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She is being super bossy with caregivers, refusing to eat, going into periodic crying spells and just having temper tantrums. Her psychiatrist said that she believes she metabolizes her meds fast but won't increase anything or change much. We are having issues at her senior daycare now because of her behavior. She has just become such a handful. Any advise is appreciated.

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A psychologist is the doctor who listens and can't dose meds.
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JoAnn29, you are probably picturing a psychiatrist performing talk therapy. Doesn't happen. Psychiatrist's are medication managers. When I see mine the nurse first goes through a check list and asks open-ended questions (that a caregiver could probably answer), she highlights changes, etc., the doc briefly reviews the nurses notes and see me for about 10 minutes, to decide whether to renew all prescriptions or make changes.

My husband, with Lewy Body Dementia, saw a psychiatrist specializing in sleep disorders for years. When the dementia manifested itself the psychiatrist referred him to a behavioral neurologist who specialized in dementia, and LBD in particular. The two doctors consulted sometimes on medications.

A psychiatrist can be an important part of the dementia care team.
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My mom started acting this way back in Feb. Her doctor could not get her meds right and at one point we were up 72 hours straight. I agreed with everything she said with a smile on my face. (Dementia patients read you by the look on your face!) I would keep low key stuff on tv or soothing music. I eventually had to put her in behavior healthcare for 4 weeks so they could get medicine right. It was a good program. Maybe your doc could recommend something like that!
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I really appreciate all of your responses. I have learned a lot. One thing was to look for triggers. I think I detected a couple just by sitting back and thinking.
I do get my respite. She goes to daycare during the day and most days really seems to enjoy it. She is just getting comfortable with them now to start showing her frustration and being bossy. They didn't expect it although I warned them in advance months ago. She does see a neurologist and she recommended that we keep with the same psychiatrist. She doesn't go for counseling because she obviously doesn't have much to say that makes sense but she goes for medication management. I know the disease will progress but I was hoping that there are options in medications to help her moods. We made the promiss that we will take care of her until she no longer knows who anybody is. Best of luck to the rest of you that are in my same shoes. It's a tough, really tough job but I will make it through this. I am not really a support group kind of person but I may just join one.
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My father had dementia. I'm also a nurse and have worked with the elderly for years. Too many choices cause huge problems, two at the most are manageable. That includes dressing, eating, time of shower or bath (now or in an hour) Touch often helps, objects from jobs or hobbies are helpful & soothing. Piano, typewriter, fabric, yarn, a board with different locks or shapes to work with, gardening even if it's in a planter in the house, animal visits, stuffed animals. My husband works on his computer for hours every day.
Don't argue-you can't win and it just upsets both of you. Yes the sun does come up in the west!
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When my friend became uncooperative in letting people clean her up when she soiled herself with her incontinence, I was told she needed to go to a geri-psych ward in a near-by hospital to find an anti-pscyhotic medication that would calm her down without doping her up. I tried 3 different hospitals before I found one with an opening. They were so skilled in handling her. I visited her several times the 3 1/2 weeks it took to find the right medication and dosage and she was happy and well-cared for whenever I saw her. I would research your nearby hospitals to see if they have anything like this. I am hoping it is becoming common-place with the increasing number of elderly dementia patients out there. Once she was "agreeable" again, I brought her back to her memory care apartment and husband where she was able to stay until she passed on. The advice I was given was good and I was surprised on how well it worked. Good luck!
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Joann29, Psychiatrists understand how to medicate the behavioral manifestations of dementia- the agitation, anxiety, depression and the like.
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sadforkathy2016: Her doctor needs to be made aware of this stat!
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My Grandma gets fussy with her caregiver. She's been to psychiatrists, takes Wellbutrin, been diagnosed with everything from schizophrenia to manic depression. The caregiver threatens to quit when my Grandma belittles her, sometimes walks out the door. Then my Grandma calls her to apologize. My Grandma is 88, very opinionated, gives money away to Jamaicans by mail, and doesn't mind offending people. I found myself hiding from her when I visited. She holds back a lot of her insults for my sake, but not the caregiver. That's my only proof she can still control herself.. The caregiver told me she hides from my Grandma... My MIL, who's 69 and doesn't believe in mental health problems; acts like a spoiled brat, humiliates others in public, and belittles others with health or psychiatric problems, despite having these issues herself.. She acts perfect in front of strangers, and turns cruel to those closest to her.. I told her to stop it since it was apparent she could go back and forth with her bad mood based on who she was with.. Her response was to call her entire family, and church members where I attend to lie about me, saying I made her cry. She also says I've made up accusations, and just want to hurt her... I was crying and having a nervous breakdown when I confronted her cruel behavior. I was on my 20th year of dealing with her two faced ways.. . How she stays blind to the pain of others is mysterious... She can't see how mean she is... My Grandma seems to even back down when we ask her to be nice, but my MIL, who's younger, acts entitled to her bitterness... Is this mental illness or just a mean person? My