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 over-sedation? can we expect more? 
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Joined: Sat Feb 11, 2012 2:24 pm
Posts: 5
Post over-sedation? can we expect more?
I introduced myself a couple of days ago. I'm looking for some experiences you've had dealing with choosing between sedation vs. hallucinations/anxiety/paranoia.

My father is being treated for symptoms of hallucinations, anxiety and paranoia. Although living in an assisted living facility, he has been fairly independent (and independent minded!) up to this point. Since July he has been treated with rx for his psychosis symptoms. He had a couple of major episodes of delusions/hallucinations/wandering at night but mostly during the day he had been lucid and jovial although at times paranoid (so and so has been doing this and that) and gets very tangled up with words. Not every day was great and there were increasing signs of paranoia/anxiety. Physically he has been great with some moderate hand tremors that have been going on for many years.

Now that he is on his Rx he is most often sedated and unable to stay awake for much of the day. He is frustrated because he has been working on a book (something that will probably never be finished) and can't concentrate. I know the book thing is difficult for him for more reasons other than just the sedation, but he is happy when he can just be "working on it".

The sedation is making him frustrated and sad. I know the hallucinations and nighttime issues have decreased, but what a rotten quality of life during the day!

Is this just the nature of the beast that he will have to contend with in order to keep those hallucinations etc. at bay?

He was taking Seroquel and then Seroquel extended release. I was concerned with some parkinson's symptoms that were increasing and the sedation was as bad as it is now so the doctor switched things in November.

He is now on the following:

Atenolol 50 mg, 1 tablet 2x daily (for blood pressure - this was decreased to see if it helped his energy but his blood pressure increase)
Aspirin 81 mg, 1 tablet daily
Allopurinol 300 mg, 1 tablet, once a day (for gout prevention which was becoming a frequent problem)
Namenda 10 mg, 1 tablet, twice a day
Aricept - 23 mg 1 tab at bedtime
Zyprexa - 5mg, 1 tablet 5pm
Vitamin D-3 2000iu per day
Vitamin B-12 sublingual 500 mcg every Mon., Wed. & Friday morning
Fish Oil supplement daily

PRN confirmed (these are given when he has had specific episodes - he is WRECKED the next day)
Zyprexa 2.5mg every 12 hours as needed for moderate to severe agitation
Lorazepam .5mg every 8 hours as needed for anxiety
Lorazepam .5 every night as needed for sleep

Thanks for any thoughts about this!
Nancy


Mon Feb 13, 2012 2:42 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: over-sedation? can we expect more?
Seems an odd choice of drugs for LBD but there is a lot of controversy about that. Perhaps his neurologist could order something different.

_________________
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 Feb 13, 2012 4:51 pm
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Joined: Sat Feb 11, 2012 2:24 pm
Posts: 5
Post Re: over-sedation? can we expect more?
Can I ask what is odd about it?

I am starting from scratch in the LBD area, psychotic symptoms area, everything.
Our neurologist (a rather well-respected neurologist in our area with a lot of experience in LBD) did the testing & diagnosis last year. Made some recommendations to my Dad's GP with regard to adding a little Seroquel to his life but then that was it.

Two previous neurlogists were basically worthless when it came to diagnosing or problem solving.


The GP was uncomfortable prescribing these types of medications without much experience in this area and referred us to a Psychiatrist who deals with dementia.

My only personal knowledge of this comes from what I read here - .

I am open to skepticism towards what has been prescribed .....

Thanks,
Nancy


Mon Feb 13, 2012 5:03 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: over-sedation? can we expect more?
Zyprexa and lorazepam are not typically given in LBD but, as I say, there is a multitude of opinions. There are other drugs that might be better. My husband uses Seroquel. Did it not work for your father when it was prescribed?

_________________
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.


Last edited by mockturtle on Mon Feb 13, 2012 9:00 pm, edited 1 time in total.



Mon Feb 13, 2012 6:13 pm
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Joined: Sat Feb 11, 2012 2:24 pm
Posts: 5
Post Re: over-sedation? can we expect more?
The Seroquel was not very affective for some behaviors - there was some verbal aggression towards the staff at assisted living (a man who is not normally aggressive). Staff was giving him PRN more often at night during his use of Seroquel due to wandering and hallucinations.


With the Zyprexa he has not had as many episodes requiring PRN but he is still quite sedated during the day.


Mon Feb 13, 2012 7:52 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: over-sedation? can we expect more?
And why is lorazepam (Ativan) added to the PRN mix? I would think one (Zyprexa) or the other (Ativan) would do the job, but both would not be needed.

If you've changed just one medication at a time, then you might have a good handle on this.

There are some care facilities in California that do not use ANY of these medications! I gotta' think that they have some LBD residents so what do they know that the rest of us (and the rest of the care facilities) do not?


Mon Feb 13, 2012 9:09 pm
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Joined: Sat Oct 06, 2007 4:28 pm
Posts: 770
Location: LA
Post Re: over-sedation? can we expect more?
Nancy, I'm sorry to say that day time sleeping is a problem that comes with LBD whether medication is involved or not. Whether he sleeps at night or not. At least that was my experience with my husband. He needed his sleep. But with proper levels of medicines it could be a normal sleep and not have him in a stupor. Continue adjusting and change only one at a time if possible... starting low and adding slow.

I would be happy to hear that between naps he would be refreshed enough to do his writing.

Dorthea


Tue Feb 14, 2012 12:17 am
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Joined: Sat Feb 11, 2012 2:24 pm
Posts: 5
Post Re: over-sedation? can we expect more?
I'm thinking that making a better connection between the neurologist and psychiatrist may help, with this particular neurologist being better versed in LBD. Also I'm not sure what the criteria is for the facility staff giving the PRN but I think it is if my dad has had a particularly bad night with wandering/dream acting out/hallucination.

I just feel so stupid in the psych office -- like why would I know any better than the psychiatrist!?

I have always been a very good advocate for my own health and always educated myself as thoroughly as possible. I feel pretty helpless in my dad's case, partly because I am not with him on a daily basis. I cannot see firsthand the trends in behaviors, how the medications affect him during specific times etc.


Tue Feb 14, 2012 4:02 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: over-sedation? can we expect more?
I give a copy of the LBDA one page 'Fact Sheet' to each provider, asking if it can be included in my husband's chart. That way, it doesn't sound like I'm implying their ignorance but it does give them a chance to read it later. It can be found here: http://www.lbda.org/content/publications

_________________
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.


Tue Feb 14, 2012 10:53 am
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: over-sedation? can we expect more?
I think overloading people with meds PRN is not very clever. Far better to change one medication at a time and document the effects. Is there anyone that can monitor this in your father?


Tue Feb 14, 2012 11:21 am
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