geriatric psychiatrist

caberr

Just wondering when do you take a LO with AD to a geriatric psychiatrist?  What do they do?

Buggsroo

My husband has been seen by a geriatric psychiatrist twice. This is what transpired.

He talked to my husband at length, asked him all kinds of questions. My husband told him all kinds of nonsense so the doctor looked to me, I just shook my head no. The doctor explained that I would receive a letter that I could present to the bank and our attorney, stating there was a diagnosis of Alzheimer’s and that me his wife would manage on his behalf.

We discussed medication, my husband was on trazadone, rispiridone and aricept. The doctor took him off the risperidone and explained that medication just helps somewhat with the symptoms but there wasn’t anything that would eradicate all the problem symptoms. It was informative for me, my husband was his charming self, all in all just part of the dementia scenario.

M1

Caberr they generally have medication expertise to help manage problem behaviors, and therefore prescribe antidepressants, antipsychotics, stimulants, and sedatives. Because of the expertise they can frequently get to a stable regimen the quickest. I would generally say that in dementia they are of more practical help to caregivers than neurologists, but that varies by the individual and just reflects how few tools/drugs the neurologists have right now.

WWhen to call them in can also vary depending on the comfort level of the primary care provider with dementia prescribing. Our internist was pretty proficient so we never saw a geri psych until she was hospitalized. Then the first one were assigned to screwed things up more than she helped. The second one was okay but didn't really change anything.

hope that helps....

Ernie123

I would second everything M1 said. 

In our case my DW’s doctor referred her to a geriatric psychiatrist when she developed delusions and paranoia. The psychiatrist first sent his nurse for a home visit assessment and then they both came about a week later. He likes home visits to see the patient in their home environment. We were lucky in that he had over thirty years of geriatric experience and familiarity with all the possible medications. Since then she has been moved into MC. Apparently there is a range of individual responses to the antipsychotic meds so a bit of trial and error is to be expected before arriving at an appropriate medication and dosage level. He has monitored her progression and has had to adjust dosage and switch medications over the last three years. So as you might guess my advice is to find a geriatric psychiatrist with experience if possible. His treatment has made my DW’s life much more comfortable. Her extreme episodes still occur, but quite rarely and most days she is calm.

harshedbuzz

We moved to a geri psych when dad's neurologist proved himself to be either out of his depth or disinterested around psychoactive medications. He took a OSFA approach to them but only after significant begging on my part. Dad had mixed dementia and one was alcohol-related Wernicke-Korsakoff's which seemed to come with some serious judgement of us as "enablers". It almost felt like we were being held responsible for dad's behavior and being left to dealt with it as a consequence.

Neither my aunt nor my friend's mom ever needed the services of a geri-psych relative to their dementia journeys. Auntie's gerontologist prescribed her a SSRI at one point and friend's mom internist did something similar- for them, a geripsych wasn't necessary.

Dad's geripsych was so much more understanding. He treated us all, but especially dad, with compassion and respect. Dad enjoyed their visits which surprised me; he'd always dismissed mental health services as voo-doo worthy of ridicule.

Visits were an unhurried 50-minute hour during which he listened, worked in some questions (always seating me in his sightline to discretely confirm or dispute dad's version of things. He was able to craft a cocktail of meds to reduce dad's delusions, hallucinations, anxiety and aggression without sedation which improved his quality of life and ours. He also happened on Wellbutrin to activate dad (the apathy was awful) but which curbed his desire to drink which really helped. 

HB

dayn2nite2

The geriatric psychiatrist was the ONLY useful medical professional we saw.  Started seeing him because my mother announced that she was saving up her pills so she could kill herself and I was able to get an appointment (I did mention it was an emergency) with the doctor, who then saw her periodically until we placed her.

He treated and gauged her periodic agitation.  Appointment would start by him seeing her for 15 minutes and the rest of the appointment would be with me going over any new behavior or issues I was noticing.  I actually started seeing him separately as he was open to treating my depression/anxiety over the whole situation and I saw him until he retired.  Excellent physician and I even called him a while after my mother died to let him know.  I didn't do that with any other professional who saw her.

