Posted by desolationrower on November 30, 2008, at 14:05:18
In reply to Re: suggestion....from rj » rjlockhart04-08, posted by Racer on November 30, 2008, at 8:58:33
Given his poor response to most medications, i think a trial of a stimulant would be well warranted. Psychosis from stimulants is mostly a feature of dose and withdrawal, and may have to do with neurotoxicity from large-dose stimulants resulting in increased sensitivity of remaining dopamine receptors. Now, that means it is much different from chronic, low level therepeutic use. Complicating things more is tonic/phasic effects at different receptors, i still haven't quite figured out the whole picture, but improving tonic DA and reducing phasic longterm i think is the goal, so ok something like aripipraazole, which preferentially increases tonic activation, would be like low, steady stimulant use, which increases tonic DA levels, whereas snorting coke would mainly cause the initial euphoria-related phasic increase. and the AP would reduce effect of initial release. Also remember that TCAs are good drugs for psychotic depression, and they increase catecholamines too. And psychosis is noted for reduced prefrontal DA, or reduced D1 function - and D1 often has opposing action to D2, which is more important to be blocked. Also extradimensional/intradimensional set shifting tests show worse results for untreated psychosis and predicted results with modafinal. Also, compared to schizotypal, schizophrenics show reduced prefrontal volume. Epecially with one of the more region-specific neuroleptics, a stimulant might warm up his prefrontal cortex enough to take control of the rest of the brain. I think thats a better idea than just staying on the neuroleptic merry-go-round again and again. And i think a trial of ECT is also warranted, probably before thinking about stimulant treatment. And it also seems from just reading his posts there is a least some mood disturbance that he is dealing with, certainly he's been clear he feels hopeless and given poor response to treatment reėvaluating the diagnosis would be wise, and psychosis is related to mood disorders. Crazy is trying the same thing again and expecting a new result. And it seems clear the APs are not much help for him. consider stimulants and anxiety. Stimulants 'cause anxiety'. but, for some people they just destroy it - now you can say 'well thats just for _social_ anxiety, thats just for ADHD heads,' or whatever, but then what the disease is is just what we figure out AFTER finding the right medication. I'm rambling but i think this is underconsidered.
-d/r
poster:desolationrower
thread:865617
URL: http://www.dr-bob.org/babble/20081123/msgs/865928.html