Sudden unexpected violent behaviour

Discussion in 'ARCHIVE FORUM: Support discussions' started by Charlie, Apr 20, 2006.

  1. Charlie

    Charlie Registered User

    Apr 1, 2003
    161
    #1 Charlie, Apr 20, 2006
    Last edited: Apr 20, 2006
    Hi All,

    My dad has been at a care home for about six months and very recently has started to become very aggitated. He has been hitting out at residents and
    carers so they are calling in the psychologist to reassess him and to put
    him on some medication. I'm going to see him and the care home manager tomorrow to sort out the practicalities but hopefully they can deal with dad and we can resolve the issues as best we can. Nothing seems to have triggered this (well it's hard to tell with the level of communication hes has). Dad has also been an obsessive wanderer with alzheimers, but has now started to amost run around the home exhausting himself. He also has a angered pained expression on his face. Right now, I understand why he may need to be sedated, at least temporarily.

    I've read the factsheet on agression
    http://www.alzheimers.org.uk/Caring...entia/Unusual_behaviour/advice_aggressive.htm
    but cannot work out the trigger....its more of a build up over the last week or two and now exploding.

    Has anyone else come across such a sudden change of behaviour?


    thanks
    Charlie....
     
  2. Lynne

    Lynne Registered User

    Jun 3, 2005
    3,433
    Suffolk,England
    Hello Charlie

    Welcome to Talking Point, and I'm sorry this distressing state of affairs has arisen.

    I don't have experience of this myself (my Mum is in early stages as yet) but from reading posts on this forum for some months I know that sudden changes DO happen. Usually a change to medication can help, although sometimes several adjustments to dosage have to be made before the right balance is achieved.

    I'm sure you will get other, more knowledgeable feed-back before the end of the day, but just thought I'd drop you a line anyway.
    You're not alone in your anxiety and worries, we're all in the same boat, in the same ****, only the depth varies.
     
  3. dmc

    dmc Registered User

    Mar 13, 2006
    1,157
    Hello charlie.

    my mum has dementia, diagnosed in feb but fairly rapid, her aggression got so bad during a recent stay in hospital they had to put in psyciatric intensive care unit, the things that triggered mums aggression was if they were trying to make her do something she didnt want to do e.g take medication, and i know another trigger with her is frustration, trying to get a word out that wont come.
    she's back in hospital now and she wont sleep she's on her feet all day from 5 in the morning wandering the corridors, she's exhausted.
    they put her on a medication called epilim, for the mood swings which did calm her down she's also on a cocktail of other drugs which they keep changing
    like your dad my mum s behaviour would change so quick one minute she'd be laughing, the next crying, then lashing out i think its just another of the sypmtoms of this flamin disease,
    im sure as lynne said you'l get lots of feedback all different in their own way
    hope you manage to get some help it is very upsetting for everyone
    best wishes
     
  4. Canadian Joanne

    Canadian Joanne Volunteer Moderator

    Apr 8, 2005
    16,112
    Toronto, Canada
    Hi Charlie,

    I think dmc is right, there are always triggers, we just have to figure out what they are.

    Certainly my mother (who is in a nursing home) hates to be told what to do. We've just had a rather aggressive period (2 months) and my mother has finally settled down. Yes, investigate the meds. Just go slowly. Perhaps an "as required" med for when your father is agitated? If he's agitated a lot, he'll probably need something. And as Lynne says, it can be a slow process to find the right medication.

    But hang in there - it will get better. I suspect it's the disease taking another turn.

    Joanne
     
  5. Suzy R

    Suzy R Registered User

    Jul 4, 2004
    40
    Switzerland
    Sadly the violence is all too common.

    My mum went through a violent stage, most notably when my dad was trying to change her for bed. When distracting her no longer worked, he stopped trying to change her specifically at bed-time (just leaving it to bath-time) and things are better. It looks like she was just trying to display her displeasure at him trying to remove her clothes and when done outside the context of bed-time things were a lot easier.

    I don't think the violent stage lasts indefinitely, it seems to get replaced with dumb acceptance, but unfortunately the carer gets to remember the violent outbursts, whereas for the sufferer they are over and forgotten almost immediately. On occasion my mother has even appologised for her anger, although not recently.

