Bipolar question, for those with Bipolar loved ones

[Spryte]

Have you found any rhyme or reason to sudden episodes of sudden onset paranoid thinking?

My loved one is in a nursing home, and finally seemed stable. She’s having paranoid thinking last night/today. Her roommate says it’s been a few weeks, but the nurses and I have only seen it today/last night.

If someone is relatively stable, would this still be part of cycling? 

Or could an event (learning something upsetting) trigger paranoid thinking and strange behavior? She was very upset last night about some bad news, and this seems to have happened afterwards.

My bipolar loved one also has dementia, FWIW. I am her POA, and her only advocate, so if there’s anything I can help make happen for her, any ideas are welcome. At this point, they are trying to preserve her relationship with the roomie and are upping her meds.

[Ottakee]

Change in seasons coming, change in location, low Vit B and D levels

[Spryte]

23 minutes ago, Ottakee said:

Change in seasons coming, change in location, low Vit B and D levels

Oh, Vits D and B — I can have them check those! 

[Grace Hopper]

1 hour ago, Spryte said:

Have you found any rhyme or reason to sudden episodes of sudden onset paranoid thinking?

My loved one is in a nursing home, and finally seemed stable. She’s having paranoid thinking last night/today. Her roommate says it’s been a few weeks, but the nurses and I have only seen it today/last night.

If someone is relatively stable, would this still be part of cycling? 

Or could an event (learning something upsetting) trigger paranoid thinking and strange behavior? She was very upset last night about some bad news, and this seems to have happened afterwards.

My bipolar loved one also has dementia, FWIW. I am her POA, and her only advocate, so if there’s anything I can help make happen for her, any ideas are welcome. At this point, they are trying to preserve her relationship with the roomie and are upping her meds.

Paranoia is definitely a feature of dementia, so it could be in part or separate from the bipolar symptoms. 
 

ETA imo with my elders it was a stage of the dementia process - but one of them had previously had a stroke which we were told left him prone to becoming paranoid. 

Edited August 17, 2022 by Grace Hopper

[KSera]

1 minute ago, Grace Hopper said:

Paranoia is definitely a feature of dementia, so it could be in part or separate from the bipolar symptoms. 

Yes, One of my grandparents had paranoia onset in the nursing home without having previously demonstrated dementia. They were very ill though. It was distressing. I’m assuming they’ve already checked to make sure it’s not a UTI?

[Katy]

Have them check for a UTI if they haven’t already.

[Spryte]

I will doublecheck that they have looked at the UTI possibility.

There is such an overlap with dementia and Bipolar symptoms — I think the two combined is particularly tricky, ugh. Paranoid thoughts are one of her Bipolar symptoms, so that is the immediate thought, but she does have dementia so it could be that, too. 

They had taken her off of her psych meds at one point, just to see what would happen (despite what I had to say), and that was a disaster. They still haven’t put her back on the dose at which was stable long-term, but they are working back up to it. Hopefully the med adjustment today will help. Since they took her off, she’s gone through four roommates with the associated honeymoons that devolved to paranoid thinking. Definitely still cycling. Such misery. I wish they had kept her on her meds.

 

[Grace Hopper]

Spryte - gently - is it possible there’s a staff member whose presence is triggering your mom?

[WendyLady]

This may be completely out of left field, but I wanted to point out that It is possible to have both bipolar and a separate psychotic disorder. Paranoia is generally associated with psychosis, and psychosis or paranoia outside of other bipolar symptoms of mania or depression may be more closely related to a schizo-affective disorder. The same types of meds - mood stabilizers and antipsychotics - could help, but thinking of this as separate from bipolar may open up other treatment plans/options. 

Julie Fast writes and speaks about managing bipolar. She lives with bipolar and schizoaffective disorder. She has a great Instagram and Facebook page (the stable table) with info about bipolar. I haven’t seen her address aging or dementia with bipolar, but here area few of her articles at bphope:

This has some info about triggers: https://www.bphope.com/bipolar-stories-video-blog/video-bipolar-disorder-triggers/

 

Angry bipolar: https://www.bphope.com/caregivers/why-can-people-with-bipolar-disorder-be-so-mean-and-nasty/

 

Paranoia: https://www.bphope.com/fast-talks-paranoia-and-trust-issues/

 

Hugs to you! There is nothing simple about this and it is so hard to know what to do, and if what we are doing actually helps. 

