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How do you handle delusions
4641
Posted: Sunday, July 28, 2019 1:14 PM
Joined: 7/28/2019
Posts: 3


Hi I'm new, trying to figure it out as I go. I am in need of advice as to how to handle delusions.   My LO was diagnosed with EO in 2015, he has recently began to have delusions of me having affairs with the neighbors.  He has become very angry and constantly states he is leaving. He is in a constant agitated state when I try and talk with him? He can no longer be left alone due to my fear of him trying to leave.  We have had other delusions which didn't involve me so I was able to get around them. I am the only one who takes care of him.  Any advice?
Crushed
Posted: Sunday, July 28, 2019 3:49 PM
Joined: 2/2/2014
Posts: 4613


The affair comments seem to be among the most common.  Whether they are delusions or not  is debated.  However pretty good discussion at https://en.wikipedia.org/wiki/Delusion
Army_Vet60
Posted: Sunday, July 28, 2019 4:21 PM
Joined: 6/21/2019
Posts: 368


Is he accusing you of an affair with random neighbors, or is there someone in particular whom he sees you talking to regularly? If it's someone specific he's misinterpreting your interactions with, maybe you could have the conversations out of his sight?
 
My DW went through a period where she started seeing some of our female friends as hostile competition for my attention. They knew she was ill so they simply stayed away from us at social scenes so as not to antagonize her.
 
 4641 wrote:
he has recently began to have delusions of me having affairs with the neighbors.  Any advice?


4641
Posted: Sunday, July 28, 2019 4:51 PM
Joined: 7/28/2019
Posts: 3



I'm not sure, I'm following you..are you saying something my LO feels to be true is not consindered a delusion.  What is the correct term to use, I was asking for advice on how to handle his feellings..as I explained this is new to me and truly exhausting.
4641
Posted: Sunday, July 28, 2019 4:54 PM
Joined: 7/28/2019
Posts: 3


Thank you, I have but it has been both random and known, so I try not to talk to anyone without trying to include him in the conversation, which is difficult for someone who doesn't  want to be around people at all.
terei
Posted: Sunday, July 28, 2019 5:04 PM
Joined: 5/16/2017
Posts: 401


The delusions may be  symptom of anxiety.  If this is upsetting you + him, I would check

to see if a medication could be tried that may help.  No one I have read about has had any luck 

‘explaining’ to their LO that what they believe is not true.  Thankfully, it is usually a phase that

does not last long term + they are on to some other unwanted behavior(s)


Rick4407
Posted: Sunday, July 28, 2019 6:42 PM
Joined: 4/4/2018
Posts: 103


Hello 4641.  Sorry you are here, it is a supportive but not a happy place.  My DW has started delusions in the last 2 weeks.  Some she is agitated and some more calm and just "confused".  Her delusions are about where she lives, who I am, and where she works and belongs.

My response is pretty calm and measured showing pictures of us or her childhood home, or whatever to show that it is a delusion not reality.  Probably easier to handle that the jealousy issue.   It is a very difficult issue.  There are drugs, like seroquel, that are supposed to help with delusions.  We have not sought them yet but will if DW gets to where she is acting out or extremely agitated.  

I think my wife has gone from a cooperative 6 year old to a terrible 2 year old is some respects.

Welcome and good luck.  Rick


elainechem
Posted: Sunday, July 28, 2019 7:08 PM
Joined: 7/30/2013
Posts: 5865


My hubby has had delusions due to his dementia. In the early days, he believed that I was in collusion with his supervisor and the neuropsychologist to force him to retire from him job because his supervisor didn't like him (because I SO enjoyed having him home with me when he was like that?). There have been a thousand other delusions since then. You can try reasoning with him. That won't work. Never, never, NEVER lose your temper over it. That will cause things to escalate. 

Plaster a fake smile on your face at all times. Reassure him that you love him completely and will never leave him. Back rubs or foot massages may help. Try to redirect him by talking about something else... the weather, your pets, the garden, a favorite book, grandkids, whatever. Make sure that it is a pleasant subject. That may help. You could take him on a walk, take him to the mall, or take him on a drive. Those things calm down my husband. 

