Brief Answer:
Please see details below

Detailed Answer:
Hi,

I went through your query and the prescriptions in detail. I do appreciate your concern for your brother.

Schizophrenia is a chronic condition which often takes time to respond to treatment. Your brother is currently on two anti-psychotic drugs: Clozapine (Sizopin) and Risperidone (Sizodon). From the prescription, I could make out that Risperidone was added to treatment on 19th XXXXXXX only, that is one week back.

In the prescription before that he was on chlorpromazine and in the prescription even before that, he was again on risperidone. To be XXXXXXX I would not recommend such fast change in medications. I would like to wait for few days currently and if he doesn't respond, increase the dose of clozapine, if he will be able to tolerate that, or else risperidone.

Another option, if he is not responding to treatment is electroconvulsive therapy (ECT) which is a safe an effective method for controlling symptoms of schizophrenia. Of course he will need medications too, but ECT will help control symptoms fast.

On another thing, you have mentioned that your brother is taking risperidone 4 mg three times a day whereas in the prescription, it is mentioned 4 mg HS (at night only). 12 mg/day is a very high dose of risperidone and if that is being given, I would recommend you to reduce the dose according to the prescription. The dose can be increased in case he doesn't respond to current treatment.

Regarding the liver problem, it would help if a liver function test and ultrasound abdomen reports are available. It can be managed depending on what exactly the problem is.

Hope, I was able to answer your query. Please feel free to ask any further questions that you might have.

Wishing your brother a speedy recovery,

Dr. Sunil Gupta

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Brief Answer:
Please see details below.

Detailed Answer:
Dear XXXX

Thanks for following up.

As I said in my last response, schizophrenia is a chronic condition and usually takes time to respond to treatment. I understand we all want quick symptoms relief, but in some conditions we just have to be patient. Its been one and half months of treatment and it might take a few more weeks to respond. the only thing to take care is that the medication should not be changes very frequently. I would generally prefer to take a medicine to the maximum dose possible and wait for its response. If even then, there is no response, I will consider a change in medication.

Liver dysfunction can cause more side effects and inability to tolerate higher doses of medicines. Like I said earlier, it will all depend on the type of liver dysfunction. It doesn't reduce the efficacy of medicines, but it may limit our ability to tolerate higher doses. You brother is already on a significant dose of clozapine and risperidone. so, I don't think that there is a problem there. The important thing to note is that the medicines themselves can cause liver problems and we have to be careful about it.

I can understand your discomfort regarding ECT. I am not recommending it as an immediate method. But it can be tried if there is no response to medicines. Trust me, it is very very safe and very very effective. We use it regularly in treatment non responders and get very good results.

Currently, the best possible course will be to increase the dose of clozapine to maximum tolerable limit. It is good that he is admitted. So, it will be easier to titrate the dose according to response and side effects can be monitored. Regular complete blood counts monitoring is recommended while on clozapine.

Regarding your queries for the treating doctor, just ask what his plan of management is. What is he planning if your brother doesn't respond to the medications? Also try to understand about the side effect profile of clozapine and what care must be taken while a patient is on clozapine. These are things which are very important for a caregiver to understand. Your target is to understand how as a caregiver, you ca help in optimising the treatment of schizophrenia.

I do hope that answers your query. Please don't hesitate to ask any further questions that you might have. I will try to guide you in the best possible way.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
Details below

Detailed Answer:
Dear XXXX

Thanks for following up. I will try to answer your queries one by one.

1. Will he be able to lead normal life and continue his Teaching Job?
>>> With proper and adequate treatment, he can maintain very well. Most of my patients with schizophrenia are able to work. In some cases, there performance may be slightly diminished, but still it will be more than enough to keep them going. Your brother can very well continue with his job, provided he remains on treatment. I might sound cheesy but Dr XXXXXXX XXXXXXX did suffer from schizophrenia but went on to win Nobel Prize in economics.

2. How to convince him about his ailment?
>>> Now this is a difficult task. It will take time and patience. More so it should e done only after he recovers from his symptoms. Once the disease severity comes down, most of the patients are amenable to convincing and are ready to take treatment.

3. How to avoid relapse?
>>> The only way to avoid relapse is to make sure he remains on regular treatment with frequent follow ups with a psychiatrist for regular assessment.

