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What Causes Psychotic Thoughts, Hallucinations And Delusions In An Elderly Person?
Question: Dear Doctor,
My father is 68 years old, he never auffered any health conditions, however he has always been anxious about his own health state. He had a pain which he didnt disclose about since last october untill we forced him to go visit a doctor and it turned out to be hernia, the operation was carried out last january.. He was anxious about it, but the main problem appeared after the operation. When he started to get more depressed and more worried about what he may suffer next. Hence a family member insisted that he should seek a psychiatrist help as his appetite was very low and he started losing weight. The psychiatrist prescribed Remeron/ mirrazapine 15 mg for 2 weeks, today is the end of the course. My question is he has got some psychotic thoughts just after taking remeron, hallucinations and dellusions which were not there 2 weeks ago, he is withdrawn, low appetite and careless about everyone and about his ownself too. Is that psychotic features accompanied with severe depression? Or this is due to hallocinogenic properties of mirtazapine? What do you suggest? Many thanks
My father is 68 years old, he never auffered any health conditions, however he has always been anxious about his own health state. He had a pain which he didnt disclose about since last october untill we forced him to go visit a doctor and it turned out to be hernia, the operation was carried out last january.. He was anxious about it, but the main problem appeared after the operation. When he started to get more depressed and more worried about what he may suffer next. Hence a family member insisted that he should seek a psychiatrist help as his appetite was very low and he started losing weight. The psychiatrist prescribed Remeron/ mirrazapine 15 mg for 2 weeks, today is the end of the course. My question is he has got some psychotic thoughts just after taking remeron, hallucinations and dellusions which were not there 2 weeks ago, he is withdrawn, low appetite and careless about everyone and about his ownself too. Is that psychotic features accompanied with severe depression? Or this is due to hallocinogenic properties of mirtazapine? What do you suggest? Many thanks
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
Depression in someone of this age is often accompanied by psychotic thoughts, hallucinations, and delusions. I can assure you this is not due to the Remeron. Indeed, over time the Remeron will help with these symptoms. However, it is a psychiatric emergency for someone to be so depressed that they are becoming psychotic. He needs to go to the ER for medical evaluation and immediate treatment, at the very least with an antipsychotic medication such as Risperdal or Zyprexa.
Dr Sheppe
tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, and thanks for your question.
Depression in someone of this age is often accompanied by psychotic thoughts, hallucinations, and delusions. I can assure you this is not due to the Remeron. Indeed, over time the Remeron will help with these symptoms. However, it is a psychiatric emergency for someone to be so depressed that they are becoming psychotic. He needs to go to the ER for medical evaluation and immediate treatment, at the very least with an antipsychotic medication such as Risperdal or Zyprexa.
Dr Sheppe
tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Prasad
Thanks for your reply Dr. Sheppe,
Well the thing that confuses me that he has got these symptoms just after he took Remeron, he was aware of everything one day before that and he used to at least communicate with family member eventhough not in a normal level. My question now is how bad is depression with psychotic features? Does he have to be hospitalised in that case? We would like to avoid him being hospitalised as in my country they dont really have good setting for these issues ( saudi arabia) . The doctor he went to today prescribed venlafaxine 75 mg once daily. What do you think ?
Well the thing that confuses me that he has got these symptoms just after he took Remeron, he was aware of everything one day before that and he used to at least communicate with family member eventhough not in a normal level. My question now is how bad is depression with psychotic features? Does he have to be hospitalised in that case? We would like to avoid him being hospitalised as in my country they dont really have good setting for these issues ( saudi arabia) . The doctor he went to today prescribed venlafaxine 75 mg once daily. What do you think ?
Brief Answer:
Followup
Detailed Answer:
In the United States he would absolutely be hospitalized for rapid treatment. Effexor and Remeron is not sufficient. He needs to be on high dose antidepressants and an antipsychotic medication, or to undergo electroconvulsive therapy (ECT). It can take up to a month for symptoms to improve. If he is not an acute danger to himself he could theoretically be managed outpatient, but this is not advised.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
In the United States he would absolutely be hospitalized for rapid treatment. Effexor and Remeron is not sufficient. He needs to be on high dose antidepressants and an antipsychotic medication, or to undergo electroconvulsive therapy (ECT). It can take up to a month for symptoms to improve. If he is not an acute danger to himself he could theoretically be managed outpatient, but this is not advised.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Prasad
Thanks for the reply. Well he is not harming himself or anyine around him, and hallucinations and dellusions did not occur in the past 3 ot 4 days.. As a pharmacist, i know that most anti depressants cause worsening of the symptoms in the first 2 weeks at least, is that not the case with Remeron? And is MRI a good tool to determine what exactly is going on in thr brain? As this was recommended by his psychiatrist who said that this will give him direction of what treatment option he would go for.. Many thanks
Brief Answer:
Followup
Detailed Answer:
Antidepressants do not worsen symptoms of psychosis. Sometimes they can increase anxiety for a few days, but Remeron certainly does not cause or worsen psychotic symptoms. As far as an MRI, this will not show anything of value, unfortunately. Depression is a clinical diagnosis and psychosis is not something that can be visualized in the brain.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
Antidepressants do not worsen symptoms of psychosis. Sometimes they can increase anxiety for a few days, but Remeron certainly does not cause or worsen psychotic symptoms. As far as an MRI, this will not show anything of value, unfortunately. Depression is a clinical diagnosis and psychosis is not something that can be visualized in the brain.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for your reply. Well, how do you decide that these are psychosis symptoms? if it just lasted for 3 days, do you consider hallucinations and delusions psychotic feature of depression? and is there a difference between psychotic features associated with severe depression and psychosis in general?
Thanks
Thanks
Brief Answer:
Followup
Detailed Answer:
Psychosis is defined as the presence of hallucinations or delusions, so this is psychosis. Depression in someone of this age is often accompanied by psychotic thoughts, hallucinations, and delusions -- this is very common. There are no differences in general psychosis versus depression with psychosis, except that depression with psychosis needs treatment with both an antipsychotic AND an antidepressant.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
Psychosis is defined as the presence of hallucinations or delusions, so this is psychosis. Depression in someone of this age is often accompanied by psychotic thoughts, hallucinations, and delusions -- this is very common. There are no differences in general psychosis versus depression with psychosis, except that depression with psychosis needs treatment with both an antipsychotic AND an antidepressant.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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