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 Geriatric Psychiatrist 
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Geriatric Psychiatrist
The nurses at the SNF where my mother lives are suggesting that she see a geriatric psychiatrist because of her mood swings that don't seem to be attached to anything. She has a depression diagnosis and is on antidepressants prescribed by her PCP.

Of course I am open to anything that might help her, but I am wondering how a psychiatrist would treat a LBD patient with a terrible memory and rapidly declining cognitive and language skills. Add to this the fact that her PCP referred her to a counselor for depression about three years before her diagnosis, and she totally stonewalled the counselor, who gave up after five or six sessions because my mother was perfectly willing to discuss literature but nothing else. If she was unwilling then, and has dementia now on top of that, I wonder what could be accomplished. Any suggestions?

Thanks,

Julianne


Mon Jan 03, 2011 12:10 pm
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Joined: Sun Oct 21, 2007 4:18 pm
Posts: 835
Location: Acton, MA
Post Re: Geriatric Psychiatrist
Except for Frank's PCP, the only other Dr he sees is a geriatric pyschiatrist. It's not to discuss and work thru any problems, because you can't work thru LBD problems, it's to keep track of where he is and adjust his meds accordingly. We, I, am very please with him, our neurologist didn't feel comfortable prescribing meds for LBD, so we,I, decided we didn't need to see him anymore.

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Mon Jan 03, 2011 12:19 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Geriatric Psychiatrist
Of course, a psychiatrist, as opposed to a psychologist, is a medical doctor and is usually dealing with brain chemistry imbalances [we've come a long way since Freud! :P ] and usually is concerned with medication management. If you have access to a Geriatric Psychiatrist, I'd say this would be a good step.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Jan 03, 2011 12:24 pm
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Geriatric Psychiatrist
Julianne, I'd say go for it. I vowed long ago to never take antidepressants or that kind of drug except under the guidance of a qualified specialist. I think geriatric pyschiatriy is the perfect specialty in this situation. Often such people do med management, and may also refer you to a therapist. I think you are right -- a therapist may not be appropriate in this situation, but med managment sounds well worth trying.

_________________
Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Mon Jan 03, 2011 12:40 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Geriatric Psychiatrist
I'd certainly give it a try. Many people in our local support group have geriatric psychiatrists on their teams and recommend them. Perhaps your mother will be less likely to stonewall if someone has "MD" next to his/her name??


Mon Jan 03, 2011 1:27 pm
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3377
Location: Vermont
Post Re: Geriatric Psychiatrist
We didn't have access to a geriatric psychiatrist, or even a geriatrician, for that matter. Since we did NOT have good experience with the psychiatrist, if I were to do it over again I'd ask/tell them before taking my LO there:

1. As POA, I want to be consulted about any med changes/additions.
2. My sister and I should be part of the team helping my dad, and any changes need to be discussed with us unless it is an emergency situation.
3. How is he/she monitoring the patient's reaction to new meds? How is he/she verifying reports from the nurses and CGs at the ALF? How often does he/she actually SEE my LO?
4. If the POA and dr. don't agree on how the meds are working, how can we work as a team to solve the problem for the patient?
5. If the MD in charge of hospice thinks your LO is being given meds that are not helpful, does the MD have the power to overrule the hospice MD?

I realize this is a sample of 1, but my dad's psych. hardly ever saw him, wouldn't listen to my/my sister's/friends/ALF admin. observations about my dad nor my requests to take him off the meds that we observed were making him worse. Firing him was the best thing I did all year after a ton of stress over the situation.

I hope you all find drs. who a) know something about LBD b) include you as a valuable part of the care team. Lynn

_________________
Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Mon Jan 03, 2011 3:58 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: Geriatric Psychiatrist
Good questions, Lynn. It's a real dilemma when you have more than one physician 'in charge'.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Jan 03, 2011 4:37 pm
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Re: Geriatric Psychiatrist
Thanks for all the helpful comments! I am sure that a geriatric psychiatrist would be a great help with med management, if nothing else, though the nurses at the SNF seemed to be suggesting one for therapy related to the mood swings, which kind of blew my mind (not understanding how therapy would work with someone in her condition, that is). Unfortunately, the nurses are good caregivers in many respects but they do not seem to have a clue about LBD. I am no expert but I have done a ton of reading in the last 10 months and often I know things about how LBD is affecting my mother's condition that the nurses clearly do not (which is scary).

