My Mom's psychiatrist says she has delusional disorder. How is this different from dementia? - AgingCare.com

My Mom's psychiatrist says she has delusional disorder. How is this different from dementia?

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My mother is 87 and lives alone in a senior community because she refuses live in help or assisted living. She has been on seroquel and risperidone and is currently taking Ativan but her condition is getting worse. She is depressed and cries that no one believes her story and she wants to die. The dr wanted to give her an anti-depressant and she refused. I don't know what to do anymore. I feel like I am at my wit's end.

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As Pam mentioned, delusional disorder can occur with or without Alzheimer's, but it's a situation where the person can exhibit paranoia about what is going on (or isn't) around them. What they think is happening is very real to them.

Since your mother is continuing to get worse, I'd ask her doctor about taking her off of risperidone for sure, and maybe the other drugs, and starting over. She'd have to be weaned, which isn't easy, but these drugs can cause the very thing that the doctor is trying to cure.

Each person is unique in how they react to drugs, and when elderly people take a combination of powerful drugs the result can be devastating. If this psychiatrist won't even consider adjusting these drugs, I'd ask for a second opinion.

Good luck with this challenge. I can see why you are at the end of your wits. Please check back and let us know how you both are doing.
Carol
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Delusional means she believes things are true, for example that they are just fine, when in fact it is not true. Or they think people are staring at them, but people are just looking. This can occur with or without dementia.
She wants to die? That's a good reason to get a full inpatient evaluation. Talk it over with psychiatrist. They can titrate her meds better in a hospital setting and brighten her outlook considerably.
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My husband was on Risperidone, and we weaned him off of it (10 months), but he is so much better without it. I couldn't believe what a difference it made. Now he is just on welbutrin and doing very well.
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You might consider giving her more omega 3 fatty acids, possibly in the form of fish oil capsules. You might also consider giving her raw walnuts, if she can eat them. Dr. Andre Weil says: "Omega-3 fats can also help lift depression as well as treating mood disorders. Aside from fish oil capsules, the best dietary sources of omega-3s are salmon, sardines, and other cold water fish, as well as walnuts and flaxseeds."
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My mom was on a cocktail of drugs and in a skilled nursing facility. She was extremely delusional and very combative. We decided to just take her home and stopped all of those drugs except for her regular dose of valium. I am happy to say she is 85% better! Her dementia symptoms are very minor and she is doing great! I think some elderly patients need to be very careful with those medications. If you seen my mom before and after, you would not think it was the same person. Good luck to you and your mom and never give up hope.
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Your mom needs to see the psychiatrist again. It's very rare for the initial doses of medication to be helpful. The Dr. will prescribe the lowest possible dose and then titrate up from there as needed. She may just need a med adjustment.

When your mom is delusional how do you react? Do you insist that what she's seeing/hearing/smelling isn't real? There's a fine line between supporting her while she's having delusions and participating in what she's going through. It's such a fine line. When she's having delusions have you tried redirecting her attention? Sometimes it can take a while to get someone redirected but it can be done.

Try not to insist that what she's experiencing isn't real. It's very real to her and probably very upsetting.

