Question: My 77 year old father suffered a stroke in late January due to untreated high blood pressure and lost the use of his left side. He's currently in rehab, and has been doing well. He can now transfer out of his wheelchair with a little help and he's learning to walk again. He has feelings in his left leg and he can lift it but not without some difficulty. His left arm, however, needs a lot more work.

About three months ago, we began noticing bad behavior mostly in the late afternoon into evening hours. He claims that he can walk and asks us to take him home, and when we don't oblige, he becomes belligerent, shouting at the top of his voice. At times, he's verbally abusive to us, the aides and nurses at the rehab center, refuses to take his medicine, not trusting that he's being given "good" medicines. When he's this agitated, he does not sleep, constantly tries to get out of bed and consequently falls.

There have also been a few instances when his blood pressure suddenly dipped critically low.

My father is currently only Metoprolol and Diovan to control his blood pressure (sorry, don't know the dosage), Neurontin for pain in his shoulders and arms, a condition he used to complain about for several months before his stroke; and colase. Prior to his stroke, he also complained that he couldn't sleep at nights.

Knowing that my father was not big on taking prescription medicines, we have been trying to limit what he takes to only what's necessary at this point. We've especially tried to stay away from any psychotropic drugs but feel that his behavior has been getting progressively worse and so it may be time to think about putting him on something. He has also complained that his brain "races" at times, and he does not know when he's behaving badly.

Do you have any suggestions for something that may be able to help calm him down with as minimal side effects as possible and that is also not habit forming?

Thank you for whatever assistance you can give.

Thanks so much for your response. I appreciate the advice very much but looks like Quetiapine has an awful lot of side effects. Can you make a few more recommendations that may be possible alternatives?

We've thought about bringing my father home for weekend visits until he's ready to be discharged from rehab to help relieve some of the stress he may be feeling and therefore reacting to, but we also wonder if he'll even recognize his home because in his current world, it's 40-60 years ago and he lives in his home country, not the US. He doesn't even remember that his parents have passed on and thinks he still lives with them.

My father's cognitive skills and short term memory have been severely impaired by the stroke (he lost a large area of his brain, the doctors told us, and he will never be the same person he was). We've asked for a psychiatric evaluation to help get him some relief, but value your input as well as we seek to find the appropriate treatment for him.

You have been extremely helpful. I thank you so much for your very knowledgeable answers.

Best regards.