I have bipolar disorder. I sometimes hear voices when I'm manic or depressed. I haven't been manic or depressed lately, pretty stable. Two weeks ago, I had a visual hallucination. I saw maggots all over my living/kitchen and they were eating my dead cat-She's alive in real life-I called my doc and left a message with his nurse. I had to reschedule an appt. w/ a new psych. b/c they had no info on me after I waited a mth. and a half to see him, they lost info on me. I went to my gen. doc. to tell him what happened. He put me on 80mg of Geodon and 200mg of Lamictal, that's all I'm taking along w/ thyroid horm. He said what happened to me was an "episode". On the med. form that u give to the receptionist, "acute psychosis" and the presc. had "for BAD/Schizo Affective Disorder". Who knows what this means? Did he change my diagnosis w/out telling me? This episode scared my husband. I was screaming at him to kill the maggots. He didn't know what to do. Call 911 if this happens again?Advice? Yes if it happens again go to the ER and tell them whats going, as for the new dx that kind of stuff can happen when you have bipolar (I have bipolar) the doctors tend not to give you a new dx just add another one to the list you already have. Do you know you have the right to read your medical files?? If you are worried go in and say you want to read them you might have to write off to get a copy but you do have the right to read them. good luck sounds more like schizoaffective disorder. look that up on yahoo.com or google it. Never heard of doctors changing a diagnosis without informing you. I'm diagnosed with Bipolar and Borderline, but due to a few particularily bad psychosis, I was intructed to attend an emergency assessment for Schizophrenia. They can re-assess you if you do not meet the criteria, but they cannot change a diagnosis without stringent testing, to the best of my knowledge. I have a friend however who is bipolar with schizo effective, though I do not know much about his diagnosis. Communicate with your doctor. If you are not comfortable with one, or they keep losing info on you and stuff, get someone you like. That is extremely important with your disorder. Keep taking the meds. I don't think you need to call 911 unless you are uncontrollable. I am bipolar as well. I have never had hallucinations but I have definitely been Manic and out of my mind...like what I'd expect someone on crack would act like. You and your husband are on a long road. Learn as much as you can about your diagnosis and take care of your health as best as you can. Learn your triggers...you may have to avoid things that are stressfull, alcohol(because it's a depressant) and anything else that you notice triggers episodes. Just know that even when things are extremely bad...the bright side?.....We always swing back! Sending Hugs! Hope all goes well. i agree with dzpnoiz2die4. when you have psychotic episodes with visual and audible hallucinations that come and guy, like mania, it's called schizoaffective disorder. you might want to look more into it. this is no bipolar. i understand the manic part, but your symptoms seem to fall more towards schizophrenia or schizoaffective disorder. however, i am not diagnosing you, i'm just telling you what i think. if you're doctor is not helping you, find another doctor. find a good phychiatrist that will help you and put you on the right medication that you're COMFORTABLE with because it sounds like they just threw a fast diagnosis and medicated you. you need to talk and let it all out in order for them to know what you are going through. having psychotherapy and being put on medication you are confortable with is the best way to go. but yeah, seems more like schizoaffective. please get of hold of you psychiatrist. let him know what you have been prescribed. sometimes DR. give medications that help different diagnosis' and a lot of psych meds have unlabeled uses that are not advertised but are know to work for certain problems. Talk to you pharmacist to make sure these meds will not affect you in any way or if you current meds will interfere with the new medication. talk to you general doctor to ask why he put you on this med. read this...
lamotrigine
(la-moe-tri-jeen)
Lamictal
Classification
Therapeutic: anticonvulsants
Pregnancy Category C
Copyright 漏 2007 by F.A. Davis Company
Indications
Adjunct treatment of partial seizures in adults with epilepsy. Lennox-Gastaut syndrome. Conversion to monotherapy in adults with partial seizures receiving a single enzyme-inducing antiepileptic drug. Maintenance treatment of bipolar disorder.
Action
Stabilizes neuronal membranes by inhibiting sodium transport. Therapeutic Effects: Decreased incidence of seizures. Delayed time to recurrence of mood episodes.
Pharmacokinetics
Absorption: 98% absorbed following oral administration
Distribution: Enters breast milk. Highly bound to melanin-containing tissues (eyes, pigmented skin)
Metabolism and Excretion: Mostly metabolized by the liver to inactive metabolites; 10% excreted unchanged by the kidneys
Half-life: Children taking enzyme鈥搃nducing antiepileptic drugs (AEDs): 7鈥?0 hr; Children taking enzyme inducers and valproic acid (VPA): 15鈥?7 hr; Children taking VPA: 44鈥?4 hr; Adults: 25.4 hr (during chronic therapy of lamotrigine alone)
TIME/ACTION PROFILE (blood levels)
ROUTE ONSET PEAK DURATION
PO unknown 1.4鈥?.8 hr unknown
Contraindications/Precautions
Contraindicated in: Hypersensitivity. Lactation.
