mornings? how to deal with seeing people?

smbren

Almost every morning now, mom thinks someone else is in the house.  It is just her and my dad.  I try to reassure her no one else is there.  Dad locked the doors and wouldn't let anyone in.  I think she sometimes thinks my dad is the stranger until she sees him and recognizes him. Some times she thinks it's her father and she seems to become very afraid. 

I'm running out of words to sooth her.

I have coached my dad to make sure she knows who he is in the morning.  And I think that helps, but that's when I think she becomes ok with him and then thinks there is someone else in the house, as at first I think she thinks he is the stranger (this is at least what I think is going on from what I see after a week or so now).  I eventually do calm her over time in the morning, but it does take some time. 

Anyone have suggestions on how to try to talk with her in the mornings to make it easier for her? 

The geri psych is aware, but due to how she has handled some of the medications, she really doesn't (can't) put her back on memantine or aricept.  She has been taking lorazepam for anxiety attacks, and I believe this has been making things worse through the day and I have been slowly reducing the amount.  She does seem to be doing better during the day and fewer side effects, but the mornings a bit tough still.  Tonight will be her last dose of the lorazepam as we see how she does without it (unless she has a real heigtened anxiety attack that I can't bring her down from).  She also does take risperidone, which I plan to ask the doc about increasing for night time if she does well without the lorazepam, at least that is my current thought. 

zauberflote

My mother had mornings in AL with a similar "haze" that colored her outlook, although it didn't manifest as strangers in her room, but rather an inability to know if she were awake, or dreaming. Staff would bring her breakfast, and sit and chat for a bit. After she ate, things generally improved. 

When she moved to MC near me, her dementia was further along. She had a room at the end of a hall, and the aides would congregate nearby and chat at high volume. Mom would become convinced they were talking about her. If I were visiting, I'd tell her I was going to check it out and fix it. I'd leave, stay out for a couple of minutes, and come back with one of a variety of answers-- "they were, and they were saying how much they love you because you are so sweet-tempered!" (True, btw), or, "I asked them to stop their gossiping and get to work", which she bought. Sometimes I walked around the corner to the guest restroom, and of course by the time I returned, Mom had forgotten I was ever there. 

People here have had success with "validation" techniques. So-- "I know, Mom, I saw that person too! Let me go give them what for and send them packing!!" and variations on that. I had success with that sort of thing with another resident at Mom's MC, whose sundowning took the form of knowing she had to get a cab home but a kidnapper was lurking out there (not that she could have gotten out, mind). One time I told her I was calling the police, faked with my phone, told her they already had the man in custody, and the cab was on the way. She was calm for long enough for me to get out the door. Best I could do. I learned that from staff, who were forever reassuring her that they'd called her mother, and mom was on the way to get her. (Mom long gone, you know). 

ButterflyWings

We started a low dose of Seroquel (Quetiapine 25 mg) for my DH to curb the hallucinations about a year ago. It quickly had to be increased to 50mg/daily, and is now at 75-100 mg daily as needed. His brain starts tricking him into thinking TV shows or Zoom calls = people are in the house, so I try to curb those experiences. And still, he may believe 4-5 ladies were bothering him in the morning, when it was only me that brought his breakfast or coffee.

It is much worse at 3p sundowning time. Mornings are a lot more clear-headed for us. I always attributed it to his being more rested. But, 25 mg of Seroquel every 6 hours for us right now, helps reduce his anxiety, agitation, hallucinations (seeing imaginary things and people) and delusions (false beliefs). Before that, he was exit seeking, hiding knives, bats, yard tools to clobber the interlopers, which terrified me of course. Redirection didn't help, and when he started not to always recognize me, I was clear that was a dangerous combination.

Even now that we have some med management, I still hear him talking with his dad (died 23 years ago) or son (lives in a different state) but at least he's not panicking or getting aggressive. Now, he often asks "where did the others go?" and I can just say, "oh you were dreaming!", "oh you know, they were on screen on the computer, not really here in person", or just agree if he's adamant that people were there. Then I say "they said to tell you bye", or "hmm...they left a little while ago, but the door alarm is on now so we will hear if anyone tries to come back". 

Anyway good luck to you. A neuro or geripsych can really help. Some here have also found the mirror was the culprit. Their LO was not recognizing themselves, and thought the person in the mirror meant someone else was in the house. 

smbren

thanks zauberflote .  As mom is still at home with dad, I struggle with how far to take the fibs here.  I don't think it is a good idea for me to say someone was in the home, as it is so out of place.  I have said no one is there now.  And the doors are closed and alarm on.  But to acknowledge someone came in is a bit 'too far' in my thinking.  In a MC facility, that would make sense.  Sometimes when she says I don't think he's here any more, I'll confirm and say nope, no one else is here now.  And choose words a bit different.  It's always hard to pick the right words in the moment as she still is very aware of the words.

thanks ButterflyWings I am going to mention Seroquel to the geri psych doc.  I wonder if she didn't suggest this a week ago due to her reaction to the other two meds and knowing reactions is similar or worse.  But I will be msg'ing her by the end of the week and this will be part of my msg.  I am more than willing to try something else if it will potentially work. 

As I have been taking her off the lexapram slowly, I really think that a lot of her anxiety has been coming from these hallucinations.  And yes, they probably have been increased due to the lexapram as well.  So if I can remove lexapram totally and then find a suitable medication such as seroquel or other to help with the hallucinations, that may take care of the anxiety and the stomach issues which is a side effect of the anxiety.  I feel like I'm constantly chasing side effects. 

Thanks for the input!

  
   

Iris L.

