Only 3 weeks ago my brother was in a geriatric psych hospital because of paranoid delusions/verbal aggression toward staff. (Won't repeat the details I posted here at the time.) A Zyprexa/Prozac combination has cleared his delusions and confusion; he is "himself" again. (He doesn't remember ANY of the dementia weeks. He trusts that they happened.) Since returning to the long-term care place he can walk again. The meds and physical therapy have worked so well he now thinks he's "cured" and can return to his home. He wants a full psych assessment (I agree this would be good), but next available appointments are 5 months away.
My understanding (from this site's postings and online research) is that Zyprexa is a temporary solution at best. Any experience out there?

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Can the LTC place have your brother seen by a Neurologist? Or possible to go w medical transport to outside Neurologist? My mother sees a neurologist...she’s home ..but when she was in SNF, I took her to same Neurologist she’s been going to since 2013....The Nursing Director knew not to change any meds without asking me first. She’s needed to be on meds that control agitation. Also the other ones for the’s not a “mind clearer “ it’s just to control agitation to make her manageable. Hugs 🤗
Helpful Answer (1)

Hi SisterMoox- I think as long as you can stall while waiting for the 5 months out full evaluation, the better off your brother will be, but you can also feel a certain amount of confidence in the fact that given his age and the types and number of behavioral issues present in his case, there may not be too much difference in his ultimate treatment plan, and the goals will always center around his comfort, level of ADL functioning, personal safety and his potential threat in whatever community he ultimate lives in.

My mother was on Zyprexa for 5 1/2 years, and it truly did help to smooth out some of the issues in her life that she’d been able to control, especially her paranoia, before she was overtaken by dementia. The only problem she had was sleeping for many hours at a time when Ativan was added to control her ferocious anxiety.

You are obviously aware that his needs are really so complicated that for his sake the best care for him will be centered on his basic needs.

How truly fortunate for him that you are taking responsibility for his ongoing care.
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Good to hear that he has gotten some help (even if it might be temporary) and that he is in a safe place!

Your plans:
"So I'll make the distant appointment and get on the cancellation waiting list. Meanwhile I'll try to ignore his intention to leave LTC against medical advice. As Isthisrealyreal noted, without POA I can do little except stipulate that he would have to "pull off the move" without my help."

Making appointment while getting on the cancellation list is good and it is great that he wants it to happen (although he is impatient about it!)

Ignoring his requests to leave may not work - he'll keep asking. Since you say you have no POA, this is gives you an "out". Assumption is he was admitted by a doctor or someone other than you - you can just say you have no power or authority to discharge him, that he will have to wait for the doctor's okay after testing.

As for "pulling off the move", I would think if he is in a psych hospital he wouldn't have keys or a wallet, perhaps not even a phone. If so, regardless of all the hoops you mentioned would need to be dealt with in another post, how would he even begin?

Just a note to you and others - POA doesn't really give you the power to keep or admit him, or move him. It allows you to act as his legal representative for things like managing finances, signing paperwork, etc. The only real way to have this "power" is to have guardianship. Keep that in mind, in the event his condition regresses. Either you have to apply to be his guardian (it isn't quick, easy or cheap!) or you have to allow the state to take over as guardian. The issue with the latter is then you have no say in how he is treated or where. Obviously you care about him, so would likely want to be involved - you might have to start seeking out legal help that might be pro-rated or pro-bono for him, since he doesn't really have assets or a job, he wouldn't have funds to pay an attorney! While waiting for the testing, check around, make some calls and see if you can find someone. Many will offer a free initial consult, but it is best to call first and ensure they are the right kind of attorney (many of us use Elder Care because it is for a parent - I don't recall your brother's age, but perhaps starting with them they might be able to point you to the "right" kind of attorney.)
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Isthisrealyreal Dec 2019
Disgusted, in Arizona there is a mental health POA that is not revocable and it does give the appointed POA all the power to keep someone in a mental health facility. It is not something that should be given lightly and only to someone that you can trust with your very life.

I think in this situation that a POA is irrelevant, it is not about financial issues. This is about trying to find a way to keep him from leaving until he is fully stabilized and not just for a few days.

He can leave if he wants, he just has to put all the logistics together himself with zero help from
Sistermoox. If he can pull it all together then he is probably better, but he has to do all of it.
Have him wait to make any decisions until his full psychiatric evaluation. All psychiatric medications have side effects and he would be best served to remain where he is manage those. If he is in full time psychiatric residential facility, it is because of his unmedicated mental health issues that create paranoia and aggressive behavior. His mental health doctors would be the best guide to whether or not he can be released.
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I may be misunderstanding something, so could you explain if someone had told you that Zyprexa would “clear the mind”?

