I'm a caregiver for my 92 year old Mom. In the past 4-5 months she has been having hallucinations and delusions on occasion. She has had 3 fairly bad "episodes" where she doesn't sleep for 2 days. I've taken her to a geriatric psychiatrist where she diagnosed her as having dementia. She instructed us to give her a very small dose of risperidone when she is having the hallucinations. I don't think it is working at all so they want to double the dose and give it at night, even when she isn't having hallucinations. They want me to bring her in any time I call for advice or have questions. Is this normal? Also, I don't know if I should make Mom aware that she has dementia (we weren't told what kind was suspected)? She is pretty sharp when she's not having an episode and I don't want to upset her and I want her to have the best quality of life she possibly can. Someone in my family called her crazy when she was having an episode so now she is constantly saying she's crazy, even though I reassure her she isn't. I'm worried if she knows she has dementia that she will think that even more. Am I wrong for not wanting her to know?
You also mention 'movement problems' being amidst your mum's history, and also that she's very sharp when not having 'an episode'.
You've done as you should in taking her to specialist.
You already know that infections can cause hallucinations and delusions and must be ruled out.
These are exacerbated in some underlying conditions.
The Psychiatrist has said -diagnosis is dementia.
There are a whole host of dementias - it's just the umbrella term!
A person who's:
1)exhibiting fluctuating cognition, (one minute/hour/day, they're absolutely 'normal', then other times, confused, fearful, anxious etc); and 2) experiencing hallucinations;
could have Lewy Body Disease and or Parkinson's.
Of the dementias, LBD people are more sensitive to a couple of classes of drugs!!!
So, for a number of reasons, you'll need to clarify which dementia he's suggesting...?
One of the best ways a Dr can help to make a LBD diagnosis, is to talk with the carer, and ask you lots!!
Additional early stage symptoms of Lewy Body presence:
*Loss of balance after standing, and subsequent falls (drops) to floor. Due to what's called Postural Hypotension.
*An intolerance to a crowd where often multiple conversations in play -- it's too much stimulus for them!!!
They often will 'rise to the occasion' whilst company present, but then, be totally exhausted and seem irrational.
*Paranoia.
UTIs, lung infections, plus others; constipation and pain can cause severe stress and hallucinations in LBD.
I hope this helps - please take care, there. I would not mention dementia to your mum at all at this stage. You are not wrong in not wanting her to know - you are protective through your loving.
If it is Lewy Body Disease - there is often not obvious dementia, till very late stages - if at all on occasion.
But there's tantrums and other. Talk about that later.
Best with those appontments!
Suggested doctor would be a Neuropsychologist. They work with Neurologists to get a well rounded diagnosis and develop treatment plans.
Yes, it is usual, customary, and reasonable (UCR) for the psychiatrist to have the patient brought in to be seen when you have questions or a change in medications is required. Especially at first.
People are different. Some do well with the facts, more information, and would normally seek that out. Others are content with less information, and can go through life not knowing. It could be your Mom is repeating the word crazy instead of really thinking she is crazy. Maybe you can gradually introduce another word to replace "crazy". For example: You are not crazy, you just had a "senior moment".
It must be confusing and painful for you to watch your mother decline in this way.
You are a good person to want to protect her.
Did she start any other new medications in the last 4-5 months?
Was she checked for a UTI at her regular physician's? In the elderly, a urinary tract infection does not bring the same symptoms, and a patient can have hallucinations with a UTI. Do not accept a dip stick urinalysis, get a more thorough testing. imo.
It is also common for physicians to think differently about the PRN (as needed) use of a medication, versus the regular dosing to build up the med to a therapeutic dose. Some psychiatrists are more familiar with "off label" uses that could possibly benefit the patient's needs. A lay person may describe this as "thinking outside of the box". These are all questions best asked of the psychiatrist, and a second opinion could help.
I feel a bit irresponsible asking questions like this actually - I'm not qualified and shouldn't meddle.
But I have to say that if I were you I'd have steam coming out of my ears by now. ALWAYS BE POLITE 😇 - of course! But it's quite possible to be perfectly polite and still take a cattle prod to your mother's doctors if need be.
With the COPD and diabetes I appreciate that there's a lot going on. But *one* of these professionals needs to get a grip on the complete picture. Do you happen to know, can you find out, if there is a highly thought-of geriatrician in your area?
Psychiatric medication management on the elderly is often a trial and error procedure.
Call mom's pharmacist and get an explanation of how this drug works.
Did the psychiatrist order any imaging of mom's brain? Do any testing, like the draw a clock test or ask her to remember 3 words, ask her who was President, and if she knew where she was?
Is your mother's health otherwise pretty good? (making allowances for her being a 1926 vintage!)
As you say your mother is pretty sharp when not having a crisis, and she herself is seeking explanations for what is happening, then I personally feel that it is wrong not to discuss her condition with her. But at this point, depending on how reliable you think that diagnosis is, I don't think there's any need to drop the D word on her specifically. Ask her what she thinks, ask her about how she's feeling, reassure her that she and you and her doctors will get this figured out. But don't tell her any lies.
And tell that family member he's not too big to go over your knee and get spanked.