Update on my son Kobe

So after reading some other posts we got DNA testing and ECT treatments done for Kobe.
The DNA results said he has a significant gene-drug interaction with the Clozaril he is taking maxed out doses of everyday. This info came back while Kobe started ECT treatments - which he completed 9 of the 12 they wanted because he was so unresponsive. He did not know the day and had no memories of anything and could barely speak. He did have a bad episode after 3 of the ECT treatments claiming he was Jesus but also the Devil and that went on for a shorter amount of time then they usually would. Since then, his doc decided to lower his Clozaril dose (maybe because of the DNA result - she said she did not believe in them much) and he seemed OK for a couple days. But then now he just recently went back into an extremely aggressive episode cornering and grabbing my wife and threatening his sister. Any thoughts on where we go from here besides a long term institution?

I am so sorry that you are struggling to find a med routine that will work for your son.

Please educate me, does the DNA results showing a significant gene-drug reaction with Clozaril indicate that he should be taking Clozaril?

I do think that Kobe isn’t stable enough to live with his family at this point. While it can be difficult to think about, many of our family members do better away from home. Having your family member somewhere else isn’t a failure on your part, often it’s a step towards a solution. The members of your family should be able to feel safe at home. In my opinion, aggressive episodes of grabbing and threatening are not acceptable.

This sounds so hard! I haven’t heard of a DNA test suggesting a bad reaction to clozaril. Do you know any more about that?It may be that some DNA evidence is correlated more so with clozaril effectiveness over the other (dopamine targeting) antipsychotics.
Did the doctor discontinue the clozaril slowly? Rapid fluctuation in antipsychotics can be very damaging.
If it were my son, I would look for an alternate antipsychotic or conjunctive treatment. My son takes asenapine and clozaril both. Not to say it will be good for your son, just offering the example.
It is true that you can’t accept violent behavior and if you are fearful then you need to try to get him hospitalized again. Regardless of whether or not your son lives with you, things may improve over time. It sounds like he is still recovering from his ECT treatments. Try not to give up!

Thanks for the help and suggestions. So the DNA report said he is metabolizing the Clozaril faster than he should which then gives his report the gene drug interaction label I believe…he does take Invega and Clozaril and yes they were working on lowering the Clozaril and maybe adding another antipsychotic med… Would anyone out there know of cases where 3 antipsychotic drugs were prescribed?

I asked my Family to Family teacher (from back in the day) to field your question. This is her response.

"I’m more familiar with the use of 2 antipsych meds taken at once. My son was usually on 2. That doesn’t mean that 3 won’t be used at the same time.

Also, I was told that most psych doctors (in the US) fall into one of two medication practices.

  1. Use small doses of several (maybe 5) different meds. A cocktail of antipsychotics, antidepressant, ADHD, anti-anxiety, sleep aids, bipolar meds for mania, etc.
  2. Few meds 1-3 with higher doses.

There are pros and cons for both methods. "

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