Delusions in dementia

[Dale Moss]

My objectivity is totally shot on this, so I'm looking for ideas.
Elderly woman in nursing home suffers from vascular dementia. She's been laboring under a series of delusions that are getting more and more bizarre -- and she's getting more and more agitated. Last week it was that her child was dead (even after seeing her child, she kept circling back to the delusion that she'd read in the papers that her child was dead). Then she had the delusion that she was about to be hanged. Today it's that people are carrying bombs in their stomachs and they're killing children.
She's running around warning all the other residents, which, needless to say, has the nursing home quite upset.
It's just about impossible to rep this case, because it's impossible to get any coherent information from her. Physically she's in really good health, so there is no pathology, other than the dementia, to serve as a guide.
There's no set time when the delusions peak (at least not that I've been able to find), and delusions of persecution are common in dementia. But is it common to have someone so deeply mired in them? I haven't treated anyone with dementia before and am feeling rather helpless.
In the past, Ars. and Kali-br. have had a slight temporary calming effect. She doesn't strike me as needing Stram., with which I'm quite familiar. I'm wondering about Plumbum, though there are no physical confirmatories.
Any suggestions?
Peace,
Dale

[Dr. Joe Rozencwajg, NMD]

Is she on any drugs?

Dr. J. Rozencwajg, NMD.

"The greatest enemy of any science is a closed mind"

www.naturamedica.co.nz

[Jean Doherty]

MIND; DELUSIONS, imaginations; danger; of (7) : 2stram., camph., fl-ac., kali-br., macrin., plb., valer.
Complete dynamics Delusions with restlessness bos-s cina. HYOS indole
Hyocyamus did come to mind.
with sadness AMBR AUR[interesting as feels must do duty ] Dros KAlI BROM morph murx nux-vom plat.
Would the agitation maybe suggest Aur Ars
Just thoughts, Best Wishes Jean

[Irene de Villiers]

Kali-br has the delusion of a child being dead, but is such a small rubric to go by.
I thought of a few rubrtics that may be worth cosidering:

MIND - COMPLAINING
MIND - DELUSIONS - loquacity, with
MIND - DELUSIONS - murdered - will be murdered; he
MIND - DELUSIONS - visions, has - horrible
MIND - DELUSIONS - vivid
MIND - DEMENTIA
MIND - DEMENTIA - senilis
MIND - PESSIMIST

Do the physical aspects give you any clues to narrow it down?
I find that most helpful in animals with an unknown history.
For example if I am trying to decide between say Lach, Puls, I will consider
* Lach is loquatious and passionate about their views, is solidly built with medium boning but a little towards shortish in the body compared to legs, tail, and in old age Lach may trip over their feet a bit (agile when young). Eyes are intense, seem to look through you. Thick/dense hair/fur. Dress to avoid getting cold.
* Puls will be attending to grooming and appearance, will have large feet and be a very large individual with heavy boning , slightly prominent sternum, wants to be on the ground (never a gymnast), wil rather plead for what they want than demand it as Lach does. Eye expression is kind. Hair well kept, not thick/dense. Dress to avoid getting hot.
Also look at any medication side effects for aggravations.
(Do a search on drug monograph of each)

Check nutrition for deficiencies, toxins (eg niacin, aluminum cooking pots.)
Namaste,
Irene

--
Irene de Villiers, B.Sc AASCA MCSSA D.I.Hom/D.Vet.Hom.
P.O. Box 4703 Spokane WA 99220.
www.Furryboots.info
(Info on Feline health, genetics, nutrition & homeopathy)
"Man who say it cannot be done should not interrupt one doing it."

[Ellen Madono]

Hi Dale,

I have been reading Liz Laylor's book on delusions. When I first read it, I thought that everything was the same. But reading it closely, I discovered that she has the mind separated into five quite distinct categories: Denial, Forsaken, Causation, Depression and Resigned.

The denial part was very important. Many of them were delusions of grandeur or how some superpowerful something was going to influence the patient's life. The important point is, what exactly are they expecting to happen. Why are they in the position that they are in, (in relation to the superhuman whatever).

Your patient sounds paranoic. This Liz categorized as "forsaken". Why are these terrible things going to happen? What is the social set up that leads to this being possible? It sounds so crazy that it is hard to ask about it and not sound insulting. But, your patient has a view of the world that makes her suppositions possible.

