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 Belligerence 
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Joined: Sun Apr 04, 2010 6:54 pm
Posts: 64
Location: Portland, OR
Post Belligerence
Okay, so I'd read the LO can get belligerent, thought, Not my husband, he's such a sweetie! Well, twice now he's cussed me out, either saying I was NOT his wife and get the @#L$L% out of his face, or tonight wanting to go home and getting very mean about it, not recognizing me at all. It's scary and disconcerting and frustrating. I just stayed quiet and let him fume a bit, but he wanted to sleep in his chair, which I would not let him do partly because he tried to walk out the other day. He's not very mobile, so that would not be an issue, but he could fall and hurt himself as he has before. Mostly I'm worried about the belligerence. How do you folks deal with it? I've been going on instinct, either trying to calm him down or laughing it off or barking at him a bit hoping to startle him out of it. Leaving him alone for a bit (and going off and crying the first time) is maybe less possible if I'm afraid he'll try to get out. (Going to buy a tinkly bell for the door to try to fix that one.) I'm afraid this is the start of the end for my being able to keep him at home. (BTW, he's on Parkinson's drugs now along with the anti-psychotics, and this has started up since he started that new med. -coincidence??)


Wed Jun 27, 2012 12:59 am
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Belligerence
The only way to know if it's the meds is to take him off them and see what happens. Many are belligerent without these meds. And, you are right, belligerence is a key reason for placement.


Wed Jun 27, 2012 2:11 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Belligerence
This has been a big problem with my husband, as well. And, like yours, it's totally out of character for him. Isolated episodes began even before he was diagnosed and started before he was on any medications so I could not blame it on his PD meds, even though they may make it worse. When he was first put on the Exelon patch, his belligerence and combativeness subsided--for a while. Much later, Seroquel was added which helped immensely but did not totally eliminate these episodes.

It's interesting that yesterday morning, at the SNF, the aide told me when I came in that he was 'none too happy' to be gotten out of bed. And she was right. He was very agitated and kept wanting the police so I took him down the hall in the wheelchair and, winking at the charge nurse, asked to confirm 'that the police are already investigating the situation' and she answered, 'Oh, yes, they are on top of it and it will be taken care of'. Whew! At least he didn't hit anyone this time but it has happened because his delusions are so strong and his anxiety level gets so high. When this focused on a delusion, he cannot be distracted. The situation has to be 'resolved'. And he considers himself violated when they try to clean up his private area and dress him.

Many times when he was home, he considered me an impostor and demanded to see his wife. I was often the object of his combative behavior. As you have found, this is heartbreaking and frustrating.

Rule out infection such as a UTI before making any medication changes. A UTI can cause such behavior, too.

_________________
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.


Wed Jun 27, 2012 10:00 am
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Re: Belligerence
Kathy, I'm so sorry to hear that you are going through this. I don't know if it helps to know you aren't alone, but the director of nursing at my mother's SNF told me that her facility will not even take male LBD patients because they are so prone to belligerence and also violent behavior. I wasn't aware that there was a gender difference, but she seems to believe it is so, and she usually knows what she is talking about.

Julianne


Wed Jun 27, 2012 10:20 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Belligerence
Julianne, that is true at several facilities here, too. I had inquired at a couple of adult family homes and was told that they would not take LBD or PDD patients. As I have posted in the past, he was 'kicked out' of a SNF in AZ for behavioral issues [their method is to send them to the hospital and then refuse to take them back].

Three acquaintances whose husbands have Lewy [two of whom have died] had to send their poor LOs over 100 miles from their homes to find placement. It's very sad.

That said, we have found Seroquel and it's timely administration to be very important. A different nurse on Derek's wing has been late giving his morning meds and the results are not good. I've had to ask that she give them promptly at 8AM whether he has been gotten up or not. His neurologist says that timing of PD meds and Seroquel is critical.

_________________
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.


Wed Jun 27, 2012 12:09 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Belligerence
An interesting gender difference I have noted is that, while both female and male patients express extreme anxiety with this disease [due, I believe, largely to strong delusions], it is mostly the males who lash out and are often medicated for anxiety. The female patients tend to cry and exhibit more neediness. It worries that me that they are not being properly medicated because they are less of a threat but are suffering more from anxiety as a result.

I should add that, if I were not there every day and in close communication with both his neurologist and the staff to make sure his medications are adjusted as needed, he probably would have been ousted from the facility by now. This was a big fear for me. They are wonderful to him there but several staff members have been slightly injured and I wondered where they would draw the line. :cry:

_________________
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.


Wed Jun 27, 2012 12:16 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Belligerence
In our local support group, we see just as much lashing out with the women who have LBD as we do with the men.