My mother took it for some time as a behavior management assist, but I don’t ever remember that clearing her mind was mentioned.
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SisterMoox Dec 2019
You're right. When I wrote "cleared his mind," I meant only that he's now oriented to person/place/time, can follow a conversation, can even make an occasional joke. The Zyprexa might or might not be the reason. No one told me anything about its purpose. Research told me it's a newer-generation anti-psychotic that sometimes helps with delusions and hallucinations associated with some kinds of dementia (and has side effects that concern some doctors). Because his delusions/hallucinations disappeared (along with the paranoia-related behavior issues) after the Zyprexa had been in his system for a few days, I assumed it was responsible.
"So I'll make the distant appointment and get on the cancellation waiting list". Excellent plan.

"Meanwhile I'll try to ignore his intention to leave LTC against medical advice. As Isthisrealyreal noted, without POA I can do little".

So hard to float along with your life with this storm on the horizen though. If it comes & he asks you to assit him leaving, kindly explain you have his best wishes at heart but you don't agree. So you can't help with that. He may or may not able to taxi or bus out of there. If he does, then eventually he will seek yours or a Doctor's help if unwell again, be re-admitted & the cycle will continue.

This lack of insight into own care needs is a very very hard part of the mental illness or dementia journey for some.

So it's a big positive he wants the full psych assessment too. You have as good a plan as you can in the circumstances I think.
Helpful Answer (10)

Your brother suffers from mental illness, not dementia, unless I misunderstand?
Many people have mental illnesses such as schizophrenia, bipolar depression and so on. They require medications and many times a "cocktail" of medications, and can live quite normal lives once they HAVE these medications. The problem for most families occur when the patient is released and chooses not to take medications (many times people with schizophrenia prefer their delusions to real life). They then descend once again into illness.
We no longer have asylums in which the mentally ill are housed. They are more often on their own in living a somewhat normal life with needs occ. to be readmitted to care.
I do not see that you have a choice in this unless you are a guardian of your brother and he has been diagnosed with uncurable dementia. But I may be missing information.
You are correct that some medications don't continue to work well, but it is more often that the patient stops taking them. There are often "tune-ups" needed with mental illness.
Helpful Answer (4)
SisterMoox Dec 2019
AlvaDeer: Thank you. Things have changed so rapidly my posts didn't reflect the latest information. My brother's latest written diagnosis specifies not only major depressive disorder w/ psychosis, but also dementia (unspecified type w/ behavioral disturbances). The DX was made 3 weeks ago by a certified psychiatric/mental health nurse practitioner (PMH-NP) who evaluated him a week after admission and shortly before his return to LTC. About his motivation to continue medication (Zyprexa plus his longstanding antidepressant): He understands that it apparently "brought him back" from the delusions/hallucinations of his recent lost weeks.
My concern is that dementia (if the DX is valid) would eventually make the Zyprexa success a moot point. That's why the full neuro-psych assessment is a good idea---especially given that it's my brother's idea. When he heard about the distant appointment, he said, "I'll be back home by then; no way I'm staying here 5 months."
So I'll make the distant appointment and get on the cancellation waiting list. Meanwhile I'll try to ignore his intention to leave LTC against medical advice. As Isthisrealyreal noted, without POA I can do little except stipulate that he would have to "pull off the move" without my help.
Thanks again.
If the drug that is helping so much is a short term solution, perhaps the appointment being 5 months out is a blessing. By that time he may need to stay because the effects have diminished.

Encourage him to stay until he gets that assessment, changing the appointment if need be.

My dad actually improved enough with good care, proper meds and good nutrition to leave the AL. It can happen. My stipulation was that he had to pull the move off with out any help from me. I wouldn't even look a number up for him, if you can do all that then you can do what you want. Me handling all the logistics wasn't a person that could move to independent living.
Helpful Answer (7)
SisterMoox Dec 2019
Isthisrealyreal: Thanks for the reality check. Without me, my brother would indeed have significant trouble pulling off a move from LTC (against medical advice) back to his former home. It would require all of the following: arranging the switch from Medicaid institutional assistance back to Medicaid community-based assistance covering 25 weekly hours of in-home helpers; finding/seeing a new primary-care doc to replace the one who retired last month, and getting that new doc to order the in-home help and necessary prescriptions; arranging transportation to the new doc, to the pharmacy, and from LTC facility to former home.
Makes me tired just thinking about it.
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