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In 2013 he had a UTI that caused active delirium but it resolved in 8 weeks. This time in May of 2016, dad had a UTI and delerium set in. We are still struggling with this and it has been 10 months. He has periods where he is completely normal and can last 3-4 days and then he relapses into craziness, it is like hyper delirium. He has seen a psychiatrist and we have tried many different meds for him. The psychiatrist diagnosed him with bipolar disorder and dad does fluctuate between depression and hypomania. The psychiatrist insists that he does not have dementia.
But some of the behaviors we are struggling with are very challenging:
1. Binge eating, when he is going to have a bad day he will come out in his wheelchair in the morning and go straight to the fridge and start eating everything out of the fridge. We will make him breakfast ussually 4 eggs and 2 pieces of toast and then 15 minutes later he is hungry again and eating oranges whole or cereal etc. If we limit his eating and try to redirect him to something else of interest he is physically violent with us and yells.
On days he wakes up normal this does not happen.
2. He hallucinates quite abit, sees and hears things that are not there. We have learned to work with this. Keeping him calm and reassuring him seems to be the best thing to do. We just let him know we are here and he is safe. He talks about the devil coming to get him. Alot of persecution hallucinations.
3. Dad has his memory intact. He knows where he is.


How do I help him. He is only on an antipsychotic at the moment. Mood stabilizers did not help. He is not on any dementia meds.

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All the advice you have received is excellent but why did dad have a catheter and why is he in a wheel chair.
I would emphasize that you are currently doing an excellent job controlling the violent outbursts and feel you have you family's safety covered BUT if this proves to be a dementia these behaviors will escalate and become unmaneageable. It is a good idea to plan your next steps should it be necessary to admit him to memory care. This will be necessary unless you are able or prepared to provide similar facilities and caregivers at home.
If Dad is sent to the ER it does open the door to getting different Drs and opinions and testing.

CM while brain scans are a good idea unless there is something very obvious like a tumor they can be of limited use in the elderly. When I started having weakness problems and they were eliminating obvious diseases. I had an MRI of my brain and the results showed changes in my brain. The neurologist said they were usual in the aging brain but if I was 40 they would be diagnostic for MS!
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Probably a stupid question - I hope it is a stupid question - they have scanned his brain, have they?
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Jewels: I don't think that it is fine that he is off 50% of the time. I also understand that you have learned how to manage his outbursts, but calling 911 and having him taken in and hospitalized creates the documentation of these events for the docs to see. Without documentation of these severe events, the doc has nothing to work with except "your word" which does not carry as much weight as medical professionals at an ER. If you are not getting anywhere doing what you have done for 6 mos, it's time to handle it differently and see if that gets the attention that he needs. Something is not right and the various chemicals (meds) given don't seem to have improved the situation.

A note on form: You may not be familiar with this site yet, but we now have a nifty feature where you can edit your post for about 10 mins after you submit. This way, you can add to your post without creating extra new posts.
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A person cant be in a delirium for 10 months can they. He is normal for 2 out of every 4 days. So 50 percent of the time he is normal
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In May, 2016 dad had a urinary tract infection and was started on a course of antibiotics and five days later he had delirium and was taken into hospital where they switched him to a different antibiotic. He had periods of normalcy and periods of delirium. He had another bout of infection in July and it resolved quickly in hospital and we look at his medications and he was started on a mood stabilizer, an antidepresssant and antipsychotic to deal with the behaviors. In August the psychiatrist diagnosed him with bipolar depression and started him on a diferent mood stabilizer, antidepressant and antipsychotic. In November he had a severe UTI and was septic was in the hospital for 10 days and he acquired an MRSA infection in the hospital. He was treated and released. They did find a fungal infection attached to the indwelling catheter and he was being treated with antifungal in hospital with catheter being taken out etc. Since that time his check ups with the family physician and urine culture have shown no sign of UTI.
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I just need to get to the bottom of why this is happening and has for 10 months.
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The doctor has also instructed us to provide him with seroquel, an antipschotic when he has psychosis and outbursts
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We have learned how to manage the physical and verbal outbursts. Everyones safety is most important.
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I think I would use 911 to call for EMTs when he is violent due to his mental state. They can give him haldol or something to stop him, and let him be evaluated for 3 days on a psych hold. You can't endanger your family like this.
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I am concerned with fronto-temporal dementia because of his behaviors especially impulsivity and binge eating.

What I do not understand is why he can go several days with no symptoms and then has a bad day. I thought with dementia it was continuous.
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When was the last time his urine was cultured?

You might think about whether he's got a bladder infection that never cleared.

Hoping some of our more nedically astute folks will be along soon.

When he becomes violent, do you call 911 to have him transported to the ER?
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He has been hospitalized twice during this 10 month period. The doctors do not fully understand what is going on. I have tried to have geriatric mental health to offer supports and help but they came up and said they could not help.
The psychiatrist involved in his care will not order any additional diagnostics as he is determined that dad has bipolar depression. I have asked for dad to be referred to another psychiatrist but there is a 6 month wait.
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I think I would seek to have him admitted to an inpatient psychiatric or senior behavioral unit to investigate what is going on.

I would want a team of geriatric doctors looking at his metabolism, behavior , brain imaging and blood chemistry to get an accuate diagnosis .
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