[Spryte]

1 hour ago, Grace Hopper said:

Spryte - gently - is it possible there’s a staff member whose presence is triggering your mom?

Thanks. That’s a possibility. There are certainly some she does not like.

She did have a very upset episode the night before this all began. She has dementia, along with everything else, and there has been some sad news — it’s been  an on-going thing over several months — but each time she hears it feels brand new. That may be the trigger this time.

They increased her mood stabilizer, and that seems to be helping, thankfully.

 

[Spryte]

57 minutes ago, WendyLady said:

This may be completely out of left field, but I wanted to point out that It is possible to have both bipolar and a separate psychotic disorder. Paranoia is generally associated with psychosis, and psychosis or paranoia outside of other bipolar symptoms of mania or depression may be more closely related to a schizo-affective disorder. The same types of meds - mood stabilizers and antipsychotics - could help, but thinking of this as separate from bipolar may open up other treatment plans/options. 

Julie Fast writes and speaks about managing bipolar. She lives with bipolar and schizoaffective disorder. She has a great Instagram and Facebook page (the stable table) with info about bipolar. I haven’t seen her address aging or dementia with bipolar, but here area few of her articles at bphope:

This has some info about triggers: https://www.bphope.com/bipolar-stories-video-blog/video-bipolar-disorder-triggers/

 

Angry bipolar: https://www.bphope.com/caregivers/why-can-people-with-bipolar-disorder-be-so-mean-and-nasty/

 

Paranoia: https://www.bphope.com/fast-talks-paranoia-and-trust-issues/

 

Hugs to you! There is nothing simple about this and it is so hard to know what to do, and if what we are doing actually helps. 

Thank you, I will check out these links. She has, among other things, Bipolar I (ultra rapid cycling) and a slew of other diagnoses, but I don’t recall any type of psychosis (not to say it isn’t there, in her records and I don’t recall, or that they didn’t miss something — either is possible). Whatever the reason, her 3 month checkups with her psych always included a lot of questions about paranoid thoughts — and those would usually precipitate an increase in meds. I wonder if there was something else going on, that I didn’t know? I might do some digging to see if her old psych may have suspected something else.

Thank you for the links. I will check them all out!

It’s hard to help her from afar.

 

[Grace Hopper]

2 hours ago, Spryte said:

Thanks. That’s a possibility. There are certainly some she does not like.

She did have a very upset episode the night before this all began. She has dementia, along with everything else, and there has been some sad news — it’s been  an on-going thing over several months — but each time she hears it feels brand new. That may be the trigger this time.

They increased her mood stabilizer, and that seems to be helping, thankfully.

 

Not sure if you’re at this juncture yet, and/or if the sad news was something she had to be informed of, but there came a point where we had to stop sharing sad news - like even the death of a close family member or friend - because, news like this can be forgotten but nags at the back of the elder’s mind, possibly causing them to worry or continue ask about the person(s) involved, with each retelling reopening a wound, as you noted. If asked about someone who has maybe stopped visiting, I have said that the person is traveling. I personally believe such a feint for the purposes of kindness is not a vulgar lie, it’s a redirection of thought. It is intended for mercy, not deception. (Somebody may throw tomatoes at me for this, but unless you’ve walked that mile…yada yada). 
 

The tricky part is letting others who spend time with her know that it’s no longer appropriate to share bad news unnecessarily and to ask them to keep their conversation to positive topics.  

God bless you, Spryte, it is hard to be distant and still help with elder life  decisions. Your mom is fortunate to have your care. 

[Spryte]

24 minutes ago, Grace Hopper said:

Not sure if you’re at this juncture yet, and/or if the sad news was something she had to be informed of, but there came a point where we had to stop sharing sad news - like even the death of a close family member or friend - because, news like this can be forgotten but nags at the back of the elder’s mind, possibly causing them to worry or continue ask about the person(s) involved, with each retelling reopening a wound, as you noted. If asked about someone who has maybe stopped visiting, I have said that the person is traveling. I personally believe such a feint for the purposes of kindness is not a vulgar lie, it’s a redirection of thought. It is intended for mercy, not deception. (Somebody may throw tomatoes at me for this, but unless you’ve walked that mile…yada yada). 
 

The tricky part is letting others who spend time with her know that it’s no longer appropriate to share bad news unnecessarily and to ask them to keep their conversation to positive topics.  

God bless you, Spryte, it is hard to be distant and still help with elder life  decisions. Your mom is fortunate to have your care. 