4.Will location change help him to bypass the bad memories of the current place that he is living?
>>> It may help temporarily but the disease process has nothing to do with the place one is living in. The only way to overcome the disease is adequate treatment.

5.Is mental illness can cause him to loose his JOB as Assistant Teacher in Primary School with the State Government?
>>> If your brother responds to treatment and is able to maintain well, he can't lose his job. No employer can dismiss a person on the basis that he has a mental illness as long as he is taking treatment for it.

6. What is the time frame needed to make him normal as before?
>>> There is no fixed time frame for response to treatment. Usually, a patient with schizophrenia responds to treatment within 2-3 months. It all depends on whether the person is responding to the first drug that is tried or a need to change his medications arises.

7.Will he be able to lead a married life?
>>> If he is already married, some co-operation from his wife will be needed. With proper treatment, he will definitely be able to lead a proper married life. In case he is not married, make sure you inform the to-be wife and her family regarding his mental state and the need for constant treatment.

8.He is not comfortable with father..will we keep him away from father?
>>> That depends on what is making him uncomfortable. if your father is passing excessvie negative or critical comments regarding him, it would be advisable to educate your father regarding the need to keep a positive environment in the family. If that is done, there will not be nay need to do as you say.

9.He is a Honest and Simple person and takes very stress of problems that he is not related with.How to make him a relaxed person?
>>> If you make sure that he is taking treatment properly, most of the anxiety will be taken care of. Other ways will include exercising daily. That will help with anxiety and stress as well as making sure that he remains physically healthy. It would also be advisable that he talks about his problems freely with someone who understand him without being patronizing. That will make him feel better.

10.He has insomnia..can not sleep at night at all.what is the solution to it?
>>> Once the delusions and hallucinations which are the main symptoms of schizophrenia is taken care of, his sleep will automatically improve. He can be given benzodiazepines like clonazepam for short period of time till then.

11.How to control his anger when he becomes violent?
>>> The best way will be not to argue or confront him immediately. It will be a good idea to listen to him when he becomes angry and instead of confronting, attempt to talk him down is made. In any case, if he remains on treatment, his violent episodes will be taken care of automatically.

12.Will medications will be given for life long?He is having Schizophrenia since 2002.
>>> In most cases, yes. Although, frequently review of medications can be done. If a patient maintains completely well and remains symptom free, reduction of dose of drugs can be tried after 2-3 years and response assessed. The reduction should be very gradual and can be brought to minimum effective dose, if no relapse occurs.

I do hope that I was able to answer all your queries. In case of any further doubts, please feel free to ask. In case you don't have any further queries, you can close the discussion and please rate the answer.

Best wishes for a speedy recovery of your brother,

Dr. Sunil Gupta

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Brief Answer:
More details regarding your symptoms needed

Detailed Answer:
Dear XXXX
Thanks for following up. I can completely understand your concren regarding the family history of mental illness. Most of the psychiatric disorders including Schizophrenia have a genetic component. But that doesn't mean that the next generation will definitely be affected. It just increases the chances.

One cannot predict who is going to have and who is not going to develop mental illness. To reduce the chance of developing metal illness, the best way is to keep a positive environment in the family, maintain adequate physical health. It is also important that in case any symptoms are suspected in any person, psychiatric assessment should be sought as soon as possible. Earlier the treatment is started, better is the response and prognosis.

Regarding your condition, it would be helpful if you could provide me details regarding your symptoms. I went through your prescription and you were prescribed anti-psychotics. It could be due to a psychotic illness as well as manic episode which occurs as part of bipolar disorder. I take it that you are maintaining well right now and are currently off medications. It is very difficult for me to comment about your illness with this limited information.

I f you can provide me more details regarding the nature of symptoms that you had in both 2011 and 2012, I will try to help you out in the best possible way.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
Please see details below

Detailed Answer:
Dear XXXX
Thanks for following up. The symptoms that you have described are suggestive that you had developed a delusion of grandiosity in which a person develops high self esteem and belief that he has many powers, or he is someone great or has too much money. These are symptoms which are suggestive of manic episode. Other symptoms of a manic episode are being overactive and over talkative, adamant behaviour, decreased need for sleep, increased religiosity or spirituality. A person can also become aggressive and dis-inhibited, becoming abusive or violent.

