Extreme separation anxiety in Alzheimer's patient

[dusty1197]

Hi All,

72 year old woman with moderate to severe Alzheimer's, came into her daughter's care after the death of her (the woman's) husband nearly 5 years ago. Her separation from her husband was sudden and unexpected, and the woman had a history of extreme dependency on her husband. After being in her daughter's care for nearly 5 years, the woman was placed in a long-term care facility a month ago. She is unable to adjust to the separation from her long-time primary caregiver/daughter and exhibits unmanageable behavior associated with extreme separation anxiety.

She repeatedly attempts to escape the facility by any means possible, including climbing or squeezing through a fence, and literally spends her entire time either trying to find her way out of the facility and back home to her daughter, or asking the attendants when the daughter will arrive, and pacing, waiting for her.

When the daughter arrives, the woman cries and repeatedly tells her how much she loves her and misses her. When the daughter leaves, the woman breaks down in tears. During the visits, she becomes panicked if the daughter so much as goes out of sight by standing behind her and the only thing the woman can talk about is how much she does not want to live in the facility and must leave. No amount of reassurance of the next day's visit or any other tactic to reassure is of any help. She has no interest in any of the people around her, in television or any projects or activities. Her one and only interest lies in being with her daughter.

She paces all day long, asking for her daughter, anticipating her arrival, insisting that she must get home to her daughter, never settling down.

At night, she will not stay in her bed, but continues to rise and search through the other residents' rooms, sometimes hysterical, crying, banging on the doors and windows, and begging for someone to help her.

She often tells her daughter, fearfully, that "you don't know what goes on in here" and fears that there is danger lurking (the daughter confirms that nothing is amiss). She feels that she is living alone, despite the other residents and attendants who are always with her. She becomes distraught, clinging to her daughter, weeping and begging her to take her home with her.

During the day, the attendants are having a difficult time redirecting her behavior, as she is so consumed by the need to be with her daughter. Though at times she responds to the attendants' efforts to interact with her, she mostly refuses to cooperate with offers to participate in activities, often disdainful of the people trying to help her, rolling her eyes and making faces.

At times, she becomes angry and defensive if told to do something or if corrected, forcefully denying whatever is told to her. She is then verbally aggressive and rude to the attendants. She resents being "babysat". She refuses to be touched or helped by them in any way and will not cooperate with any efforts to redirect her behavior, entertain or amuse her.

In the absence of her daughter, she follows so closely on the heels of the attendants, that they cannot do their work without literally bumping into her. This was, in fact, the leading factor behind the daughter finally deciding to place the woman in the facility. The woman was so dependent and so anxious about being separated from the daughter that the woman followed her all about the house, into the bathroom, stood closely behind or beside her at all times, and could not let the daughter out of her sight for a moment without anxiously going in search of her. At night, she would not stay in bed, afraid, believing that the daughter would leave her alone in the house. She had to have visual contact with the daughter at all times. Even being in the same room was not enough, unless visual contact and direct interaction could be maintained. If the daughter tried to engage in an activity, such as reading a book, the woman would become agitated, pace and become anxious. If the daughter dozed off, the woman became anxious and would wake her up. So not only was the daughter's presence and visual contact required, but also her undivided attention.

Stram was the original remedy of choice. 200C aggravated at the manic end of the remedy's potential, resulting in the woman screaming and running about the facility, banging on the doors and windows, spitting, and crying hysterically to be let out and to go home to her daughter. 12C aggravated by generating extreme stupor, confusion, disorientation, slurring of nonsensical speech. 30C stimulated the rude, verbally aggressive behavior. Since the doses, the woman has developed an extreme hunger.

It is my thought that addressing the dependency, the separation anxiety and its associated grief and insecurity is tantamount, regardless of the Alzheimer's. This is, in essence, a case of a "child" enduring a forced separation from her "mother". Can I get thoughts on how I might proceed in this case?

