Category: #dementia

Is it a psychiatric illness or a drug-induced psychosis?

First, what is psychosis? Psychosis is a term used to describe when a person interprets or perceives reality in a different way than those around them. Psychosis may be a symptom of mental illness, but that is not always the case. Nobody knows exactly what causes psychosis.

May 11, 2022

Observations

Suzi visited her mom, Val Thursday after work. Suzi checks in on her about twice a week. Val is 70, active with high cholesterol, high blood pressure. arthritis, and mild depression. Val takes her medication regularly and as directed. Suzi notices that her mom is not quite herself. Val cannot follow the conversation and does not seem to be able to concentrate.

The first thing Suzi thinks is, an UTI. Possible dehydration. They go to the Dr., but the urine test comes back clean. No infection and her electrolytes are all in the normal range. Hmm. Now what? Nobody seems to know what to do next, but wait and see.

It is now a week later and Val is not better and in fact she is a little worse. She cannot remember if she has taken her meds or not. She is unsure of what has happened over the last three days. Suzi is getting more and more concerned. This is not normal and her mom has never been this way before. Suzi wonders if her mom is developing dementia, Alzheimer’s disease or mild cognitive impairment.

In this particular case, her physician looked at her medications and had a consult with her pharmacist. They determined that most likely it was her blood pressure medication and/or her arthritis medication. Outside chance it could be anti-depressant med, but not likely. They began a withdrawal of HBP medication and started a different one. Val was some better, but not back to normal. It was not her arthritis medication; it was her anti-depressant medication. She was slowly weaned off of that and they did a wait-and-see approach to see if she needed to be on an anti-depressant anymore. Her mind cleared and she was back to her normal self.

While this case was a success, many more are not. No one thinks to check the medications. Why? Well, their thought processes go along these lines – She has been on these meds for three years or more. It came on suddenly, it must be a UTI or dehydration or she does indeed have the beginnings of mild cognitive impairment or a dementia.

Medications are not without risks and problems over time. As we age, our metabolization and kidney function decrease. We cannot clear meds as quickly or as easily as we once did. You know when your loved one is “not right.” You may not know what it is, but you know that something is wrong. Push for answers, never accept it is “just old age,” dementia, or other assumptions. Blood tests and urine tests need to be done. Medications need to be checked. Hydration and nutrition need to be addressed. We want to rule out any fixable problems.

Psychosis can be:

  • Due to stressful life experiences or trauma
  • Part of a neurological condition such as dementia. Alzheimer’s disease, or Parkinson’s disease
  • Triggered due to a brain injury
  • Medication side effects
  • Effects of illicit or illegal drugs such as marijuana or cannabis
  • Effects of alcohol withdrawal
  • Triggered by menopause
  • Triggered during times of severe stress or anxiety

As you can see, it is not black and white. Many things can trigger a psychosis. By the way, marijuana is not the gateway drug to addiction. Trauma is the gateway to addiction. The self-medication, whether it is alcohol, marijuana, cocaine, hydrocodone, heroin, etc., becomes the problem due to another problem. We have to deal with the primary problems first! Yeah, I know, we chased a rabbit there.

We don’t think about medications as causing a psychosis or a psychotic episode, but they sure can. Too often, we assume that it is a mental health issue. Maybe it is, but, we need to find out and rule out other fixable causes.

Understand that some classes of drugs can cause psychosis.

Classes of meds that may cause psychosis:

  • Muscle relaxants
  • Antihistamines
  • Antidepressants
  • Cardiovascular medications
  • Antihypertensive medications
  • Analgesics
  • Anticonvulsants
  • Antiparkinsonian medications
  • Chemotherapy agents
  • Corticosteroids
  • Stimulants

From the list above, you can see that the possibility is real that the psychosis is from a medication and not mental illness. Alcohol abuse or misuse is another inducer of psychosis.

Drug-induced psychosis usually only lasts until the medication/drug has cleared the body. Depending on the drug, the metabolization and clearing may take from 1 day to several weeks (if it is from a stimulant medication).

A healthcare professional needs to be contacted. They can decide where the safest place to “come-off” the medication will be. Drugs can affect different people in different ways. What causes a psychotic episode in one person may not cause a psychotic episode in another person. Genetics plays a part. Life experiences play a part. Pre-disposition to mental illness plays a part. Remember, mental health disorders can cause substance use or misuse on its own. The mental health disorder can be exacerbated or intensified by medication use, abuse or misuse, but it is not caused by the meds.

