On Valparin, Serenace And Arfane For Bipolar Disorder. What Else Can Be Done To Provide Relief?

Posted on Sun, 10 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sun, 10 Nov 2013 Answered on

Wed, 4 Dec 2013 Last reviewed on

Question : There are no psychiatrists where we live. We are looking after a 16 year old boy who is taking valparin 200, serenace and arfane. What can we do to help him please?

Answered by Dr. Preeti Parakh (6 hours later)

Brief Answer: Some details of his illness are needed. Detailed Answer: Hi, Welcome to Healthcare Magic! There is indeed a shortage of psychiatrists in most parts of the world, and that is why doctors doing their post-graduation in internal medicine are also expected to have basic knowledge of psychiatry as well. Though this cannot substitute for a psychiatrist's specialized clinical knowledge, but at least patients do not go totally untreated. For you, there is the option of contacting psychiatrists on our site and discussing the information you gain with your local physician so that he can prescribe what is needed for the young man. Although you have not described his symptoms, from the treatment regimen, it appears that the young man is being treated for a manic episode of bipolar disorder. Valparin contains valproate which is both an antiepileptic and a mood stabilizer. Serenace (haloperidol) is an antipsychotic used to manage the elation, aggression and grandiosity seen in mania. Arfane (or is it Artane?) is most probably trihexyphenidyl used to control the extrapyramidal side effects of Serenace. I will be able to guide you better if you can let me know his history in detail, focusing on the duration of illness, type of symptoms, response to treatment and current status. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (24 minutes later)

Many thanks. I will chat with him some more. He has only been with us for 2 days. He feels better since taking these meds "most of the time". He was having no seizures, that I do know. He appears to sleep well, though his appetite is quite poor, certainly compared to my own teen! I will try and get more details from him. Many thanks

Answered by Dr. Preeti Parakh (11 minutes later)

Brief Answer: Ensure that he is regular in his medicines. Detailed Answer: Hi, Thanks for writing back. From what you have written, it appears that he is not taking his medicines regularly. You should take care that he takes his medicines regularly without fail, as otherwise he may suffer a relapse of the disease and then you will find it difficult to manage him at home. Since you perhaps do not know him well, he may not feel comfortable opening up about his mental illness. If he appears unwilling to discuss the issue, please do not insist. Just ensure that he does not miss his medicines and observe for any change in his behavior or any abnormal behavior like talking excessively, appearing excessively cheerful or overconfident, talking illogically, sleeping less and doing things faster than usual. These are some signs and symptoms of mania and will help you identify early if he has a relapse. Hope this helps you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (34 minutes later)

Hi there, you are helping a great deal, thanks. We have just chatted again. He tells me that he was having hallucinations and hearing voices. These are no longer happening. The doctors here did not tell him that he was being treated with drugs related to bi-polar disorder and schizophrenia and he was quite surprised by this information. He goes for a reviews twice a week and they ask him how he is feeling. He takes meds twice a day and I will make sure he takes them. He mentioned a period of time where he was smoking cannabis and consuming a lot of alcohol which is what he thinks may have started his problems. He tells me he does not feel suicidal and never has. He seems to be quite a 'chilled' boy. He says he doesn't feel angry or stressed and he has no tremors. He had a bad episode at school two weeks ago, which he cannot remember. My daughter told him that he stayed in the bathroom for an hour and when he returned to class he only had one shoe on and threw his tie in the bin. She referred to him as hyper. He tells me he had not taken illegal drugs or alcohol at that time. As a youngster I suffered from depression. Can my experiences be of any help?

Answered by Dr. Preeti Parakh (28 minutes later)

Brief Answer: Explained below. Detailed Answer: Hi, He is perhaps right in thinking that cannabis may have started his problems as cannabis induced psychosis is quite common. He should keep away from cannabis and other illegal drugs all his life. If his doctors have not informed him about the nature of the medicines he was prescribed, they must have had some reason for that. Probably they were afraid that he would refuse to take these medicines if he knew what they were for. So they might have informed only his guardians and not him. From the episode that your daughter narrated, it appears that he was still symptomatic at least till two weeks back and you should keep a close watch on him as long as he is with you. Taking medicines regularly is of paramount importance. Your own experiences can definitely be of help, particularly if you can convince him that having a mental illness does not stigmatize him in anyway and he should not feel bad about having to take medicines for the same. He is at an age which is crucial for career decisions and future prospects and he should be very careful at least for the next few years so that his career does not suffer. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 minutes later)