However, the delusion of grandiosity can also be part of schizophrenia. In your case, you have had 2 episodes. The second episode seems like a manic episode. And in between the episodes and thereafter you have maintained well. It might be possible that you have bipolar affective disorder in which a person has repeated manic episodes or manic and depressive episodes. Another possibility is that you have had short lasting episodes of psychosis.

In both cases, it will be advisable to be on medications as maintenance treatment. You are currently on Amisulpiride and Aripiprazole which are both anti-psychotics, fluoxetine which is anti-depressant and clonazepam and alprazolam which are both benzodiazepines. Although your doctor must have had reason to prescribe them, still I would reconsider the decision to keep two anti-psychotics and two benzodiazepines together. You can discuss with your psychiatrist the need for the same.

Had I been your psychiatrist, I would have kept you on one anti-psychotic, mostly aripiprazole (the dose could be increased if needed after stopping amisulpiride). I would preferred to taper and stop the benzodiazepines very slowly if you would maintain well without them. The decision regarding anti-depressants could be reviewed every few months.

I do hope I was able to clear some of your doubts. I will glad to be available for you for any further queries too.

Best wishes.

Dr. Sunil Gupta

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Brief Answer:
Please see details below.

Detailed Answer:
Dear XXXX

Thanks for following up. Lack of freshness, and motivation, withdrawal from social activity, feeling lethargic and not wanting to anything are symptoms suggestive of a depressive episode that you might have suffered few months back. This combined with the other episodes suggests that you might be suffering from Bipolar disorder.

Currently you seem to be in remission. To avoid further episodes of either depression or mania, the most important thing that you can do is to take medicines in a proper way and have regular follow ups with your psychiatrist. The medications that would benefit you most would be Aripiprazole. As I mentioned in my last reply, I would review the need of all other drugs. If needed, a mood stabiliser like valproate can be considered at a later stage in case you have symptoms. However, my sincere advice would be that never take decisions on your own regarding medications. Let your treating psychiatrist decide what's best for you. Also avoid any kind of addiction like alcohol, tobacco, etc.

The reasons for the episodes is your underlying disease. You just need to follow your psychiatrist's advice regarding treatment and you will be fine. Yes, it can be avoided by regular treatment. You must remember that despite treatment there can be subtle symptoms. In case you feel any problem or your family members notice any change in your behavior, please don't hesitate to visit your psychiatrist. If treatment is started/ modified at an earlier stage, it doesn't lead to much dysfunction and has better outcome.

You can have a normal married life and have normal emotional and physical relationship if you remain on regular follow up and take treatment as advised.

The medications may lead to increased weight, but they need not be the only cause. In any case, aripiprazole is an anti-psychotic which is doesn't cause weight gain. The other drugs might, but in my opinion they are not required in long run anyway. But if you have gained weight, you should start exercising daily and also make sure you take a balanced diet with minimum fat content. That is the only solution.

The medications may or may not be needed for life time. No one can predict this. the need for medications are generally reviewed every 3-5 years of remaining completely symptoms free. Gradual dose reduction is than attempted under close observation. If there is relapse, the drugs are initiated again, or else stopped and regular follow ups without medications advised.

Regarding being relaxed, its totally your initiative. Daily exercise, balanced diet, proper schedule with adequate sleep will help a lot. Make sure you de-burden yourself by talking with someone about your problems. Avoid any kind of addiction (alcohol, smoking, etc.). Make sure you have adequate time for yourself and try to have more time with family. You can also start writing diary daily which will help you in letting out your emotions and make yourself calm. it can also work as a mood diary which will help your psychiatrist in treating you better.

I do hope I have answered all queries that you asked and didn't miss any. Please let me know, if I can be of any further assistance. I will be glad to help.

Best wishes for a healthy life ahead,

Dr. Sunil Gupta

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Brief Answer:
Details below

Detailed Answer:
Dear XXXX

Psychotherapy is of different types and depending on the type of disorders, different types of psychotherapy is recommended. Coming directly to psychosis, psychoanalysis is a definitely not recommended. Regarding cognitive behaviour therapy (CBT), it can be used as adjunctive treatment to medicines. But, the frontline therapy remains medications.

CBT can be used in following conditions in psychosis:

>>> If a person has symptoms of delusions and hallucinations even after medications.

>>> If a person has negative symptoms like social withdrawal, not being active or taking interest in anything.

The right time for opting for psychotherapy is only after the symptoms has decreased significantly. Counseling is different from psychotherapy. It involves educating the patient and family members about the nature of illness and about treatment. It can take place simultaneously with medical treatment.

