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karooma70

Can anyone help please,

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can anyone help please

I have a 30 year old chap with schizophrenia, he is on Haldol decanoate decent dose and recently became psychotic.

Does anyone know the best augmenting medications that i can use safely and effictivley for this chap.

Thank You

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Wonder what precipitated his relapse if he has been stable on it.

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Have you consulted your supervisor?

Have you consulted Maudsley guidelines?

How about finding out the reasons for this relapse?

What about doing a medication history? and why each medication was discontinued?

What about the Urine Drug Screen results?

How about increasing the dose of oral depot and supporting with oral haloperidol until steady state is reached?

Considering the chap is already on a depot, compliance is evidently an issue.

Has anyone spoken to him when he was stable to find out his advance directive(s)?

He has Schizophrenia with non-compliance as an issue. What level of CPA is he on? who is his care co-ordinator? His RMO?

A non-compliant patient on depot antipsychotic relapses... Does he need compulsory treatment?

Have you spoken to the pharmacy?

Has he already been tried on depot atypicals?

Giving an answer like Risperdal Consta is easy, but whenever such a situation arises, a detailed work-up on the cause of the relapse would be the way to go, rather than opting for short-term remedies, IMHO.

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Hi,

I second Usain Bolt's suggestion to consult your supervisor or the available text, unless you have done so but the chap is still presenting such treatment conunndrum.

Having said that, the info you gave is so sketchy to make any advice-giving less meaningful

Let us know how you get on though

Best wishes

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Have you consulted your supervisor?

Have you consulted Maudsley guidelines?

How about finding out the reasons for this relapse?

What about doing a medication history? and why each medication was discontinued?

What about the Urine Drug Screen results?

How about increasing the dose of oral depot and supporting with oral haloperidol until steady state is reached?

Considering the chap is already on a depot, compliance is evidently an issue.

Has anyone spoken to him when he was stable to find out his advance directive(s)?

He has Schizophrenia with non-compliance as an issue. What level of CPA is he on? who is his care co-ordinator? His RMO?

A non-compliant patient on depot antipsychotic relapses... Does he need compulsory treatment?

[highlight]Have you spoken to the pharmacy?[/highlight]

Has he already been tried on depot atypicals?

Giving an answer like Risperdal Consta is easy, but whenever such a situation arises, a detailed work-up on the cause of the relapse would be the way to go, rather than opting for short-term remedies, IMHO.

woahhhhhhhhhh

and u had doubts about capabilities before paper 3 ?!?!??!?!

Bi*ch !

:lol:

definately do that,, they won't bite trust me on that one :D

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can anyone help please

I have a 30 year old chap with schizophrenia, he is on Haldol decanoate decent dose and recently became psychotic.

Does anyone know the best augmenting medications that i can use safely and effictivley for this chap.

Thank You

Depends on how much depot and how psychotic he is, if there are any risk issues, if he is agreeing to treatment or is under MHA, how he is tolerating the depot, what meds he's had before, how effective they were, what other support he has, whether he is on other medication currently, how his physical health is, what his bloods are like, whether his psychosis has been precipitated by anything, whether he uses drugs, whether there is any local policy on antipsychotics, what your preferences are, what his preferences are, and what is practicable within the constraints of your CMHT.

So that makes it difficult to just say 'oh, add in some placeboxetine or something' because none of us can know your patient's circumstances as well as you do.

The advice given by others above is sensible. If you do not know what to do, ask someone locally who does or look through the recommended treatment guidelines.

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Giving an answer like Risperdal Consta is easy,

By easy do you mean wrong?

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Not really, j: what I meant was, for each relapse we should ideally need to do a work up rather than go for a knee-jerk question and answer type of reaction.

Circumstances may be different in different situations.

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Not really, j: what I meant was, for each relapse we should ideally need to do a work up rather than go for a knee -erk question and answer type of reaction.

Circumstances may be different in different situations.

Well said Nocty, a full drug history would be very useful if it is a purely medication issue, plus drug interactions with any relevant acute/chronic/acute on chronic medical history. What abt the guy's family? Or friends/ They might have good suggestions if he does not have capacity.

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You should not be trying to augment the antipsychotic with another medication. Polypharmacy should be avoided wherever possible.

Once you have properly worked up the patient i.e. history, drug screens etc, you can either increase the haloperidol to a higher dose or if its at the max recommended dose stop the haloperidol and change to a new antipsychotic.

The only times when polypharmacy of antipsychotics is acceptable is either short-term when switching between two agents or for augmentation of clozapine in severe, treatment-resistant cases.

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Or consider high dose, if they are already at max BNF dosage. But again the evidence is poor that this is beneficial.

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I have to say I cannot agree with ever prescribing a medication above the max recommended dose. The evidence does not show it to be beneficial, it also increases the side-effects and can be dangerous. If a patient had an adverse outcome and sued the doctor prescribing above the max recommended dose, that doctor is totally liable.

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