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.
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.
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?
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....
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?
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?
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.