1st Time Post - What Profession Should Provide Diagnosis?

Skeebler

Situation is LO seems to be displaying EO symptoms for about 2-3 months. Hearing voices, noises periodically. Some agitation. Some anger. Sometimes accusational. Some regret. Some stubbornness.

LO has seen regular MD and just had 1st visit with neurologist. Neurologist has prescribed Seroquel (quetiapine) as needed, scheduled an EEG and an MRI next week and suggested an appointment with a Psychiatrist. We are certain that LO would not go to a Psychiatrist, at least not now.

I guess we didn't even consider a Psychiatrist in pursuing help to resolve or treat whatever is causing these issues, so we are looking for some feedback from other's experiences regarding which profession(s) to involve and at what stage.

Further, your thoughts on how to get LO to actually attend appointments, complete tests and take prescribed treatments would sure be appreciated as well.

Thanks,

M1

Welcome. The Seroquel should help but I would suggest giving it in a scheduled fashion (at least once a day if not twice), not "as needed." Tell her the tests are  necessary to keep her insurance, and just don't tell her its a psychiatrist she's seeing (you can let the office know the issue, and they will usually play along with you). Every now and then there are adverse reactions to Seroquel and similar medications, so do watch out for that. Not common but it can happen. Good luck, this is not easy. 

jfkoc

A diagnosis of Alzimers  et al is made following a protocol..it is a process of eliminating anything which is treatable.

It is not at all unusual to have a PCP, a neurologist and a phychiatrist as team members. The phychiatist will be the one to work with meds. ...not talk therapy.

Please google Alzheimers diagnosis and also go to the top of this page and select ALZ.com. There is much to learn now as well as when this disease progresses.

Rescue mom

My DH with Alzheimer’s thought psychiatrists were a crock. When I talked to him about it, I just called the psych a “doctor.”, which is true.  In my state (FL) and some others, a psych. is needed to get a longer-term supply of certain needed meds, including Seroquel. Plus they can best deal with other issues and problems that often arise during Alzheimer’s and honestly, most “regular MDs” or PCPs can’t and/or won’t deal with those issues, like the ones you mentioned.

As for taking the meds, my DH is not able to keep up with or manage that, so I have to give them to him myself, as needed. He will take them without arguing. Caregivers whose LOs fight taking meds often mix the meds in with a favorite food, so the person doesn’t realize they’re taking it.

Skeebler

M1 wrote:

Welcome. The Seroquel should help but I would suggest giving it in a scheduled fashion (at least once a day if not twice), not "as needed." Tell her the tests are  necessary to keep her insurance, and just don't tell her its a psychiatrist she's seeing (you can let the office know the issue, and they will usually play along with you). Every now and then there are adverse reactions to Seroquel and similar medications, so do watch out for that. Not common but it can happen. Good luck, this is not easy. 

Thanks for the feedback! I'm concerned that not telling ends up bad since he could read the "shingle" that the Dr (psychiatrist ) has hung out.

Skeebler

Rescue mom wrote:

My DH with Alzheimer’s thought psychiatrists were a crock. When I talked to him about it, I just called the psych a “doctor.”, which is true.  In my state (FL) and some others, a psych. is needed to get a longer-term supply of certain needed meds, including Seroquel. Plus they can best deal with other issues and problems that often arise during Alzheimer’s and honestly, most “regular MDs” or PCPs can’t and/or won’t deal with those issues, like the ones you mentioned.

As for taking the meds, my DH is not able to keep up with or manage that, so I have to give them to him myself, as needed. He will take them without arguing. Caregivers whose LOs fight taking meds often mix the meds in with a favorite food, so the person doesn’t realize they’re taking it.

As I mentioned to M1, Thanks for the feedback! I'm concerned that not telling ends up bad since he could read the "shingle" that the Dr (psychiatrist ) has hung out.

Emily 123

My mom's PCP sent her to a neuropsychologist to rule out depression and screen for dementia. You could hold off on the psychiatry visit if the neurologist is comfortable making a diagnosis after the MRI and EEG--Find out if the Neuro intended to handle meds, or if the plan was to hand off management to the psychiatrist?  Sometimes a psychiatrist (esp. a geriatric psychiatrist) is the better choice for medication/behavior management.

If he notices the 'shingle'..Medicare is requiring a psychiatry consult nowadays, every 5 years, to screen for depression...or elder abuse...or medication adjustment for the elderly.

Skeebler

Emily 123 wrote:

My mom's PCP sent her to a neuropsychologist to rule out depression and screen for dementia. You could hold off on the psychiatry visit if the neurologist is comfortable making a diagnosis after the MRI and EEG--why not ask if that's acceptable, and also find out if the Neuro intended to handle meds, or if the plan was to hand off management to the psychiatrist?  SOmetimes a psychiatrist (esp. a geriatric psychiatrist) is the better choice for medication/behavior management.

