Hello
Thanks for using Doctor Spring for posting your query.
I have gone through it in details, and I can understand what you are going through.
Schizophrenia is indeed a very difficult illness to treat and ones it becomes resistant then it is all the more difficult. I understand you confusion initially about neurosis and psychosis. Infact many patients of schizophrenia have neurosis initially followed by psychosis as in your case. I could understand all the drugs that you have mentioned except Rouland 40 mg which I could not understand what does it contain. I would appreciate if you can let me know the content of this medicine. Is it Ziprasidone?
Further after going through all your medical history i have certain comments to make
1) The drug of choice for resistant schizophrenia is clozapine and it seems you have not even tried this drug. Its a very nice drug and very effective even in the resistant cases. The only issue with cloazapine is its possibility to cause neutropenia. Hence a weekly CBC while elevating the dose and there after CBC every 15 days should be good.
2) Now that you are stable on these medicines that you are taking you may take the same but there is no use to break abilify in these many doses as the half life of abilify is long and hence ones a day dose of 5 mg or 10 mg should be good.
3) Regarding your third drugs (Rouland) which also you are breaking in these many parts, may not be required as most of the psychiatry medications can be given in ones a day form or at the maximum twice a day, but not more than that.
4) For resistant auditory hallucinations, hearing music from ear phones is a good therapy. That reduces the hallucinations.
5) Keep your self occupied by some work and you need to communicate to people around you. The more you socialize the better it is.
6) Blonanserine is a new drug and many people have not used it as a first line drug. However if you are comfortable with it, you may use it.
Hope this helps,
If you need any further clarifications, i would be more than happy to help you.
Kind regards
Dr. Srikanth Reddy MD (Psychiatry)
Patient replied :
Doctor, Srikanth.
Thank you for your great advice. I told my doctors about you and they are very surprised.
My doctor told me that Cloazapine will work well but in Japan we have to go to big hospital where hematology are available. Also my doctor told me that Rouland is used only in Japan. He was little confused about asking an advice from foreign doctor.
I'm not sure about Rouland. I searched about Rouland but it says you may use twice a day. I think more than 8mg a day will be very difficult to spend your daily life. I did not tell you but I used Latuda before. It was terrible. I could not sleep more than 4 days. Depression was so hard and I did not look very well. I feel that almost got killed by this medicine. I started from 80mg a day and reduced for 20mg a day but it did not work at all. I could not move and sleep at all.
The voice(Hallucination) makes me stressed. Also depression and lack of memory(hard to remind things). I have good memory so I don't understand why this is happening to me.
I invest and make money these days. It is hard for me to work normally with these situation. Also it is hard for me to take medical treatment in Japan. Is there any way that I can take normal medical treatment around world?
Best regards,
Yoshiki Mino
Hello Yoshiki,
The treatment patterns vary from country to country. Its unfortunate that in Japan clozapine is started only where hematology facility is available. In US and in India we can start clozapine at home based treatment as well and it is the drug of choice for resistant depression.
Anyway being in japan it would be wise to follow your local treatment guidelines. Seeking treatment from outside country is not advisable as in schizophrenia you need to have regular follow-ups and that is not possible from outside the country.
However if you shift to a new country for a longer duration then the treatment will be possible. Many Indian hospitals cater to foreign tourists for the medical interests.
Hope that helps,
If you need any further help I would be glad to help you.
Patient replied :
Dr, Srikanth.
Thank you for your great advice.
I think I have to think another option. I can not take normal medical treatment in Japan. I move around Japan and seeking for doctors.
I asked many times that I want to get normal medical treatment but my voice(hallucination) are hearing all day long and medication has changed for ten years.(since when I was 17) I used almost every medication that doctor can use. I had met more than 20 doctors including big hospitals and university hospitals. I had met the Japanese professor of university (Kobe university, Harvard university, Seimarianna University) But they had done nothing.
Will you write letter of introduction? So that I can get normal medical treatment. I have never been to India so it has risks of getting medical treatment in India. I have friend in India. It feels comfortable for me. But it has risks.
I think US sounds great to me. I have lived US for two years since when I was Junior high school student.
Thank you for your great support.
Best regards,
Yoshiki Mino
Hello,
Thanks for the follow-up information. Sincere apologies for this but without personally and physically examining you I wont be able to provide you a letter of introduction.
If you want to take your treatment away from Japan, you can take it and its your choice. Regarding the option of India, I don't think there is any significant risks involved. There are plenty of corporate hospitals in India which provide excellent care. I can provide you a list of such hospitals if you can specify which city you want to select. I my self practice in Indore in Madhya Pradesh.
Regarding the US, option is not bad but the treatment without social security will be very costly. The cost will be atleast 10-20 times more as compared to India.
Practically speaking, India would certainly be a better option.
Regards
Dr. Srikanth Reddy MD
Patient replied :
Dr, Srikanth.
Thank you for your great advice. I'm feeling better by your message. I think India is one of the best option. I don't know about India but I think Education and Medical care is one of the top level in the world. I know many intelligent people who are from India making world better place.
Is it possible to take medical treatment without visa in India? Is there medical care visa in India?
What should I do for taking medical care from you or other doctor in India?
I took TOEFL test a week ago and waiting for my score. I think it is possible for me to become college student in India or I will just wait for the treatment gets well and do my own business in India.
There are many options if my medical treatment gets well.
I think the best option is to get medical treatment from you.
Thank you for your advice. I deeply appreciate it.
Best regards,
Yoshiki Mino
Hello
Thanks for your follow up information.
Yes you need a visa to travel to India and there is a provision of medical visa as well. You may contact your travel agent for the details.
If you need any further help you may contact me in future through doctor spring.
Regards
Dr. Srikanth Reddy