My Mom's psychiatrist says she has delusional disorder. How is this different from dementia?

Delusional means she believes things are true, for example that they are just fine, when in fact it is not true. Or they think people are staring at them, but people are just looking. This can occur with or without dementia.
She wants to die? That's a good reason to get a full inpatient evaluation. Talk it over with psychiatrist. They can titrate her meds better in a hospital setting and brighten her outlook considerably.

You might consider giving her more omega 3 fatty acids, possibly in the form of fish oil capsules. You might also consider giving her raw walnuts, if she can eat them. Dr. Andre Weil says: "Omega-3 fats can also help lift depression as well as treating mood disorders. Aside from fish oil capsules, the best dietary sources of omega-3s are salmon, sardines, and other cold water fish, as well as walnuts and flaxseeds."

My husband was on Risperidone, and we weaned him off of it (10 months), but he is so much better without it. I couldn't believe what a difference it made. Now he is just on welbutrin and doing very well.

Your mom needs to see the psychiatrist again. It's very rare for the initial doses of medication to be helpful. The Dr. will prescribe the lowest possible dose and then titrate up from there as needed. She may just need a med adjustment.

When your mom is delusional how do you react? Do you insist that what she's seeing/hearing/smelling isn't real? There's a fine line between supporting her while she's having delusions and participating in what she's going through. It's such a fine line. When she's having delusions have you tried redirecting her attention? Sometimes it can take a while to get someone redirected but it can be done.

Try not to insist that what she's experiencing isn't real. It's very real to her and probably very upsetting.

You're a good daughter to walk down this path with your mom. She's lucky to have a strong advocate like you.

As Pam mentioned, delusional disorder can occur with or without Alzheimer's, but it's a situation where the person can exhibit paranoia about what is going on (or isn't) around them. What they think is happening is very real to them.

Since your mother is continuing to get worse, I'd ask her doctor about taking her off of risperidone for sure, and maybe the other drugs, and starting over. She'd have to be weaned, which isn't easy, but these drugs can cause the very thing that the doctor is trying to cure.

Each person is unique in how they react to drugs, and when elderly people take a combination of powerful drugs the result can be devastating. If this psychiatrist won't even consider adjusting these drugs, I'd ask for a second opinion.

Good luck with this challenge. I can see why you are at the end of your wits. Please check back and let us know how you both are doing.
Carol

I guess I don't see it the same as others; 87 is old...we used to accept that and just embrace people as old and let them live and die in dignity. Back in the 70s my grandma was on a cocktail of medications, and my mom took her to some other doctor to get her off, and she got to live our her days less muddle headed. It sounds like she is just lonely; again, another change in our society that folks lived out their days as extended family and not on drugs. Feeding her this, making her do that...she is showing the signs of being lonely and old, and I don't know why we can't use the 'old' word anymore, it irritates me. When my parents got to be that age, as they had me later in life so the usual scenario is a senior citizen taking care of a senior citizen parent, but that is not the case. My brother and I had young families and were middle aged, so we were clear headed when our parents said do NOT put us on medication, do extraordinary measures, prolong life, etc, and I know at least I have that agreement with my husband and I in our wills, so making a choice of how to live and die with dignity was set when they and we were younger. When my dad got ill,mom broke this rule and did extraordinary measures, and he lived 10 years with dementia, so when she started thinking the neighbor were staring and saying crazy things, my brother and I intervened. He ended up having to live with and monitor her, but that is cruel to uproot a family and sell their home to live with mom while she called the shots [my point is, she could have, and would have in the old days, moved in with him]. Still, in the end she got to live and die with dignity, and even with full time having family and caretakers tell her what reality is when she insists otherwise, she wasn't on a cocktail or drugs. Growing old IS depressing; who wouldn't be depressed? If one lives a happy life and grows old happily, well they probably aren't a patient on this discussion board because we NEED to embrace that old IS old, people do grow old and die, rather than masking it, and embrace them as members of family and community, not a patient [or irritant] that needs to be managed and drugged...just a thought. And for the seniors taking care of them...think about how YOU are living life? Is it with anger, resentment, despair and giving up the things you love? Because I guarantee you will go the same way...