PWDs often don't recognize their own image in a mirror and think it is another person or several persons.  Covering mirrors may help.

Iris L.

towhee

smbren, risperidone and seroquel are both atypical antipsychotics. Sometimes one might work better than another in a specific person, but the doctor is unlikely to prescribe both.

Regarding the anti-anxiety drug lorazepam your geri-psych does know you are discontinuing this right? If not, they need to know. It could possibly be contributing to the problem, a very few people have an effect that is opposite the intended one and some people have a strong rebound effect when the level of the drug in the body drops past a certain point each day. Think withdrawal symptoms. I would not be surprised if she has a couple days of increased anxiety when the drug is stopped completely.

Hope things work out well.

smbren

Iris L. Have to consider the mirror.  She does have a mirror attached to her dresser.  But with the digital pictures I started displaying, she does recognize herself.  But in the morning haze, that could be part of it.  I will talk with my dad to see if we can see if that might be playing a part.

towhee Thanks for the info.  Yes, she wouldn't do both in that case I'm sure.  But we have talked about increasing the risperidone.  She has been on that for about 7 months now and it has been extremely effective with the agitation, anger, yelling, etc.  Seroquel was a new one to me, but if it is in the same category, I think the doc will be in my mind set, stick with what is working and adjust dosage perhaps. On the lorazepam, it has been as needed with a maximum amount.  These visuals have actually started since she has been on the maximum dosage prescribed of lorazepam.  They have been during the day as well.  As I've reduced the lorazepam, the visuals have decreased in frequency as well, as have some of the other issues.  So it appears lorazepam is giving us some negative effects.  Negative enough that we will need to figure out what the doctor would like to do in place of lorazepam.  But I must say as I slowly reduced the dosage, her anxiety is not what it was as we started her on this due to the anxiety attacks as well.  Her primary care has suggested the risperidone be increased and 3 times a day as opposed to twice a day and I did talk with the geri psych about that recommendation 2 weeks ago, but we increased the lorazepam to start with.  While I may talk with the primary care on this, I work with the geri psych to manage the meds, primary care is just another point of feedback.  All this info is going back to her so we can adjust based on how she has been doing and I think we will replace lorazepam with something else that hopefully she won't see side effects from. 

  

Lp57$

Hi smbren, I am going through the same thing with my DH. Sometimes they are in the morning but most of his is at night when he starts sundowning.  Sometimes he will see people during the day inside the house but he sees all day long things outside. Like for example we live in a small subdivision and he says to the house across the street there is a woman who stands all day long at the end of their yard. It is the neighbors mailbox, but he don’t see it that way. I have taken him to the eye doctor and she says his eyes are fine. The people in the house are real to him so sometimes while he is in the bedroom because when he sees them he goes to his bedroom because he feels safe there. I have to run them out. I will open the doors and tell them get out of here and that helps him. He also says even though I reassured him there is no one in the house but is he will say I feel like other people are here. His doctor says that is the type of hallucinations that are called presence hallucinations. She says that happens a lot with people who have Parkinson’s with Dementia like my husband has. The best way I can tell you that works for us is to go along sometimes with him. I will try to help him anyway I can to help him not to be stressed about it. I don’t like the fibs either but it eases his mind because he will say I don’t want you to think I’m crazy. This is a strange disease and I have never knew anyone who had it before until now and it is a challenge!  My husband is on 25 mg of seraquel and neoplazid and they have stopped working. So his doctor has called in for us to have a home health care nurse to help with his medication once a week. I hope this helps and I wish you the best!

Lcpsurry

My husband “sees people” in the house too. Sometimes during the night and also during the day. For a couple of weeks now he sees people sitting in the trees outside. Tonight i decided to leave more lights on in the house, and he just told me a woman came and told him to turn that extra light off. I told him not to listen to her and he said ok.  Usually he argues with me. Last night he woke me and told me there were a bunch of kids in the living room. So i said that they were fine and behaving so go back to bed, and he did!. But many nights he roams the house with a flashlight looking for “ the people”.  He even thought a truck drove through our bedroom one night! But I try not to argue with him, i just say “ they’re not going to hurt you” or “stay out if their business so they don’t get mad at you.” Nothing really helps permanently.

smbren

Thanks for the additional feed back Lp57$  and Lcpsurry

Sometimes I have gone along and said they are gone now.  Or dad made them leave and then shut the doors and turned the alarm on.  As I know you aren't supposed to contradict them as it is real to them, but I also feel it's like a child have a really bad nightmare that you try to comfort and you want to say it's not real and you were dreaming (easier to do when it happens when she first wakes up, but not the middle of the day).

Good news!  The lorazepam has caused a lot of the side effects that made her seem to advance in the disease so rapidly.  Slowly weened her off of this.  Once off for a couple days (yesterday), she started to have a little anxiety.  So we are keeping the amount to a minimum until her doctor to re-evalute on Monday to determine a better medication for her to help with the anxiety.  As we would give her this to help with the anxiety, her anxiety would increase and the dosage increased, then frequency increased a few times as it continued increasing.  As the amount she was taking continued to increase we saw the visual hallucinations increasing, the drowsiness, anxiety increasing, general confusion increasing more, and more.  It just seemed starting with the anxiety attacks, the disease was was moving at a very rapid pace.  It is often hard to tell what is side effects from the medications vs what is progression of the disease. 

Now that she is only taking 1 a day until we can get this re-evaluated, she is not having any of the visual hallucinations.  And the other side effects didn't start to increase until higher doses, so all of that has cleared up as well.  So we need to try and keep her calm and not increase this dosage any more than neccasary (I may go back to half pills if neccasary to give her something if she starts to have small panic attacks during the day).