Try to get him in to see a geriatric psychiatrist. They're experts on treating patients with dementia. Medication may become necessary. Some people here recommend CBD oil if it's legal in your state. I haven't tried that, but I'm not opposed to trying things that may help. 


elainechem
Posted: Sunday, July 28, 2019 7:18 PM
Joined: 7/30/2013
Posts: 5865


The definition of delusion is a rigidly held  false belief. I'm somewhat of an expert on the subject because our now 27 year old son had (or has) delusions and hallucinations. It's SO much fun! He kind of knew that the hallucinations weren't real (like the time he saw life sized chess pieces milling around in the bathroom, or when he heard a voice telling him bad things about his brother), but he was firmly convinced that his delusions were absolutely true. They didn't upset him, but they were so bizarre. I just got him to tell me about them because he liked talking about it. For instance, for awhile, he believed that his friends could read his mind. 

He doesn't talk to me much anymore, so I don't know what's going on in his brain anymore. I just assume that he still has them because there's no reason that they should have gone away. He has autism and epilepsy, either of which can cause hallucinations and delusions. They don't seem to affect his life in an adverse manner. He has just come to terms with them over so many years. The voices in his head are probably his best friends. 


Crushed
Posted: Monday, July 29, 2019 6:13 AM
Joined: 2/2/2014
Posts: 4613


4641 wrote:

I'm not sure, I'm following you..are you saying something my LO feels to be true is not consindered a delusion.  What is the correct term to use, I was asking for advice on how to handle his feellings..as I explained this is new to me and truly exhausting.

It's a complicated argument that deals with subjective and objective reality. 

objective reality deals with proven and provable facts

subjective reality deals with beliefs about the world.

   If he thinks he is Captain of the Titanic we can "objectively" call it a delusion.  If he thinks he is on a "mission from God" How do we know if it's a delusion?  

  e.g. The spouses  "claim" they are not having an affair. Lots of people make that claim who are actually having affairs. 

Are anti-vaxxers "delusional" or just wrong?

It comes up a LOT in criminal law. 

Dealing with "non disprovable" subjective delusions is incredibly difficult.


lvcatlvr
Posted: Tuesday, August 27, 2019 12:59 AM
Joined: 5/7/2018
Posts: 103


My husband's delusions started as thinking other people were in the house or that someone had stolen something from his bank account. Those were the easy ones. Eventually, the delusions progressed to him thinking I was someone out to hurt him, rob him, stay uninvited in his house, etc. I was sometimes a teenager (I wish), a man, a homeless person (female at least) and other people. He would get very agitated and even aggressive. One time he started pulling the mattress off the bed to get me out. It was 3am. I had to call the police and the paramedics. This happened off and on. It was becoming dangerous. Our neurologist prescribed risperadone, which is an anti psychotic. It makes him apathetic and and he has forgotten how to do certain things that he could do when not on it, but nothing I can't deal with. It is much better than living on eggshells wondering if he was going to "force" me out of the house. Your DH may start having more intense delusions, so you may need to have him on a similar med. I notice many on here have their LO's on Serquel or something like that name that is also an anti psychotic.Good luck.
McCott
Posted: Tuesday, August 27, 2019 1:39 AM
Joined: 8/22/2017
Posts: 356


The answer is Seroquel.  Debate about whether these are 'delusions' or something else is really beside the point and, if I may say so, frivolous.  My husband was seeing people on our deck, in the front yard, in the back yard, in cars parked on our street, upstairs, downstairs etc.

Our PCP prescribed 25 mg Seroquel, but I cut the pills and gave him 12.5 on the advice here of Rick.  One week on Seroquel, very low dose, and he has not noticed people in any of the above places.
Crushed
Posted: Tuesday, August 27, 2019 5:17 AM
Joined: 2/2/2014
Posts: 4613


Its always possible to trivialize very complex questions but defining delusion is not easy.In particular how do you distinguish between religious beliefs and a delusion?   