Toni

[eternalhealth]

A child patient with the same behaviour might respond to puls so she may also
________________________________

[Joy Lucas]

You have some maintaining causes here as it appears that the dispatching to a care home was instrumental in making her situation <<

[Rochelle]

Dear Toni,
I know we have spoken about all this before but I see the following remedies screaming out, Ars, Puls and Baryta Carb. Have you tried these? Since Puls is an antidoting Rx to Stram I would think about this seriously to begin with.
All the best
Rochelle
Registered Homeopath
EFT(Advanced) Practitioner
www.southporthomeopathy.co.uk

[Shannon Nelson]

But--

"This was, in fact, the leading factor behind the daughter finally deciding to place the woman in the facility. The woman was so dependent and so anxious about being separated from the daughter that the woman followed her all about the house, into the bathroom, stood closely behind or beside her at all times, and could not let the daughter out of her sight for a moment without anxiously going in search of her. At night, she would not stay in bed, afraid, believing that the daughter would leave her alone in the house. She had to have visual contact with the daughter at all times. Even being in the same room was not enough, unless visual contact and direct interaction could be maintained. If the daughter tried to engage in an activity, such as reading a book, the woman would become agitated, pace and become anxious. If the daughter dozed off, the woman became anxious and would wake her up. So not only was the daughter's presence and visual contact required, but also her undivided attention. "

This is not a situation where bringing her back to the daughter's house would solve anything!

Toni, what was her behavior and situation *before* her husband died? You say she was dependent; but was it dependent "within the range of normal," or if not, what were the behaviors? Did she at that time have any fears, or areas where special arrangements had to be made for her fears or sensitivities? It may be that the remedy she needs now is the same that she needed then; or it may be a related one. I think it's important to get more history, and bigger picture.

Shannon

[MM]

EFT may be applicable here.
________________________

Joy Lucas wrote:

[Gail]

There are remedies like Bor, Bism, Gels, Coffea, Stram, and a few others
if you look up "Clinging' rubrics.

And Lac H has clinging to the 'mother' - helps with separation and
moving into your own life. I know it is the mother clinging to the
daughter, but that dynamic can happen if the mother hasn't been able to
grow up and separate from her own mother, she will look to her
daughter/children to be the parent. It does sound like she is still in a
very young baby phase, needing that constant attention where they are
the centre of the world, and the parent is unable to get on with the
other things that need doing.

Gail.
--- In minutus@yahoogroups.com, "Christine Gillen"
wrote:
anxiety
the
forced
proceed
when
function
giver,
simply
about the
has
I
norm.
loss
*afraid
bad
Chamomilla,

[tg.partington]

All very useful... especially as I saw a child exhibiting these symptoms recently. However, as the mother has huge difficulty finding time for the appointments (chopping and changing, arriving late and leaving early) I doubt I will be able to use this information. Any suggestions for mother? A 'fantasy' prescription, obviously.
Theresa

--- In minutus@yahoogroups.com, "Gail" wrote:

[Joy Lucas]

I personally would start with a rubric from where you cannot go any further, a leading rubric you could call it as many of the sx described are what follow a main sx. This could be the actual Alzheimers, just a word and a description of a mind condition but some reps do include it as a way of locating certain rx. But you could also use a rubric such as 'doubtful of soul's welfare' which also sums up her presentation of sx. Arsenicum is one of the big rx in that rubric and covers many of her sx.

It does depend on where you start with a case and you need confirming sx to help decide on a rx as so many come to mind. Physical sx often do that job such as thermals, eating habits, bowel and bladder habits ect.

Joy

http://www.joylucashomeopathy.com
http://health.groups.yahoo.com/group/homeopathystudy/

[Dale Moss]

For separation anxiety this extreme, I would suggest looking at Hyoscyamus. This case reminds me of a young girl I recently treated: could not sleep alone at night, could not let mom out of her sight, etc. It looked like a Stramonium case on the surface because her fears at night were so pronounced, but that remedy did nothing.
Peace,
Dale