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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Can I Do About Frontal Lobe Damage And Psychosis After Stopping Olanzapine?

My son is 27. Has had a few TBIs that were never treated. He has significant frontal lobe damage. Was on olanzapine for the past 5 years. He stopped talking it and has been in psychosis for a couple of months. The withdrawal side effects of coming off of antipsychotics is inhumane!! He has been in the hospital for 2 weeks and is now taking risperdol and lithium. But he still sounds off. And is delusional about the facts. And now he gets angry more easily. He desperately needs neurobehavioral rehabilitation but there is nowhere in Colorado that has a program to help him. The medication is just a bandaid. They re supposed to release him on Friday. I feel so helpless and afraid for him. He lives with me and I feel so responsible for not getting him the proper care when he really needed it in 2017. What do I DO to help my son?
posted on Fri, 20 Oct 2023
Twitter Thu, 16 Oct 2025 Answered on
Twitter Fri, 31 Oct 2025 Last reviewed on
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General & Family Physician,  's  Response
Hello,

Your son’s frontal lobe injuries and the abrupt change in antipsychotic medication both contribute to his symptoms. However, your son is in treatable stage. This stage is a transitional stage. Risperidone is an antipsychotic medication. It helps calm delusions, agitation, and mood swings. Lithium is a medication which stabilizes mood and reduces impulsivity. It may lessen aggression linked to frontal-lobe injury.

Used together, they can cover both psychotic and manic or irritable features. However, there is risk as this combination often causes neurotoxicity, extrapyramidal symptoms (EPS), and cognitive dulling. It will be better, if the treating doctor goes for gentler alternatives. This combination is relatively safe if the doses are kept quite low.

Lithium and Risperidone should be kept low (not high therapeutic range) to minimize side effects. Make sure that regular kidney, thyroid, and sodium checks are done so that the medicines can be monitored accordingly for betterment of your son. Your son should be adequately hydrated. No sudden low-salt diets, and NSAIDs should be avoided as they raise lithium levels.

Risperidone and Lithium can be safe and effective only under tight monitoring. Lowest effective doses should be given. You are advised to be vigilant for side effects, as the medication can be altered, likewise. Report to your treating doctor when your son sounds off.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Nupur K., General & Family Physician
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What Can I Do About Frontal Lobe Damage And Psychosis After Stopping Olanzapine?

Hello, Your son’s frontal lobe injuries and the abrupt change in antipsychotic medication both contribute to his symptoms. However, your son is in treatable stage. This stage is a transitional stage. Risperidone is an antipsychotic medication. It helps calm delusions, agitation, and mood swings. Lithium is a medication which stabilizes mood and reduces impulsivity. It may lessen aggression linked to frontal-lobe injury. Used together, they can cover both psychotic and manic or irritable features. However, there is risk as this combination often causes neurotoxicity, extrapyramidal symptoms (EPS), and cognitive dulling. It will be better, if the treating doctor goes for gentler alternatives. This combination is relatively safe if the doses are kept quite low. Lithium and Risperidone should be kept low (not high therapeutic range) to minimize side effects. Make sure that regular kidney, thyroid, and sodium checks are done so that the medicines can be monitored accordingly for betterment of your son. Your son should be adequately hydrated. No sudden low-salt diets, and NSAIDs should be avoided as they raise lithium levels. Risperidone and Lithium can be safe and effective only under tight monitoring. Lowest effective doses should be given. You are advised to be vigilant for side effects, as the medication can be altered, likewise. Report to your treating doctor when your son sounds off. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Nupur K., General & Family Physician