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/

Although an important element of psychiatric diagnosis, delusions have yet to be adequately defined. The last decade has witnessed a particular intensification of research on delusions, with cognitive neuroscience-based approaches providing increasingly useful and testable frameworks from which to construct a better understanding of how cognitive and neural systems are involved. There is now considerable evidence for reasoning, attention, metacognition and attribution biases in delusional patients.

 See also

  https://www.researchgate.net/publication/256374628_Understanding_delusion_in_dementia_A_review

 Of course if all you have is a hammer,   every problem is a nail.  My wife took seroquel for well defined psychotic syndromes that created a physical hazard to her. She no longer takes it.  It is a powerful drug and not a trivial decision.Also as the article notes Jealousy is a powerful motivator for violence.   Seroquel can minimize the  expression of the delusion without affecting the underlying belief.  That can enhance the hazard for the caretaker

Antipsychotic medications were initially developed to treat schizophrenia, a mental health condition characterised by psychotic symptoms such as delusions and hallucinations. Because of their sedative effects, antipsychotic medications (such as risperidone, olanzapine, quetiapine and haloperidol) are often used to "manage" people with dementia.

 https://medicalxpress.com/news/2018-09-antipsychotic-drugs-rarely-effective-calming.html

 Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Quetiapine fumarate is not approved for the treatment of patients with dementia-related psychosis or for patients under 10 years of age. There is an increased risk of suicidal thoughts and behavior in children, adolescents and young adults taking antidepressants. Monitor patients closely for clinical worsening and emergence of suicidal thoughts and behaviors.

 

  


Rick4407
Posted: Tuesday, August 27, 2019 7:14 AM
Joined: 4/4/2018
Posts: 103


I will add just a brief note. First Seroquel is indeed an extremely powerful anti-psychotic drug.  I should be noted that in the clinical setting it is occasionally prescribed up to 800 mg per day.  More traditional prescriptions are 200 mg per day.  In this application, delusions associated with dementia, prescriptions of 25mg per day are more traditional.  My second point is that the half life of the drug in the body is 6 hours, so after 12 hours there is only 25% of that remaining (3mg?).  

In the case of my DW, we strive for 7AM and 7PM.   Two days ago I gave her the evening 1/2 pill (12.5mg) early and then the next  morning we got busy and I forgot the morning pill.  By 11AM it was obvious that she had missed her pill, her agitation level was at the uncomfortable level and her delusions were in full swing.   

I have become a believer in these small regular doses of the drug.  It improves her (and my) quality of life considerably!  From where I sit, with her terminal disease any improvements in quality of life are very important.


Crushed
Posted: Tuesday, August 27, 2019 9:23 AM
Joined: 2/2/2014
Posts: 4613


Rick4407 wrote:

I have become a believer in these small regular doses of the drug.  It improves her (and my) quality of life considerably!  From where I sit, with her terminal disease any improvements in quality of life are very important.


DW took low dose Seroquel until the side effects became dramatic. (Pisa Syndrome)  The issue at these low doses is whether it has anti psychotic effects or is simply a sedative  


Marabella
Posted: Tuesday, August 27, 2019 4:55 PM
Joined: 2/2/2019
Posts: 132


Following an assessment by a geriatric psychiatrist, my DH was prescribed a low dose of trazodone to ease day time agitation and a larger dose of the same for sleeping and relieving middle of the night disturbances. Whether DH was experiencing delusions, nightmares, false beliefs, or hallucinations, the events were distressing, disturbing and difficult to deal with. Medication, when needed, seems to be helping at this time and I am entertaining trying CBD oil as well. My DH is mid stage 6.
Rick4407
Posted: Tuesday, August 27, 2019 6:21 PM
Joined: 4/4/2018
Posts: 103


Thank you Crushed.  I had noted you mentioned the Pisa Syndrome before.  She is new on it and I'll keep that in mind.  Our experience is that most drugs wear out their welcome after some period of time.  Rick
Davegrant
Posted: Wednesday, August 28, 2019 8:42 AM
Joined: 6/20/2017
Posts: 25


