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Dementia treated with antipsychotic?
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Dementia treated with antipsychotic?

My father is 93 years old.  Fell and was hospitalized.  Hospital gave him Seroquel 12.5 mg, morning and night to control his agitation and supposedly reduce his delusions and paranoia.  (He also suffers from very occasional halucinations.)  When he released home, his aggressive behavior ramped up, since he is so weak he cannot get himself out of bed which angers him.  The doctor upped the Seroquel to 25 mg at night.  He's now been this medication 1 week, and the last 4 days at 25 mg at night (plus 12.5 mg during the day).  He appears to be more confused and having more hallucinations, so it doesn't appear to be working.  On top of that, I've researched this drug and see it is contraindicated for treating people with dementia.  Essentially, what we want is a drug to give him at bed time that will help keep him calm and help him sleep so he doesn't try to climb out of his hospital bed (now in the home) causing another fall.  What would be suggested for this purpose with the least possible side effects.  Also, very occasionally he becomes agitated during the day due to some bizzare thought in his head.  When this occurs, what would be suggested for an "as needed" medication.  
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Avatar_dr_m_tn
Hi,
Your father’s symptoms suggest of Schizophrenia . That is why Seroquel has been administered . If the drug has not worked or is causing adverse effects , please intimate the doctor and ask him for a drug change .Sedatives alone may not be helpful . His symptoms of Schizophrenia need to be treated . Please consult a physician or a  Schizophrenia specialist . Hope this helps you . Take care and regards !
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Avatar_f_tn
Why do you believe he may be suffering from Schizophrenia?  I've never heard of someone becoming Schizophrenic in their 90s.  Up until he was 91, he was mentally very healthy, but at 91 or so we noticed he would say a few strange things here and there, but not often.  This past year his confusion has increased, particularly the past 3 months I'd say, along with delusions and some paranoia (boyfriends for my mom)  and a few hallucinations here and there, but not that often.  From what I'm researching, those symptoms would be typical for someone suffering from dementia of the multi-infarct type, which he has been diagnosed with June, 08.    
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Avatar_f_tn
I've experienced something similar with my mom.  She is 86 and has dementia (her MRI shows that she has had multiple small strokes which have caused the dementia. )Sometimes she has very bizarre, distorted ideas ( for example, thinks people are plotting to steal things like pennies in the house and are communicating with walkie-talkies to pull this off).  The doctor prescribed Zyprexa, knowing that she has dementia.  It helped some, but I've had people who work with the elderly question why she was put on an anti-psychotic for dementia.
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Avatar_f_tn
Your father should not be on Seroquel, this is commonly believed.  Instead, last year some Canadian scientists discovered that an anti-epilepsy drug, Depakene which is also called Valporic Acid (I think that's how it's spelled), stops the plaques that form in the brain which leads to dementia.  In addition, it should help him sleep better.  That particular medicine will sometimes deplete Folic Acid in the body, so he should have that as a supplement.  VPA also goes by several other trade names.  