I do hope I was able to clear your doubt regarding psychotherapy. Please let me know if you have any further questions. I will be glad to offer my assistance.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
More ECTs would be required.

Detailed Answer:
Dear XXXX

I am sorry to hear that your brother is still symptomatic and really wish him very speedy recovery. We will have to be patient at this stage as it usually takes time to respond to treatment in case of schizophrenia.

I did go through the reports that you sent. Your brother has been started on ECT and I feel that is a good option. I could not make out the dates of ECT given s the reports were cut from the side, but it was enough to make out the he has received 3 ECTs till date. Personally, I would like the ECTs to continue (at least 3 more ECTs to be given at 2-3 days interval, can be more depending on response).

I was a bit disappointed to see the list of the medicines though. He is currently on 5 anti-psychotics and none of it being given at an adequate amount. Your psychiatrist must have reasons for the same. But I would like to differ with him in this particular scenario. I would have preferred to keep him on clozapine (sizopin). I could not make out the number of 100 mg tablets he is currently on as the scan is cut from the side. But the dose should be somewhere between 300 mg to 500 mg increased slowly taking into account how much he is able to tolerate without side effects. If he is not responding to clozapine alone, one of the other antipsychotics could be added and dose increased gradually. I would definitely not want him to be on 5 different types on anti-psychotics, all being on a sub-optimal dose. I think you can discuss with your brother's psychiatrist regarding the same. I am sure, he must have his reasons for the same.

Regarding being treated by a neuro-physician, I would like to disagree again. Schizophrenia is a condition which ought to be dealt with psychiatrists as they are the ones who are trained to deal with it. It would be your choice finally. But, I as a psychiatrist personally would not approve of it. I won't deal with a neurological condition such as Multiple sclerosis since I am not trained in it. I believe the same applies to other specialists as well. Getting a second opinion would do no harm, but preferably from a psychiatrist.

I do hope I was able to be of some help. Please let me know if I can be of further help. I would be glad to do so.

Wishing your brother speedy recovery,

Dr. Sunil Gupta

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Brief Answer:
Please see details below.

Detailed Answer:
Dear XXXX

Thanks for updating me. The gap between the ECTs is fine and I do hope that your treating psychiatrist does continue with more ECTs. Your brother can have normal food after ECT. Initially, it is preferable to give some liquid 45 minutes to 1 hour after he recovers. Thereafter he can his normal diet. Regarding weakness, it might also be due to the effect of medications. Don't worry about, as he will recover his strength.

I was able to understand all the doses except for clozapine (Sizopin). He is getting 100 mg tablets, but could not make out how many of them. I consider it the most important medication for your brother. Depending on the current dose, is dose can be increased further.

I am sorry about the phone number though. I hope you will understand that. You can contact me anytime on this link. I will try to answer you as soon as possible. I am sorry once again.

Please let me know if I can be of further help to you. It will give me immense pleasure if I am able to do so.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
please see details below.

Detailed Answer:
Dear XXXX

Thanks again for updating me. Your brother is getting clozapine 100 mg twice a day. I feel the dose of clozapine can be further increased gradually 25 to 50 mg every 3-4 days depending on how much he is able to tolerate without much side effects. The main side effects to be concerned about will be excessive salivation and lowering of total white blood cells in body.

Regarding his taking to himself, that is a symptom of schizophrenia itself rather than the side effects of medicine. That will go off as he improves further.

His stay in hospital should be decided by his improvement and response to treatment. There's no point pre determining it. If he responds well to clozapine and ECTs, he can be discharged. If needed, don't hesitate keeping him longer.

Till 25th July, there is significant time. I am quite hopeful that with proper treatment, he will be much better by that time and he will be able to do the needful. Did you consider taking leave for him on medical grounds? I feel that will solve your problem regarding his job.

I will suggest not to be disheartened at this point of time. Your brother will definitely be better. We just have to have patience and hope. I will try my best to guide you ever time you need any help or have any query.


Wishing your brother a speedy recovery,

Dr. Sunil Gupta

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Brief Answer:
Clozapine and ECT will help.