Thanks very much. I will be in touch if anything else comes up. Best wishes

Answered by Dr. Preeti Parakh (3 minutes later)

Brief Answer: Sure. Detailed Answer: Hi, Please let me know if something comes up and you need help. I hope this young man is able to take control of his life and do well. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (28 hours later)

Hi there, Are you available for a chat? Our young friend went back to school today and is staying at his home until he asks to come back for a night. I spoke to his Mum, a colleague, (who is nursing a hospitalised sick husband) and another colleague, the school nurse, about him and our conversations on line; ( I am a primary school teacher by the way:)) When I spoke to his Mum she was also not aware that he was seemingly being treated for bi-polar problems. I told her I would print some information, but the stuff I have found is very technical..... Would it be possible for you to assist with a simple breakdown of this for us? Mental health issues are often still regarded as madness and/or witchcraft in many parts of Africa and I want to dispel this to ensure that the boy is not stigmatised in any way. I talked at length with him about my problems and I think he got it, in general, though I do feel that coming from a professional would be of great help. Many thanks and regards.

Answered by Dr. Preeti Parakh (41 minutes later)

Brief Answer: Yes. Detailed Answer: Hi, Welcome back! Please let me know how you would like me to help him and I'll do what I can. For the time being, please explain to his mother that the medications her son is on are used to treat bipolar disorder, schizophrenia as well as cannabis induced psychosis, among other disorders. From what you were able to tell me about his symptoms, it appears that his symptoms started after a heavy use of cannabis. If he is still symptomatic in spite of having stopped all illicit drug use for at least a few weeks, then what we can understand is that his symptoms might have been cannabis induced to begin with but now are a full-fledged mental disorder, either bipolar disorder or a psychotic disorder (like schizophrenia). More information on his symptoms would be needed to form an exact diagnosis. Whether it is schizophrenia or bipolar disorder, please tell his mother that it can be controlled well with medications and life style changes and the boy may do well in life. I am available for a chat. You can just drop a mail to YYYY@YYYY for the details. If some specific information is required, I guess it will suffice to put a query in this thread. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (17 minutes later)

I will find out if his Mum has access to the internet to be able to discuss things with you further. If not, I will try to make a plan with the school for her to be able to connect with you. In the meantime can you recommend a website that explains these disorders in lay-man's terms? The things I have printed are very technical and I do not wish to make things seem worse/better than they may be. Many thanks again for your time Doctor.

Answered by Dr. Preeti Parakh (19 minutes later)

Brief Answer: Link given below. Detailed Answer: Hi, Please tell his mother to have a look at a website called 'helpguide.org' for simply written explanations of common mental illnesses. This site is for patients and family members and gives detailed information but avoids technical jargon. Ask her to look at the schizophrenia ( WWW.WWWW.WW and bipolar ( WWW.WWWW.WW sections. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (22 minutes later)

Super! Thank you, I will pass the information on tomorrow and by printing our conversation page also. Goodnight from where I am!

Answered by Dr. Preeti Parakh (24 minutes later)

Brief Answer: A pdf file for print out. Detailed Answer: Hi, Please also take a print out of this pdf ( WWW.WWWW.WW au/sites/ WWW.WWWW.WW au/files/documents/UnderstandingSchizophrenia_001.pdf). It explains a lot about schizophrenia in just four pages, especially what the family members should do when the patient is having symptoms like hallucinations. It will be of help to her if she does not have internet access. Its a Goodnight from here too, in fact just a few minutes before midnight! I also wanted to tell you that you are a very kind person and it is very nice of you to take so much trouble to help someone. May God bless you! Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (12 minutes later)

I am so sorry! I didn't realise it was so late where you are! So many thanks and sleep well :)

Answered by Dr. Preeti Parakh (10 hours later)

Brief Answer: As below. Detailed Answer: Hi, Please do not apologize. Different time zones are not an issue at all. Please write whenever you want to. I hope your colleague finds the material of use and is able to make some sense out of it. But the label of schizophrenia is very frightening and I hope she isn't disheartened by it. Tell her that the symptoms of schizophrenia may be seen in other psychotic disorders also, which are less serious than schizophrenia. This material was simply to help her understand the symptoms of her son and not to tell her that her son is suffering from schizophrenia. Have a nice day! Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (34 hours later)

Thanks I will pass the information on to her. Regards

Answered by Dr. Preeti Parakh (22 hours later)

Brief Answer: Thanks. Detailed Answer: Hi, Thanks. I hope things turn out well for her and her son. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar