she prescribed.

In my experience Aripiprazole (Abilify) is a great drug - it's pretty good at lowering prolactin levels due to the fact that it has some pretty unique qualities being a partial D2 and 5-HT1A agonist. Everyone responds differently to medications and unfortunately there is no way of knowing who will get what side effect and how severe that will be. Hyperprolactinemia has varying effects -some people struggle with sexual dysfunction, fatty tissue developing in the breasts (Gynaecomastia), milk production from the breasts (Galactorrhoeh) and a whole host of other symptoms but some people have high levels of prolactin and don't seem to suffer any adverse effects.

That said, Aripiprazole does seem to have a lower side effect profile and seems to be an effective treatment - I really hope it works for you.

 

[Miss Tecal]

A lot of psychiatrists and patients - myself included - make the informed decision that a risk or occurance of high prolactin is a reasonable pay off for stability. My current medication combo stabilises me very effectively - I work and study, have a very happy and functional marriage, and haven't had an episode of any kind in over five years. This has been unachieveable on any other medication. Unfortunately, my prolactin levels are through the roof, but my medical team and I have decided that (at least for the moment) I'm willing to accept the health risks/ramifications of that in order to maintain my current mental health status. I guess I've got my fingers crossed that another option presents itself within the next ten or fifteen years, before it really starts affecting my bones.


That said, this should be an INFORMED decision - while it's a reasonable risk to take if you have all the information and the medication is highly effective for you, your doctor should have let you know that this was a possible outcome of your prescription and explained what it meant. I'm constantly horrified by how little engagement most psychiatrists do with their patients about side effects.

Totally agree with you here - don't get me wrong some psychiatrists are fantastic but unfortunately the majority either seem to be in the job for the wrong reasons or are completely burned out and don't care anymore. Lately I'm horrified about how little engagement most psychiatrists have with their patients full stop!

Glad to hear you're doing well, it's a really hard trade off sometimes and people can be stable for years and have the slightest tweak in medication and relapse badly and end up back at square one so I understand why you take that risk.

 

[Hilary]

In my experience Aripiprazole (Abilify) is a great drug - it's pretty good at lowering prolactin levels due to the fact that it has some pretty unique qualities being a partial D2 and 5-HT1A agonist.

That said, Aripiprazole does seem to have a lower side effect profile and seems to be an effective treatment - I really hope it works for you.

This sounds like a pharmaceutical representative... just saying

 

[Miss Tecal]

This sounds like a pharmaceutical representative... just saying

Ha I wish - they make a hell of a lot more money than I do. No I'm a an over worked and under paid psychiatric nurse with a geeky passion for neurology and how medications work in the brain - mainly due it being drilled into me at nurse school and also finding it a good way to remember what drugs cause what side effects and my exam was on hyperprolactinemia (risperidone induced though) treated with aripiprazole.

I also have first hand experience seeing people on the wards and how people seem to react to medications hence my enthusiasm at some drugs.

Looking back it does sound a bit reppy - but they always bring sandwiches when they're selling something!