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My mother's behavior is getting even more erratic. She has a lot of problems with anger. I'm concerned that her behavior might eventually get her booted from the ALF. There's a lot of issues at play, including mental health and possibly drug reactions, so it seems like a psychiatrist might be the go-to person for this. There are like 2-3 geriatric psychiatrists in the entire state of Colorado so I'm conflicted. Any thoughts?

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Your profile says that your mother has dementia. People with dementia are often difficult to deal with. They are often disagreeable, agitated, accusatory, etc. Most Memory Care facilities understand this and are equipped to handle it. Maybe, her condition is too advanced for the place she is currently. I know that when I moved my cousin to a Memory Care unit, she immediately seemed more content. She seemed to sense that she was with others who she had more in common with. Plus, the staff knew how to assist her better than a regular AL.

Often the patient may need medication to address anxiety, depression, etc. I'm not sure they medicate just if someone is mean or manipulative. I would certainly explore medications that might help your mom feel better. I think that psychiatrists may be of assistance, but other doctors may prescribe meds as well.
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Sunnygirl, thanks! I always seem to be one step behind in getting her into the level of care she needs. Her Internist has prescribed a daily antianxiety med on top of the paxil she's taking. It might just be the holidays that's got her in a tizzy.
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Antidepressants and anti-anxiety meds will sometimes quit working properly in the elderly or if she in ALF your mother may not be compliant in taking them. A psychiatrist is useful in more than one way - drug prescription, drug interaction (also ask pharmacist about meds with a list of what she is taking in hand), and laying a trail if you later have to move her to memory care or get guardianship. By the way, I think the hotel fixation where she lied to family about you spending her money is her broken brain calling the ALF a hotel and not understanding why she cannot go "home". My MIL is having decline with the Parkinson's and my husband lives in Egypt (by the river DE-NIAL). The filters for acceptable comments just goes away...and selfish is excused by the people not having to fix things.
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My mom was seen by a geriatric psychiatrist both during a hospitalization and later, had regular visits with one at her IL residence (I'm in NY; we've got LOTS of psychiatrists). There are antidepressants that have antianxiety effects, I don't know how Paxil stacks up in that regard.

Most dementia patients are thrown off by change in routine, so in that regard, the holidays may be playing havoc with what is "usual" at her residence. I'd start out with a conversation with her regular doctor, especially looking at side effects from the meds she's on.
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I'm not familiar with the meds she is taking. Maybe, they need adjusting.

Is it feasible to get her to a geriatric psychiatrist? If you can't, then go with the best you can.

I guess that doctor we had who originally prescribed Cymbalta for my cousin was a lucky break. It was the first thing she tried and it worked like a charm. It's for depression, anxiety and pain. She had all three. We saw such a difference in her. It is monitored and if things change, we'll have her evaluated.
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Your profile also says, in so many words, that mom is an old pro at the "poor me" routine. Chronic pity parties mask anger and anxiety, not sadness. Always the victim. Always maligned. Always cheated out of their due. Always someone else's fault.

When these types "have all their buttons," they can suppress the lashing out. No audience = no feed. They take (some) care not to scare away their flatterers....and the poor souls whom they "enlighten" with their tales of woe. Once impaired reasoning sets in, the stuffed-down resentment sometimes takes center stage. Decades worth of bile and rumination just.....pop out.

My mom always had a "yes but" for everything. Now that her mind and body aren't what they used to be, the gloves are off. She's not a full-time rager. But she can go from zero to screw-you faster than the speed of light. Her brain can't concoct the her spin as swiftly as it did back in the day. But she's still right all the time -- and sometimes makes her point in a way that's all mouth and no manners.

You should certainly get your mother's med list and review it with her MD or a psych. (I hear ya on the paucity of geriatric psych specialists. Only a sprinkling of them in my state, too.) I agree that she may need a fine-tuning of existing meds, or the addition of something.

One last thought. This behavior that you fear might get mom kicked out of AL: Has the AL staff or management approached you with concerns about her outbursts? Have mom's fellow residents mentioned these outbursts to you? It's important to determine if this is truly mom's new "normal"......or if she's reserving her sh*t fits exclusively for you.

