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Behaving strangely, not sleeping whole night, getting angry and upset. What treatment should be done?

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General & Family Physician
Practicing since : 2007
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HI ,

My Mother is having strange issues. I am not sure if this is depression or what. Although my mpther have been issues like behaving strangely since many years like she used to shut her inside a room and starts beating it but usually these were temporary and went away on their own after some time. Few months back I have noticed Loss of Attention in my mother i.e. she was lost in her own world and was not aware what we were talking about although that was still fine but a couple of months back our neighbours with whom we don't go well along and my mother does not seem to like them for historical reasons came to our house for complaining about seepage that was going into their house from our bathroom. I spoke to them to understand their problem although my mom did not want me to speak to them. She called me 4-5 times and I kept telling her that I am just coming. When I came back she was very upset and after that day started behaving strangely like going here and there and when I tried to ask her, she started behaving agressively and took out a stick and said she will beat me with this if I come near her although she hit me very lightly. A few days of agression episode and then she was sitting quietly not talking nor interested in daily activities. It has been 3 months now and now the condition is that sometimes she starts behaving strangely. Here are a few of her symptoms :--

1.) She will walk too much from one End of the house to another end.
2.) Sometimes she will not sleep at all whole night ( Although she had this problem previously also)
3.) If there is some work which I am getting done in my house from carpenter, electrician etc., she gets angry
4.) If I ask her that I can take her to the doctor, she says NO and says I am alright or no doctor can resolve her issues.
5.) Sometimes she seems allright when I try to talk to her like the other day old movie songs were coming on a TV channel and I was asking her does she knows who the actors are and she was telling all the names and speaking normally but she gets into the other mode all of a sudden also normal episodes are rare.
5.) She opens the door , comes out and closes the door goes to one end of the house comes back again open the door, comes back into the bedroom and closes the door and she repeats it many times. Sometimes she will go out of the house, take a round and then come back.
6.) She becomes upset and agressive when we talk about taking her to Doctor.

Normally she is quite unaware of the conversation going around her however she is eating and preparing the tea, sometimes for us also but most of the times she is behaving strangely and this has been going on for 2-3 months now. PLEASE HELP
Posted Sat, 4 Aug 2012 in Mental Health
 
 
Answered by Dr. Sourav Ganguly 1 hour later
Hi,

Thanks for your question.

Thank you for the clear description.

After reading the problem thoroughly it is supposed that your mother is suffering from bipolar disease. Bipolar disease is a combination of recurrent attack mania and depression.

Manic features are aggressive and abusive behaviour, decrease sleep, on may also noticed during attack when she become more talkative and appear that she gain some more energy.

Depressive features are then she was sitting quietly not talking nor interested in daily activities.

But remember one thing she had probably some psychotic features like suspiciousness, going outside room, looking vacantly, sometimes appears she was absorbed in his own world. That type of features called psychotic feature so she now having bipolar disorder with psychotic features.

In old age mania, a neuroimaging like a MRI of the brain is a must to see any brain lesion present or not.

So please consult a psychiatrist at the earliest, get the tests done and then start drugs immediately. before going to psychiatrist please keep her in close observation as she may try and attempt suicide.

Hope I have answered your query. If you have any further questions I will be happy to help

Thanks,

Dr Sourav Ganguly
Above answer was peer-reviewed by
 
Follow-up: Behaving strangely, not sleeping whole night, getting angry and upset. What treatment should be done? 11 hours later
Hi Doctor,

Thanks for the answer. The problem is whenever we talk to her about taking her to the doctor, she becomes upset and agreesive and will walk away without talking and then may even go to some other floor and if I try to come near her she will scold me and try to run away from me.

Most of the time she is sitting quietly in a corner and unaware of the discussion going around her and even if somebody rings a bell of the house she will not respond after many times. Finally she may respond. Sometimes all of a sudden however she may appear normal for few minuets only, for instance I go to her all of a sudden and say Hey Mummy can you prepare tea for me, she may prepare it or she will say I just prepared it and its there in the bowl and I can take it. However sometime she talks completely nonsense which does not make any sense like she will talk about putting a trunk in bedroom for keeping clothes which does not make any sense. She also gets irritated when there is a lot of Noise around her sometimes and may go out of that room in anger.

