Geripsychs & meds; venting, advice welcome

Rescue mom

Some may recall my DH,  stage6, who’s been docile and compliant, started exploding in anger and saying he saw me doing bad things with strange men, and/or just about any man DH noticed. His rages were extreme, and scary.  His PCP tested and ruled out a UTI and other things. Getting those tests back took a couple days.

In the meantime, I contacted the memory clinic and neurologists where he was diagnosed with Alzheimer’s. No help. They don’t do much at all after Dx. Back to PCP, asking about some drugs that might help calm him or block a rage. No help. Doc said PCPs can’t prescribe those meds. (I’m in FL and there are major state bans on PCPs prescribing many drugs but I never thought about these before).

But PCP referred us to 3  different geripsychiatrists. None can see DH before February. (It’s a big winter tourist destination and not a lot of geripsychs).  Several people in various doc offices  said the rages and threats are just part of Alzheimer’s and I need to learn to deal with it.

My advice to others is, if you can establish a relationship with a geripsych, do it when you can ASAP.  Even if you don’t need it now, you may really need it later, and it can take a while.

loveskitties

You might be able to get some help sooner, if during one of his rage episodes you call 911.

They might be able to do an eval and get meds to help.

Ed1937

Rescue mom wrote:

His rages were extreme, and scary.  

If you are afraid he will attack you, loveskitties might be on to something. If you can get him in the hospital, you can refuse to take him out until they can get some help for him. I know you've posted about this before, and I'm sorry I don't have better suggestions for you.

Paris20

My husband is also subject to rages. I finally gave in and said OK to add Seroquel, an antipsychotic medication, to his Rx for depression. It has made a big difference for the better. If you can’t get an appointment for two months, the 911 call could be your salvation. Meanwhile, I’d call around to neurologists in your area and if you find someone, tell your PCP to make a referral ASAP. A geriatric psychiatrist is a good idea but for now your husband needs meds.

JoseyWales

This is a real problem everywhere. There are no geripsychs in my area, so I have to use a psychatrist. The wait is over 3 months here. No help in the meantime. I've been trying to get an appointment since early August. I have even take him to the ER, but because he wasn't trying to commit suicide he wasn't admitted.

It's hell.

Ernie123

Your family doctor or emergency clinic should be able to give you a temporary script until you have an assessment by a Geriatric Psychiatrist. Low dose Risperidone or Olanzapine will make a huge difference. Safety is an issue. Others reading this thread, follow the good advice given above and get your LO assessed early on by a Geriatric Psychiatrist who can follow the progression of your LO as time goes on. Aggression, paranoia, delusions unfortunately are often a part of this awful disease and cannot be dealt with by a single caregiver. Ounce of prevention….

Sunrise24

I went through a similar situation in September with my husband.  I ended up having to call 911.  Police sectioned him and brought to geriatric psych hospital.  He was stabilized but kept saying he was married to someone else and that he had divorced me.  The psych hospital could no longer get approvals from insurance for him to stay and they said I had to take him home which I could not given that he was still somewhat delusional.  I had to place him in MC assisted living where he has since made huge progress on risperdal.  He is like he was a year ago…. We have great visits and I took him home for a visit the other day which went well.  He also enjoyed family Thanksgiving.  My husband had been seen regularly at a memory center near Boston and a few meds were tried but just don’t think dosage was high enough so he spiraled into a psychotic break.

John_inFlorida

Rescue Mom,

Not sure where you are in Florida. We are in Tampa and use the Byrd Alzheimer's Center. My DW doesn't have the kind of issues your DH has, but they have been really great. Don't know if this could help you or not

abc123

Dear Rescue Mom, I'm very sorry this is happening to your husband and to you. I think the people who told you rages and threats are just part of Alz. and you need to learn to deal with it, should be ashamed of themselves. What a horrible thing to tell you. IMO they don't know what they're talking about. There is a good chance that medication could greatly help your husband, I learned that fact here on this forum. I hope you are able to get help soon.

Jo C.

I am so sorry this is happening.  There may be some options:  Very important to communicate that this is "an abrupt change in condition" when ever you have a healthcare contact.  They must address abrupt changes in condition rather than thinking of this as "usual." 

One:  Very often, if the primary MD contacts the specialist and speaks to him/her personally, the primary can state it is an abrupt change in condition and is urgent due to the behaviors and that he needs to be seen asap. That often works in getting an appt. very quickly; often within 24 hours give or take.

Two:  The primary MD can contact a psychiatrist on staff at a local GeroPsych Unit, explain the situation and the level of care needed for the abrupt changes that have not responded to lesser care and get him admitted.

Three:  Whenever in the ER, it is "an abrupt change in condtion" and has not been seen before this.  AND then insist . . . . referral as an inpatient to a GeroPsych Unit at whatever nearest med center has such a unit. There he will be admitted, assessed on a 24 hour continuum, meds adjusted and assessed for effectiveness and any side effects.

From GeroPsych, you can either decide to take him home, or have him placed in a care facility that can meet his increased needs. If he is admitted to GeroPsych and you decide to have him transferred to a care facility at discharge, it would be best to make best friends with the psychiatric social worker from day one so you can get a list of facilities best suited to his needs.

If you take him home, there are Home Health agencies with staff qualified to see dementia or mental health patients in the home environment for a few visits to assess how things re going; the hospital GeroPsych Social Worker should also know which agencies have this service. 

If things are still in bad shape, when he rages, you can contact 911; have him transferred by ambulance to an ER and insist he be referred to GeroPsych as he is a danger at home.

I am sorry you have to experience this; the stress must be so high. Please let us know how you are doing and how things are going; we will be thinking of you.

J.
 

Rescue mom

Thanks so much to everybody. I have learned a lot more right here (as usual) than anywhere.

A little update (not a closing, advice still welcome!): my DH has not had one of these episodes in a week, although I do not think they’re “over.” I would not hesitate to call 911, but these things come out of nowhere and last maybe 5 minutes. Then he’s back to “normal,” and in 30 minutes will deny that he ever said or did anything extraordinary.

If he hit me, I’d have more of a case for forced intervention, but he hasn’t, so far, and it’s like Josey said.. I’ve thought he would, and positioned to run, but not happened yet. How crazy is it to think getting hit could be a good thing?

Jo, I did not know, hadn’t thought about stressing the abrupt change in condition. I told his PCP this started very suddenly, 3-4 weeks ago, and that didn’t seem to register with him (pcp). I will do that again, and ask him to make a call. It doesn’t help that DHs former longtime PCP retired a year or so ago, and we’ve only seen this one a couple times. His former guy had a lot of issues rex, but he would at least work with other specialists on DH behalf as needed.

I suggested seroquil, or similar, from the PCP and was told he could not prescribe that. I don’t know if that’s really “could not” or “will not,” but he wasn’t doing it, hence the referral to geripsychs. Maybe if I call him back and talk about the wait time, he’ll be more interested…. 

Just for shots and giggles,  staff at the Alzheimer’s memory clinic were among those who told me this is part of Alzheimer’s and I need to learn how to redirect and deal with it…glad I’m not the only one who found that unhelpful.

John:  we are several hours from the Byrd center, but they are supposed to be great. Just a little FYI (you may know already), it’s named “Byrd” for the former state House speaker who funded its creation and years of continuing operation. One, maybe both, of his parents had Alzheimer’s, and he was frustrated at the lack of help around there. This was maybe in 1990s. controversial them as “pork project” but we all know the need and good it does for so many.

Thanks again to everyone.