Dad - 2nd neuropsych appointment - the long one

Quilting brings calm

Today was my step-dad’s 2nd neuropsych appointment.  We were told to expect it to last 3 hours.  It lasted 2.5 hours.   Dad has a very raspy, scratchy voice, some times  he sounds as if it is painful to talk( he says it isn’t).  This is due to 4 thyroid cancer surgeries over the years.  He was sounding pretty bad at the 2 hour mark. So the doctor skipped the name as many words starting with this letter test.  He had done that in in the first appointment anyway. 

The doctor also skipped some  tests due to Dad’s reading level- late third grade according to the doctor. The reading level  is not a  recent change. He only had an 8th grade education in the first place. His listening comprehension when being read to is early 7th grade. 

I was not sitting where I could read what Dad wrote or drew during the tests. So I don’t know the results there yet.  I was present for  all the tests where he responded verbally.  He did pretty well, considering the reading issue.  The reading issue impacted his vocabulary knowledge also.

He did so well that halfway through the tests I slipped the doctor a note with two questions. 1) how can you tell the difference between low IQ and cognitive dysfunction and 2). Are his issues  related more to  emotional, mental and personality disorders than cognitive dysfunction.  The doctor responded that everything taken together would answer number 1.  When dad took a break, the doctor told me that he could not give Dad the 180+ question test that would help with question number 2 because Dad wouldn’t have the patience for it.  However, the doctor’s prior experience ( including working in a mental hospital) would allow him to do a pretty  good job at that question anyway. 

The worst issue is Dad’s delusion that he has insects living in his body.   This has gone on for about 18 months and started because Dad was  coughing up bloody mucus due to his pneumonia and COPD.  He swore the dark spots in it were bugs.  He had not said much about it for a few months.  Then early this week, he said that insects were escaping his upper arm.  He scratched it to the point that it is bruised 

​fesk

That sounds like a very long day for you and your dad. When can you expect the results?

I hope they can do something to provide relief for his delusions.

Quilting brings calm

Fesk- 

Results will be told to us in September.  Not as soon as I had hoped.  However I don’t think the timing will really matter in the long run.   Either he has mild cognitive impairment or he doesn’t.  His education,  reading level, and lack of intellectual curiosity make him functionally illiterate in today’s world even if he doesn’t have mild cognitive disorder. He most likely has at least this delusion, paranoia about my handling their finances, and a personality disorder or two.   I’d be thrilled if the doctor  gives  him some medication to curb those things.  

What was odd is that he never expressed curiosity as to why the tests today were what they were.  Not while we were there and not on the way home.  Surprisingly he was in a good mood the entire time I was with him.  Rather than being irritable with me for making him sit through the tests. 

My mom called tonight because she ( who does have MCI / mild  dementia ) was curious about how things went.  I plan on taking her to the September appointment because she needs to hear what they tell him.  Doctor said  he’d give us ( and him) things to do/say to handle his strengths and weaknesses. Hoping that will help the two of them get along better in their assisted living apartment 

M1

QBC, in case you want to look it up, the bug delusion is pretty common as these things go and has a very specific name--fermiculosis.  But it's very hard to treat; there is one particular antipsychotic (Pimozide) that has the best reputation for success, but even that is pretty limited I think.  

I once had a patient with a variation, she had a delusion of mice being everywhere in her apartment.  We put her on Zoloft and she said it made the mice quieter.  Interesting.

Quilting brings calm

M1- I had found similar information under a different label - delusional parasitosis.  He’s gone from saying it is in his lungs, to everywhere in his body, to now saying the bugs are trying to escape.  Hopefully we are finally  at the right doctor for it at least.  His PCP just shrugged it off when it was mentioned multiple times( both in person and through the patient portal).

Do you know if people with this delusion also develop other delusions? 

​fesk

I am just curious why this delusion in particular is different than others, M1? My mother did not have this one, but did have another which Zyprexa quieted.

Quilting, I'm sorry it will be so long for the results. That's frustrating, but hopefully the time will pass very quickly.