Thanks. I completely agree with you that it’s a kindness, and a supportive measure, to perhaps not share upsetting news. Thank you for saying it outright, it’s helpful to hear that from others. I’m so sorry you’ve been down this road, too.

My MIL hit this point a few years ago, and it felt easier to navigate. For my mom, I’m her only local advocate, and have compromised on what to tell/not tell her. I can’t visit as often now, due to my own health issues, so it’s made advocating for her psych needs harder. And, of course, there’s that interplay between psych needs and dementia needs, and teasing out which is which. 

Did you find a way to encourage others not to share (all of the) bad news? She is getting periodic updates from someone about their own heart failure and other difficult issues, and each time it’s like she hears it anew, must process it, and it’s too much for her. I do think that’s the trigger. I’m not sure the person sharing grasps her level of dementia, or knows how this is affecting her. He hasn’t seen her in years, and just calls with these sad updates. She seemed to forget in between calls until a few nights ago.

In some ways, it was easier when she lived with us, because I had more of a window into what’s going on. Moving her into LTC has been a huge change not just for her, but for me as well. It’s a hard transition!

 

 

 

[Grace Hopper]

42 minutes ago, Spryte said:

Thanks. I completely agree with you that it’s a kindness, and a supportive measure, to perhaps not share upsetting news. Thank you for saying it outright, it’s helpful to hear that from others. I’m so sorry you’ve been down this road, too.

My MIL hit this point a few years ago, and it felt easier to navigate. For my mom, I’m her only local advocate, and have compromised on what to tell/not tell her. I can’t visit as often now, due to my own health issues, so it’s made advocating for her psych needs harder. And, of course, there’s that interplay between psych needs and dementia needs, and teasing out which is which. 

Did you find a way to encourage others not to share (all of the) bad news? She is getting periodic updates from someone about their own heart failure and other difficult issues, and each time it’s like she hears it anew, must process it, and it’s too much for her. I do think that’s the trigger. I’m not sure the person sharing grasps her level of dementia, or knows how this is affecting her. He hasn’t seen her in years, and just calls with these sad updates. She seemed to forget in between calls until a few nights ago.

In some ways, it was easier when she lived with us, because I had more of a window into what’s going on. Moving her into LTC has been a huge change not just for her, but for me as well. It’s a hard transition!

 

 

 

I was a sole local care person, as you are. There was no telephone in my elder’s room, so that really helped. (Calls could be taken at the unit desk.)
 

I directly contacted the people who might call or write (unlikelier, but also visit). I let them know how much their contact was appreciated, but that truthfully, explain that it was hard for my elder to process bad news and please not to share any, to simply encourage and enjoy talking about “the old times” together. I found all were very understanding when I spoke with them. Of course I could not control all conversations (and egads would not want to!), but all I told - and seriously it wasn’t a ton of people - were cooperative. So it depends on the other person, kwim? It sort of sounds like your mom is being contacted by a long term friend/family member who is using her for talk therapy. Not sure how to navigate that, but I’d say consider if being graciously straightforward might be appropriate. 

[KidsHappen]

I am bipolar and have known other people with bipolar and I have only heard of  paranoia in full blown bipolar psychosis. Is this something that she previously suffered from? If not, it seems like it is more likely related to the dementia which is common or there is something else going on. There are complications in treating a bipolar patient with dementia because some of the meds are no longer advised. However, I have said this before and I don't know if I could say it enough but you should never change a bipolar person's medication when they are stable. Do you know if the meds they have her on are somewhat sedating? Seroquel is a good one that is good for both phases, is sedating and helps with rapid cycling. Also so do they have her on an anti-anxiety med? Even if not on regular basis, it can help when she is really agitated. I am so sorry you are going through this. Bipolar is hard enough when the person is lucid and can participate in own care. I can't imagine trying to manage it if I didn't really know what was going on. That alone may be causing some paranoia. I hoping they get this smoothed out for her soon. 

[Spryte]

@KidsHappenThank you so much.

I sure wish they had not tinkered with her meds. She had been stable for 2 years or so, when they did, and it just killed me to see it happen. We had worked so hard to find the the right cocktail, and she had a wonderful psych we saw every three months for adjustments — but really, she hadn’t needed any changes for a few years. It was a relief. Once she moved to LTC and onto Medicaid, the Medicaid Psych NP took her completely off of her mood stabilizer (abilify), despite some long calls from me. It was so hard to watch. She wanted to “see what would happen” and wow, have we ever. My mom does have an anti anxiety med daily, and one of her anti depressants is good for anxiety, as well. It just doesn’t feel like things are balanced yet.

