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87 years old hyper active. Constipated and feeling restless. Taking different medicine. Any advice?

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Psychiatrist
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My father aged 87years is hyper active ,repeats matters more than 15times in a day while talking.Talks continuously for 2-3hours,not ready to listen to any body, pretends a lot in a nice manner.
Food--normal.
Problems----Constipation, restless, interested to consume many medicines without knowing any thing about it. Difficult to control him.
I am interested to have your advice so that he lives with love and piece with all family members.
He faced very tough time in his childhood.
he sleeps about 5-6hrs per day, he has been given 50mg quitipin as per Dr. advice
Posted Fri, 2 Nov 2012 in Mental Health
 
 
Answered by Dr. Ashish Mittal 1 hour later
Hello,
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     87 year old male
•     Known case of myeloma
•     Complaints of: Constipation, restless, interested to consume many medicines without knowing any thing about it and difficult to control
•     Currently on quitipine 50mg

You case is interesting and but difficult too. Even your attending physician is facing to solve it with quitipine. I will try to give my best effort to help you in this problem.

With above history, I would like to consider multiple possibilities in following hierarchy:
•     Dementia: It is very common in people more than 85 year of age. Most important feature is recent memory loss. People with it can present behavior symptoms like you mentioned in query.
•     Psychosis.
•     Neurological problem: get MRI brain. Spread of myeloma to brain

In all these condition in person mental status examination is must along with lab investigations. He may need anti psychotic medicine for behaviour control.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,
Above answer was peer-reviewed by
 
Follow-up: 87 years old hyper active. Constipated and feeling restless. Taking different medicine. Any advice? 14 hours later
Dear Dr.Mittal
I would like to clarify certain things.
The patient is behaving similar to this for more than 25 years to a lesser extent. Only after myeloma treatment this type of intolerance has increased.And MRI has been done in feb.2012.
after one doss of treatment for myeloma. Nothing abnormal has been noticed in MRI.
Myeloma treatment has been discontinued in feb. 2012 because he faced lot of breathing problem during myeloma treatment for about four to five hours and kept on oxygen for some time.He suffered by a stroke before admitting to the hospital in feb.2012. His physical fitness unquestionable. His behavior is normal in presence of
new visitors.His behavior is abnormal with family members and close relatives and friends.At least 25-30% of the day he will be absolutely okay.I hope this information will help you to understand the case and you will be able to advice me some treatment for the patient.
Thank you very much in anticipating a favorable reply,
XXXXXXX
 
 
Answered by Dr. Ashish Mittal 3 hours later
Hello again,
Thanks for follow up.

I had already kept myeloma as last possibility. But it can not be rule out for current exacerbation of problem.

With 25 year duration of illness, history of stroke and current exacerbation of symptoms, the hierarchy of differential diagnosis are:
• Psychosis: long duration of illness and behavior symptoms
• Delirium: due to fluctuation in symptoms, old age, myeloma
• Dementia: history of stroke increase its chance
• Neurological problem: Known case of myeloma, Spread of myeloma to brain
• Combination of above factors

Again in all these condition in person mental status examination is must along with lab investigations like liver/kidney function test, complete blood count, blood sugar level and repeat MRI (if necessary after examination).

I can understand your concern, but there is high chance that, he will need anti psychotic medicine for behaviour control which can be given only on prescription after mental status examination by his physician or psychiatrist.

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Regards.
Above answer was peer-reviewed by
 
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