My mom was on a cocktail of drugs and in a skilled nursing facility. She was extremely delusional and very combative. We decided to just take her home and stopped all of those drugs except for her regular dose of valium. I am happy to say she is 85% better! Her dementia symptoms are very minor and she is doing great! I think some elderly patients need to be very careful with those medications. If you seen my mom before and after, you would not think it was the same person. Good luck to you and your mom and never give up hope.

See if you can find a geri-psych unit and/or psychiatrist near you. These are professionals who specialize in elderly with mental health and health problems. Elderly usually need lower doses of medications, they don't process the medications as efficiently as younger folks so end up with build up in their systems. Elderly sometimes respond just the opposite to what you'd expect to medications, a "paradoxical response". That's why it takes someone who specializes in old people.

For now, you can help calm her by saying something like, "I can see how it might seem that way to you." The go on with some alternative point of view..."but maybe they have a hard time remembering names and were just looking at you trying to remember yours." Or a reality check she can use. I worked with a couple people who saw others who were not there. They also had pets, but the pets never responded to these unseen others. If strangers came around, real ones, the pets would have barked or hidden, but the pets were just fine with the ones who were not there. One person thought people were coming into her house and could not sleep out of fear. I suggested she place empty soda cans by the door that would make noise if someone knocked them over. It worked.

Good luck with your mom.

Delusional is the mind playing tricks on the person, stimulated by any number of environmental triggers and/or related to imbalances of body chemistries caused by those or whatever the person is consuming, or is sick with.

Dementia is related to the brain becoming changed, not only perhaps in structure, but in the function of brain chemistries.

It can be tricky to tell the difference--sometimes it's a matter of the Doc preferring to use one term instead of the other, barring any specific lab tests that definitively prove one or the other.

A Delusional person senses something actual, but their brain interprets it incorrectly....they're making up PART of the story.
If someone is Hallucinating, their brain is making up the WHOLE story.

One patient I cared for, on narcotic pain meds, kept saying there was a monkey in his room. After days of this, I asked him, where he saw it exactly? He pointed to the wall, near the TV. I asked him if the monkey ever moved?
No, it just sits there looking at him, making faces.
I reached up and put my hand on the steel bracket that held the TV on the wall, and pointed to the bolts---the guy said "look out, he might bite you!"
I said "my hand is on the bolts holding the metal bracket for the TV to the wall--can you see my hand there? No worries, this is what is fooling your mind, probably because of the meds you are taking"
He had a good chuckle, and felt better. Just having someone believe him [instead of just fliply saying he was delusional and charting it], and talk with him compassionately, and show him what was triggering it, helped his mind sort things out better--helping re-ground him to reality.
But it is NOT always so easy.
Delusional disorder can be extremely life-interrupting, if not down-right destructive.
Many kinds of drugs--not just narcotics, can cause delusions.

Or, for instance, a bad imbalance of gut bacteria---that's a fairly simple fix---taking a good probiotic twice a day--there are many. Most good ones need refrigerated; Mt. Capra's Caprabiotics Advanced needs no refrigeration--it's the only one of it's caliber I know of. But there are loads of brands, and many stores selling good ones in the ref rig. section. Even better, Probiotics taken daily are good at helping heal many other ailments, sensitivities, etc. L. Rhamnosus, in fact, is being closely studied because it seems to have a VERY beneficial impact on lowering anxiety and depression. Good gut bacteria are critical to our health-maintenance.
Nutritional deficiencies are common, related to not eating well, and/or being exposed to things that impair absorption of nutrients.

