What could be the diagnosis and best treatment course for the following person?
60 year old mother. Never had any psychotic symptoms before.
At the end of last year she had one psychotic episode with paranoid delusions (including being watched sensation), visual hallucinations, false memories and thought withdrawal. The same day started 10 mg Zyprexa (olanzapine). Within two weeks symptoms began to improve. Much sleeping and sedation while on it. One month later abruptly stopped Zyprexa. Then another month later relapsed with paranoid delusions and the same being watched sensation. Started on 5 mg this time for two months with improvement, but later developed insomnia. Now on 10 mg since that time for three months now, with no paranoid delusions and other schizophrenia-like symptoms, but with insomnia with depression-like worrying thoughts being the greatest complaint now. She accepts she has an illness.
Got an MRI with bright signals in T2 weight image and FLAIR at bilateral frontal, right parietal and occipital cerebral.
Glucose, cholesterol, and blood pressure normal.
No memory problems.
Has seen two psychiatrists. One says MRI result must be responsible for psychosis. Other denies this. One other neurologist also denies this.
- If schizophrenia at this age (60 years) is not common, what other diagnosis could be possible?
- Depression-like symptoms in schizophrenia are common? The fact is that she was not having any depression symptoms before her psychotic episode.
- Does the result of MRI has anything to do with her psychotic symptoms?
- Why Zyprexa was causing sedation and too much sleeping at first, and now there is insomnia even when taking the same dose? Does it have to do with stopping Zyprexa in the middle?
- Is six months of taking antipsychotics enough to see if they are affective?
- How about olanzapine/flouxetine combination? Will that help?
- Is coming off (gradually, of course) of Zyprexa at this time a good idea? Could Zyprexa be causing insomnia and depression-like symptoms?
- What could be the best medication for her condition?
I’m sorry if I sound like as though I’m in psychiatrist office, but I’m sure I’ll get more help from the wonderful people at this forum than any doctor’s office. I don’t want my mother to go on taking anti-psychotics for life when she didn’t need them. Please ask any additional questions to clarify any point.