Schizophrenia #female#akathisia#amenorrhoea

A 32 year old female with a history of chronic psychotic illness diagnosed as schizophrenia left medication and relapsed.on relapse found to develop affective symptoms like singing loudly,excessive restlessness,talking assertively along with anger outbursts,disorganized behaviour like passing urine in clothes,decrease self care...patient was put on tab .risperidone (2-4mg) increased gradually ,trihexyphenydyl 2mg bd and also given inj .fluphenaxine 25mg long acting with tab.divalproate 500mg bd during 10days of her stay in hospital.On follow up patient maintaing well affective symptoms in control psychotic symptoms in control but patient didnot menstruate.Hence presuming it to be drug induced tab aripriprazole started at 10mg increased gradually to 15mg ,tab divalpraote changed to tab carbamazepine 200 mg bd(started gradually)...patient now developed severe akathisia...so akathisia managed with tab.lorazepam 2mg tds tapered gradually,propranolol 10mg bd and aripriprazole stopped replaced with tab.olanzapine10mg.is my approach ok?need help?

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Pt can be controlled by olanzapine 5 to 20 mg daily . As she is a chronic scizophrenic clozapine monotherapy can be considere with WBC monitaring .

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ECT try also prefer in this case...during admission Can start tablet clozapine with low dose under observation

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Maybe a combination of lithium 300 mg bd with quetiapine will help

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