Good luck. This stuff is so draining. I try really hard to see my mom as more than the sum of her flaws. But most of the time, she doesn't give me much else to go on. Sounds like you can relate.
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I'm taking mom to one on Monday. I'll let you know.
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Thsnks for all the input! Blackhole, I suspect that she reserves most of her ire for me, but I am going for a visit and will touch base with the staff. It's the level of her anger that concerns me; it could spill out against some of the other residents. She had a run in with another resident recently that ended with the resident hitting her with a cane! The staff reported that Mom would occasionally mutter things to this person that would set her off, so I suspect that Mom egged her on to a certain extent. If this is indeed still manipulation, and I think it might be, she is certainly pulling out all the stops.
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ADDENDUM: It would really be nice to be able to edit these posts, at least for a short time. I was going to add that she might just manipulate herself into a memory care facility!
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Ribbman - that's exactly what I'm trying to get across to my mom. From day one when this all started five years ago it been my mothers manipulations and need for attention that keeps landing her in more and more restrictive environments. But the irony of it all is that because she can't see how she is doing this to herself proves that the new more restrictive environment is the appropriate place for her - if that makes sense? Right now she has two angles she's working. With my brother - mid visits she starts to pretend she doesn't know who he is anymore. Brother gets all freaked out - every time - and she gets a kick out of it. The other is her "falling". She is laying down on the floor in her room claiming to have fell. The plan is for me to think she isn't safe at the NH and I will whisk her home to live with me!!! Thing is - both these little schemes are only gonna end up with her being moved to a memory care facility.
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I have worked in facilities for several years, am board certified in Alzheimer's care and education. In my experience, geriatric psychiatrists have been light years ahead of any other physicians in helping people to balance out moods and behaviors. They tend to be more knowledgeable of medications and how they work together than general practitioners or neurologists. They would also be sensitive to pre-existing mental issues that affect how the current brain illness shows in her behaviors. BTW, Paxil has been around since the Stone Age, never saw it do much. Doctors unfamiliar with psych meds tend to prescribe it as the side effects are minimal and it was popular when they last learned about antidepressants. If you can't get her to a geriatric psychiatrist, I would call the ones in your state and see if they can suggest how to find someone local to assist. Good luck!
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Yes, it was the best thing I've done yet. It was a struggle because of really bad anxiety. After talking to many nurses i discovered the Xanax she was to strong for her age group. We had to go to her doctor many times but finally got the timing right. The therapist changed her from Xanax to klonopin and things are so much better now.
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regarding the anti-anxiety effects of paxil - yes, it's very effective for that. I know because I've been taking it for 13 years, originally for depression after my marriage ended, but I found it knocked out my OCD symptoms at the same time and my psych. at the time said that it's one of the top drugs for that. That said, I can see where someone might need a little more sedating effect during period of particular anxiety too.
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A psychiatrist is a medical doctor specializes in brain disorders, so it makes perfect sense to take your loved one for mental health issues. If they don't specialize in dementia, then a neurologist is your best bet. There is a lot of turmoil going on in the psychiatric community with Medicare not paying what it should and doctors just wanting to get paid what they think they are worth (a reason why there are so few anywhere).
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How do you GET your parent to a psychiatrist?? That would be my question! Mother fears them--and for good reason, I'm sure. She is hoping to have a 2nd hip replacement next year and if she gets it okayed and goes ahead (completely against all us kids' opinions and with no "support" from us) can we ask for a psych consult while she's in the hospital? I mean, it's probably 70 years too late, but I'd love to hear an actual diagnosis of what we suspect is the underlying causation of mother's behavior. She is on 2 antidepressants but she says she takes it for pain.
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Ribbman and Rainmom, I am in the same situation as you are. My mom is currently in Assisted Living, but will soon need to move to Memory Care. I used to say how lucky I was that she was cooperative and not aggressive, but that has changed. She has become increasingly agitated and angry over the past three months. At first the anger was directed only toward me, then toward her elderly sister, then to the staff at AL and now, just two days ago, she raised a fist to a fellow resident. When a staff member intervened, she picked up a juice glass and attempted to throw it at the staff member. I took her to a psychiatrist two weeks ago to ask about a medication change to deal with her agitation and anger, but he chose only to up her anti-depressant, citing the side effects and fall risk associated with the other meds. Her behavior has only gotten worse since the visit. Although she is still living in an AL apartment, the staff is taking her to the memory care wing for most of the day to try to keep her busy. She will move when a space is available. In the meantime, I get anywhere from four to as many as eleven angry calls each day. We tried taking her phone away, but she became increasingly aggressive with the staff because her phone was gone, so we returned it. (We had de-activated her phone and told her it was broken and I took it to be fixed.) Not answering her calls is not an option since she will just continually redial until I finally answer. I am at my wit's end, not knowing what to try next. The AL staff is going to start documenting all of her behavior and will contact the psychiatrist and ask him to reconsider. I wish you better luck with you situations.
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I have not taken a parent but I gave taken my husband who suffers from Lewy Bogdy dementia. The psychiatrist was recommended by his neurologist and she is adjusting his medication. Things gave been a little better. On the second visit she adjusted it more, so we will see. It is a step by step process that is worth a try. I did have to wait 2 months for an appointment because there are not many psychiatrists who take medicare so be patient.
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Definitely take your mother to a geriatric psychiatrist. I know they are very hard to find but a regular psychiatrist would not have as much expertise with the meds that would be effective with dementia patients.. If you can't find a geriatric psychiatrist you might try a good geriatric doctor. I took my father to a geriatric psychiatrist and we have thank G-d found some meds that are helpful with agitation
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Akdaughter - I so feel your pain. The phoning in itself is enough to drive you out of your mind! I don't know what the answer is - obviously - which is why the Geriatric Psy. My big fear is that mom will be having a "good" day and be able to keep it together and put on a good show. I can only pray the dr is experienced enough to see thur it if that's the case. On my end I am working on detaching and stepping back a bit. I have to find a way to keep her life from being my whole life - it's not fair to my own family and it's not fair to me. I'll let you know how the appointment goes.
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My Mom goes to a neurologist as do a number of people I knowwith Dementia.
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Thanks for all the help! I found a neurologist in the area and will give that a try initially. If that doesn't pan out, then it's off to the Ger. Psych...
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We took Mom to a neurologist once we began to see symptoms of dementia. After a battery of tests an assessment was made, medication was prescribed for age related atrophy of the brain, and from then on she had visits to her neurologist to access her for any changes to her mental health (good or bad). We also switched her to a geriatric doctor rather than her standard visits with an internist. In my opinion, this all worked well.
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