Paranoia / Aggression?

[Cal5]

I'm just looking for input really. In the last few weeks Dad (who has moderate-severe VaD) has started to display new aggressive and paranoid behaviour. This typically has happened with carers when they sit with him on the few hours I get out. Three times recently he has threatened to throw a chair at the carer (though fortunately not followed through) and generally has prowled round the place, banging doors and trying to get out.

Now, quite consistently, whatever we do in an evening he starts getting agitated around 8pm. Recently this has led him to accuse us of maltreating, deceiving him, etc. He keeps saying he 'just want(s) to go home' and makes it clear that this means suicide.

His GP has increased his anti-Ds (Escitalopram) recently which has helped with moods with us during the day time, but not with carers or with us in an evening.

Should we expect to spend each evening being verbally accused and at risk of worse (I had to take the poker off him this evening!)?? I now don't relax even if I'm out for fear of what I come back to, and what might happen with the carer...

I've read the Az Soc leaflets on aggression etc. I'm just wondering when I refer this back to GP / Psychiatrist (the latter has been of little help though) ? I guess I'm concerned they'll just prescribe anti-psychotics and I'll only be left with an empty sleeping shell...


Any thoughts?

(Where did my lovely Dad go?? )

[Christin]

Hello Cal, I am so sorry to read this, I can understand why you are so concerned.

Can I ask if it has been the same carer each time, perhaps they are not connecting with your dad at all. We were very lucky that we had two sitters who were marvellous and sat and talked to my FIL and they became like friends.

I am just wondering if it might be worth asking for someone different to sit with your dad. Sometimes it can be down to personalities, with no disrespect to the sitters.

By all means contact the MHT, your respite time is important for you, and you must find a way around this.

Very best wishes to you x

[Cal5]

Can I ask if it has been the same carer each time...

Hi Christin.

This is partly what's worrying me. The first twice was with the carer he had previously got on with the best. She knows him very well, is very caring and experienced. The third time was with a totally new person. So the only consistent thing was me not being there.

Obviously I'm also concerned that he's now turning his aggression etc towards my wife, and myself.

[Christin]

Hello, Cal.

I wonder if your father would respond to a male sitter?

I can see that you are concerned about the aggression towards your wife and yourself too though. You may have already read this, but I am just popping in this AS factsheet Unusual Behaviour which talks about Sundowning.

I do think now is the time to contact your GP. When we felt we not getting anywhere we wrote letters to our GP, and sent copies to the Mental Health Team. It did move things on for us, although we were told there was no medication that could help. The answer, in my own opinion, is that you should not have to spend each evening in fear.

Can I just add that in our experience, my FIL began to think that I was his wife. On one occasion when we had some friends round and he wanted to go to bed, he became very annoyed with me when I said I was staying up with our friends. He also swore at me when I went out with my own husband, leaving him with a sitter. It was only later that we understood why he was so upset.

Very best wishes to you all. Please do let us know how you get on. You have my sympathy. x

[Grannie G]

My husband had strong reactions to carers being with him, it was part of his paranoia to believe everyone was watching him because he was `mental`.

I managed to get the carers to agree to doing some housework and staying in the kitchen, allowing my husband to believe they were there to help me.

Do you think you could get round your difficulties in a similar way.

I can think of three possibilities causing the problems during the evening . One is if the rooms are not well lit and another might be the effect of tiredness.

The third is sundowning which is certain restlessness and agitation, often with indications the person wants to `go home`.
It was at this time my husband started to pack his bags and it happened almost every night for quite a long while.

Sadly sedation and antidepressants did not help . All I could do was let him get on with it, making sure the doors were securely locked. It was easier in the winter because he did not want to go out in the dark. When the nights were lighter and he had no concept of time, it was much more difficult.

I hope you have discussed these issues with your father`s doctor.

[Cal5]

Many thanks for this.

Dad has had 'sundowning' episodes for quite some time now. Until recently these were just agitation and confusion, what we're getting now is more clearly aggression and paranoia.

Off for a day out with him today (despite feeling a bit apprehensive about his behaviour). We're hoping this might break the cycle for this evening at least....

I'll give some thought to the idea of re-focussing the carer, as I hadn't thought of this - though they have recently been using an adjoining room much of the time. I suspect that it's more about Dad's attachment to me and feeling left out if I actually go anywhere.

Thanks