My DW is delusional about one incident in particular and all women in general. She doesn't want me to be in any social situation where there are women present. She would prefer that I not leave the house. I feel that she is continually watching everything I do and looking for notes or signs that I may be up to something. Her intensity fluctuates from time to time. This is so different from our last fifty married years when I always felt free to do whatever I wanted  and now she has become the opposite type. I usually do not react and try to change the subject. It usually happens in the evening when I go to bed. She stays up late and I am an early riser. In the morning she is fine. It is challenging to live under suspicion. It does seem like it is unfair as the more I do the more suspicious she is. Most of the time my daily readings keep me on the high road but it does wear me out sometimes.
Davegrant
Posted: Wednesday, August 28, 2019 8:53 AM
Joined: 6/20/2017
Posts: 25


I wanted to add what helps me is remembering the year after her drivers license was suspended and how challenging that was for both of us. Her daily rant about the unfairness .  But I recall that it eventually passed and now is only occasionally mentioned in passing. Then there was the access to my facebook page and some of that is still strong in her mind. This too shall pass. I think that as she is feeling her mental life slipping  by she is trying to hang on to mine. I am willing to share but I can't give her what she is loosing; the mental capacity.
Roach
Posted: Wednesday, August 28, 2019 3:48 PM
Joined: 8/28/2019
Posts: 1


Thanks so much
Crushed
Posted: Wednesday, August 28, 2019 5:40 PM
Joined: 2/2/2014
Posts: 4613


Humor mode on

My father used to refer to DW when we were dating and she obviously liked me as "that poor deluded girl"  Lets hear it for delusions!!!!


RWOODS
Posted: Friday, August 30, 2019 10:15 AM
Joined: 7/23/2019
Posts: 2


I too, am new at this care-giving role. My husband has delusions and accused me of having an affair with his brother. I have been successful by giving him a serious face and explaining I would never do that to him. He has moved on for the moment about affairs. But is now having delusions about his role as a coach or teaching young people sports. He was an educator and college football player. I listen and explain that coaching jobs are not available in our area. As someone else wrote the affair delusion will pass-may return but will pass. Sometimes just sitting and letting him share in "world" is all that's needed for the moment. He recently went on seroquel and CBD oil. He was on CBD prior to going to assisted living. But the facility's corporate policy refused to administer it. After several weeks the nursing staff agreed it would have been best to continue. He is now returning home after we mutually agreed this was not the best placement. I suggest you talk with his doctor about possible medications.
anneleigh
Posted: Saturday, August 31, 2019 8:38 AM
Joined: 1/24/2019
Posts: 50


Last night was my first night with a delusional DH.  He woke me up at 3;30am with a suitcase on the bed saying, "where did I put the money?"  He said he hid money in the suitcase in the attic and it was now gone.  He went into the attic in the middle of night to get 3 suitcases down.

Granted we are in hurricane area range, E Orlando, and perhaps the anxiety of the hurricane is having an effect.  I just tried to reason with him and tell him I did not have it, but of course he thinks someone came into our house and took it.

If anyone has advise, I would welcome it......I know this is just the beginning and it is going to get worse.  thank you in advance for your prayers!


Marabella
Posted: Saturday, August 31, 2019 1:59 PM
Joined: 2/2/2019
Posts: 132


Anneleigh, using validation and fiblets may work to alleviate the anxiety about his “missing” money. Rather than saying you do not have it, perhaps put a positive spin on it....you put the money in the bank to keep it safe and he does not have to worry. Or, have some small bills in an envelop and give it to him with comments that you had put it away for safe keeping.  Our loved ones with dementia often worry about money, that it is missing, or someone stole it. Trying to reason with someone who has dementia does not work especially as the disease progresses. You have to step into their reality and not correct. If your DH continues to have nightly sleep disturbances a prescription for sleep and anxiety may be warranted. You certainly do not want him to be climbing to the attic regularly, falling down stairs or leaving the house. My DH is on a low dose of trazadone for both sleep and anxiety, given only if needed. It has certainly made a difference in reducing night disturbances and improving sleep.
anneleigh
Posted: Sunday, September 1, 2019 8:25 AM
Joined: 1/24/2019
Posts: 50


Marabella,  thank  you for the response.  I will try your suggestions. It is a learning process.