I've read your recent posts and to me, you could have gone a while ago.

Waldorf

I think I have been lucky. DW has been seeing a GP since 2017 on a quarterly bases. He was part of university medical department. He was conducting research as well as treating and counseling patients, We participated in a research group to determine if meditation was beneficial to the patient with dementia. I do not know the scientific conclusion, however my conclusion was that it was more beneficial to the care giver. As the disease progressed, he tested and provided treatment including prescribing anxiety and psychotic drugs. The drugs improved DW's quality of life and provided some stress relief for me. DW is currently in the middle of stage 6.  I would recommend getting a Geriatric Psychiatrist ASAP.

Rescue mom

I took my DH to a Geri-psych when he started having delusions—insisting he saw things that did not exist, or did not happen. He’d say he saw a plane crash in the yard, for example, and insist that he “saw” it happen….sometimes those delusions led to violent anger and aggression.

Other doctors, including his PCP, said they could not prescribe the serious drugs needed for that. The Rx had to come from a Geri-psych. Meanwhile, other caregivers in my area also say they could only get certain major meds (like Seroquel) from Geri-psychs. 

I know FL law restricts which docs can prescribe pain meds; I’m told the same law restricts who can prescribe anti-psychotics. Regardless, other docs would not do it, for whatever reason. Had to be a Geri-psychiatrist.

The GP has been by far the one doc who “gets” DH and his Alzheimer’s. The GP still doesn’t do a lot of talking; it’s mostly for the Rx.

Jo C.

It is amazing the different experiences all of us have.  In our case, my LOs Board Certified Geriatrician misdiagnosed for type of dementia; stating it was Alzheimer's Disease.  That led to my LO being put on meds that were actually contraindicted and oh boy; did the noxious behaviors ever ramp up.

We were referred to a Geriatric Psychiatrist who was in absentia even when he was present. Diagnosis was:  Alzheimer's.  His only prescription was to try two different antidepressants, one after the other when the first did not work.  LO worse.

We were referred to a second Geriatric Psychiatrist with same results; diagnosis Alz's.  Antidepressant despite the LOs dread 24 hour behaviors that were over the moon and having a huge effect on LOs quality of life.

I am an RN;  symptoms just did not feel fitting with Alzheimer's.   I finally decided to get my LO to an excellent Neurologist who sees many dementia patients as a routine part of his practice. He did new exam; ordered a SPECT Scan since CTs and MRIs usually do not show much but can rule out tumors, or other Neuro issues, etc. BOOM! There it was after his intake and scan - a behavioral variant of FrontoTemporal Dementia, NOT Alzheimer's.  He had already dc'd the contraindicated meds and he then prescribed appropriately; it was nothing short of seeming like a miracle.  I was so thankful.

Then . . . step-dad developed Alzheimer's Disease along with dreadful GI issues of severe pain.  He had been seen and worked up by two different GI specialists and had been scoped up and down and up and down multiple times and also scanned over three years; all to no avail.  We were in the ER with his horribly severe abdominal pain many times; often in the middle of the night.

He had some behavioral issues and off to the referred Geriatric Psychiatrist we went.  This was a third one from the other two my other LO had seen.  Same thing - antidepressant and not good results.  I decided not to mess around with it and got him to the Neurologist.

After exam and testing, Neuro asked if there were any other problems. I replied, "No; other than his GI issues that have been worked up mutiple times with no results."  Neuro stopped and asked many questions.  He stated he felt we may be working with a delusion, not a GI problem and explained he would like to do a trial of a very low dose of Seroquel and see what happens.  I was skeptical as I had seen that horrible level of pain sufficient to cause ER runs, but decided to approve the med.

To my utter astonishement, within one day, all GI Pain gone, and it never, ever, ever resurfaced again.  I had never thought of the pain as being a delusion; it seemed so real.  None of the GI specialists or Psych specialist had realized it either.

So; this is just one more person's input regarding specialists - it depends and each specialist is unique unto themselves with skills and experience.

J.