I got a lot out of Liz's book, but unfortunately I don't have it with me. She used very ordinary rubrics, but you have to really go with the patient into her imaginary world to find why you would use them. Liz's rubrics were not at all just delusion rubrics. The point is, they were pathological.

While I lacked the time to read the whole book, here are the notes that I took.
1 Denial

perpetuates self destruction

denial of death

hubris

Under overwhelming influence of god or the devil Kali-brom

victim of own idealism can’t live up to Cyclamen

2 Forsaken

Persecution complex

Argcntum Nitric•um will be despise if they fail

Bartya Carbonica will be laughed at. Projecting abandonment because they are ugly. They make themselves ugly so that close to them will abandon. the need to self fulfilling prophecy.
Rhus glabra abandonment means they will be deceived, cheated, betrayed, attacks, picked, and stabbed in the back.

Staphasagria is similar criticism, criticize, persecuted, and poisoned.

3 cause The delusive explanation of why they are having problems.

no sense of guilt, instead transfers all guilt to others means they have no sense of cause. Palladium feels therefore Depressed

4 Depressed

perpetuates self destruction

5 Resigned

Best,

Ellen Madono
Ellen Madono

[Diane]

Has a UTI been ruled out? They can often cause delusions and hallucinations in the elderly,. Then there is also Sundowner's Syndrome to consider, if such tendencies seem to occur in the afternoon and evening, as the sun goes down.
My objectivity is totally shot on this, so I'm looking for ideas.
Elderly woman in nursing home suffers from vascular dementia. She's been laboring under a series of delusions that are getting more and more bizarre -- and she's getting more and more agitated. Last week it was that her child was dead (even after seeing her child, she kept circling back to the delusion that she'd read in the papers that her child was dead). Then she had the delusion that she was about to be hanged. Today it's that people are carrying bombs in their stomachs and they're killing children.
She's running around warning all the other residents, which, needless to say, has the nursing home quite upset.
It's just about impossible to rep this case, because it's impossible to get any coherent information from her. Physically she's in really good health, so there is no pathology, other than the dementia, to serve as a guide.
There's no set time when the delusions peak (at least not that I've been able to find), and delusions of persecution are common in dementia. But is it common to have someone so deeply mired in them? I haven't treated anyone with dementia before and am feeling rather helpless.
In the past, Ars. and Kali-br. have had a slight temporary calming effect. She doesn't strike me as needing Stram., with which I'm quite familiar. I'm wondering about Plumbum, though there are no physical confirmatories.
Any suggestions?
Peace,
Dale

[Dale Moss]

She was not until very recently. The nursing home put her on a very small dose of Lexapro for depression a couple of weeks ago, and a few days ago added Lamictal for the delusions. Apparently they gave her a dose of Ativan yesterday without the family's approval.
I decided after sending that post yesterday to try cell salts, so today started her on Kali-phos. and Nat-sulph. 3 of each, three times a day. I've treated patients at this nursing home before, but never with remedies that required multiple doses a day. It was interesting, to say the least, getting approval for this so the nurses could dispense the remedies.
Unfortunately, this same woman is now in the hospital after having gotten belligerent while on an outing. Looks like a UTI.
Thanks to everyone for their suggestions, but I do think this may be a deficiency issue, which is why cell salts seemed appropriate.
Peace,
Dale

[Dale Moss]

Thanks, Ellen. I was not aware of Lalor's book on delusions -- will have to take a look.
This patient definitely falls into the forsaken category. And with good reason: she's had a lot of loss in her life. Arg-nit. is a remedy that's come up on repertorization, and she does have a lot of performance issues, wanting to do everything right, probably so people will like her and not leave.
I'm keeping it in mind, but for the moment am trying to see if cell salts will help.
Peace,
Dale

[Dale Moss]

A UTI was ruled out last week, but this week it may be a possibility. I thought of Sundowning, but am not sure there's enough of a pattern for that.
Peace,
Dale

[domenicstanghini]

HI Dale

Have you considered this?

The dangers of hospital delirium in older people - Harvard Health Blog

The dangers of hospital delirium in older people - H...
Many older people develop delirium when they are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientatio...
View on www.health.harvard.edu
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Best Wishes Domenic