We should note that schizophrenia is not caused by drug use, abuse or mis-use. It may trigger schizophrenia symptoms in those people susceptible to schizophrenia.

Common signs and symptoms of psychosis includes:

Hallucinations – when you see, hear, feel or taste things that other people don’t

  • Hearing voices or sounds that others don’t
  • Seeing things that others do not see
  • Tasting things when you haven’t had or eaten anything
  • Feeling someone touching you who is not there
  • Smelling things which other people cannot smell

Delusions – unusual beliefs that other people in your “community” do not share, even though they feel real to you

You may worry:

  • That you are being followed by secret agents or members of the public
  • People are out to get you or to kill you (may be strangers or people that you know)
  • That a chip has been implanted in your brain to monitor your thoughts
  • That your food or water is being poisoned
  • That you are a powerful person or God

Cognitive impairments – these relate to mental action (learning, remembering, functioning)

  • Problems concentrating
  • Memory problems
  • Difficulties understanding new information
  • Having a difficult time making decisions

Alcohol, amphetamines, phencyclidine (PCP), cocaine, and hallucinogens are among the most common causes of drug-induced psychosis. Symptoms of drug psychosis include:

  • Paranoia and terror
  • Hallucinations. A person might see, smell, or hear things that aren’t there.
  • Delusions. A person may adopt demonstrably false beliefs, such as that a demon is pursuing them.
  • Dangerous behavior. A person might attempt to fly, harm themselves because a voice told them to do so, or become a danger to others. Some people who experience psychosis become aggressive.
  • Disconnection from other people or from reality. A person may appear catatonic or totally withdrawn.

Drug-related psychosis is distinct from other forms of psychosis in a few ways:

  • It appears while under the influence of or withdrawing from a drug.
  • It comes on suddenly.
  • It is typically more intense than other forms of psychosis.

Illicit/Illegal Drugs that most commonly cause substance-induced psychosis:

Methamphetamine

Cocaine

Marijuana

LSY

Peyote

Mushrooms

Ketamine (this is a Rx drug, but is used illicitly)

PCP

Ecstasy

This overview is so that you know and understand that medications can cause psychotic episodes. What signs and symptoms to look for? Contact your healthcare provider for withdrawal and monitoring needs.

Pat

If it isn’t visible, it isn’t happening and other bull$%^!

If it hasn’t happened to them, they have no idea what is going on. But, a lot of them have an opinion about how you are; how you should or should not feel. Even if they have experienced it, it may not be the same as how you experience it.

March 9, 2022

We are all different. Our life experiences are different. Our pain tolerance is different. Our bodies are different. Sure, they are comparable, but they are not exact. We metabolize foods and medications differently or not at all. So many variables affect our immune system. So many things affect the inflammation inside of our bodies.

Biological processes are variable. Cultural traits are different. Genetic make-ups are different. We all have special qualities. We have our own body type.

When did healthy become based on appearance?

You can be really thin and be very unhealthy. You can be overweight and be really healthy. People of all shapes, sizes, weights, can either be healthy or unhealthy. You are in your body 24/7 how do you feel and what is going on with you? Is your body nourished with the foods that it needs? I am not talking about stress eating or emotional behaviors, just plain old giving your body what it needs to function at its highest level. Food, hydration, rest, activity and sleep are all important for a healthy body.

What happens when a body has an autoimmune disorder? An autoimmune disorder is a condition when your own immune system mistakenly attacks your body. It destroys healthy body tissue by mistake.

How would you think a person might feel while all of this is going on inside their body? They have pain, tiredness, fatigue, nausea, rashes, headaches, dizziness and more depending on what disease they have. They feel these things, All-of-the-time, because they have these things all-of-the-time. It would be rare for them to not to feel bad because their body is under attack.

My hope is that these folks are working with their doctors and other health care providers to find out what works best for them and their needs. To have the best quality of life possible. I only want folks to take the medications that they need. To use other means to help manage their conditions. Nutrition, hydration, strengthening, mindfulness-based stress reduction meditation, stretching, rest and activity. It takes all of these things plus medications to improve quality of life.

I get it. It is hard to do all of these things, work full-time, have a family life, friends, etc. Don’t look at it as giving things up. Look at it as caring for yourself to improve your energy and strength so you can spend more time with those that you love and do the things that you enjoy doing. Your friends and family can do all of those things with you, except, take your medication. It is probably easier to have a work-out buddy to keep you engaged and committed to the routine. That is the key anyway. It will become a routine and then a habit. Once it is a habit, you no longer have to use a lot of brain energy to figure out all the particulars.

