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In the past year, especially the last three and a half months, my psychotic symptoms have been coming out of the woodwork, after having been gone for years, and have especially hit hard in the last three weeks. In the most recent times I have had insight, even though I have lacked insight to some degree at times in the past, but I have definitely observed a pattern in recent times of acting on my delusions as if they very much were real, of that what insight I have has very little impact on my actual behavior, of that what insight I do have is not enough. I am afraid that, at some point in the near future, I will lose insight altogether, and will simply go off the deep end.

Recently my pdoc has added a tiny amount of cariprazine (1.5 mg) to my risperidone (6 mg), but I feel she is being overly conservative, as 1.5 mg is indeed a tiny dose of cariprazine. I hope at my next appointment she will increase the cariprazine to 3 mg, rather than, as I suspect she might, waiting until I really lose it before increasing my dosage.

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2 minutes ago, Closure said:

I hope at my next appointment she will increase the cariprazine to 3 mg, rather than, as I suspect she might, waiting until I really lose it before increasing my dosage.

If at the next pdoc appt she only raises the med a little bit, I would ask her about what happens if the amount prescribed isn't high enough, and you feel like you might lose it at the lower dose.  And so you are asking for the higher dose so you can avoid that (avoid possibly losing it).

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Just now, melissaw72 said:

If at the next pdoc appt she only raises the med a little bit, I would ask her about what happens if the amount prescribed isn't high enough, and you feel like you might lose it at the lower dose.  And so you are asking for the higher dose so you can avoid that (avoid possibly losing it).

The 1.5 mg has not made my psychotic symptoms go away, or be less compelling. Right now I feel somewhat like I was between the two last clear psychotic episodes in the last few weeks, except that the psychotic symptoms are still more pronounced than then, meaning I have been left with more psychotic symptoms after the last definite episode than I had before.

Right now I am just asking that she increase the dose to 3 mg rather than leave it at 1.5 mg. (Cariprazine is normally prescribed at either 3 mg or 6 mg.)

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14 minutes ago, Closure said:

The 1.5 mg has not made my psychotic symptoms go away, or be less compelling. Right now I feel somewhat like I was between the two last clear psychotic episodes in the last few weeks, except that the psychotic symptoms are still more pronounced than then, meaning I have been left with more psychotic symptoms after the last definite episode than I had before.

Right now I am just asking that she increase the dose to 3 mg rather than leave it at 1.5 mg. (Cariprazine is normally prescribed at either 3 mg or 6 mg.)

I think that is reasonable to ask.  I would tell her just what you wrote in this post; I think the explanation you give makes a lot of sense and makes a good argument for increasing the dose to 3 mg instead of staying at the 1.5.

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18 hours ago, melissaw72 said:

I think that is reasonable to ask.  I would tell her just what you wrote in this post; I think the explanation you give makes a lot of sense and makes a good argument for increasing the dose to 3 mg instead of staying at the 1.5.

My problem is that my pdoc is very conservative - and she especially does not like me being on more than one AAP simultaneously - such that the appt before last, after I had already been having definite psychotic symptoms - and my pdoc had made reference to psychosis too - beyond my usual hallucinations, she did not add any extra AP and rather took a wait-and-see approach to things, and this time, after I had definitely become psychotic - in her own assessment - she still added only a minimal dose of cariprazine. This is why I fear she is going to wait until I become seriously psychotic - i.e. lose insight - before she increases my cariprazine to a sufficient dose.

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6 hours ago, Closure said:

My problem is that my pdoc is very conservative - and she especially does not like me being on more than one AAP simultaneously - such that the appt before last, after I had already been having definite psychotic symptoms - and my pdoc had made reference to psychosis too - beyond my usual hallucinations, she did not add any extra AP and rather took a wait-and-see approach to things, and this time, after I had definitely become psychotic - in her own assessment - she still added only a minimal dose of cariprazine. This is why I fear she is going to wait until I become seriously psychotic - i.e. lose insight - before she increases my cariprazine to a sufficient dose.

You know, that really sucks ... I think it would be so much better to increase the dose and catch it before you become more psychotic that the wait-and-see approach. 