    Suzy
     
  6. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Yes there always seems to be a trigger, but it is not always the same one.

    I find Lionel hates to be "told" and always likes his needs attended to first, if not, anger and frustration. I guess he does not really like having to accept help, or when asks for something feels dismissed if it is not acted upon immediately.

    I do hope it is a "phase" in your dad's case, and that it will pass soon. Thinking of you,Connie
     
  7. Kriss

    Kriss Registered User

    May 20, 2004
    513
    Shropshire
    Frustration - that seemed to be the common denominator with Dad and Aunty. I always tried to see their view and a pretty hideous one it was too. Dads outbursts were short lived (although in his case his decline was very rapid so perhaps that faze was accelerated as well). With Aunt it meant that her care home could no longer cope and she was moved to one with EMI care. I had visions of high levels of sedation and god knows what else but could not have been more wrong. Her EMI home is bright and airy, she is more alert than ever and still only on small doses of Quetiapine, and she apparently greets the staff every morning with "Good Morning" the only words that ever seem to come out in any correct context. She does not appear to have shown any of those former problems and my feelings are it is because the level of attention she is given is much higher and more specialised.

    Having said that Dad was at home and the level of attention we gave him we felt could not have been higher though now with hindsight and experience we realise that maybe we should have been more accepting of his wishes to "go home" - something that we found so difficult at the time but now understand a little more.
     
  8. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    Hi Charlie,

    If there aren't any obvious environmental triggers, it might be some physical pain that caused this sudden change of behaviour.

    If your dad was in acute pain, it sounds like he would have a hard time communicating that clearly?

    I can imagine it would take a very skilled physician to pinpoint any underlying problems if your dad is quite aggitated.

    Perhaps they could try some stongish, non-sedating pain medication and see if his behaviour improved. If it did, then it might at least confirm that the pain hypothesis was worth further investigation.

    Take care,

    Sandy
     
  9. Lynne

    Lynne Registered User

    Jun 3, 2005
    3,433
    Suffolk,England
    #9 Lynne, Apr 20, 2006
    Last edited: Apr 21, 2006
    I do so hope that the above paragraph may be of some help & comfort to distraught carers facing the dreaded decision to look for an EMI care home for the loved ones. With dementia, it can become hobson's choice, it is NOT for any lack of love or lack of willingness to soldier on. The fact is just that family-home care can only cope up to a certain point, after which specialised care becomes a must.

    KRISS - did you think that his wish to "go home" (or do you think it now) meant he wanted to leave all this distress & confusion behind - die?
    (I know this is a sensitive topic - sensitively worded replies please.)
     
  10. Áine

    Áine Registered User

    Like Sandy, I wondered if he might be in some physical pain. Another discussion forum I visit talks about people "wandering" / walking because of Restless Legs Syndrome. Someone described that as feeling like loads of worms crawling around inside your legs. I guess feeling like that, especially if you can't tell anyone, could cause someone to be aggressive.
     
  11. Kriss

    Kriss Registered User

    May 20, 2004
    513
    Shropshire
    #11 Kriss, Apr 20, 2006
    Last edited: Apr 20, 2006
    Hi Lynne

    "going home" was to see his mother (long dead). Home of 30 years plus was suddenly a strange place with strange people, distressing for all.

    We did gradually find that one of our last resorts ,when all other distractions had failed, was to say OK I'll give you a lift, jump in the car, and then drive around - dropping in at friends on the way to delay our progress until he eventually "forgot" where we were going and agreed to go home (the real one) for a cuppa. It was always more difficult though in the early hours of the morning. Those were the times when we ended up walking the country lanes in pyjama's!

    As Aunty's speech is so poor I feel very strongly that much of her frustration at her previous care home may have been due to wanting to "go home" - recent or distant past - but not being able to make anyone understand. The current care home has a lovely long corridor to walk along and around and I think maybe by the time she has done a circuit the purpose of her journey may have been lost.

    I do however feel that Dad wanted to "give up" at the end. He was tired and had had enough. Being in respite was the catalyst for him.
     
  12. Charlie

    Charlie Registered User

    Apr 1, 2003
    161
    Change in medication and withdraw Aricept again?