Living with a chronic disease is hard. It is hard on the person that has it and it is hard on those that love them. It sucks to make plans and then they get cancelled because of a flare-up or a bad day. Once or twice, you can usually get over it, but more than that, it begins taking a toll on all involved.

No body wants to make plans because they get cancelled. A wall begins to build up. Everybody is pissed and nobody is talking to nobody about the elephant in the room. Maybe, it is because you don’t want each other to feel bad? Maybe, it’s because, you know that sometimes shit happens and you have to adjust.

It is great to realize all of that. You must also talk with each other about it. How you see things, how it makes you feel and what you want. You aren’t really mad at each other; you are mad at the situation. If you are mad at each other, I suggest you go and get counseling now. It does not matter if it is a partner relationship or a friend relationship, you do need help in navigating these issues.

Too often, only the medical side is addressed. No body wants to deal with the messy part of a chronic illness. The parts that leave families strained and sometimes broken. You have to deal with the messy parts. Once you do and you have a workable plan, it can make all the difference in your relationships. It is not easy, but the results are worth it. In my business, I deal with the medical side and most parts of the messy side. If you need a therapist, I will recommend that.

Learning and understanding what is truly going on with a person that has a chronic illness is eye opening. Being able to modify plans or activities will improve relationships. You want them at their best, so what are you going to do to help them get to their best?  Can you relate to what they are experiencing?

Pain is subjective. We all have different tolerances and what may be a 10 (the absolute worst pain you have ever had) may be a 3 or 4 (mild to moderate) to me. I am sure you have heard people state that they have had a kidney stone and it was the worst pain possible. It has to be worse than having a baby. Why? Because you “say so?”  Because the pain you experienced was the worst pain in your life does not mean that it was worse than the pain of childbirth. Some of you mom’s that have had both can speak to this. I have heard a few moms say that childbirth pain was the worst and I have heard a few moms say that the kidney stone pain was worse.

Here comes a rabbit chasing. No one needs to suffer from uncontrolled pain. I understand that all pain cannot be eliminated and that is not really the goal of treating chronic pain. We treat chronic pain to help those with that type of pain to live the best quality of life possible. An active life. A fulfilling life. Managing the pain to a tolerable level is the goal. Treating chronic pain takes a multi-prong approach. Medication alone will not provide the relief needed. Strength training is one way to reduce pain. Running or walking is another way to reduce pain. Eating for nutritional needs, is yet, another way to reduce pain. Hydrating every day is another way to reduce the pain. It is all connected. Yes, I know there are many different types of pain. Thus, the multi-prong approach. I don’t believe in cookie cutter approaches to treating pain. People are different, their pain is different, their tolerances are different, medications work for some, but do not work for others. It is very easy to get frustrated when every thing that you try does not work. I use a combination approach with my clients and that seems to work better for pain relief and pain control. It will take effort, some fine tuning to the plans to get the right combination that works for you, but it will be worth it. Rabbit chasing over, for now.

After a while, folks just give up. The one with the chronic illness and the one without the chronic illness, just give up. If your loved one has a chronic illness, help them to become they best they can be. Encourage them to take back control of their life. Help them to focus on the solutions and not the freaking problems. What can they do? What can they improve? What will it take to help them? You can’t make them, but you can encourage them, believe in them and help them when they ask. You can’t do it for them and they do get to decide what they will or won’t do.

To the one without the chronic illness, you need to take a look at your beliefs about the one that has the chronic illness. This may get ugly. Do you understand what they go through every day? Do you understand that they feel like they let everybody down? Do you understand your part in not being able to go and do? Are you becoming an enabler to their lack of action or lack of participating in activities? There are other things, but you get the idea.

Don’t give up! There are things to try. There are things that will make your life easier. Get ready to look forward to activities again. Yes, you have to think about getting ready. You have to reason it out in your mind. The negatives will come rushing at you. All of the “you have tried this and it didn’t work,” thoughts will flood your mind. It may not have worked then, but it is possible that it will work now by doing “x,y and z.” If you are not open to the possibility that things can get better and actually be better, then they won’t.

Who do you need to add to your health care team? Me? A sports psychologist? A nutritionist? A therapist/psychologist? A trainer? A workout partner? A deal with my anger and other emotions therapist?