Detailed Answer:
Dear XXXX

Thanks for updating me and sending more information. I did go through all the attachments that you have sent. I think we are on the right track. With clozapine and ECTs, we have a very good chance of improvement. As of now, I would suggest to just continue with the ECTs (3-5 more). Regarding the dose of clozapine, it can be further increased by 25-50 mg after a gap of 5-7 days if required.

For now, we have to wait and hope for the best. Regarding complete recovery, frankly that's a tricky question. Your brother will hopefully show significant improvement within next one week, and he can be fit for discharge and going to work. But complete recovery can take much more time. It is very difficult to say exactly how much time, but can take even a month. We can only wait and hopefully, everything will be all right. Remember that his medications will have to be continued even after he recovers.

Sincerely hoping for the best for your brother,

Dr. Sunil Gupta

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Brief Answer:
Please see details below.

Detailed Answer:
Dear XXXX

I am so glad to hear that your brother has shown signs of improvement. Its only the beginning. I am sure that with he will show much more improvement further.

I will want to continue with the ECTs for now. He has just started showing improvement. If we discontinue ECTs now, it won't be helpful. I will forward to at least 3- 4 more ECTS. The exact number of ECTs can be decided only according to the actual clinical situation of your brother, evaluating him after every ECT.

Regarding his weakness, he will recover gradually. You don't need to worry much. Just keep him on a balanced diet. Regarding memory, his memory might be a bit weak due to ECT. Forgetfulness can occur due to ECT. But it is reversible once the ECT is stopped. So, you don't need to worry much regarding that too. Another important thing to understand that he might not remember many events when he was at peak of psychosis, when he completely recovers. That's the nature of his disease.

I do agree that 300 mg/day of Clozapine seems to be effective as of now and you don't need to increase it further at the moment. For now, you need to continue with few more ECTs and medications and hope for the best. Further decisions can be taken depending on the improvement he shows. Once he improves a bit more, he can be started on psycho-education sessions so as to make him understand what he is suffering from and the need for medications. It will be a very gradual process and will lots of patience. As the condition improves, most of the patients do start gaining insight into illness and hopefully your brother will do that too.

Following discharge, he can be reviewed every 10-15 days for 3-4 visits. If he maintains well, the follow up period can be gradually increased, 1st to 20 days, then a month and so on.

ECTs do help in reducing the symptoms and most of the effects last only for a few months. If he is not maintained on medications, the symptoms can re-emerge. It does improve the potential of anti-psychotics who show treatment resistance to medications. It is a very effective treatment for drug resistant schizophrenia. If there is a relapse, he might need ECTs again. But that can't be decided now and the decision can be taken only depending on the condition then. Hopefully, with proper treatment, there won't be a relapse, and that question won't arise.

The maximum recommended dose for clozapine is 900 mg/day. For Indians though, the required doe is much less. Most of the patients respond between 200-500 mg/day. The maximum dose that any of my patient has ever received it 600mg/day. Most of the patients don't tolerate it more than 400-500 mg/day.

The decision to start ECT depends on many factors. Severity of symptoms, resistance to medicines and past response to ECT are some of the factors on the basis of which we decide about starting ECT. If a person is not responding to Clozapine (even when used alone) as such, ECT can be used as augmenting agent. I personally do use Clozapine only when a person doesn't respond to at least 2 other anti-psychotics for a period of at least 1 month at maximum doses. Your brother was not responding to medications, but as I had mentioned earlier, I felt the doses of the medicines had to be increased. I personally prefer to keep a patient on a single drug rather than a combination of drugs and increase the dose to the maximum an than evaluate the response. That way, I can reduce the side effects and can ensure that he remains on minimum possible drugs as they have to be given to a very long time.

I do hope that your brother recovers soon. Please let me know if you have more queries. I will be glad to answer them and in due course possible help with your brother's improvement.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
Please see details below

Detailed Answer:
Dear XXXX

The decision regarding ECT varies depending on the clinician. Various guidelines do help us deciding that. we generally follow the western (American or the European guidelines). In general, we decide regarding the number of ECTs depending on the clinical improvement a person shows. It can be anything from 5-12 ECTs. My idea of continuing ECT for now is that he has just started showing improvement. So, continuing with ECTs can help in further improvement. If with the next ECT, he doesn't show any more improvement, termination can be considered.

The quantity or voltage of ECTs doesn't decide the number of ECTs. If a person is not getting response at the maximum recommended current, then we can think of stopping it. Most of the time, its individual preferences which decide regarding the use of ECTs.