Vitamin D is a commonly known deficiency--people are NOT getting enough simply by getting bright daylight, anymore, related to all our daily exposures to so many hormone and nutrient-interrupting man-made chemicals. IT's easy to supplement with D3; it's cheap, found at many stores. There's a blood test for that: "25[OH]D". It's quickly done, and if the results are too low, you can BET that depression and anxiety are related to that deficiency, as can many other disease states!

Mental issues can be caused by all kinds of illness, infections, lack of sleep or disrupted sleep, nutritional deficiencies, etc.
Any sensory input she gets, which she can't explain, can lead a person with a strong imagination, or a frail person, to lose connection with reality.

She is very old. That brings a certain amount of fragility.
She's likely had many losses which impacted her emotions.
She's at an age when death is around the next turn, and one doesn't know exactly when or how--that's scary.
Fear itself can cause more fear, and can trigger delusional perspectives.
Any changes can cause more fears and imbalances.

It can become difficult to even offer calming emotional support, because of how worked-up a delusional person can become--their defensive behaviors can block everyone's best efforts to help them, and can shatter families apart, and can endanger the person.

If she's making statements about wanting to die, it needs to be taken seriously--especially since she lives alone.
It might be appropriate to ask her Doc if she would benefit from being admitted on a suicide watch? and at the same time, to adjust her medicine? Or put her on a "medication vacation"?
Maybe they could do both at the same time, while evaluating her for need for supervised living situation.
While she's in the hospital being evaluated and having medications adjusted, you could be working with a Social Worker [[try Area Agency on Aging, or, the hospital social worker or facilitator]], to find an appropriate Assisted Living facility for her---if the Doc thinks that would be helpful.
Her living situation needs evaluated for her safety.
When someone is delusional, they are NOT able to make healthy decisions for themselves adequately, and, could potentially be a danger to themselves or others--if not by intent, than by accident.
That sounds like strong language. It is.
It's up to you to decide if this might apply to your Mom's situation, and decide if or what might be best for her health and well-being. It is very emotional and feels very hard, to take autonomy away from one's elder. You love them, they've always been independent, and now they can't manage so well.
This is when, despite their behaviors to block it, they might need help getting helped.

LeoLady, I hear what you are saying and I agree that the extreme measures that we take at all ages to avoid aging and postpone death have become an obsession (largely fed by Madison Ave., Hollywood and TV).

However, there are other factors that have made senior dementia and debilitation so commonplace, namely, the garbage that passes for "food" these days. It all began after WW2 with the so-called "Green Revolution" that resulted from transferring chemical poisons from the battleground to the farm in the form of pesticides and herbicides. Since then the adulteration of our food supply has skyrocketed: GMOs; MSG; high fructose corn syrup (HFCS); trans fats; artificial coloring and flavoring; animals dosed with hormones and antibiotics. Add to that the laundry list of drugs that the medical industry routinely and cavalierly prescribes for anyone past retirement age, and is it any wonder that so many of us are struggling with how to care for our out-of-it elders? The very ones who should at this time in their lives be contributing the wisdom of age and experience to a troubled society have been reduced to little children (minus the cuteness) or worse.

I took my own mother (93) completely off statins. The only med she is currently on is low-dose aspirin. I have her taking pro-biotics (which fixed digestion and diarrhea problems), co-enzyme Q10 and a balanced Omega supplement. When I am the one caring for her I have to be sure and make dinner before she gets in the kitchen and fixes herself the same thing she had for breakfast: white bread (which she insists upon buying) and cheese and nothing else. She doesn't eat lunch, but has an early dinner. When I make a dinner of grass-fed beef or fish or other high quality protein, salad of mixed greens, and a side of yams or quinoa or whatever, I simply give her small portions. She always eats it all exclaiming how good it tastes. I'm fortunate that way. I just have to beat her to the kitchen at an hour that is uncustomarily early for me.

With an improved diet and a few natural supplements and NO prescription drugs, she is doing better as far as her attitude and general health. She is still reality challenged, but as long as she doesn't take to doing things that could harm her, who cares?

