We Saw the Psychiatrist!

Cinsababe

So yesterday DH had his first Psych appointment in 48 years!  He was diagnosed with BiPolar2 when he was 24 (now 72) and started on Lithium and he has never gone back.  Now with a dementia diagnosis and probable bvFTD the neuro wanted him to see the Psychiatrist to sort out what was what.  He did not want to go and I was definitely scared.  I wrote her a similar letter to what I had written the neuro with all of his recent symptom changes, inappropriate sexual behavior, agitation, anger, violence, communication problems, etc. and delivered it the day before the appointment.   

     We went in together and she started with "Why do you think you are here?" And his answer was "Because my wife constantly insists I go to doctors."  She then started going through a list of symptoms for both Bipolar and bvFTD asking him "Do you think you".  The first was  "Why do you think you are often angry?" and I was impressed that she didn't ask IF he was often angry--His answer was "Because my wife constantly insists I go to doctors."  The sideways glance let me know she knew what I have been dealing with!  When she asked if he had inappropriate sexual behaviors.  He told her to ask me. So she did and I said yes.  She then asked him if he knew what behaviors I was talking about (refer to my previous posts about shed episodes which she knew about in the letter)  He said he did and she asked if HE thought what I was talking about was inappropriate and he answered no.  The questions and answers continued for about 45 minutes and surprisingly he let his guard down a bit with her, admitting he "occasionally" has violent outbursts, is often agitated and can't always control himself.  In the end she told us that she sees no signs of Bipolar any longer and feels that he is dealing with bvFTD.  Her recommendation is going to be that they stop his Lithium and start him on Depakote which I have not heard of--anyone else have LO on this and with what result?

  She did say that there really isn't much that can be done for FTD behaviors, unfortunately.  He still has an appointment at the specialty clinic at MUSC in December.

Ernie123

Cinsababe: in MHO you are  so wise to be reaching out and establishing a connection with a psychiatrist. Unfortunately as your DH’s condition progresses, more challenging behaviors become likely. I have read many posts in this forum where people are over their heads in behavioral problems because they have waited too late to seek advice and medications from psychiatrists. My DW, who now lives in Memory Care, has benefited greatly from the ongoing assessments of a geriatric psychiatrist who has prescribed and adjusted medications for her paranoia and delusions over the last few years. While it is true that one can learn how to deal with difficult behaviors to a degree without employment of antipsychotics, it is important to establish a connection with a psychiatrist earlier than later to help judge when medications have become necessary. As time passes I hope you can continue to find the supports you both need.

Doby

Hi Cinsababe. You mentioned MUSC - is this MUSC in Charleston, SC?

M1

C I suspect Depakote (valproic acid) is a good choice, it's used in bipolar disorder as well as in dementia.  Liver function and drug levels will need to be monitored intermittently but not a big deal (difficulties uncommon).  Definitely worth a try.  So glad you got him there.

harshedbuzz

I'm so glad you were able to be seen and that the visit went well.

Cinsababe

Doby wrote:

Hi Cinsababe. You mentioned MUSC - is this MUSC in Charleston, SC?

Yes, they have a specialty clinic there and supposedly the doc who runs it has experience with bvFTD.

Doby

We see a neurologist at MUSC as well. It might be the same clinic. He helped tremendously with the diagnosis but he doesn't seem too interested in helping with medications for symptom management. I'm assuming that we would need a referral to a GeriPsyc for that. I'm currently working on getting DH in to see a GeriPsyc in Columbia so we don't have to make the drive.

Cinsababe

Doby wrote:

We see a neurologist at MUSC as well. It might be the same clinic. He helped tremendously with the diagnosis but he doesn't seem too interested in helping with medications for symptom management. I'm assuming that we would need a referral to a GeriPsyc for that. I'm currently working on getting DH in to see a GeriPsyc in Columbia so we don't have to make the drive.

What was the process like there? Did your DH have FTD? Our neuro here in Myrtle Beach said the Psych would manage meds once diagnosis was finalized.

JJAz

Good that you are established with the psychiatrist.  My husband had Lewy Body Dementia which also has a significant behavioral component.  As the disease progresses, you will likely  need someone to adjust meds  regularly so make sure that you keep in good standing with the psychiatrist.  A lot of the behavioral issues are beyond what a neurologist can handle.

Blessings,

Jamie

Doby

Cinsababe wrote:

Doby wrote:

We see a neurologist at MUSC as well. It might be the same clinic. He helped tremendously with the diagnosis but he doesn't seem too interested in helping with medications for symptom management. I'm assuming that we would need a referral to a GeriPsyc for that. I'm currently working on getting DH in to see a GeriPsyc in Columbia so we don't have to make the drive.

What was the process like there? Did your DH have FTD? Our neuro here in Myrtle Beach said the Psych would manage meds once diagnosis was finalized.

Hi Cinsababe. The MUSC experience for us was very thorough but again more focused on determining a diagnosis rather than helping with symptom management. My DH initially went through a 2 hour virtual assessment but then a few months later we went to Charleston and had a 4 hour cognitive eval. If I remember correctly my DH scored a 13/31 on the MMSE but some of that may have been attributed to his terrible eyesight. Regardless, there is no definitive diagnosis but the neurologist says they are pretty sure he has posterior cortical atrophy, although Lewy Body Dementia isn't off the table. He had a DAT scan a few months ago and didn't show any signs of LBD but I still think it's a possibility due to the early onset of delusions and paranoia. The aggravating thing about the MUSC neurologist is that he wanted to take DH off of clonazepam, which had been prescribed to help him sleep. The neurologist said that the clonazepam could hurt him cognitively. I agree that we need to do everything we can to help him, but there has to be some balance here in terms of sleep, quality of life, etc. I still work full time and I cannot be up every night with him! We finally got a Seroquel prescription from his PCP here in Columbia and I'm crossing my fingers that will help.

I think you've done the right thing by getting in to see a Psych. I'm still working on getting in to a practice here in Cola that has a geri psych on staff. 

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