Dealing Immediately with Aggression?

Cobalt

I understand my son with EO is far more complicated because he was born with congenital brain damage.  BUT, surely there must be some people who have had to deal with occasional aggression?  When I look online, I only see well-meaning articles about understanding the triggers and root causes of a tantrum.  I get it that this is good information and I do understand it and try to rule out triggers and help him to de-escalate. We are continuing with specialists to find out the cause of the extreme pain he has.  The pain IS the trigger to meltdowns. And yes, doctors believe it IS pain, not a "neurological pain". 

However, when you are in the middle of a full blown meltdown where your LO is pounding, trying to smash a hole in the wall, trying to break things and today, add in when he ripped out the electrical cable of his recliner, I'd like suggestions on how to IMMEDIATELY handle dangerous behavior.  When I say dangerous I mean:

1.  you or your caregiver for your LO could be hurt

2. Your LO could hurt himself

3. Your LO could destroy/break property

All I know to do at present is draw on my training when I was a teacher two years in a max security prison, and draw on my experience as a teach in a lockdown evaluation center for troubled teens with ED, BD and other disorders.  Sooooo I sometimes have to physically hold down his arm, or hold onto him tightly until he starts to calm. After he ripped out the cord from his recliner (breaking it), I and his caregiver put him to bed with the rail up and turned out the light.  I had his caregiver just sit in the room with him for an hour.  He got a little calmer but not all the way calm.

When I called his Alzheimer's doctor today for permission to increase his Risperidone temporarily, I got an ok to start giving it twice daily.  It's a low dose.  We see the doctor this coming Wednesday, but wow it is a hard slog to make it through the next five days!  Ideas?  Your experiences?

Iris L.

Have you tried Cymbalta or neurontin for pain?  They did help me and I had good pain relief but I had side effects and could not continue.

Iris

Cobalt

Oh well, I was hoping someone here on the forum would have experienced this even one time.  Am thinking there are no experienced professionals or family members who actually do direct care with someone who can tantrum this aggressively, at least in this forum.  

Since he doesn't have a mental illness or psychosis, I've ascribed it all to dementia.  Yesterday he had a marvelous day, and with all of the caregivers things went great.  So right now these horrible episodes are mostly happening with the new caregiver.  (And yes, I am watching this new caregiver by listening and passing by her, giving her some tips.) It's pretty quirky.

Stuck in the middle

Hello, Cobalt.  Not much fun, is it?

My son has a psychosis, not a painful illness.  At present (age 46), he is well compensated on anti-psychotic meds and I don't have problems in dealing with aggression.  He is pleased to be emotionally stable and to have the voices quiet.

Many of DS peers at the RCF have "PRN meds" to be given at the discretion of the RCF staff to calm then down, and he did as well for several years.  When faced with aggression in earlier years (throwing chairs or smashing kitchen cabinets), I held him as you did your son, while remaining calm and not exhibiting anger myself, until he calmed down.  Calmness and patience are the keys, so as to not further anger him.  I did not have PRN meds at home, but it might be a good idea.

I don't know what PRN meds are used.  It probably varies with the individual, based on that individual's needs and the individual's other meds.  Some of my son's peers are autistic, some are intellectually challenged, some have PTSD, some are psychotic, etc.  Does your son have a psychiatrist?  Perhaps a psych consult would be helpful.

Cobalt

Thanks for your support!  In general, we've never been a family to ask for medications and try everything else possible for alternatives first, like behavior management techniques, stress reduction, reducing stimulation, aromatherapy, soft music, etc.  But I now think there has to be some kind of PRN used sparingly, in order to keep him in our home.  I would fear that if he went to a nursing home, he would likely be drugged all the time, and not in a good way.

The doctor appointment in 5 days will be important:  perhaps he will suddenly decide that yes, there IS some PRN drug we can try.  No doctors want to prescribe for him because he already takes so many meds, including 4 anti-convulsants.

He has no Psychiatrist because he's not diagnosed with a mental health issue but depression.  That is actually controlled fairly well with Ventalafexine prescribed by the Alzheimer's Doctor.

jfkoc

Have you done a drug evaluation on a site like drugs.com to check for all side effects and/or interactions?

Adding a psychiatrist to the care team is a good idea. Their expertise is drugs. Try to find one who is also a neurologist.

abc123

Hello Cobalt, I'm thinking about you & your son today. I hope his appointment with the doctor goes well and he will get some relief. Please let us know you are both doing.

Cobalt

Can't wait til tomorrow when we see his Alzheimer's doctor!  He's also a neurologist.  In our experience his regular neurologist who takes care of his seizure disorder is highly competent on drug interactions.  Sadly, our state, Arizona, has few psychiatrists who accept his Medicaid insurance.  Literally the ratio here is something like 1 psychiatrist to 6,000 residents.  So if we tried one again, it would be a 3 month wait.  The two we tried were horrible.  The state here will not allow a pdoc to prescribe more than 1 month of pills at a time. It's a governmental scam because the pdoc only sets monthly appointments for 10 minutes and their sole role is to renew refills on meds.

Since the doctor allowed twice daily Risperidone, .5 mg, I am thinking it is possibly starting to help.  But it's not a med you want anyone to stay on.  We have also noticed that the new caregiver is having far more trouble than anyone, so that's an issue with behavior.  If we reduce his stress and deal with his pain, we are doing ok.

abc123

I’m thinking about y’all this morning. I hope the doctor can and will help!

aod326

Hi Cobalt. I hope your appointment goes well today. Even if you go down the drug route, I found PRN meds weren't helpful for DH, because when he was aggressive or in a major rage, there's no way he would take any. Short of being able to shoot him with tranquilizers, like you see in old movies, that wasn't happening.

I certainly wasn't always successful, but holding him tight sometimes worked. Often it didn't because he'd be lashing out, didn't want to be held and was significantly stronger than me. He'd always be pacing around when angry, so I couldn't sit on him, which I would have. Sometimes I'd fabricate a reason that we needed to drive somewhere, and getting into the car seemed to be enough to break the chain in his mind. (Obviously that didn't work when the aggression started in the car.) A couple of times I cried, out of despair, and actually that worked, mostly because I rarely cry and I think it shocked him. I put his sister on speaker phone a couple of times to talk to him, which worked temporarily. (Those were actually the only times she was remotely helpful. I think she thought she was the only one able to handle things because of that limited interaction.)

Mostly, though, I'm afraid all I could do was wait it out. I "anger-proofed" the house as much as I could - which I know you've already done - and hoped that he didn't bust through a window. I had to repair holes in the dry-wall, but at least dry-wall didn't hurt him too much.

It's horrible to be in - you feel so awful for PWD, at the same time as super-stressed and potentially worried for your safety. Best of luck.

abc123

Excuse me for being totally ignorant on this subject but I can’t imagine any other way to administer a PRN to my PWD during a fit of rage other than a shot.

Stuck in the middle

If he's that bad and doesn't calm down when held, it may be time for a psych admission.  I've had to do that more than once.

abc123

Hi Cobalt. Just checking to see if you posted an update on the appointment. We are thinking of you and your precious son. Hope it went well.

jfkoc

how about an update.....

Vickivicki

I am so very sorry for the problems your son has. How difficult it must be as his mother to watch him suffer and feel so very helpless. He is blessed to have you as his advocate seeking proper care for his unique needs. May God bless you as you care for him.