Concluded Case

BIPOLAR DISORDER

34yr old male, known case of bipolar mood disorders since 8 years on the medications mentioned below presents with following complaints: -Insomnia, sleeps only after taking Lopez 2 mg instead of Zapiz 2mg. -Non stable in decisions -No self control -Not satisfied with any job. -Obesity due to Olimet What could be done for this patient? Patient is unaffordable for any consultation Main concerns are, how long to continue medication? Any substitutes for Olimet ? Anything can be suggested to avoid benzodiazepines prolonged use?

4 Likes

LikeAnswersShare
Concluded answer

Patients of BPAD often require LONG-TERM Medications, & often life long to maintain their stability of mood. Benzodiazepines are generally required & should be given for SHORT-TERM. But here in India, Psychiatrists often continue it for long term; It is sometimes due to enforcement by the patients too, to administer them BZDs, as they get addicted, after sometimes. If U want to remove BZDs, Taper Lorazepam dose from 2mg to 1mg for 7 days, then 0.5mg for 7 days & then stop to prevent the withdrawal symptoms. But Continue Olanzapine, as it has also Sedative Action. Tell the patient to take Olanzapine 1 hour before food, that will give adequate sedation to the patient for sleeping. If even after continuing Olanzapine 1 hour before food, if the patient does not get sleep, then add Melatonin (ALTONIL 5mg-10mg), which physiologically induces sleep. These can be done for the sleep. Later If U want to remove Olanzapine too (But It can be continued, as it is being given in very low dose i.e. 5mg), U can replace it with Arip-MT 5 mg. If anger outbursts are there even after taking Lithium, U can add Sodium Valproate. U can treat him for now, but later on, if the pole changes, Only Experienced Psychiatrists can treat them well. BPAD cases are one of the Complex Psychiatric Cases & often require LONG-TERM FOLLOW-UP.

All Answers

Patients of BPAD often require LONG-TERM Medications, & often life long to maintain their stability of mood. Benzodiazepines are generally required & should be given for SHORT-TERM. But here in India, Psychiatrists often continue it for long term; It is sometimes due to enforcement by the patients too, to administer them BZDs, as they get addicted, after sometimes. If U want to remove BZDs, Taper Lorazepam dose from 2mg to 1mg for 7 days, then 0.5mg for 7 days & then stop to prevent the withdrawal symptoms. But Continue Olanzapine, as it has also Sedative Action. Tell the patient to take Olanzapine 1 hour before food, that will give adequate sedation to the patient for sleeping. If even after continuing Olanzapine 1 hour before food, if the patient does not get sleep, then add Melatonin (ALTONIL 5mg-10mg), which physiologically induces sleep. These can be done for the sleep. Later If U want to remove Olanzapine too (But It can be continued, as it is being given in very low dose i.e. 5mg), U can replace it with Arip-MT 5 mg. If anger outbursts are there even after taking Lithium, U can add Sodium Valproate. U can treat him for now, but later on, if the pole changes, Only Experienced Psychiatrists can treat them well. BPAD cases are one of the Complex Psychiatric Cases & often require LONG-TERM FOLLOW-UP.

Check for the compliance of treatment advised.Most of the patient do not regularly take the prescribed medication. Investigate for lithium level.

Cases that would interest you