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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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My mother has been experience these episodes of unbalanced

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My mother has been experience these episodes of unbalanced behavior such as .....really aggressive anger moods, and saying things that don't even make sense to any of us. She has ms and though she has seen neurologists ...all of them confirm that this behavior is not associated with her medical condition physically. We experience this same behavior about a year and a half ago, she was diagnosed with steroid psychosis....her doctors weaned her off of her medication and she made a full recovery at least until now....she has been long off of prednisone which was causing those episodes....what I don't understand is that two days ago she started to lose control of some of her functions like her arms and legs started moving uncontrollably ....and my sister called the ambulance they decided to admit her thinking it could be ms related but after that she started hallucinating .....and being incoherent speaking to someone who was not there and experiencing mean ...aggressive anger towards nurses and family....but when her doctor came in to evaluate her she said that she can't do anything about her condition because all her test came back normal......and the only way she could do a hold on her is if she wanted to harm herself...I tried to let her dr know that she could potentially hurt herself and someone else.....please help us me and my sisters are at our end of the rope.....we would take her with us but she constantly says things like people are after her ...which causes her to not sleep for days roaming the halls ....while everyone is asleep....I have small kids and currently 8 mos pregnant and I'm afraid that she will get too violent around them....please tell us what can we do?? Or if you know this condition please tell me more about how we can go about this.....and if you have anyone you can refer us to in San Diego ca that will be so awesome thanks .....

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.

You are correct that it is not safe at this time for you to have your mom living in your home; you are not set up to care for her adequately in case she does lose control. This is important.

Cognitive decline is associated with MS. However the type of hallucinations and paranoia you are describing are not. They are more associated with onset of one of the dementia disorders: 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 need to be concerned about. The first is the onset of dementia such as Alzheimer's as we said. 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, perhaps something other than the Prednisone. Between these two possibilities, most likely is that you mother is beginning to show signs of onset of dementia with paranoid features.

You, therefore need to broach this subject with her doctors and ask to have her begin the assessment procedures. If she is diagnosed with onset symptoms, then that would make finding a residential facility for her easier for you as there would be a diagnosis for it. You will also need to discuss with the doctors the process of getting a medical power of attorney so that when she becomes incapable of making medical decisions someone in the family has the authority to act.

Here is the web address for Psychology Today's therapist directory. You can sort by zip codes or just San Diego and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list working with the elderly population and perhaps psychotic disorders as one of the areas they work with. You want to enlist their help in assembling a team approach for the care of your mother. Because if she is indeed having onset symptoms, there will need to be a coherent approach to her care.

There will also need to be more a sense of activism with the doctors who care for her. You will need to make sure they feel you are on their side and treat them as if they are on your side. But you must also make sure they know the family is intending to be involved and to participate in making decisions. So if you feel you want evaluations done, for example, you may need to be more forceful and take more charge. It is so much better in accomplishing this, by the way, when all of you in the family are united and in good communication continually.

Yes, this is a heartbreaking possibility that is becoming more possible with this paranoia that she is displaying. It is not a black and white situation, though. She can be helped with medication (possibly) and with good geriatric psychotherapy (very helpful!). There is no need to panic at this point because you don't know yet which of the two possible situations might be coming on and you don't know yet the speed of the onset. That is why therapy will be very useful. It will also help your family in dealing with the new situation as it progresses (hopefully slowly) when you periodically meet with her therapist for consultation.

I wish your family and her the very best !

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