Use Cautiously in: Patients with reduced renal function (lower maintenance doses may be required). Patients with impaired cardiac function. Patients with impaired hepatic function (lower maintenance doses may be required). Pregnancy or children (safety not established as monotherapy) . Prior history of rash to lamotrigine.
Adverse Reactions/Side Effects*
*CAPITALS indicate life threatening; underlines indicate most frequent.
CNS: ataxia, dizziness, headache, behavior changes, depression, drowsiness, insomnia, tremor. EENT: blurred vision, double vision, rhinitis. GI: nausea, vomiting. GU: vaginitis. Derm: photosensitivity, rash (higher incidence in children, patients taking VPA, high initial doses, or rapid dosage increases). MS: arthralgia. Misc: allergic reactions including Stevens-Johnson syndrome.
Interactions
Drug鈥揇rug: Concurrent use with carbamazepine may result in 鈫?levels of lamotrigine and 鈫?levels of an active metabolite of carbamazepine. Lamotrigine levels are 鈫?by concurrent use of phenobarbital, phenytoin, or primidone. Concurrent use with valproic acid results in a twofold 鈫?in lamotrigine levels, 鈫?incidence of rash, and a 鈫?in valproic acid level (lamotrigine dose should be 鈫?by at least 50%). Oral contraceptives may鈫搒erum levels of lamotrigine (dose adjustments may be necessary when starting and stopping oral contraceptives).
Route/Dosage
Epilepsy
* In combination with Other Antiepileptic Agents
PO (Adults and Children >12 yr): Patients taking carbamazepine, phenobarbital, phenytoin, or primidone鈥?0 mg daily as a single dose for first 2 wk, then 50 mg twice daily for next 2 wk; then increase by 100 mg/day on a weekly basis to maintenance dose of 150鈥?50 mg twice daily (not to exceed 500 mg/day). Patients taking carbamazepine, phenobarbital, phenytoin, or primidone with valproic acid鈥?5 mg every other day for first 2 wk, then 25 mg once daily for next 2 wk; then increase by 25鈥?0 mg/day every 1鈥? wk to maintenance dose of 50鈥?00 mg twice daily (not to exceed 400 mg/day).
PO (Children 2鈥?2 yr): Patients taking carbamazepine, phenobarbital, phenytoin, or primidone鈥?.6 mg/kg/day in 2 divided doses (rounded down to nearest whole tablet) for first 2 wk, then 1.2 mg/kg in 2 divided doses (rounded down to nearest whole tablet) for next 2 wk; then increase by 1.2 mg/kg/day (rounded down to nearest whole tablet) q 1鈥? wk to maintenance dose of 5鈥?5 mg/kg day (not to exceed 400 mg/day in 2 divided doses).Patients taking carbamazepine, phenobarbital, phenytoin, or primidone with valproic acid鈥?.15 mg/kg/day in 1鈥? divided doses (rounded down to nearest whole tablet) for first 2 wk; (if initial calculated dose is 2.5鈥? mg/day, then initial dose should be 5 mg every other day for 2 wk; if patient weighs between 6.7鈥?4 kg, use 2 mg every other day for 2 wk). Then 0.3 mg/kg in 1鈥? divided doses (rounded down to nearest whole tablet) for next 2 wk; then increase by 0.3 mg/kg/day (rounded down to nearest whole tablet) q 1鈥? wk to maintenance dose of 1鈥? mg/kg day (not to exceed 200 mg/day in 1鈥? divided doses).
* Conversion to Monotherapy
PO (Adults 鲁16 yr): 50 mg/day for 2 wk, then 50 mg twice daily for 2 wk, then increase by 100 mg/day q 1鈥? wk to maintenance dose of 300鈥?00 mg/day in 2 divided doses; when target level is reached, decrease other antiepileptic by 20% weekly over 4 wk.
Bipolar disorder
o Escalation regimen
PO (Adults): Patients not taking cabamazepine, valproate or other enzyme-inducing drugs鈥?5 mg/day for 2 wk, then 50 mg/day for 2 wk, then 100 mg/day for 1 wk, then 200 mg/day; Patients taking valproate鈥?5 mg every other day for 2 wk, then 25 mg/day for 2 wk, then 50 mg/day for one wk, then 100 mg/day; Patients taking cabamazepine (or other enzyme inducers), but not taking valporate50 mg/day for 2 wk, then 100 mg/day (in divided doses) for 2 wk, then 200 mg/day (in divided doses) for one wk, then 300 mg/day (in divided doses) for one week, then up to 400 mg/day (in divided doses).
* Dosage adjustment following discontinuation of other psychotropics
PO (Adults): Following discontinuation of other psychotropics鈥攎aintain previous dose; following discontinuation of valproate鈥?00 mg/day, then increase to 150 mg/day for one wk, then 200 mg/day; following discontinuation of carbamazepine or other enzyme-inducers鈥?00 mg/day for one wk, then 300 mg/day for one wk, then 200 mg/day.