Hypothetically ... I mean why wait until you become full-blown psychotic to raise the dose because by then things could go out of control and you'd need more than a dose raise.  I think if they were the patient things would be different.

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2 hours ago, melissaw72 said:

You know, that really sucks ... I think it would be so much better to increase the dose and catch it before you become more psychotic that the wait-and-see approach. 

Hypothetically ... I mean why wait until you become full-blown psychotic to raise the dose because by then things could go out of control and you'd need more than a dose raise.  I think if they were the patient things would be different.

I agree with Melissa. You need to kick psychosis in the ass, even if it means two APs. You might even be able to use one of them prn just for when things go wonky on you. Psychotic episodes can be absolutely horrifying. You don't want to end up there, if there is any possibility of containing it. If you look through the signatures here, you will find people on multiple  ADs, multiples APs, and multiple mood stabilizers. You need to rely on your pdoc, but you also have to have confidence in her/him. If your current AP isn't doing there trick, you need a change of some type. I've had some of the most horrendous psychotic episodes, and trust me: you DO NOT want to go there. I would suggest describing your episodes to you pdoc, and explaining how ineffective your current treatment regimen is. Hopefully, that will lead to the change that you need.

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7 minutes ago, Flash said:

I agree with Melissa. You need to kick psychosis in the ass, even if it means two APs. You might even be able to use one of them prn just for when things go wonky on you. Psychotic episodes can be absolutely horrifying. You don't want to end up there, if there is any possibility of containing it. If you look through the signatures here, you will find people on multiple  ADs, multiples APs, and multiple mood stabilizers. You need to rely on your pdoc, but you also have to have confidence in her/him. If your current AP isn't doing there trick, you need a change of some type. I've had some of the most horrendous psychotic episodes, and trust me: you DO NOT want to go there. I would suggest describing your episodes to you pdoc, and explaining how ineffective your current treatment regimen is. Hopefully, that will lead to the change that you need.

Oh I have described in detail my past two episodes, which were severe enough that my pdoc referred to them as psychosis - I was pretty much constantly delusional during my last one - but mild enough that I still had insight. But even then she put me on a minimal dose of cariprazine, when what I would have wished is that she erred on the side of too much AP rather than too little, so as to suppress the psychotic symptoms definitively, and only then possibly reduce the dose some once things have stabilized. So far, I am still delusional, but it is not so constant or intense, and I just hope that at our next visit, next week she will opt to increase the cariprazine rather than just figuring that things are mild enough - after all, it's no longer constant, is less intense and I have insight - and leaving things as is. My fear, though, is that this is just a lull between episodes rather than a sign that the cariprazine is actually working, and who knows how severe the next episode will be.

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41 minutes ago, Closure said:

My fear, though, is that this is just a lull between episodes rather than a sign that the cariprazine is actually working, and who knows how severe the next episode will be.

Right, I agree  ... it would be nice if your pdoc would be preventative instead of 'waiting and seeing.' Because like you said, who knows how severe the next episode will be.

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I'd straight up ask for an increase. My doctors also tend to be fairly laid back and will wait until I'm totally nuts before making a significant intervention. This time around (manic episode) I insisted on it, and it worked out in my favor. 

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Hmm my dilemma now is whether to call my pdoc or not. After all, my psychotic symptoms were really acting up last night - the people in chat seemed really worried - and were acting up some early this morning, but as the work day has progressed they have settled down some, so that they are only a bit worse than they have been over the past week. To me they don't seem bad enough now to justify calling my pdoc, as opposed to waiting for my appt next week (contrasting with the last two times I called my pdoc, where then I was actually psychotic at the time rather than merely having psychotic symptoms).

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I think call...and suggest a dose raise. I mean the starter pack for that only has you on 1.5 for one day and then you go to three and then you can jump to 6 if you need to. I understand her caution especially with two antipsychotics but how is the med gonna help if she won't give it a chance. Let me kno how this goes please!  I just started it too 

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On 2/23/2017 at 2:31 PM, Closure said:

Okay, I left a message with my pdoc; it seems that even if she wanted me in she would have to wait until next week Thursday, which is when my appt is anyways, but at least she can make a med change if she wants over the phone.

How did that go?

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