Regarding psychoanalysis, frankly that is not recommended in schizophrenia. If at all you want psychotherapy, it should be more of cognitive behavior therapy. It will help him gain insight regarding his illness and understand how to cope up with the symptoms of delusions and hallucinations if any of it persist. It will also help in getting back to his schedule and help in dealing with negative symptoms of schizophrenia like not wanting to do anything and social withdrawal, which may happen in long course of disease.

I am very hopeful that your brother will do wonderfully well ahead. Your psychiatrist has been doing a good job. I do hope that the information I have been providing is being helpful to you.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
Please see details below

Detailed Answer:
Dear Samrat,

It nice to know that you feel tat your brother is back to his usual self and not having any more delusions and hallucinations. That is great news. Don't worry about his ability to take decisions. It will come back to him soon, once the effect of the ECTs reduces in some time as well as the sedation due to medications decrease. He just might be a bit confused due to ECTs and medications. That will go off with time.

Regarding psychotherapy, the best time will be only when he starts understanding and doing things. I feel its too early now for that. As i said in my last response, CBT will help him understand regarding the nature of disease and what he needs to do so as to keep himself in better shape. It will help him develop insight and also help control the negative symptoms like not feeling like doing anything, if he has any.

Regarding the status of schizophrenia, the best person to answer will be your psychiatrist. He will tell you exactly how the medications has to be given and the timings of follow up according to him. Just remember, medications are the primary form of treatment of schizophrenia. Anything else including CBT is just in addition and complementary to medications. Nothing substitutes medications as a mode of treatment of schizophrenia. The psychologist can help the family members cut down on the expresses emotion in the family and directly help the patient in understanding and coping up with the disease.

Regarding best neuropsychiatry centres in XXXXXXX I would consider NIMHANS, bangalore; PGIMER XXXXXXX and CIP, XXXXXXX to be good. However, you have to remember that schizophrenia is a chronic illness. Whatever place you decide, you have to make sure that it is accessible to you for regular follow ups. Single visits can be only for second opinions. For that you can visit any center.

I would rather suggest a local psychiatrist whom you trust so that he can regularly follow up your brother and will be available in time. Moreover, since your brother is already improving considerably, simply visiting other centers is not what I will recommend.

Just ensure that your brother remains on regular medications with frequent follow ups. He will also require regular blood investigations in form of total and differential leukocyte counts, renal and liver function, blood sugar and lipid profile as advised by your psychiatrist so as to monitor any side effects due to clozapine. Motivate your brother to exercise daily. That will help him physically and mentally fit. The family members should try to motivate him to work and try to minimize negative comments in the family. A healthy family atmosphere works really well and that will help your brother a lot.

As I have said earlier, with proper management and adequate care, your brother will do really well. More so, he has a brother like you who really cares for him and that in itself is a big advantage.

You can contact me anytime for any doubt regarding his disease or condition. I will try my best possible to help you out at the earliest.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
All the best for healthy future

Detailed Answer:
Dear XXXX

First of all, thanks for your kind words of appreciation. I am happy to note that your brother has shown considerable improvement. Regarding weakness, you don't have to worry much. Since his delusions has improved, he will start taking food and gradually his weakness improve.

The WBC count and DLC is for monitoring the hematologic side effects of clozapine. Make sure your brother gets it done as and when your doctor recommends it.

Regarding medications, I will prefer to keep him on the same dose of medications as he is now at least for few months provided he is not having any side effects. Urgency in reducing the dose can only lead to relapse of symptoms.

As I have said before, the process of letting him know about the disease and treatment will be very gradual. I would personally recommend the process to be carried out by your psychiatrist or psychologist rather than by any of the family members. Limited information has to be given and focus on continuing with medications will be the most important thing.

I understand the distress regarding having this illness in the family. But you can't really do much and there is no way to predict who will suffer and who won't. The only option as of now is early diagnosis and earliest possible initiation of treatment. It will help in providing good outcome.

Regarding your brother or any patient with schizophrenia, the most important thing will be to ensure that he takes medications and remain on regular follow up. Try to keep a positive environment in the family keeping down stress to minimum.

I do hope that you and your brother maintains well throughout. Please let me know whenever you have any kind of doubt or query. You can contact me at:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657

If you decide to close the discussion, please do rate the answer.

Best wishes,

Dr. Sunil Gupta

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