If he notices the 'shingle'..Medicare is requiring a psychiatry consult nowadays, every 5 years, to screen for depression...or elder abuse...or medication adjustment for the elderly.

Thanks for that feedback!

Tfreedz

Welcome Skeebler, but sorry you have to be here. This site and its participants have a wealth of knowledge that I’ve found incredibly helpful.

My mother was referred to a memory care clinic (neurologist and social worker) after her PCP noticed issues and after I contacted them. PCP did simple memory test which my mom passed without an issue, but something was clearly wrong. No short term memory, paranoia, agitation and questionable decision making. Mom refused further testing and appointments. It wasn’t until months later that she was extremely sick at home and hospitalized with sepsis and pneumonia that she got the official diagnosis of dementia. The hospital Dr did not give me details when I asked what kind or what stage. Only that she needed 24hr care due to safety reasons. I brought her home to live with me. Once she lived with me, she refused all meds, but would go to her appointments when I took her. I did say to her that at this appt you can talk to the Dr about going home, that encouraged her to go.

We were never recommended a psychologist. The neurologist and SW asked me privately many questions about moms behavior and based on that plus her MRI diagnosed her with FTD. The neurologist also prescribed remron to help with anxiety, sleep and appetite. She is now taking her meds after neurologist told her that taking her meds proves she cares about her health. Of course, I do need to give them to her and explain what they are each time because she forgets and questions.

Hope our experience helps in some way. It is very difficult to get someone to go somewhere when they refuse. I believed it was a deep down fear that my mother knew something was wrong and didn’t want to address it.

Iris L.

Please familiarize yourself with anosognosia.  Your LO won't admit to needing help or anything.  

Iris L.

harshedbuzz

Skeebler-

IMO, a neurologist is the specialist for diagnosis which is made by ruling out other conditions. This is especially critical in an early onset (under 70) presentation where mental health conditions and conditions (some treatable and even reversible) that mimic dementia need to be ruled out first.

My dad was diagnosed at a memory center by a neurologist MD/PhD. But the single most important player on his care team aside from my mom was his geriatric psychiatrist. Psychs are the specialists in the dark art of prescribing psychoactive medications. While many PCPs and neuros will prescribe these meds, geripsychs have the additional training and experience in fine tuning and combining meds to yield the best benefit with the lowest incident of side effects. (I agree with M1 on Seroquel being taken regularly rather than "as needed"- it's better with agitation and hallucinations to address them proactively rather than in a "wack-a-mole" reactionary mode.)

I was surprised how easy it was to get dad to the psychiatrist given his dismissive attitude towards mental health issues. Dad could read, too, so I feared he'd see "psychiatrist" and make a run for it. But he didn't. Maybe it was because his reading by that point was strictly decoding without comprehension because of his short-term memory loss.

My dad loathed his neurologists- he hadn't much in the way of bedside manner, forbade driving and was insisting dad quit drinking (one of dad's mixed dementias was alcohol related)- so I offered up "another specialist" to provide a second opinion and make sure we were doing everything we could for him. The geripsych was warm and engaging and never veered into what felt like judgment so dad actually looked forward to his visits. The geripsych fine-tuned a cocktail of meds which allowed dad to be less anxious and agitated without making him a zombie. He also tried a medication off label which curbed dad's compulsion to drink which was huge. 

HB

MN Chickadee

If you can get an appointment with a psychiatrist I wouldn't let go of it. Having a relationship with one and the initial "establishing care" appointment may be very beneficial down further down the line. Sometimes if our loved ones get dementia related behaviors that are difficult to manage at home, become unsafe, or affect the quality of life for the person and family a psychiatrist is extremely valuable to get meds right. 

For both taking meds and going to scheduled appointments you may find therapeutic fibs to be helpful. One our loved one gets to a certain point in the disease we have to find workarounds and say whatever brings comfort and reduces their stress. Don't talk about it ahead of time, maybe you are just out for a drive and then bring it up. Maybe the appointment is for you and he is along for the ride. Maybe we're seeing a different kind of doctor housed in this building that happens to say psychiatry. Maybe it's a blood pressure check or some new requirement by the insurance company.  You might call ahead or slip a note to the clinic and doctor as to what you are saying to get him to come in so they have a heads up. We're going to run to this appointment quick and then have ice cream or some other treat that would be appealing. As for meds I wouldn't make a big deal out of it. Calmly lay out meds, maybe for both of you. It's time to take our medicine together now. Don't say they are for dementia or anything, try to keep it vague.  If you don't take meds take some tic-tacs or vitamins. Keep it up beat, time to take our medicine to keep us healthy. Got to keep our hearts strong or bones strong or whatever might sound right to him. Some medications can be crushed and hidden in a tasty treat like pudding. Consult a pharmacist as not all can be crushed. 

Skeebler

Thanks to all of you for taking the time to help us.