How best to take care of my husband

Posted by Carmen on June 13, 1999 at 03:18:51
Dear Dr.
My husband has had a diagnosis of dementia for 2 years now. He also has liver disease stage 1 fibrosis do to Hepatitis C.  He was taken in on a psychatric hold for 11 days due to violent outbursts and hallucentations.  Varius Dr. diagnosed him with bipolar disorder, Wernikes Korsakoff Dementia, and Temportal Lobe Zeizures and subcortical dementia.  How can I determine from this mix what he really has?  After his hosptitalization, he did well for a year and a half.  Recently he has started in again with the strange manic behavior and hallucinations. He had been drinking and was foaming at the mouth. He recently believed he smelled an odor so bad that he was retching and choking, sobbing for God to help him.  He has also had recent episodes of small amounts of blood in his vomit.  I can't get him to go into the doctor or the hospital.  He is somewhat parnoid and will not start the new round of meds (Haldol and Paxil) the Dr. has just prescribed.  He has been med free for 16 months.  What can I do? Can you tell me what these symptoms sound like?  Please help. I am concerned for my children during these outbursts and I have had to have him removed from the home by law enforcement.

Posted by HFHS.MD-T.B. on June 14, 1999 at 17:01:58
Dear Carmen, It sounds as though your husband has symptoms of violent outbursts, hallucinations, "manic" behavior and paranoid thoughts.  From the limited information that I have available, I can not make an accurate diagnosis.  Your husband's symptoms could be found in several different conditions and a detailed history and examination would be necessary to determine a diagnosis.
Dementia is a syndrome characterized by multiple impairments in cognitive function without impairment in consciousness.  In dementia, sudden outbursts of anger, hallucinations and delusions(fixed, false beliefs) can occur.  Bipolar disorder is a mood disorder typically characterized by periods of "highs"(mania) and "lows"(depression) and one can exhibit all of the symptoms listed above.  You also mentioned your husband drinking.  Alcohol use can also cause all of the above symptoms and also with chronic use lead to dementia.  Temporal lobe seizures can cause psychiatric symptoms like hallucinations, deja vu, derealization, depersonalization and repetitive motor acts.  I would also want to consider delirium secondary to hepatic encephalopathy.  Psychiatric symptoms of hepatic encephalopathy  include euphoria, disinhibition, psychosis and depression.  Delirium is a syndrome characterized by disturbance of consciousness with reduced ability to focus, sustain, or shift attention and a change in cognition or the development of a perceptual disturbance not better accounted for by dementia.  The disturbance tends to fluctuate during the course of the day.  This would be a consideration because you husban has multiple factors affecting the liver(hepatitis C and alcohol use).  The key to diagnosing and treating your husband's condition would be for him to follow up with a mental health professional.  If he is unwilling to do so, and you feel he is in danger to himself or others, he can legally be taken to a hospital against his will to be examined.  
I hope that this informati0on has been helpful for you.  It is intended for educational purposes only and should not replace consultation with a physician.  If he would like to be seen by a mental health professional at Henry Ford Hospital, please call 248-689-7476.