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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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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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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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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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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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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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This is really young for Dementia. And with what ur describing, it's not moderate.
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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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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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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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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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