    Update – thanks for all your kind words.
    Dad was checked out by a psychiatrist and CPN and they decided to immediately stop his dose of Haloperidol and replace this with quetiapine. They also checked dad thoroughly and it is clear that he is also depressed and he also gets very tearful and emotional.

    To cut a long story short, the change over to quetiapine caused quite a stir and dad was very aggressive for a day or two and was even separated from the other residents. He ran around manically all day and was very very disturbed. However, he has now settled for the last few days and we are hoping that the quetiapine helps him balance his emotions for his own sake as he has so much angst. Hes on 25mg in the morning and 50mg at night.

    The CPN returned today for a reassessment and they have recommended that they continue with the dose and perhaps introduce antidepressants in the next few weeks.

    They have also requested that dad Aricept dosage is discontinued. The CPN and psychiatrist say that at dad’s stage the Aricept is unlikely to have any effect.

    Does anyone have any thoughts at what stage we should discontinue Aricept?

    I can see where they are coming from as the dementia has progressed to another stage; however, our reservations are that he had a bad reaction the last two times that Aricept was withdrawn. He seemed low and had no recognition of us (his family) when it was withdrawn. Dad still recognises my mother and it means so much to her.

    Again thanks for everyone’s help!
     
  13. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Hi Charlie, thanks for the update. Sorry to hear that things have not settled yet for dad.

    Strangely, Lionel has just been put on quetiapine. The first dose knocked him out as though he was drunk, so I am unable to give him a morning dosage.

    He is on 25mg (morning & night) so have asked consultant if I can give him 50ml at night. Have read up on this medication, and these dosages are very low.

    Lionel has had his anti-depressant doubled, and seems more cheerful, but is still totally out of my control at times, hope the quetiapine works soon.

    Do let us know how dad settles, not much we can do except share troubles and experiences. At least we are not alone. Take care,
     
  14. Norman

    Norman Registered User

    Oct 9, 2003
    4,348
    Birmingham Hades
    Charlie I think it must depend on the individual consultant.
    Ours does not discontinue even with a low memory score.
    Norman
     
  15. SallyB

    SallyB Registered User

    May 7, 2005
    60
    Hi, Really interesting reading through this thread.

    It has been suggested to me in the last few days that dad's agression and smashing things could of come from frustration. Ie smashed the clock as he knows he carn't tell the time. Smashed the phone as he carn't use it anymore, it has now come to light he doesn't phone my Aunt now. When I questioned all the other things that were smashed It was suggested that he just carried on, maybe it felt good to get some of the frustration out?

    Dad was also being agressive with the nursing staff but they were trying to give him an injection to settle him down! Maybe he didn't want to be quiet!

    Sally
     
  16. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Just an update on Lionel and the quetiapine. This has now been discontined as even in a small dose (50mg) it rendered Lionel almost unconcious.

    He is now starting on Sulpiride, again minute dose, and the consultant did say this would be 'trial & error'

    Unfortunately it is very hard when things don't go quite right, as I am coping alone at home with him. Hey ho - maybe a better day tomorrow.

    I must take my hat off to the Mental Health team here, they have been absolutely wonderful. They deserve a bouquet.
     
  17. Charlie

    Charlie Registered User

    Apr 1, 2003
    161
    #17 Charlie, May 22, 2006
    Last edited: May 22, 2006
    Hi Connie, sorry to hear that the quetiapine didn't work so well. Although dad is a little more 'balanced' he seems extreemly tired all the time. Fine as long as he doesn't sit down for too long as he nods off. It really makes me feel guilty that he is being sedated in this way, but we have little choice at the moment. He does seem more alert in other ways and cracks a joke again. Unfortunately, the CPN has hassled my mother into discontinuing Aricept soon, so it is hard to measure what is keeping this alertness.

    Has anyone noticed side effects with Quetiapine????
    My dad seems be incredibly sensitive to light since taking Quetiapine. Anyone come across this side effect? We will get an optician out this week.

    Also, does anyone know any other eye disorders that may cause extreeme light sensitivity??? I came across this list of possibilities, but would like to find out if it is something to do with the medication as well

    http://www.nei.nih.gov/health/cornealdisease/

    thanks
    Charlie..
     

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