Patient: Director Yang: Hello! The patient started taking the medication on June 14 according to the following prescription: morning: 2 tablets of sodium valproate, 1 tablet of sertraline, 1 tablet of ApoVita, half tablet of Olanin afternoon: 2 tablets of sodium valproate, 1 tablet of ApoVita, half tablet of Olanin The condition improved significantly after 3 or 4 days of taking the medication, and the condition was good until June 24, but from the 25th, the condition started to recur, talking to herself, or saying that someone downstairs was talking about her, and her The menstrual cycle also happened to start on the 25th, to see if it was due to irritability during menstruation. After the end of the menstrual cycle (early July) the situation has improved, but until now has not returned to the level before June 25, the recent high temperature, I do not know if this is the reason for the impact. The above is the basic situation of her recently, do you see any other good way? In addition, her brother-in-law will come to your office again in this day or two to help her prescribe medicine, so I have to trouble you again. Guangzhou Brain Hospital Psychiatry Department Yang Mingzhe: It should be related to menstruation, and the medication does not need to be changed for the time being Patient: Last time she saw Dr. Yang Mingzhe or was discharged from the hospital: The patient is female, 36 years old, and was seen again at your clinic on April 22, and took her medication on the 24th according to the new prescription (morning: ziprasidone 1 tablet, sertraline 1 tablet, aprevita 1 tablet; afternoon: ziprasidone 2 tablets, aprevita 1 tablet, olanzapine half tablet). In the first two or three days, she always felt hungry and ate a lot, then this phenomenon disappeared; however, she seemed to be getting more and more excited, always talking to herself, the content seemed to be about some things about colleagues and family relations, sometimes cursing, and she didn’t listen even when others communicated with her, giving the impression that she was trapped in a certain thing (mostly in her imagination) and couldn’t extricate herself, and the content was often changed. Now the situation is getting worse, her voice is getting louder and longer, and she is basically talking non-stop except for sleeping, and yesterday (May 2) she had insomnia; in addition, this period coincides with her menstrual cycle, which may also have a great impact. Tests done at the last visit, results, disposition plan: March 21 at your clinic, prescription: morning: Depakene 1 tablet, Sertraline 1 tablet, afternoon: Depakene 2 tablets, Olanine 1 tablet. Effect: 1 Self-talk is less than before, slightly worse around 5 pm. 2 Most of the time silent, dazed, slow to respond to communication with people; very hesitant to do things, even a very simple thing (such as taking a thing) has to walk around and consider repeatedly. 3 Head is always down, according to myself it is neck discomfort. Now the condition, want to get help: see her current situation, we are very anxious, anxious to get your guidance, thank you Guangzhou Brain Hospital psychiatric department Yang Mingzhe: last time due to economic reasons, change to slightly cheaper drugs, the results are not very satisfactory. We suggest adding half an extra half tablet of Olanine in the morning. See how it goes and contact again. Patient: Thank you for your reply. I will add half a tablet of Olanine in the morning from tomorrow, and contact you again if there is any situation. Patient: Since May 5, she started to add half a tablet of Olanine in the morning. During this period of time, the phenomenon of self-talk is much better, and she feels that her consciousness is much restored. She feels as if she is particularly annoyed, she doesn’t like what she sees, she doesn’t like what she hears, and she starts to curse when she is not careful. I’m looking forward to hearing from you if her medication needs to be adjusted and if her condition shows any signs of improvement! Guangzhou Brain Hospital Psychiatric Department Yang Mingzhe: If necessary, add half a tablet of olanzapine at night, and then reduce it after control. Last time her brother-in-law was afraid of her financial pressure, so he asked if he could change the medication. Patient: Thank you for your reply, now it is according to: morning: ziprasidone 1 tablet, sertraline 1 tablet, ApoVita 1 tablet, Olanine half tablet afternoon: ziprasidone 2 tablets, ApoVita 1 tablet, Olanine half tablet at night plus half tablet olanzapine, should the half tablet Olanine added in the morning be reduced down? Thank you. Yang Mingzhe, Psychiatry Department, Guangzhou Brain Hospital: No, half tablet of Olanzapine in the morning and one tablet of Olanzapine in the evening. Patient: Hello, Director Yang! After getting your guidance the night before yesterday, I was going to add half a tablet of Olanine in the evening, but I found that my condition has shown signs of improvement, the number of tantrums has decreased and the duration is very short, so I didn’t add it for the time being. Guangzhou Brain Hospital psychiatric department Yang Mingzhe: temporarily do not add it. Patient: Director Yang: Hello! I received the new medication you prescribed today, and after reading the instructions, I found that sodium pivalate tablets and quetiapine fumarate tablets are very harmful to liver function (may cause acute liver necrosis), and my family is afraid to give them to her. Thank you very much! Guangzhou Brain Hospital Psychiatric Department Yang Mingzhe: The actual side effects are not that big. Patient: Director Yang: Hello! On May 20, I started to take the medicine you re-prescribed (the old prescription), after a period of observation, it seems that the condition has not changed much, neither serious, nor signs of improvement, mainly self-talk, as if people are particularly excited, when at home, they always say that there are people downstairs eavesdropping, or talking badly about him, the situation is more serious from 6 pm to 9 pm (the time to take the medicine is 8 am and 8 pm a day The situation is worse from 6:00 to 9:00 p.m. (medication is taken at 8:00 a.m. and 8:00 p.m.), but he is more conscious. In general, the condition is better than the first half of May, and basically has not changed much since late May. Do you think there is any need to adjust the medication in this case? Thank you. Yang Mingzhe, Psychiatry Department, Guangzhou Brain Hospital: It should be adjusted, please send me the details of the medication she is taking. Patient: April 24 prescription morning: ziprasidone 1 tablet, sertraline 1 tablet, aprevita 1 tablet afternoon: ziprasidone 2 tablets, aprevita 1 tablet, olanzapine half tablet May 5 because the effect is not satisfactory, after consulting you online, adjusted to (morning plus half tablet olanzapine): morning: ziprasidone 1 tablet, sertraline 1 tablet, aprevita 1 tablet, olanzapine half tablet afternoon: ziprasidone 2 tablets, aprevita 1 tablet, olanzapine half tablet tablet, Olanine half tablet adjusted for a period of time after the condition has improved, (see 1 – 10 straddle), May 20 in your place to re-prescribe the same prescription (May 5 after the adjustment), has been taking medication until now, but the condition from late May onwards has not changed much, no improvement, but also not serious. Yang Mingzhe, Psychiatry Department, Guangzhou Brain Hospital: 1 tablet of Olanine at night. Guangzhou Brain Hospital Psychiatric Department Yang Mingzhe: Please take sodium valproate.