Grandma says sorry for being mean, but MIL doesn't.. I'm not sure if these are symptoms of some form of dementia, depression, or just plain bitterness from not getting her dream life. That's all she talks about.. She's always the victim.. Is this what you Mother in law does? To cope,find a hiding place, or you'll get real angry at those you care for. Pray for patience, stay outside, or in separate rooms.. Stop allowing yourself to hear what she says when the tantrum starts. The Drs and psychotherapy are ok, but they only feed that constant need, and that need won't stop til death. She must find a way to cope with her anger without intervention.. She may feel robbed by life, cheated out of happiness.. Walk away, but don't leave. Is she into family history? Are there subjects that calm her, and others that upset her? I find my Grandma and MIL love the family history stuff. It makes them feel needed and important when I ask them about their childhoods, parents, etc. That was the only time I saw my MIL cry was when she spoke of her childhood.. They start telling stories, some good, some bad, but they can relive these traumas through more mature eyes, and take the sting out of the memories. It gets hard to humor them when they play the prune, but you never know when someone won't be around... I lost my Mom and Dad already. Both under 60 years old... I hope things get better for you and your MILs dementia...
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This is really young for Dementia. And with what ur describing, it's not moderate.
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Please answer this question: why a psychiatrist? A Dementia patient cannot express what they need or want. Dementia is a neurological disorder so why not a neurologist?
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The short answer (from my experience over this last 1-1/2 years dealing with a client (not relative) is (1) set boundaries; (2) leave when you need to and get a respite for 10 minutes to 2 hours to two days. While 'some' of this behavior is due to dementia, I realize that life-long patterns of behavior (feelings of powerlessness, anger from childhood wounding) manifest now - in these later years. While she may or may not connect that her behavior = you leaving (for a period of time, i.e., there are consequences to her behavior), a part of her may get it. If not, you leave and not get emotionally sucked in. This is something I work with constantly over 1-1/2 years. The more I can learn to deal with it, the more growth for me in all ways - setting boundaries (emotionally and psychologically, and physically). It makes me a stronger person. We can be both compassionate and caring AND set boundaries. Do not allow yourself to be depleted and learn to set boundaries for your health and well-being.
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How does one find a good psychiatrist to deal with the dementia behavior mentioned above? It seems no caretaker fits the bill, and combative reaction towards me (her daughter) is standard. My mom's primary doctor is a joke, the insurance company will only provide a list of doctor's to choose from, the HMO doctor that I chose for elderly care, the supposed Gerontologist, took tests, reluctantly discussed then with us, prescribed medication, when that didn't worked, told me to get a psychiatrist (not personally but through her front dest people!) Imagine? and now we are back at step one again. Dealing with HMO insurance plans are ridiculous because no one cares. Medicaid simply wants to put her away in a nursing care facility and that's that. How do we fight city hall?
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Know that a person with dementia is basically a 3 year old - they can turn from happy to angry to happy again in minutes - when my kids were small I gave them control on small items such as ketchup or mustard on a hotdog [but not what bedtime is] & those with dementia need that sort of thing possibly even more due to life experience -
Let her choose which sweater she will have that day but only give these choices between 2 or max 3 items - so say 'which slax to you want to wear .. the black or grey' but not 'what do you want to wear?' as that will overwhelm her & cause a new problem
When I visit mom I always bring a small treat [cookie/doughnut with premium coffee] so she now associates me with something positive - I ask her if she wants to go to garden or her room - this seems to give her a moderate level of control - this is very important to someone who had very little control because she is in nursing home where meals, activities etc are all set -
The nurse who regularly checks her blood sugar tells her that she is checking to see if she is sweet enough & they have a giggle over that - a bit of humour is a help - when mom said she wanted to be buried with her parents [3 hours away] I promised her I would even if I had to strap her to the roof & put fake xmas antlers on her ...she got such a hoot over this saying she wouldn't be 'a departed dear but the dearly departed' - she remembered this so well she repeated it to several people & laughed each time - this issue has never come up again as she was so happy with it she has scratched it off list of issues to worry about - yes they worry about issue you wouldn't think they do
Mom went through the crying stage, the anger stage, the accusation [stealing, talking behind her back etc] stage however I found her behavior improved drastically when she was switched from the super strong coffee my dad made to decaf - caffeine is stimulant & she was over stimulated [we used to joke when she woke up she headed straight to coffee pot that we should just but caffeine in her insulin] - this is the easiest change to make - we mixed regular & decaf gradually so there was no noticable change - good luck
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I found my Mom's disposition in the mornings hateful and short fused. I later found out the caregivers would help themselves to a strong pot of coffee upon arrival and offer her the same WITH HER AM PRESCRIPTION- STEROIDS. Metabolizing too fast or just not being monitored, it's a daily thing that my Mom will do regardless.
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Good tips above. I would consider stressing the need to adjust meds to her doctor and if she's not interested, I'd get a second opinion. I know that's a huge deal, but in the long run you need a doctor who is sensitive and responsive to the patient's needs. These outbursts signal mental turmoil and that has to be treated.