We are in a very rural area. When my mother was having issues three years before her diagnosis (when she ended up with the counselor), my niece who is a nurse practitioner and my niece who was then a medical resident (both in very large cities) told me in no uncertain terms that no one but a psychiatrist should be prescribing antidepressants to my mother (and this was, of course, well before her dementia was obvious, let alone LBD).

So I tried to find one, and it turned out to be next to impossible. The only ones (either two or three in total) within 60 miles were booked about 12 months out. It would have been necessary to drive her 90 miles to the nearest teaching hospital to find a geriatric psychiatrist, and now often she can barely tolerate a 15 minute drive to the doctor due to her bad back, hips and knees.

The PCP is very diligent about investigating medications with the pharmacist at the local hospital and she has made prudent decisions so far (to the best of my knowledge) about my mother's antidepressants and other meds. While I would love to have the meds reviewed by a geriatric psychiatrist, it doesn't seem realistic at this point. I was mainly wondering about the therapy aspect and whether it could be more effective than I imagined.

And actually, Robin, I don't think my mother would give a hoot about whether the therapist had M.D. after his/her name. She took an immediate dislike to her attending physician (neurologist) when she was hospitalized for diagnosis of the LBD, and she was incredibly disrespectful of him. Talk about lowered inhibitions! It was shocking. :o)

Julianne


Mon Jan 03, 2011 5:03 pm
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Joined: Sat Jul 31, 2010 5:28 pm
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Post Re: Geriatric Psychiatrist
What they seem to be suggesting is talk therapy which is always insight driven. Not likely to be successful in your moms case. At this stage of the game, med management is probably the best you can hope for. Nan


Mon Jan 03, 2011 5:10 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
Post Re: Geriatric Psychiatrist
Doesn't sound like traditional "counseling" is going to work at this point. I thought it would help my dad 18 mo. ago but realized when I went to the first appt. with him, he did showtime, acted like he was totally fine, and told the psychiatrist what he thought he should say, like "I still read 4 newspapers a day", and he had been studying who the pres. is, what day it was, etc. He had not been reading all his papers for a while at that point. Once they are delusional and it is obvious they have dementia, it doesn't seem worth it to me to expect counseling/talking to be a viable treatment. Lynn

_________________
Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Mon Jan 03, 2011 5:37 pm
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Re: Geriatric Psychiatrist
Nan and Lynn, I think you are correct. It would be terrific if it would help her, but I think it is too late for talk therapy or counseling.

Thanks,

Julianne


Mon Jan 03, 2011 6:14 pm
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Geriatric Psychiatrist
Julianne, do the nurses have a specific geriatric psychiatrist in mind? Where is he or she located? Can you find out if he or she offers therapy or med managment? If there is no such doctor available within a reasonable distance, the topic is not worth pursuing. And talk therapy does not make sense now. But to have a specialist look at the meds she is on and make suggestions about the mood swings might be worthwhile. The doctor could certainly not rely on your mother's report of her symptoms, so I would think you would play that role. That would have to be clear before an appointment was made.

Whether you see a new doctor or not, I wish you the best in dealing with this round of challenges!

_________________
Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Mon Jan 03, 2011 6:41 pm
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Re: Geriatric Psychiatrist
Jeanne, thank you for your good suggestions.

I am not sure if the nurses have someone specific in mind or not. I think they were possibly referring to one or two of the psychiatrists who have waiting lists of a year, and they are both at least an hour away. I should inquire further, though that distance would be a challenge for my mother even now. It's even getting hard to get her into our vehicles (we live in the country--actually need 4WD and ground clearance--and just have two tall SUVs). Really, I would do about anything to improve her life, so I will look into this.

Her meds were all changed up by the attending neurologist when she was diagnosed with LBD last February (she was worked up at a major teaching hospital). After learning more about LBD, I now understand some of the changes he made. The PCP has not made any significant changes since then except adding pain meds, but she researched that before she did it. I don't know if these doctors would have the same perspective as a psychiatrist. Surely the neurologist would be tuned into her needs.

Thanks again,

Julianne


Mon Jan 03, 2011 8:27 pm
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