I have to remember "not to correct DH".  

I had a grace period when one of the kids called yesterday and I was able to quickly put the suitcases back in the attic while he was talking on the phone.  He did not even mention the suitcases at all yesterday.  The things we do to keep life normal!  Wishing everyone a good day~


Jo C.
Posted: Sunday, September 1, 2019 10:20 AM
Joined: 12/9/2011
Posts: 9941


If the delusions are pleasant and a positive for a Loved One,  (LO), there is no need to do anything about it. 

However; when delusions are causing issues and are really a negative for our LOs, then we try to do what can be done to bring them relief and defuse situations.

We all pretty much learn very fast to never, ever argue with a LOs delusions, never try to convince them they are wrong or otherwise; this only causes heightened negative behaviors and ramps things up and also sometimes will cause distrust of the caregiver.

First; one can try to address the feelings behind the delusion if there is fear or anger; validating the Loved Ones feelings, and then refocus them; this sometime brings the problem issue down.

When the news is on television, such as the hurricane issues, mass shootings or other disasters, this can cause onset of delusions based on fear and the need to "do something."  In such a case, it is best not to tune  the TV to such information when the LO is present in order to help our LO maintain balance.

Structure and routine and an uncluttered environment with no loud noise in the home can also be helpful.

The delusion regarding the unfaithful spouse is a sad delusion based on fear and insecurity which may be free floating as the LO with dementia cannot work through that feeling nor expresss it or the reasons behind it.   It certainly is also a dynamic that can cause issues for the caregiver.  Some have shared that telling their LO that they are the only one they love and will always be there for them; that "we are a team," and we will do everything together and I will always care for you and take care of you, can sometimes help.  And of course, sometimes this has to be said more than once, etc.

If being on Facebook is an issue, tell the LO a fib . . . . you do not use Facebook any longer, there are too many problems and it is not good.  Then let the LO feel you are not contacting others when on the computer and do what you are going to do when not in sight of the LO and no need to tell the LO you spoke to so and so on the computer or saw input from so and so on the computer.  Just best to let go of such information to bring peace to  one's LO.

Sometimes, no matter what we do, our LO can be delusion driven on the highly negative side of the ledger.  When this happens, it affects the very quality of life for our LO who is in a highly upset and often even irritable or agitated state much of the time.  Imagine what is is like to be in such a situation with no relief; not only believing all the dread rigid false beliefs, but FEELING them. 

If it is within our power to help our LO to a better quality of life and free them from fear and horrible upset, then for me it would be unconscionable not to do so.  We must advocate for them because they are no longer able to do this for themselves.  This is what I ran into with my LOs.  Yep, times two.  My LO was delusion driven which caused her to be over the moon with horrible behaviors that no lesser measures could help.  Then my second LO had ongoing persistent delusions causing upset and even intefered with sleep.

In one instance Risperdal was prescribed;; in the other instance, it was Seroquel, both at low doses.  It was for my LOs, nothing short of a miracle.   Neither had any side effects nor were they sedated or confused by the med and delusions were actually quelled.  Their quality of life was SO much better.   They each were on the meds for years as whenever we tried to taper the meds under medical supervision, the dread behaviors once again resurfaced.  In all that time, there were no untoward effects from the meds which was a blessing.

As I am wont to say; one size does not fit all, we will each find a way to assist our LOs to bring them peace and also a bit of peace to the caregiver who strives so mightily against everchanging challenges.

Oh; and yes, when delusions increase or become more problematic, have your LO checked for a "silent" urinary tract infection.  These UTIs are called, "silent," because there will be no overt physcal symptoms or complaints, BUT there is often a change in behaviors and ramping up of delusions to the negative side of the ledger until the UTI is  treated.  It can be very dramatic and it happens quite a bit to many of our LOs.

Warmest thoughts being sent to one and all,

J.