Availability
Tablets: 25 mg, 100 mg, 150 mg, 200 mg. Chewable dispersible tablets: 2 mg , 5 mg, 25 mg.
NURSING IMPLICATIONS
Assessment
Assess patient for skin rash frequently during therapy. Discontinue lamotrigine at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Rash usually occurs during the initial 2鈥? wk of therapy and is more frequent in patients taking multiple antiepileptic agents, especially valproic acid, and much more frequent in patients <16 yr.
Seizures: Assess location, duration, and characteristics of seizure activity.
Bipolar disorders: Assess mood, ideation, and behaviors frequently. Initiate suicide precautions if indicated.
Lab Test Considerations: Lamotrigine plasma concentrations may be monitored periodically during therapy, especially in patients concurrently taking other anticonvulsants. Therapeutic plasma concentration range has not been established, proposed therapeutic range: 1鈥? mcg/ml.
Potential Nursing Diagnoses
Risk for impaired skin integrity (Adverse Reactions).
Risk for injury (Side Effects).
Implementation
Do not confuse lamotrigine (Lamictal) with terbinafine (Lamisil), diphenoxylate/atropine (Lomotil) or lamivudine (Epivir).
PO: May be administered without regard to meals Lamotrigine should be discontinued gradually over at least 2 wk, unless safety concerns require a more rapid withdrawal. Abrupt discontinuation may cause increase in seizure frequency.
.
Chewable/Dispersible Tablets: May be swallowed whole, chewed, or dispersed in water or dispersed in fruit juice. If chewed, follow with water or fruit juice to aid in swallowing. Only use whole tablets, do not attempt to administer partial quantities of dispersible tablets.
Patient/Family Teaching
Instruct patient to take medication exactly as directed. Take missed doses as soon as possible unless almost time for next dose. Do not double doses. Do not discontinue abruptly; may cause increase in frequency of seizures.
Advise patient to notify health care professional immediately if skin rash occurs or if frequency of seizures increases.
May cause dizziness, drowsiness, and blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Do not resume driving until physician gives clearance based on control of seizure disorder.
Caution patient to wear sunscreen and protective clothing to prevent photosensitivity reactions.
Advise patient to notify health care professional if pregnancy is planned or suspected or if patient intends to breastfeed or is breastfeeding.
Instruct patient to notify health care professional of medication regimen prior to treatment or surgery.
Advise patient to carry identification at all times describing disease process and medication regimen.
Evaluation/Desired Outcomes
Decrease in the frequency of or cessation of seizures.
Decreased incidence of mood swings in bipolar disorders. You will need to call the Dr. because it could have been an episode and your medicines may need to be changed just temporarily or they may have found enough evidence to change your diagnosis but as a patient you have every right to know what is going on in your treatment and your treatment plan. I would call and make an appt. or if you already have one scheduled make it a point to discuss this with him the next time you go in. Yes, I would say if this were to happen again that your husband would need to call 911 but with the medication you are on hopefully those symptoms will not reappear. I am very sorry you had to go through that. My wishes go out to you~ See schizophrenia at http://www.ezy-build.net. (.net.nz/~shaneris) on page 7, and bipolar disorder and depression on pages 5 and 2. Doctors are not experts in this area, and he had to change his diagnosis on the basis of new symptoms. Medications take a while to become fully effective, so, hopefully , it won't happen again. I would have changed my psych, suspecting incompetance may possibly be repeated: it's not a good sign, but accidents happen, and you need treatment soon, so, if it will take longer elsewhere, stick with the one you have got, at least for the time being. I'd tell your husband to let you know that you are having another episode, and to calm down, because it's just another hallucination. Learn and practise daily, one of the relaxation methods on page 2 of ezy-build. "BAD" is an abbreviation that fortunately has fallen out of favor. I saw it a lot in the nineties. It means bipolar affective disorder, no different than "bipolar". The doctor writing that script was being noncommittal whether you are bipolar or schizoaffective. Different doctors don't necessarily agree on who has bipolar disorder and who has schizoaffective disorder. There are more hallucinations and delusions with the latter, and they need not be associated with moods as tightly as typical bipolar who only have psychotic features related to their manias and depressions.
There is no practical significance to which label one receives. The meds are the same, a mood stabilizer plus an antidepressant if needed plus an antipsychotic if needed. Presumably there is some difference in the biology of each one, but maybe not. Maybe it's the same biology looking different in different people.
You shouldn't have to resort to calling 911. I have bipolar disorder and for years I've known from my psychiatrist that if I feel myself drifting toward mania or if some of these psychotic symptoms creep up, I can take Seroquel, an antipsychotic that I ordinarily don't take. Usually I just take lithium. You should work out your own plan with your doctor. If you call 911, and they take you to the ER, you're just going to be given an antipsychotic. You can do that orally at home. |
