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I'm a 53-year-old only child who had been living with my wife and daughters about 125 miles from my Mom (82), whom I would drive down to visit several times a year. She's been living alone since my Dad was confined to a nursing facility 7 years ago; he passed away last year just before COVID hit. I was visiting in October to help Mom out while she recovered from a bone graft to her jaw in preparation for dental implants, when she fell and broke a hip. And I've basically been living with her ever since, working remotely at my IT job from her house.


So she has a number of physical complaints (most recently, Bell's Palsy, which we found out after a stroke scare sent us to the ER), but had been fine mentally, apart from evident anxiety and depression, which she resisted my suggestion that she see a psychiatric professional about. There were a couple of incidents of anxiety-triggered delusions, one centered on the rehab facility where she stayed immediately after her hip replacement; the doctor there started her on Mirtazapine to help her fall and stay asleep at night. But she mostly seemed fine once she got home. Then on one of my weeks away, the first night she was alone she became convinced the house was on fire and called my cousin in the wee hours, who came over and found every light in the house on and Mom insisting she could see smoke where there wasn't any. A few days later when a friend of the family came to visit and stay with her overnight, she became convinced that the friend and I were conspiring to have her taken away. The morning I was due to come back she called in quick succession 7am to ask when, then called her sister and asked her to come over but she couldn't, then her cleaning service to see if they could come early, and then 911, due to apparently just an anxiety attack (I get those myself and have made plenty of unnecessary trips to the emergency room). It became clear that she had not slept hardly at all while I was gone, and even my first night back she didn't sleep - she was convinced that the white smoke, who it turned out had spoken to her once, was going to get her. The next day was Mother's Day and she did finally fall asleep and sleep most of the day ("best Mother's Day ever", she said) and all through that night; she seemed back to her old self Monday morning. But then Monday afternoon she started talking about the conspiracies again, was sure the police were coming to get her. During later lucid moments she said she thought at various times that the police thought she'd murdered Dad, that everyone thoughts was a witch using magic to make her cat do evil things, and a number of other delusions.


Her GP referred us to a psychiatrist and gave us a few Ativan to get us through any anxiety episodes until the appointment, but it really doped her up. The psych said that the delusions could come from sleep deprivation due to anxiety, and he didn't want to add to her cocktail of meds if he could help it. So he cancelled the Ativan and instead doubled her nightly dose of Mirtazapine, but gave us Buspar to take as needed.


Well, we've needed. And it hasn't helped, other than to also make her dopey (a full pill leaves her barely able to hold herself up on the walker) _and_ paranoid instead of just paranoid. Even with the doubled Mirtazapine she stays up at night, often fully clothed with her purse handy because the men in white coats or police are coming to take her away any minute. I know I'm supposed to reassure her without contradicting her delusions, but when her paranoia is centered on me and what she thinks is my dishonesty, I don't know how to do that! She keeps asking what she'll be allowed to take with her!


We have an appt with her GP tomorrow to go over a thyroid scan (she has a nodule that may be cancer) and I'm going to ask for a neuro consult; the psych suggested checking for a UTI but they did that in the ER. Meanwhile I'm at my wit's end and not sure what to do.


Any advice appreciated.

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If you have access to a psychiatrist/psychologist/neurologist with SPECIFIC GERIATRIC TRAINING AND EXPERIENCE you may be able to get more helpful information than you’re receiving at present.

We have done EXTREMELY WELL after just by luck connecting with several specialists currently managing my LO’s care. Unfortunately paranoia is not an unexpected behavior in someone in early dementia, but as you are aware, there are so many other complications in your mom’s situation that differential diagnosis
is probably even MORE COMPLICATED in her case.

We are now working with a PCP who deals with geriatric patients only, AND with a group dealing only in geriatric psychiatric and behavioral issues. As you can imagine, they’re prepared to pinpoint the issues of the elderly more quickly than even an otherwise very capable generalist in either field.

Hoping you are able to get information that will be helpful to you and your mom. She is lucky to have you.
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Please don't sacrifice your own physical/mental/emotional health and your marriage! to this. You've already been staying with her for 7 months...what is the plan? It seems like she shouldn't be living alone anymore, and also that she needs to be closer than 125 miles away.

What does your wife say?

I see you are an only child, so there are no sibs to consult. I assume you have POA/HCPOA for your mother?
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And while your're at the GP tomorrow, make sure they do a urine culture (takes several days, not just a quick dip stick test).

Bone grafts for dental implants are pretty standard; my husband just had that done. But good to make sure that there is no infection there....
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XenaJada May 2021
I was also going to say, there have been countless times when I've taken relatives to dr or ER and had to specifically REQUEST a test for UTI, when there were obvious signs of one.
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You're already doing it - ask for a neuro consult a.s.a.p.

Your mother was absolutely A-ok up until October, yes?

P.S. a bone graft for dental implants? That sounds... quite ambitious, and quite a radical approach. It's all been checked out and is fine, is it?
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It sounds as though you have the drug regime sorted into what one would expect as a starter, but these drugs have side effects especially of causing drowsiness/dopiness. Its a stage one has to go through and in 2-3 weeks the side effects should settle down. If she sees a psych and gets put on anti-psychotics you will most likely still have to go through some weeks of the body adjusting but it may be a better outcome than anti anxiety that is the current treatment - but bear in mind that unless someone is psychotic then anti psychotic drugs can be like using a sledgehammer to crack a nut. She needs an assessment, although she has seen a psychiatrist one visit does not enable any practitioner to see a pattern, to determine if this is anxiety or a psychosis - I think you have to keep on that track, but talk it out with her Dr who will (hopefully) have known her sometime and see what he/she says.
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I couldn't sleep on several SSRIs, including Remeron/mirtazapine, that I tried taking to help with a general anxiety disorder and also help me to fall asleep and get good rest. I have no way of knowing if your mom could be having a similar reaction as I had to that medication, and certainly your mom's reaction is more severe, but I thought I would mention it. I can't recall which med it was, but I think I was trying venlaflaxine/Effexor, and that one also caused far more agitation and sleeplessness than I already had. So, SSRIs can have these kinds of reactions... and if the behavior is more extreme than before, I'd talk to mom's psych about it asap.

I ended up recently starting nightly ambien/zolpidem, and it's incredibly helpful to me. I know there are horror stories out there about that medication and I've only been taking it about 2 months. I asked my psych about possibly taking gabapentin again for anxiety, and he prescribed it recently and that's also helped me a lot. Gapabentin/neurontin is more often prescribed for seizures or nerve pain but has off label use for anxiety as well.

I'm saying all that to say -- there are a lot of medications out there, and if the ones your mom is currently taking aren't working for her, her doc should consider different ones.

Of course you have to screen all of the other physical causes out first, and UTIs are a common cause of sudden increase in mental health symptoms, but if that's been done then I would want my mother's doc to switch her psych meds to some that really help. These aren't helping her.

Could there be some developing dementia?
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You should know that UTIs (urinary tract infections) in the elderly can cause no other symptoms other than personality changes and behavioral issues.

At the very least, get her PCP to do a urine culture (not just a dip stick test) to see if this is a UTI. Expect to be laughed at. Persist, nonetheless.

Sometimes, hospitalization in a good geriatric psychiatric unit can be a blessing to sort out the medications needed, but test for a UTI first.
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TaylorUK May 2021
Do you really mean "no other symptoms"?
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