An autoimmune disorder may cause destruction of body tissue, may cause an abnormal growth of an organ, or even cause changes in organ function. The areas most often targeted are blood vessels, connective tissue, joints, muscles, your skin, red blood cells, your thyroid or your pancreas and other endocrine glands.

Very few of these disorders can be seen. It is all happening inside the body.

Here are some of the most notable autoimmune disorders:

Next time, we will touch on other non-visible health conditions such as migraine, depression, heart disease, etc.

Pat

How the senses change in dementia…

No, they are not just being difficult.

March 2, 2022

Your loved one is having an unexpected reaction to the food they are eating. They stop eating, declaring that it has no taste. They become very apprehensive while walking through a door into a restaurant. They are nervous and are becoming more and more irritated. They cannot seem to judge how to sit down in the seat. They seem so distracted that they cannot read the menu or decide what to order.

These things and more are due to the brain not being able to process the sensory inputs correctly or in a timely manner. Their sense of taste and smell have lessened or may even become non-existent. When areas are too dark, they are unable to differentiate the floor from the walls, tables or chairs. Their depth perception is way off and maybe they begin to sway more and even fall more. Noisy places can send them over the edge. Too much sensory information overload can cause a meltdown and unwanted lashing out behaviors. The talking, the music, the televisions may be too much for them to handle.

You probably will not be able to calm them down and so it is best to remove them from the situation. They cannot follow the conversation with all of the distractions. They will become disoriented more easily and their balance will be affected as well.

Why is this sensory overload happening? It could be an auditory processing disorder. That can be tested by an audiologist. In mild cognitive impairment, any dementia, including Alzheimer’s disease too much “noise” can strain the brain and make it work harder. Our brains only have so much focused energy to use during the day and an impaired brain, has way less energy to use. If they expend all their energy on the “noise” issue they have no energy left to work on anything else. They may be able to hear well, but they cannot process/interpret the sensory input. By the way, hearing also affects balance.

Sight/Vision issues:

  • Lack of depth perception
  • Decrease in ability to detect movement in the room
  • Decrease in ability to see colors
  • Problems recognizing people, faces or things
  • Shadows and light can mess with their minds and what they think they are seeing   .
  • They may be able to see, but are unable to interpret what they are seeing.
  • Things may appear blurry.
  • They may no longer have peripheral vision.
  • They will need more light to see.

Smell issues:

  • Sense of smell decreases
  • They can no longer smell smoke, odors, foods that may be spoiled.

Taste issues:

  • Sensitivity to taste declines in dementias.
  • The last taste to go is the sweet taste.
  • They will add a lot of salt, if the salt shaker is visible.
  • It is perfectly fine to use other spices to help them “taste” their food.
  • When the sense of smell goes, taste goes too.

Touch issues:

  • They may be unable to tell when things are hot. You might want to decrease the hot water heater temperature.
  • They may not know when they have cut themselves with a knife.
  • They may not be able to tell the difference in hot water and cold water on their body.

Hearing issues:

We talked a little about that in our example above.

  • A person with dementia may have normal hearing, but they will probably be unable to process the information correctly. Remember, we hear with our brains.
  • Competing noises are very distracting. Even if it is normal to you, a person with a dementia cannot filter out the extraneous noises.
  • Are the batteries in their hearing aids good? Are their hearing aids working?
  • Do they need to be checked by an audiologist? NOT, a hearing aid specialist.
  • They need a quiet setting. Low music is usually fine. TV is not good and needs to be turned off, while they are eating and talking.

Impaired movement issues:

  • They may take shorter steps.
  • They may drift to one side.
  • They may shuffle their feet.
  • They may slow way down as they walk.

Balance issues:

  • It becomes harder to judge distances and they may bump in to things.
  • They struggle or can no longer negotiate stairs.
  • Balance and coordination may be off and so they trip or fall more easily.

Stiffness/Shaking issues:

  • The muscles can become more rigid which makes it more difficult to move.
  • The muscles can become tighter and restrict movements.
  • The muscles can waste away from inactivity and malnutrition.

Coughing/Choking issues:

  • The ability to chew and swallow may become compromised and even lost.
  • It becomes easier for them to aspirate and a pneumonia set up in their lungs.

A person with a dementia is actually having brain failure. The brain can no longer receive, process, interpret and react to sensory signals appropriately. What is so frustrating is that sometimes our loved ones are “all there and with it,” other times, they cannot do anything. No rhyme or reason. Some days and moments are good and other days & moments suck.