Bipolar psychosis — I will have to look that up. She was only diagnosed in her 70s, so she spent most of her life cycling and not knowing why. She was so relieved to be diagnosed and get treatment. She had managed fairly well, overall, but there were a few, ummmm notable episodes that I think might have crossed into bipolar psychosis. I’ll have to read more, to understand what it looks like a bit. Certainly, she’s going through something now, and the paranoid thoughts are prevalent now.

Thankfully her main nurse is very proactive and caring.

Thanks so much!

 

 

[Ottakee]

@Spryte sorry they messed with the meds.  If someone is stable that means the meds are WORKING, not that they don’t need them in most cases.

I wish more docs understood this and would continue what is working well 

[Selkie]

I don't know if this is similar to what your mom is going through, but both my grandma and my FIL experienced paranoia as part of their dementia.

My grandma thought the nursing home staff members were stealing from her (they weren't - all her belongings were safe and sound). When we sat  in the dining room together, she would say that other residents and staff were talking about her and making fun of her (they weren't - everyone was engrossed in their own meals and conversations).

My FIL went through a phase where he thought that anything happening on TV was happening to him. Once he called us in a panic saying that the sheriff was after him, when that was something he had just seen in an old western.

[fairfarmhand]

I second the idea that fibbing is merciful. If you can get others onboard it will probably help her stay more stable. My grandfather had dementia and grieved repeatedly for his father whom he had forgotten had died decades earlier. Someone said they wouldn’t lie to him when he asked how his father was so it repeatedly traumatized him which seemed cruel to me.

[Harriet Vane]

On 8/20/2022 at 11:19 PM, fairfarmhand said:

I second the idea that fibbing is merciful. If you can get others onboard it will probably help her stay more stable. My grandfather had dementia and grieved repeatedly for his father whom he had forgotten had died decades earlier. Someone said they wouldn’t lie to him when he asked how his father was so it repeatedly traumatized him which seemed cruel to me.

I don't call it fibbing or lying. I call it playing along. 

And yes, it's much, much kinder. It absolutely must be a way of life when caring for a loved one with dementia. The memory deficits mean that the person has effectively broken the time-space continuum and dwells in another reality. It's up to us to enter that reality and play along.

[TravelingChris]

On 8/17/2022 at 11:00 AM, Spryte said:

I will doublecheck that they have looked at the UTI possibility.

There is such an overlap with dementia and Bipolar symptoms — I think the two combined is particularly tricky, ugh. Paranoid thoughts are one of her Bipolar symptoms, so that is the immediate thought, but she does have dementia so it could be that, too. 

They had taken her off of her psych meds at one point, just to see what would happen (despite what I had to say), and that was a disaster. They still haven’t put her back on the dose at which was stable long-term, but they are working back up to it. Hopefully the med adjustment today will help. Since they took her off, she’s gone through four roommates with the associated honeymoons that devolved to paranoid thinking. Definitely still cycling. Such misery. I wish they had kept her on her meds.

 

And I really hope that will help.  Because unfortunately, if she turns combative, these places normally kick them out and send them to a psych ward.  Unfortunately, I became aware of this practice because of visiting a family member in such a place, and I asked about why they had what appeared to me were dementia patients.  The patients I was playing a game with told me about that practice.

And fast forward a lot of years, and I heard about a similar complaint about this happening in my current state too.  

[Miguelsmom]

I have Schizoaffective: Bipolar type. Paranoia outside episode is normal for me because of the schizo part. Which requires an injection of an antipsychotic monthly (there are some that are 2x a year) to even agree to take the rest of my medications. I have symptoms even heavily medicated. My paranoia on medication is just the uneasy feeling someone's standing behind you looking over your shoulder. I would ask  if there was a safe injectable antipsychotic if she's willing.  So her baseline is more stable. 

[Kanin]

4 hours ago, Miguelsmom said:

I have Schizoaffective: Bipolar type. Paranoia outside episode is normal for me because of the schizo part. Which requires an injection of an antipsychotic monthly (there are some that are 2x a year) to even agree to take the rest of my medications. I have symptoms even heavily medicated. My paranoia on medication is just the uneasy feeling someone's standing behind you looking over your shoulder. I would ask  if there was a safe injectable antipsychotic if she's willing.  So her baseline is more stable. 

I'm sorry you have to deal with that 😢