Also, since your dad wants to get out of bed more, then I reckon that will have to be arranged for him, everybody gets bored stuck in bed.  I know, it's that he can't get himself out of bed, so just increase how much he gets up, and if you have to, roll his bed out of his room.  If you can get him outside, that will really help him a whole lot, grounds a person and helps them feel more normal.  I hope you have enough help around you while he's recovering from his fall.  And I hope your docs will try that medicine.  I take an anti-convulsant and it's for a completely different reason than what the drug is normally used for.
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Avatar_f_tn
Thanks so much for the advice.  It's now been 1 1/2 weeks since he's release from the hospital.  He is gaining a bit more strength with the help of occupational therapists that come to the home.  We've been getting him out of bed as much as we can, including to do outside, but it is so hot he prefers to stay in, but the rooms are all light and bright and airy.  It's only at night when he is put in the hospital bed that he becomes aggressive and agitated about not being able to get out of the hospital bed.  He says he's "chained up" and we have no right to do so.  Of course, he does realize there are no physical chains, but since he cannot get himself out of the bed, that's how he sees it.  I spent much time speaking with him yesterday about this.  He recognizes if he were to get himself out of bed at night on his own (no caregiver after 9:00 PM) he doesn't have the strength in his legs to hold himself up and he'll fall.  Yet, he insists this should be his decision and he should not be placed in a bed that prevents him from getting out of it.  Ugh.  We stopped the Seroquel a few days ago.  I even called the company who makes Seroquel and they said one has to balance the risks vs the benefits of using the drug and many doctor's prescribe it for off label use, i.e. dementia with psychosis, dispite the block box warning.  Even a hospital program for the elderly said this is a common drug they prescribe for their elderly clients with good success.  That's just amazing, knowing one can die from this medication.  Now we have him on Xanex at night.  Tried .5 mg, but he was still agitated.  Upped it to 1 mg at night.  We'll see if they helps alleviate the agitation.  Hope so.  I'll research the other drugs described above.  Thanks so much for the suggestions.  His psychosis seems to be worse in the later afternoon (even though it's fully bright outside), but even with the psychosis, he is aware he's being put in the hospital bed at night.  At first we thought he was agitated from the psychosis, but now we see he is aware of more than we thought he was.  Hard to keep straight what he realizes and what he doesn't, especially when he speaks about his childhood as though it's current.  This is such a bizzare medical condition.  
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999692_tn?1250641550
I have heard mention of medications and such, but is he seeing a therapist? I suffer from bi-polar and for some reason the psychosis does become worse in the evening due to association with negative things occurring in the evening. He may be demented, but there are still things that can be done psychologically, especially if he's aware, even to some extent. Working with his perception of reality and around his condition would be incredibly helpful to his quality of life.
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Avatar_m_tn
Hmmmm. First off Seroquel at such a low dose wouldnt do anything for hallucinations anyway. Secondly its proven that seroquel given in cases of dementia only makes matters worse. Health care providers are so eager to give out that and other drugs in its class (i.e Zyprexa, Risperdal) for every sneeze and sniffle (metaphorically speaking of course). I am convinced that most doctors who perscribe these meds have no idea what they are doing. A few years back i was suffering from severe anxiety and a doctor put me on Luvox and Seroquel, two drugs which i found through researching after being on them, should not be taken at the same time.

Dementia and Schizophrenia although both thought disorders are on two totally different sides of the spectrum

Dementia is a degenerative disorder in which neural transmissions arent always recieved properly or completely due to degeneration and damage of receptors and sender neurons. It isnt due to chemical imbalances.

Schizophrenia and other delusional thought disorders are thought to be  caused by over stimulation in dopamine pathways in the frontal lobe of the brain, resulting in bizarre thoughts and hallucinations. Antipsychotic drugs partially block the flow of dopamine to dampen signals and lessen activity in these areas.

To give a person a drug which dampens thought transmissions in a disease where signals are already being recieved incompletely makes no sense. It scares me that these are the people that take care of us and our loved ones.
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Avatar_f_tn
Dear Lil,
I loved your new post with all the info on how your Dad is getting so much good assistance, I could picture vividly how things are there at your home.  You're doing great with him.  Let's see, one thing you COULD try, on explaining the nighttime bed stuff, is (A) tell him you've "decided: he CAN get out of bed at night if he wants to, and (B) ask him to lift his arms up in the air, and then his legs, and say, "See, you are not tied down," and (C) THEN tell him the reason he's struggling to get out of bed is because he has an injury, and point to the place where he hurt himself before, and (D) then ask him to please get out of bed and come with you.  Hopefully when he hears all this in sequence, followed by of course not being able to get out of bed, a lightbulb will go off in his head, and maybe he won't get so rambunctious.  And then I think I'd quickly turn his attention to a book or magazine or the TV, and yourself share and show some interest in it, so HE'LL get interested, and that way you switch the subject.

This is how they do dogs that get frustrated and bored in the house and start to chew furniture (akin to your Dad yelling and so forth).  They REDIRECT the dog's attention from his frustration to something he can "take it out on," which is a bone (nylabone).  Magazines or whatever you can come up with, that will be his bone.  In other words, try to train your Dad to get over his need to get up by replacing it with something he likes to do in bed, to keep his mind occupied until he falls to sleep.  Plus, if he gets a drug that will help him sleep, he SHOULD get to where almost as soon as he lays down, he'll pass out.

But it sounds like you've gotten some good info here at this forum, and it sounds like you have indeed done a lot of really good things for him, and I'm sorry you have to deal with this bedtime thing.  As for him spending time in his childhood, that might be another "bone" to throw him when he gets upset, since he likes the subject so much.  Many older people like to talk at length about stuff that happened when they were younger, because those are the memories that stay the longest and are easiest to retrieve, as the memory fails them from time to time.  In the end, I really think once this injury heals, he'll be a lot better in a very short time.
GG
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