I would also try to do some investigative work on her behavior at the senior center. Can you observe her without her knowing for a day to try to see what may be inspiring her behavior to happen. Sometimes, it's the brain that has been damaged, but other times, events and people can trigger it.

For example, is the senior center too loud for her now? She may have progressed to a stage where she has little tolerance for noise and commotion. Maybe, she's overly stimulated there. Does she get tired and frustrated? It could be any number of things contributing.

You might check to see if she has any pain that she may not be able to verbalize. Sometimes pain can result in acting out in a dementia patient.

If you can't pinpoint anything, I'd try to change up her schedule and see if that helps, along with a medication adjustment. Can you only attend the senior center for half a day? Just to see how she responds.

What is causing her dementia? This stage may pass with time. My cousin was very confrontational for no real reason for a while, but, later that changed and she stopped the arguing, anger, etc. She also is on meds for depression and anxiety though.
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I agree with ferris 1. Time for a new doc. She's metabolising her meds fast AND the solution is?.... You can't live under this stress and neither should she.
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Is there perhaps a reason she is acting out? Often children who cannot verbalize their emotions will act out when something is afoot. Older individuals with cognitive decline can do the same. Is something going on at adult day care? Does she have a caregiver she doesn't like, who she thinks/perceives is 'mean' or rubs her the wrong way? Does she get enough choices? Even little things like what to eat for breakfast or what to wear that day can be huge. She may be having tantrums because she feels things are out of her control? Remember, even when our seniors have dementia, they are still in there, feeling, reacting, etc. They may lose the ability to articulate the feeling, but not the feeling itself.
Good luck! This is a tough one!
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As with any mood disorder plus dementia, it is important to have the right psychiatrist. Try finding one that will adjust her meds so she will even out her mood swings. You can fire a doctor you know. If your mother-in-law is presenting with behaviors that are so disruptive to her daycare, then you need to find a solution, and one is to try changing doctors who can change her meds because something is not sounding right to me. This advice is given because I have had lots of experience with psychiatrists. Just like anything else, there are varying degrees of expertise.
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not sure if she has yet to find a fellow soul mate, or buddy to comfortabily chat with - sometimes God helps those who are willing and want to be helped, and not attention seekers. Its gooa be 1 person unhappy - or spread to everyone else....I think at a certain point, when all available care is provided, we have to then step back and lives our own lives too.....
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Is her psychiatrist someone who specializes in the care of elders with dementia? What is she recommending you do?

It's possible that the doctor isn't getting the impact that her behaviors are having. Keep a log. Video an outburst. Present these to the doctor. If she doesn't have any better medication suggestions, the you need to find a doctor who will work with you to get your mom's agitation under control.
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We do convince her to eat by the way.
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