Wed Jun 27, 2012 12:51 pm
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Joined: Sun Apr 04, 2010 6:54 pm
Posts: 64
Location: Portland, OR
Post Re: Belligerence
Whoa, injuries! Yikes, hope we don't get to that! I have contacted his neurologist that I don't see the Parkinson's meds working anyway, so maybe will take him off those. (First one we tried seemed to get him very confused and not work, either.) He's on Seroquel and Depakote and his (very good ) psychologist and I have been tweaking the Seroquel to get him through the early-afternoon Sundowners'. I have found what seems to be a very good foster care home (we have lots here in Oregon) very close by, and they SAID that nothing would make them kick out a patient. I kept saying I would keep him home as long as possible, but this stage is scary. VERY hard to talk him down last night, and I'm sure he didn't recognize me--both issues quite new, as I said. Finally I just didn't talk to him, just escorted him off to bed and gestured what he was to do. Any other things you have tried to get LOs down from a bad spell?


Wed Jun 27, 2012 1:00 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Belligerence
I'm not sure "talking" seems to work.

I think you are wise to look at placement options.


Wed Jun 27, 2012 1:08 pm
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Joined: Sun Apr 04, 2010 6:54 pm
Posts: 64
Location: Portland, OR
Post Re: Belligerence
Interesting -I wasn't going to bring it up this morning but he did -says he doesn't want the "boy" who got in his face last night to come back. Says he "touched him" like he didn't want. (I got on my knees to look in his face, which used to help.) So, maybe just avoiding him for a while when he gets bad would help -except he wanted so badly to leave and "go home" I feared he MIGHT if I didn't stick around.


Wed Jun 27, 2012 1:39 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Belligerence
Kathy, yes, leaving the room [not always possible, especially if they are endangering themselves] is often the best solution.

_________________
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.


Wed Jun 27, 2012 2:16 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Belligerence
robin wrote:
In our local support group, we see just as much lashing out with the women who have LBD as we do with the men.

That could be. Perhaps it's just that men are usually stronger and capable of more damage. My husband still has amazing upper body strength--especially when he's angry.

_________________
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.


Wed Jun 27, 2012 2:19 pm
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Re: Belligerence
Pat, what you said about LBD patients' anxiety stemming from delusions certainly makes sense to me. The more delusional my mother has become in the last few months, the more her anxiety increased (until medication adjustments resolved it). And when she was more anxious, she did just sit and cry rather than lashing out or becoming belligerent.

The SNF staff didn't seem too concerned about her increased anxiety and crying. (They are kind people but I think they get used to patients who cry, I think.) I observed it and had to call the doctor and push the issue until the medication changes were made. So, maybe more female patients do sit and suffer. I don't know if my mother's experience is just an anomaly or is typical. It sure helps to be a consistent presence at one's LO's facility, and persistent, though.

Julianne


Wed Jun 27, 2012 5:29 pm
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Joined: Sun Oct 17, 2010 2:06 am
Posts: 63
Post Re: Belligerence
My hb struggles to his feet and says he's "going home" almost every night. I think it really means he wants to go back to who he used to be. We've lived in the same house over 30 years.
I've seen flashes of belligerence, usually because he thinks I'm talking too loud and "they" will hear. It must be so frustrating to believe you're protecting your family and your family isn't cooperating. It's possible a lot of lewy belligerence comes from the fact that the caregiver never is able to know enough about the delusional world the patient lives in--and which changes all the time. It must be like those nightmares where everyone but yourself seems to know what's going on, and you not only have no clue, you know they're all out to get you. :D
Anyway, I try to look at it that way, sometimes it helps me to visualize what he's imagining--staves off the tears to a more appropriate time. Lewy has affected his eyesight and hearing, too, turns bushes into people and our dogs into some vague threat.
It's not really your husband, or, rather, it is, it's just his reaction to the terrifying world of Lewy-land. Your touch and care are important to him, even when you feel you and he have lost all control.


Thu Jun 28, 2012 11:02 pm
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Joined: Tue Apr 24, 2012 5:00 pm
Posts: 78
Location: Fayetteville, NC
Post Re: Belligerence
Here I am again, looking for help. Had a long talk with psychiatrist & NH Administrator about Ted yesterday. He has been getting more aggressive & belligerent. I have been playing a voice mail from our VA neurologist. He talks about the unpredictable decompensation and that medication changes may or may NOT be beneficial. So, I'm walking a tightrope & trying to control a moving target without much success. I am glad I asked for their help, but my visit with Ted tonight was awful. I've had several incidents where he's acted out pretty badly and I've been scared about what he's seeing or what he's going to do (2 years ago, he pulled the car over because of "guys with guns in the other cars"). He's been talking about the "guys cleaning their guns in his room and keeping him up. He wants to go home and I told him the Lewy body "stuff" is too strong, that it is not safe. They just changed him to Risperdal as per Mayo clinic's recommendation, to see if that may help. But, when he said, "what does it matter? I don't have that much time left & I want to be accommodated. You've dumped me here." I just was crushed. I am scared and sad and hurt all at once. Never going to be able to give him everything. The nurse helped me leave while he followed me & I left with him banging on the door in frustration & anger at me.


Fri Jul 27, 2012 9:51 pm
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