You're a good daughter to walk down this path with your mom. She's lucky to have a strong advocate like you.
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I guess I don't see it the same as others; 87 is old...we used to accept that and just embrace people as old and let them live and die in dignity. Back in the 70s my grandma was on a cocktail of medications, and my mom took her to some other doctor to get her off, and she got to live our her days less muddle headed. It sounds like she is just lonely; again, another change in our society that folks lived out their days as extended family and not on drugs. Feeding her this, making her do that...she is showing the signs of being lonely and old, and I don't know why we can't use the 'old' word anymore, it irritates me. When my parents got to be that age, as they had me later in life so the usual scenario is a senior citizen taking care of a senior citizen parent, but that is not the case. My brother and I had young families and were middle aged, so we were clear headed when our parents said do NOT put us on medication, do extraordinary measures, prolong life, etc, and I know at least I have that agreement with my husband and I in our wills, so making a choice of how to live and die with dignity was set when they and we were younger. When my dad got ill,mom broke this rule and did extraordinary measures, and he lived 10 years with dementia, so when she started thinking the neighbor were staring and saying crazy things, my brother and I intervened. He ended up having to live with and monitor her, but that is cruel to uproot a family and sell their home to live with mom while she called the shots [my point is, she could have, and would have in the old days, moved in with him]. Still, in the end she got to live and die with dignity, and even with full time having family and caretakers tell her what reality is when she insists otherwise, she wasn't on a cocktail or drugs. Growing old IS depressing; who wouldn't be depressed? If one lives a happy life and grows old happily, well they probably aren't a patient on this discussion board because we NEED to embrace that old IS old, people do grow old and die, rather than masking it, and embrace them as members of family and community, not a patient [or irritant] that needs to be managed and drugged...just a thought. And for the seniors taking care of them...think about how YOU are living life? Is it with anger, resentment, despair and giving up the things you love? Because I guarantee you will go the same way...
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See if you can find a geri-psych unit and/or psychiatrist near you. These are professionals who specialize in elderly with mental health and health problems. Elderly usually need lower doses of medications, they don't process the medications as efficiently as younger folks so end up with build up in their systems. Elderly sometimes respond just the opposite to what you'd expect to medications, a "paradoxical response". That's why it takes someone who specializes in old people.

For now, you can help calm her by saying something like, "I can see how it might seem that way to you." The go on with some alternative point of view..."but maybe they have a hard time remembering names and were just looking at you trying to remember yours." Or a reality check she can use. I worked with a couple people who saw others who were not there. They also had pets, but the pets never responded to these unseen others. If strangers came around, real ones, the pets would have barked or hidden, but the pets were just fine with the ones who were not there. One person thought people were coming into her house and could not sleep out of fear. I suggested she place empty soda cans by the door that would make noise if someone knocked them over. It worked.

Good luck with your mom.
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LeoLady, I hear what you are saying and I agree that the extreme measures that we take at all ages to avoid aging and postpone death have become an obsession (largely fed by Madison Ave., Hollywood and TV).

However, there are other factors that have made senior dementia and debilitation so commonplace, namely, the garbage that passes for "food" these days. It all began after WW2 with the so-called "Green Revolution" that resulted from transferring chemical poisons from the battleground to the farm in the form of pesticides and herbicides. Since then the adulteration of our food supply has skyrocketed: GMOs; MSG; high fructose corn syrup (HFCS); trans fats; artificial coloring and flavoring; animals dosed with hormones and antibiotics. Add to that the laundry list of drugs that the medical industry routinely and cavalierly prescribes for anyone past retirement age, and is it any wonder that so many of us are struggling with how to care for our out-of-it elders? The very ones who should at this time in their lives be contributing the wisdom of age and experience to a troubled society have been reduced to little children (minus the cuteness) or worse.

I took my own mother (93) completely off statins. The only med she is currently on is low-dose aspirin. I have her taking pro-biotics (which fixed digestion and diarrhea problems), co-enzyme Q10 and a balanced Omega supplement. When I am the one caring for her I have to be sure and make dinner before she gets in the kitchen and fixes herself the same thing she had for breakfast: white bread (which she insists upon buying) and cheese and nothing else. She doesn't eat lunch, but has an early dinner. When I make a dinner of grass-fed beef or fish or other high quality protein, salad of mixed greens, and a side of yams or quinoa or whatever, I simply give her small portions. She always eats it all exclaiming how good it tastes. I'm fortunate that way. I just have to beat her to the kitchen at an hour that is uncustomarily early for me.

With an improved diet and a few natural supplements and NO prescription drugs, she is doing better as far as her attitude and general health. She is still reality challenged, but as long as she doesn't take to doing things that could harm her, who cares?
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Get her to a neurologist specializing in psychiatric as well as brain diseases. These two diagnoses intertwine, so it takes someone who knows their stuff to correctly diagnose her. Try switching meds. Not everyone reacts to meds exactly the same, and if one is clinically depressed it may take 20+ times before you get the right combination in her brain to alleviate the depression. Keep searching for answers.
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