Delusions, Paranoia and Destructive Behaviors

crgriffin

 My sister was diagnosed with Alzheimer's 1.5 years ago. For several years, she exhibited OCD behaviors, which gradually got worse. She is now at the point where she unpacks and repacks the contents of her dressers and file cabinets and closets, and then doesn't remember where she put the items, so she accuses her husband, her daughters (who live 8 hours away) of stealing her belongings. She's even go so far as to take scissors to her own clothing and books, to prevent them being stolen from her. She's also starting to have anger outbursts, some out of the blue, but mostly when she suddenly thinks of an item she wants, and then she goes through her purse, her backpack, and all her little pouches, looking for the "missing" items.

She has taken a hammer to the kitchen floor, a door into their study, two different cell phones, and destroyed picture frames, a mug collection, and who knows what else. Last month, she told us that she sleeps with a pair of scissors and a knife, but we doubt that. But we're starting to wonder when to take these things she mentions seriously.

At her last evaluation at her neurologist's office, she had difficulty telling time on an analog clock, and couldn't remember the current month. We've never been given a definite staging for her dementia. She was prescribed Aricept and is taking it daily, but she was also prescribed sertraline and refused to take it more than once or twice. In fact, she flushed the pills down the toilet.

She can still do dishes, laundry, bathe herself, take care of her toileting needs, etc. She so far has not wandered off, which we know is common with dementia patients. She and her husband live out in the country, so it will be difficult to find in-home caregivers.

Have any of you experienced this phase of dementia? Her neurologist's office doesn't seem to worry that she's not taking the anti-anxiety medications, and they offer no help in handling her paranoia and anger outbursts, and we're at our wits end.

Any advice for us?

M1

Good morning.  I think you posted a similar story on another thread but you'll get more responses this way.  Welcome to the forum; this is a good place to learn.

I live in a rural area too but have a big city about 30 miles away which is where we have to go for decent medical care.  Can you find a geriatric psychiatrist to see her?  You'll get more behavioral help that way.  It will probably take medications other than Aricept to help with these things--Seroquel, Risperdal, what are called the atypical antipsychotics.  Sounds dangerous if she started using those tools on herself or others.

Good luck, I'm sure others will respond as well.  

abc123

Dear cr, welcome! I’m sorry you have to be here but glad you are. We support each other and encourage each other. Others will come along who have experienced bits and pieces of what you are dealing with. My LO doesn’t have any of these issues, not yet anyway. My MIL used to pack her clothes while sun downing everyday. She hid her purse and meds constantly. It was a full time job staying on top of her meds. I finally took charge of that and gave her a pill box full of vitamins. M1 mentioned a geriatric psychiatrist. They are specialist in dealing with behavior issues and prescribing meds. From what you’ve told us, I think she would benefit from having a geriatric psychiatrist on her team even if you have to drive to the nearest large city. How old is your sister? I’m sorry she has this disease. It’s all so difficult and sad. Please keep posting and read everything you can about this disease. Read as many of the threads here. Knowledge is power. I wish you the best.

crgriffin

Thank you for your quick responses to my post. I will work with my BIL to get her an appointment with a geriatric psychiatrist. We didn’t know there was even a specialty like that. Getting her to take any new prescriptions she might be given will be a challenge. She accepts and takes the Aricept, but doesn’t believe she needs any other medications.

jfkoc

Until you find helpful drug treatment you will be left with non-medical treatment which requires a lot of education.

Please read Naomi Feil...her validation theory. I think this knowledge is essential .Then I suggest going on line and reading everything with the name Teepa Snow. My go to book is I'm Still Here by Zeisel.

Please do make certain that her diagnosis was done correctly using proper protocol by a neurologist who has a focus of dementia.

We will always be here to listen, support and share information...we understand and can help.

Iris L.

crgriffin wrote:

 Getting her to take any new prescriptions she might be given will be a challenge. She accepts and takes the Aricept, but doesn’t believe she needs any other medications.

You cannot rely on her taking her own medications.  She has anosognosia, that's why she doesn't believe she needs other medications.  Since her memory is impaired, you have to be concerned about both not taking meds or taking too much.  The members have ideas and work-arounds for dispensing medications.  Also discuss this with the geriatric speialist, because it is a common issue.  

Iris L.

ButterflyWings

crgriffin wrote:

Last month, she told us that she sleeps with a pair of scissors and a knife, but we doubt that. But we're starting to wonder when to take these things she mentions seriously.

!!!Please take her seriously. My DH started doing this routinely at bedtime, and it led us to Seroquel for his hallucinations which were causing him to 'weapon up' at night. First a hammer, then bat, then butcher knife under the mattress and steak knives in the nightstand drawer was the tipping point for me. Combined with not always recognizing me/us, and "seeing" people in the house who are not there, it was an accident waiting to happen. It sounds like she should not ever be alone anymore. Upon diagnosis, my DH's memory clinic team (neuropsych + social worker) told me (among other things) in no uncertain terms: "You're going to have to watch him". I took them seriously and would never have imagined the things he did/does. Daily, I am just amazed at what I observe, but can calmly and sometimes secretly just fix the risk before it becomes a problem or disaster. There really is no point discussing with him either. His reasoner is broken. The other thing they told me is: "You're in charge now." 

she was also prescribed sertraline and refused to take it more than once or twice. In fact, she flushed the pills down the toilet. Sertraline in combination with Seroquel has really helped my DH (and me) with his depression and anger that started with AD. I know some meds, maybe this is one? cannot be started and stopped abruptly without potential issues.

She so far has not wandered off, which we know is common with dementia patients. She and her husband live out in the country, so it will be difficult to find in-home caregivers. My DH is exit seeking and I would not wait even though "so far" she hasn't disappeared. The first time could be disastrous. Can her DH keep an eye on her constantly? Are there cameras available? Alarms? Locks on doors, windows, upstairs/downstairs/sheds, any place she could get into mischief alone? Who is nearby when she is cutting and smashing things? Could she set fire to something? Please urge her spouse to intervene now. (Yesterday)

Her neurologist's office doesn't seem to worry that she's not taking the anti-anxiety medications, and they offer no help in handling her paranoia and anger outbursts, and we're at our wits end. Any advice for us? 

Side note: I am about to change DH's long time PCP due to inaction and my unwillingness to be compromised any more by a big system doc who just isn't knowledgeable (or especially interested in learning) about his patient's new primary illness. He's been an impediment to getting UTI treated timely, and doesn't get that the family member is the expert on what behaviors are problematic and not, at a certain point. My advice:  1)Be persistent with explaining the urgency of your situation. 2)Tell them you are concerned about "patient safety if they choose not to treat". 3)Get a new neuropsych. Fast. We have an awesome one and it is a true partnership in navigating this hot mess that living with dementia is turning out to be.

My other advice is for the caregivers: it sounds like she needs more help with ADLs activities of daily living and definitely with safely managing her meds, meals, and the disease symptoms (hallucinations delusions are normal with dementia). She is possibly further along than you all realize. Here are some helpful links for you and BIL: 

http://www.dementiacarestrategies.com/12_pt_Understanding_the_Dementia_Experience.pdf   

6 Ways to Help Someone Who Doesn’t Know They’re Ill: Anosognosia in Dementia – DailyCaring

Table 1 . Stages of dementia and their symptoms 2,7 Stages of dementia...

Good luck to you! We are all in this leaky boat together.