Pat

Has your life been hijacked by responsibilities outside of your control?

How do you feel about that? Okay, now, how do you feel about how you feel? Whew! That in itself is enough to make your head explode, isn’t it?

February 16, 2022

I learned a new phrase today, as I was doing some research on dealing with feelings, and I came across “meta-emotions.” I have never heard of that term before. I was thinking about my own experiences of how I felt about the frustration and anger that I felt when my life was hijacked. I did berate myself for feeling that way. How could I feel that way? I love my mama and I will do anything that I can for her. The frustration and anger was never about her. It was about the situation.

Meta-emotions can be classified into four types: negative-negative (e.g., feeling embarrassed about feeling sad), negative-positive (e.g., feeling guilty about feeling happy), positive-positive (e.g., feeling hopeful about feeling relieved), and positive-negative (e.g., feeling pleased about feeling angry).

I could not make things better. I could not fix this so we did not have to deal with all of this crap. I wish that I could tell you that I adapted well. I did not. I made it much harder than it had to be on myself. I sure learned the hard way, that I would have been better off if I had learned to accept things as they were & adapt to the ever-changing situation.

Nope, just stuff it all down. Deep down, inside. Soldier on. That will work for a while, but not forever. It will come out. It will come up in screwy ways. You won’t even know why you are feeling like you feel. It may years down the road. You can’t figure out why your emotions are all over the place. Maybe, if you got still and curious you could figure it out? Talk therapy is a much quicker way to figure it out.

I think everyone needs to do some talk therapy. Shoot, three or four sessions may be all that you need. Therapists will give you the tools you need to figure some of this “emotions” stuff out. You will also be taught how to deal with it in an appropriate manner. In other words, you won’t have to show your ass.

You won’t have to keep beating yourself up for feeling bad about feeling bad. If you are a helper or care giver you have probably dealt with all kinds of emotions. I use feelings and emotions interchangeably sometimes because I won’t slow down and figure out which one it is. Here is my attempt at understanding the difference. Emotions are neurological reactions to external stimuli. They are instinctive and we are not usually conscious of them. That friggin’ amygdala, again. It really is trying to keep us safe. We have to help it, by realizing when we are in danger and when we are really NOT in danger. Feelings are the reactions to the emotions.

  1. Something triggers you
  2. You have an automated response (your fear emotion, anger or whatever the emotion, is being sent out through your body)
  3. That lasts about 90 seconds and then that part is over
  4. What happens next, is up to you. Will you cling to that emotion or will you interpret the situation as not life threatening, reassess and move forward?
  5. Realize that how you think and how you feel directly impacts how your body reacts. This is the point where you take a breath or three and separate yourself from the experience to observe it, be objective and be curious about how you feel. No judgement allowed.

How do you manage difficult emotions?

Can you reinterpret what you experienced? Can you look for the good in the bad? Sometimes, we have to sit with that uncomfortable emotion. We have to feel it to process it. That is not fun. The upside is that we can learn from it and we don’t have to always have the negative emotions when we are triggered. We can learn. “Whatever you resist will persist.” I have no idea who said that first, but I have heard it a lot.

Emotions may not signal danger, but they may signal that you need to make a change.

Care givers have many, if not all of these emotions at one time or another. See if you can relate?

  1. Guilt
  2. Resentment
  3. Anger
  4. Frustration
  5. Worry
  6. Loneliness
  7. Defensiveness
  8. Grief

Questions to ask yourself when you feel certain emotions arise:

  1. Is what happened unexpected?
  2. Is what happened enjoyable?
  3. Is what happened going to make it easier or harder for me to get what I want?
  4. Can I control it?
  5. Will I be able to cope with what happened?
  6. Does what happened match with what I think is right or wrong?
  7. Is what happened my fault or someone else’s?

(I borrowed these questions, but I cannot find my cite link.)

What are the positives of negative emotions?

Sadness or grief may make you pay more attention to details?

Anxiety or stress may encourage you to find new ways to deal with situations.

Anger or frustration may make you see that it is time for help or another set of eyes on a situation or problem.

Guilt may help us to figure out what is ours to deal with and what is not ours to deal with.

Negative emotions may be what you need to motivate you to make a change.

**Any time that you deal with your emotions, you will get tired and feel drained. It is very exhausting, but it is worth it in the long run. **

Pat