abnormal behaviour .... schizophrenic like picture ... not responding to medication ... with h/o epilpesy in childhood .... ? treatment ? Management a young girl in her twenties came with the parents reporting sign n symptom of schizophrenia for 3 years - muttering ... laughing without reason - crying without reason - neglect of self care - like bathing justp utting water on body .. does not use soap ..... Treted with olanzapine by another psychiatrist with olanz - had side effect as exxcessive weight gain with excessive appetite on history n on inquiry - frequnet faith healer visit n Irregular intake of medicine ( as can be expected in the village ) came for the second opinion ... on inquiry n detail history noticed h/o epilepsy in the childhood ... 6 times in 4 years then stopped without medication .... so need your views n opinion regarding is there any or can there be any corealation - of abnormal behvior with h/o childhood epilepsy ... if yes then does any body has any experience or explanation ? pl share can this be treated or should be treated with the addition of Antiepileptic medicine even though there is not active seizures ? does supplementary or dietary support or psychotherapy support helps ? should we go for Imaging study ? like CT Scan Brain / MRI Brain with contrast ? or PET Scan Brain .... what do you advise n why ? what should we look for ? pl share your ideas

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He must be added antiepileptic drug with suitable antipsychotic. Valproic/valproate works better in case of schizophrenia as well as in mood disorder. I am sure it will help your patient. As a routine investigation MRI brain & EEG should be done, doesn't matter if investigations are normal.

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If recently done EEG features seizure activity, then AED shd be started immediately, otherwise not. May be autism spectrum disorder

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20 YEARS OLD FEMALE.HAVING LONG STANDING SCHIZOPHRENIA HAD SUFFERED FROM EPILEPSY IN CHILDHOOD YES SHE SHOULD HAVE TREAMENT FOR BOTH

Hi Sir, firstly the seizure if the last episode of seizure is more than 4-5yrs then not to get worried about it and even medication may not be required.(Neurologist would be better person to comment.) Coming on to symptoms like muttering to self, inappropriate laugh/cry, decreased self care, she is likely to suffer from Schizophrenia. History of weight gain with Olanzepine which is one of its common side effects- she can be tried on Risperidone 3-4mg initially and gradually increase the dose to 6-8mg wait for 2-3weeks to see the response and add Tab Trihexyphenidyl for Extra pyramidal side effects like tremor, salivation and rigidity which can happen with Risperidone.

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Schizophrenia with history of over 3 years with early age of onset from rural background ,poor family awareness with predominantly negative symptoms apart from positive symptoms.(childhood history of seizures -need not be considered in view of no further attacks can be ignored). Considering above all, chronicity has established. First of all psychoeducation of parents and considering of IP care of patient and newer atypical psychotropics like respiridone can be considered with 3-4 weeks treatment apart from psychological therapies like motivational enhancement, behavioral modification therapy can give better response in this case.

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Sir, first is the diagnosis concurred as schizophrenia..? Some neurological conditions presents with above symptoms...(like neurosyphilis,enchaphilitis) ,before starting any psychotropics better to review the history again and ruleout of organicity.

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I will  prefer to put her on carbamazepine plus respridon.  Oleanzapine is out of question as it gave side effects and it also lowers seizure threshold. Resperidone will be better. Carbamazepine will be helpful.

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I agree with Dr B.P.Sinha.

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Psychieducation about the illness to the parents is required as it is likely to be long term illness in her case. Weight reduction she needs regular walking and do some daily household chores.

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Last attack of seizure how many days back? Was a eeg done? How is the iq of the child? And are their only behavior abnormality or any paranoid ideas has to be clearly enquired and mentioned

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