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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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Hi, my mother is 64 and started getting paranoid delusions

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Hi, my mother is 64 and started getting paranoid delusions about the police about 2 years ago. She is being treated with Olanzapine, initially 7.5mgs a day, decreasing to 2.5mgs but the symptoms returned at this does. She is also being prescribed a low dose anti-depressant to stimulate seratonin production.   She is now developing symptoms of Tardis Dykenesia resulting from anti-psychotic drugs. Can she take an alternative medication to prevent this? She has had a succession of doctors who do not really take an interest other than re-prescribing the drugs which are now at 10mgs per day. She is socially withdrawn and will not do anything outside her daily routine which is very reclusive. She always declares she is "fine" but displays outward symptoms of anxiousness. Any advice would be valued.

Hi! I believe I can be of help to you with this issue.

First, let me say I can imagine how difficult and worrisome this situation is for you. On the one hand your mother needs medical attention. But on the other hand, the doctors seem disinterested. Let's see if we can get an overall sense of what is going on with your mother and what would be the best strategy to follow.

It certainly seems your mother may be transitioning to a thought disorder that may be parallel to and/or caused by an onset of elderly dementia. Unfortunately, about a fourth of elderly people who have onset of one form or another of dementia will also have paranoid symptoms accompanying that onset. Here is Merck's Manual entry for dementia.They bring up paranoia, I believe:


Let me also give you the Mayo Clinic's entry for dementia. It's quite a few pages:

There are two possibilities that you are right to be concerned about. The first is the onset of dementia. Paranoia and/or hallucinations are early symptoms associated with dementia and Alzheimer's. The second possibility is the onset of a straight thought disorder such as schizophrenia. That possibility is sometimes due to some illness/disease that needs to be diagnosed or a reaction to a medication. Between these two possibilities, most likely is that you mother is beginning to show signs of onset of dementia with paranoid features.

I assume she is seeing NHS doctors. And they've seen this so many times, the progression is almost routine. And I assume that tardive dyskinesia caused by medication is also something that they've seen before. It is unclear whether it is laziness on their parts or lack of confidence in any substitute medication that accounts for their unwillingness to try substitute medications for the paranoid symptoms. But there ARE other second generation anti-psychotics and third generation anti-psychotics that could be tried. Again, you don't know their calculations on this.

And so this is the key to your mother's care because as her dementia progresses she will need more care and more consistent care. Your job is to get the doctors to be on her side and your side, to WANT to go the extra mile for her and you. That means that you have to make sure they feel you are on their side and treat them as if they are on your side. So you have to develop the art and skill of asking them for advice while trying to lead them to the solution you want. This is the current example but there will be more in the future. You need to make them feel they are in charge and you respect them and their expertise and appreciate their help and efforts as you ask them what are the alternatives to the Olanzapine and what they know about the latest treatments and (very important) what can they do for your mother with the constraints they have.

So, there is no guarantee that you will get the best care for her. You can only coax out the best efforts from her caretakers through your making them want to go the extra mile for you and her. This is the reality of the situation and I hope that you can accept it with grace.

I wish you and her the very best !

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

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