Since it is difficult to take her to a psychatrist, because of the reasons I gave above, I consulted a local psychatrist myself here and he has told me to give her olimelt 5 mg for a couple of days by mixing it in some juice or her food etc. and then he is saying that she will become somewhat normal and then we can take her by speaking to her. Shall I go ahead and give her the medicine

Also the brain lesions you are talking about, what disease will they be used to diagnose

 
 
Answered by Dr. Sourav Ganguly 1 hour later
Hi,

Thanks for your query.

As I mentioned earlier, your mother seems to be suffering with bipolar disease with psychosis. I understand your difficulty in taking her to a psychiatrist. Very often in psychosis patient’s touch to the reality is lost; she may not understand or agree that she has some problem and medical help is required. So I agree with your current doctor to try drugs by mixing it with food or by injections till she gets stable.

However if I were your treating doctor I would keep olimelt 5 mg twice a day instead of once a day. I think that will control her symptoms earlier. Discuss with your treating doctor if that seems appropriate you may increase the dose.

In late onset bipolar disease disease, we do Magnetic Resonance Imaging (MRI) scan as a large number of cases patient may have Central Nervous System tumor, infarction or gross brain atrophy. These conditions (if any) need to be treated.

Hope I have answered your query. If you have any further questions I will be happy to help
If you do not have any clarifications, you can close the discussion and rate the answer and write a review.

Wish you good health.

Regards
Dr Sourav Ganguly
Above answer was peer-reviewed by
 
Follow-up: Behaving strangely, not sleeping whole night, getting angry and upset. What treatment should be done? 5 hours later
Ok One last thing. Do I need to fear dementia or anything uncurable/untreatable like that. I was worried about it

 
 
Answered by Dr. Sourav Ganguly 3 hours later
Hi,

Thanks for your query.

In your mother’s age group there is a high chance of dementia. If a bipolar disorder patient has dementia, then the dementia features are usually not prominent and only a psychiatrist after taking proper and detailed history from the patient can diagnose it.
A MRI will help us pick this up since we’d be looking at changes like diffuse brain atrophy, ventricular dilatation, ischaemic changes e.t.c .
As of now, I don’t think we need to worry in this regard. Even though there is no cure for dementia, but if it detected early then patient can be fully symptom less by drugs and can spend a normal life.
Hope I have answered your query. If you have any further questions I will be happy to help
If you do not have any clarifications, you can close the discussion and rate the answer. Wishing your mother the very best.
Thanks,
Dr Sourav Ganguly
Above answer was peer-reviewed by
 
Follow-up: Behaving strangely, not sleeping whole night, getting angry and upset. What treatment should be done? 1 hour later
Thanks Doctor,

I saw on the Internet somewhere that Olimelt (olanzapine) should not be given to elderly patients as it can cause NMS (Neuroleptic malignant syndrome) or sometimes stroke. Is it true. How much are the chances and what should be done.

To start with I was thinking of giving just 2.5 mg of dose rather then 5mg just to see the reaction of my mother's body to the drug.

Do you think even 2.5 mg of Olimelt will give some releif from the symptoms or is it too less of a dose.

Also I saw you are saying that Dementia although not curable but person can still live symptom free for his whole life. Does that mean dementia if NOT at all fatal and will not reduce the age of a person if detected early and if person takes drug for his whole life. By the way I tried checking on my Mom by asking her what day it was and what was the date. She was able to tell me Today's date and day although for some questions she doesn't reply at all. Her major symptom I am worried about is loss of attention.
 
 
Answered by Dr. Sourav Ganguly 48 minutes later
Hi,

Thanks for your query.

Yes olimelt can cause neuroleptic malignant syndrome particularly in high doses(20 mg) and elderly lady,but 5 mg BD dose is safe. Please speak with your physician about drugs like trihexiphenidyl to further reduce her chances. Also, a dose of 2.5 mg olimelt is too low and didn't work.

Please consult your psychiatrist earliest and discuss the symptoms. He will taken care of this.

Hope I have answered your query. If you have any further questions I will be happy to help


Wish you good health.

Regards
Dr Sourav Ganguly
Above answer was peer-reviewed by
 
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