Psychotic episode response

Just Bill

My wife woke up at 3 this morning wanting to take all the kids home. There are no kids just me and a dog. Its as if the dog and I look at each other with here a we go again head nod. Like a team that has played and practiced a lot together. She has her job I have mine. There was a time psychotic episodes scared the wits out of me and were highly emotional events. The dog and I work like a finely tuned machine talking her off the ledge of darkness and lead her into the light. It is a routine we both go into autopilot like an ambulance driver at an accident scene doing what we have to do to mop up the mess. It amazes me how adaptable the human mind is, what was terrifying before is routine now.  I have developed an emotional callous that helps me through these events with a cool calmness that she can pick up on instead of the panic and shock that she would pick up on and feed off of before. It literally has become a routine that my competitive brain turns into a timed event. I actually get to enjoy an endorphin rush when I can get her back into the light as fast as possible as painlessly as possible. Me and the dog give each other a job well done head nod and off to the next adventure.

ImMaggieMae

Just Bill, I think many of us caregivers develop our own responses which become routines to deal with dementia related events. Please share how you (and the dog?) bring your dear wife in off the ledge, out of the darkness and into the light. I am sure a lot of us caregivers could benefit and learn from your experience.

Just Bill

I'm kidding about the dog, she started at 3 in the morning and I just got her stabilized then I was still feeling a little goofy when I posted. These episodes usually start early in the morning 1-3 am. So the first thing I do is prepare for a long conversation where I cannot lose my patience I go into a zone. Then I calmly ask her questions and have her describe everything she sees in detail. Once she calms down I start to reason with her and remind who, what, when, where, why and how. I soften my words and speak softly slowly and clearly. I am very careful with my body language palms up legs open. Then I can usually talk her into going back to bed and she will sleep and wake up having zero memory of our conversation as if nothing happened. The dog helps by jumping into my lap when she yells at me. Petting a dog further reduces my threat to her. She was tough today, had a few more episodes we had to handle. We took the dog for a walk and she is tired and stable for now. In an hour or so she will apologize for today and I reassure her it isn't her fault and to not worry. The dog earned her biscuits today. That is what I do, and it works for my wife at her current level. This a work in progress and I am always polishing my act. I hope this helps someone. Good luck to all of you walking this walk.

Dio

We had one last night, too. Around 3am, DH shook me awake and cried out, "Where are we? What are we doing here? This isn't our house! What's going on? We gotta get out of here!" He sat up and frantically looked around in the dark, touched my face and repeated his questions.

I was dead tired, and simply said "Let's figure it out after we get some sleep when we both have more energy." Surprisingly, he did. But 15 minutes later, he awoke and repeated the questions. This went on for a couple more hours. Each time, I either remained silent or repeated "let's figure out what to do in the morning when there's more light (or when we have more energy)."

When we awoke at 8am, this was forgotten and he was onto a new issue to be paranoid about.

darn* this disease! (ok, editing profanity works automatically)

Then he went to the farmer's market with my sister, had a great time with her and bought me a beautiful bouquet.

ImMaggieMae

Bill and Dio, are your spouses on any dementia medications? My husband takes Risperidone and Memantine. I think he’s somewhere around stage 6 but hasn’t had any episodes like the two of you describe. I wonder if the Meds keep them from happening or he just hasn’t reached that point. The Risperidone was for obsessive/repetitive behaviors, not aggressive or  threatening, but highly agitated, up all night brushing teeth, cleaning his glasses, sorting watches, etc. He was in constant motion.

Dio

My DH is on 3mg of rivastigmine (just got increased from 1.5mg) plus 1mg of lorazapam 2x/daily. We just started the increase 2 weeks ago, but it seems to be not working after 2 months on 1.5mg of rivastigmine. His care team is discussing possible alternatives at the moment.

He was sundowning big time early May, when ... long story short ... I had to call 911 for police 3x within 2 weeks. Each time they took him to the ER but he was released a few hours later cuz he was all well behaved and calm by then. I have a bag full of meds that were prescribed  differently each visit by the ER psychiatrist on duty. The last one gave my DH's own psychiatrist a near heart attack by prescribing Haldol. When he heard, he texted me: CEASE IMMEDIATELY. Supposedly it has deadly effects for patients with LBD. Anyhow, it's a cautionary tale when your LO is in the ER. Check and double check the meds they prescribe. They don't have time (really?) but should find out more before prescribing meds.

Just Bill

I learned early I cannot say go back to sleep we will deal with it in the morning. That is a trigger, she lives in the perpetual right now. Later doesn't mean anything to her, she requires immediacy. So I have to wake up patient and enter her emergency in her world on her time. It sucks but it is what it is and it is necessary for success. She takes lamotrigine and effexor in the morning and an aricept and an ambien at night. Tomorrow I am going to call her neurologist and let him know the hallucinations are getting out of control. He will prescribe something and we will see what we will see.

Dio

So sorry, Bill. I just got lucky that DH obliged and tried to go back to sleep. Otherwise, it'd be a sleepless night for me, too.

However, I dread the day his sundowning returns... once, he kept me awake for 36 hrs. I thought surely I would die if that hadn't been managed by our psychiatrist who suspected LBD and prescribed rivastigmine. So we were both able to sleep better starting end of May. But now it seems we're back to figuring out what is the right dosage or perhaps even another medication.