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My mother's behavior is getting even more erratic. She has a lot of problems with anger. I'm concerned that her behavior might eventually get her booted from the ALF. There's a lot of issues at play, including mental health and possibly drug reactions, so it seems like a psychiatrist might be the go-to person for this. There are like 2-3 geriatric psychiatrists in the entire state of Colorado so I'm conflicted. Any thoughts?

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Your profile also says, in so many words, that mom is an old pro at the "poor me" routine. Chronic pity parties mask anger and anxiety, not sadness. Always the victim. Always maligned. Always cheated out of their due. Always someone else's fault.

When these types "have all their buttons," they can suppress the lashing out. No audience = no feed. They take (some) care not to scare away their flatterers....and the poor souls whom they "enlighten" with their tales of woe. Once impaired reasoning sets in, the stuffed-down resentment sometimes takes center stage. Decades worth of bile and rumination just.....pop out.

My mom always had a "yes but" for everything. Now that her mind and body aren't what they used to be, the gloves are off. She's not a full-time rager. But she can go from zero to screw-you faster than the speed of light. Her brain can't concoct the her spin as swiftly as it did back in the day. But she's still right all the time -- and sometimes makes her point in a way that's all mouth and no manners.

You should certainly get your mother's med list and review it with her MD or a psych. (I hear ya on the paucity of geriatric psych specialists. Only a sprinkling of them in my state, too.) I agree that she may need a fine-tuning of existing meds, or the addition of something.

One last thought. This behavior that you fear might get mom kicked out of AL: Has the AL staff or management approached you with concerns about her outbursts? Have mom's fellow residents mentioned these outbursts to you? It's important to determine if this is truly mom's new "normal"......or if she's reserving her sh*t fits exclusively for you.

Good luck. This stuff is so draining. I try really hard to see my mom as more than the sum of her flaws. But most of the time, she doesn't give me much else to go on. Sounds like you can relate.
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I have worked in facilities for several years, am board certified in Alzheimer's care and education. In my experience, geriatric psychiatrists have been light years ahead of any other physicians in helping people to balance out moods and behaviors. They tend to be more knowledgeable of medications and how they work together than general practitioners or neurologists. They would also be sensitive to pre-existing mental issues that affect how the current brain illness shows in her behaviors. BTW, Paxil has been around since the Stone Age, never saw it do much. Doctors unfamiliar with psych meds tend to prescribe it as the side effects are minimal and it was popular when they last learned about antidepressants. If you can't get her to a geriatric psychiatrist, I would call the ones in your state and see if they can suggest how to find someone local to assist. Good luck!
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Ribbman - that's exactly what I'm trying to get across to my mom. From day one when this all started five years ago it been my mothers manipulations and need for attention that keeps landing her in more and more restrictive environments. But the irony of it all is that because she can't see how she is doing this to herself proves that the new more restrictive environment is the appropriate place for her - if that makes sense? Right now she has two angles she's working. With my brother - mid visits she starts to pretend she doesn't know who he is anymore. Brother gets all freaked out - every time - and she gets a kick out of it. The other is her "falling". She is laying down on the floor in her room claiming to have fell. The plan is for me to think she isn't safe at the NH and I will whisk her home to live with me!!! Thing is - both these little schemes are only gonna end up with her being moved to a memory care facility.
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Antidepressants and anti-anxiety meds will sometimes quit working properly in the elderly or if she in ALF your mother may not be compliant in taking them. A psychiatrist is useful in more than one way - drug prescription, drug interaction (also ask pharmacist about meds with a list of what she is taking in hand), and laying a trail if you later have to move her to memory care or get guardianship. By the way, I think the hotel fixation where she lied to family about you spending her money is her broken brain calling the ALF a hotel and not understanding why she cannot go "home". My MIL is having decline with the Parkinson's and my husband lives in Egypt (by the river DE-NIAL). The filters for acceptable comments just goes away...and selfish is excused by the people not having to fix things.
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I'm taking mom to one on Monday. I'll let you know.
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I have not taken a parent but I gave taken my husband who suffers from Lewy Bogdy dementia. The psychiatrist was recommended by his neurologist and she is adjusting his medication. Things gave been a little better. On the second visit she adjusted it more, so we will see. It is a step by step process that is worth a try. I did have to wait 2 months for an appointment because there are not many psychiatrists who take medicare so be patient.
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Thanks for all the help! I found a neurologist in the area and will give that a try initially. If that doesn't pan out, then it's off to the Ger. Psych...
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Your profile says that your mother has dementia. People with dementia are often difficult to deal with. They are often disagreeable, agitated, accusatory, etc. Most Memory Care facilities understand this and are equipped to handle it. Maybe, her condition is too advanced for the place she is currently. I know that when I moved my cousin to a Memory Care unit, she immediately seemed more content. She seemed to sense that she was with others who she had more in common with. Plus, the staff knew how to assist her better than a regular AL.

Often the patient may need medication to address anxiety, depression, etc. I'm not sure they medicate just if someone is mean or manipulative. I would certainly explore medications that might help your mom feel better. I think that psychiatrists may be of assistance, but other doctors may prescribe meds as well.
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I'm not familiar with the meds she is taking. Maybe, they need adjusting.

Is it feasible to get her to a geriatric psychiatrist? If you can't, then go with the best you can.

I guess that doctor we had who originally prescribed Cymbalta for my cousin was a lucky break. It was the first thing she tried and it worked like a charm. It's for depression, anxiety and pain. She had all three. We saw such a difference in her. It is monitored and if things change, we'll have her evaluated.
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ADDENDUM: It would really be nice to be able to edit these posts, at least for a short time. I was going to add that she might just manipulate herself into a memory care facility!
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