Pipruby, your story about the soda cans in front of the door reminded me of when my firstborn was three years old and convinced that there were alligators under his bed. (Don't ask me where he got that notion, since we were living far from alligator habitat and didn't have a TV.) I instinctively knew that pooh-poohing the idea and assuring him that there were no alligators would just confirm his suspicions that adults were clueless. So I simply looked under the bed and commanded the alligators to get out of our house. Kicked those reptiles down the hall and out the door. That satisfied the little tyke and he fell asleep with no more worries.

Hi You say your mum is on Risperdone and Seroquel and I would say it is her medication that is causing her problems and I feel very sorry for her if the only help she is getting is to be prescribed even more harsh mind altering drugs I am against drugging the elderly in this way Old age is not a mental illness yet nowadays most elderly people are sent to psychiatrists who usually prescribe cocktails of drugs Psychotropic drugs are causing premature death in the elderly and causing horrific side effects like tardive dyskinesia . My advice is listen to your mum and take her to a doctor who uses natural gentle remedies . It is the psychiatrists who are turning everything into a disorder requiring drugs. They are the delusional ones not your poor old mum Give her all your love and support She really needs you

Get her to a neurologist specializing in psychiatric as well as brain diseases. These two diagnoses intertwine, so it takes someone who knows their stuff to correctly diagnose her. Try switching meds. Not everyone reacts to meds exactly the same, and if one is clinically depressed it may take 20+ times before you get the right combination in her brain to alleviate the depression. Keep searching for answers.

My mom is 91. She has been delusional, paranoid, depressed, etc and diagnosed with dementia. She had a psychotic episode nearly 2 yrs ago and was hospitalized. They piled more drugs on her on top of mild ones she was already on, blood pressure, antidepressants, sleep aid, pain med, etc....well she only got worse. Long story, but she ended up stopping all of them on her own, she said she didn't feel good on them. I'm here to tell you that in my moms case she is better and more lucid in the last year than the previous 3-5yrs.

I don't advocate this for everyone, and some drugs are absolutely necessary, but I feel like drs are too quick to layer on more drugs to treat his or that without any close follow up or really understand in the consequences or whether it truly is improving quality of life. Seniors, like my mom, are very trusting and are less likely to confront the dr and give them real time feedback on how they are doing. Also, I find that elders are quick to want a pill or whatever to fix the problem. I'm against any antidepressants, anti anxiety prescribed to seniors without insisting on other therapies such as socialization activity, talk therapy, exercise, grief therapy, etc.

I should add to my last sentence "in conjunction with the drug therapy".

I concur with the first answer. Unless your Mom has a lifetime history of severe mental illness, the drugs you mentioned are "last resort" medications. Those drugs will do a number on the coherence and functionality of young people, let alone the aged, and some of them are contraindicated in anyone with a heart condition (and heart problems are common in the elderly!). Worse, they can cause hallucinations, delusions and other issues (paradoxically!).

There is a phenomena called prescription cascading that most commonly afflicts elderly people. It occurs when drugs begin to be prescribed to treat the symptoms of what, in fact, are other drugs. The risk of prescription cascading increases with the more specialists (and health issues) the patient has (with each physician prescribing his/her answer to the problem). The side-effects of each medication can interact in unexpected ways, sometimes to the point where the patient can scarcely communicate or care for him or herself. On a more technical note, many medications are metabolized in the liver by the same chemical pathway. If too many medications are competing for those enzymes, they can either become weaker, cancel each other out or become highly toxic (intensified). In other words, this can be a potentially dangerous situation!

Regardless of what other issues your Mom may have, she may benefit from having her care managed by a geriatrician — that is, someone specializes in the needs of older patients. From what you've said, the psychiatrist currently treating her has not given due diligence to the age of his patient, and her ability to metabolize (or properly benefit from) such powerful medications. If I were you, I'd find another psychiatrist!