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Suggest Treatment For Impaired Cognition Skills And Hallucination
Question: hello sir,
i have asked you questions in past regarding my father's mental confusion and hallucination.
now he dont seems to have confusion and hallucination.
what i observe now is-
he is on bed most of the time even when not sleeping.
he has impaired cognition - like not able to do daily tasks(bathing and eating) like a normal person.
like while bathing half of water may be falling behind him on floor.
soap may remain on his body.
not able to change clothes properly. his legs may stuck in pants and may fall sometimes if not held.
continuously go on eating at bit fast pace.
his chin gets dirty.
he may eat whatever portion of roti and sabji comes in his hand. sometimes too big sometime too small.
sometimes he does bedwetting too.
he started eye blinking few weeks ago but again he stopped blinking now.
he also does not have control over his walking specially coming down stairs.
like he will not be able to control his legs while coming down. its like running down on stairs.
recently i visited to Neurologist XXXXXXX sardana (Head in Kota)
he prescribed - rezoid , divaa-OD 500mg and olimelt 5mg.
and he also refered me to psychiatrist.
but psychiatrist prescribed -
EZOLENT PLUS, MIRTEE MELTAB 7.5MG , ALZIL- M 5MG, XXXXXXX 100, OSTEOCOBAL.
so now i am confused which course should we take.
what is your opinion.
i have asked you questions in past regarding my father's mental confusion and hallucination.
now he dont seems to have confusion and hallucination.
what i observe now is-
he is on bed most of the time even when not sleeping.
he has impaired cognition - like not able to do daily tasks(bathing and eating) like a normal person.
like while bathing half of water may be falling behind him on floor.
soap may remain on his body.
not able to change clothes properly. his legs may stuck in pants and may fall sometimes if not held.
continuously go on eating at bit fast pace.
his chin gets dirty.
he may eat whatever portion of roti and sabji comes in his hand. sometimes too big sometime too small.
sometimes he does bedwetting too.
he started eye blinking few weeks ago but again he stopped blinking now.
he also does not have control over his walking specially coming down stairs.
like he will not be able to control his legs while coming down. its like running down on stairs.
recently i visited to Neurologist XXXXXXX sardana (Head in Kota)
he prescribed - rezoid , divaa-OD 500mg and olimelt 5mg.
and he also refered me to psychiatrist.
but psychiatrist prescribed -
EZOLENT PLUS, MIRTEE MELTAB 7.5MG , ALZIL- M 5MG, XXXXXXX 100, OSTEOCOBAL.
so now i am confused which course should we take.
what is your opinion.
Brief Answer:
Please read below
Detailed Answer:
Dear XXXXXXX
Thanks for writing back to me.
Although I will prefer not to take sides (I am a psychiatrist) but I think the question is really puzzling and need to take some sides.
First of all I do not see any rationale for antipsychotic as well as mood stabiliser. Olimelt is antipsychotic and Divaa OD is mood stabilizer. This is because there are no psychotic symptoms or irritability (mood symptoms) on this day.
So it can be said that you need to follow the psychiatrist opinion.
But I will not end here.
Considering his history over the last four to five months I feel the Alzil should be 5 mg but there must be memantine 10 mg as well. I understand that there is no proven value for any of them but there are some reports of having positive effect on dementia associated with alcohol withdrawal for memantine. It also comes as ALZIL- M- (contains donepezil 5 mg and memantine 10 mg). Since I am not supposed to prescribe online I request you to discuss this part with your psychiatrist. In case he needs you can give my reference as geriatric psychiatrist. In case your tablet contains 5 mg and 10 mg I do not think this need to be discussed.
On the next part I also feel that there should be check for thyroid. In case any abnormality is found that need to be treated.
Thirdly give him the Vitamin D3 60000units per week. Although Osetocobal contains some amount but it will not be enough on early basis.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.
Please read below
Detailed Answer:
Dear XXXXXXX
Thanks for writing back to me.
Although I will prefer not to take sides (I am a psychiatrist) but I think the question is really puzzling and need to take some sides.
First of all I do not see any rationale for antipsychotic as well as mood stabiliser. Olimelt is antipsychotic and Divaa OD is mood stabilizer. This is because there are no psychotic symptoms or irritability (mood symptoms) on this day.
So it can be said that you need to follow the psychiatrist opinion.
But I will not end here.
Considering his history over the last four to five months I feel the Alzil should be 5 mg but there must be memantine 10 mg as well. I understand that there is no proven value for any of them but there are some reports of having positive effect on dementia associated with alcohol withdrawal for memantine. It also comes as ALZIL- M- (contains donepezil 5 mg and memantine 10 mg). Since I am not supposed to prescribe online I request you to discuss this part with your psychiatrist. In case he needs you can give my reference as geriatric psychiatrist. In case your tablet contains 5 mg and 10 mg I do not think this need to be discussed.
On the next part I also feel that there should be check for thyroid. In case any abnormality is found that need to be treated.
Thirdly give him the Vitamin D3 60000units per week. Although Osetocobal contains some amount but it will not be enough on early basis.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your answer.
Yes he is taking psychiatrist's medicines.It's been 5 days since he started on course prescribed by psychiatrist.
Nowadays he is sleeping all the time. Doing bed wetting also. And not concerned with wet clothes.
Today Neither brushed teeth nor bathed even when told to do.
He just went to kitchen, ate food and slept again.
Why these symptoms may be occuring and what we can do now?
Yes he is taking psychiatrist's medicines.It's been 5 days since he started on course prescribed by psychiatrist.
Nowadays he is sleeping all the time. Doing bed wetting also. And not concerned with wet clothes.
Today Neither brushed teeth nor bathed even when told to do.
He just went to kitchen, ate food and slept again.
Why these symptoms may be occuring and what we can do now?
Brief Answer:
Please read below
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I think there is need to review two more medicines which I did not discuss last night.
First is emollient plus. In this I think escitalopram should be continued while the etizolam part should be removed. I mean to say that it can be replaced with either Nexito or Rexipra or C pram S as it contains only escitalopram.
The second is Mirtaz. In case the earlier option do not give results I think Mirtaz should be removed.
I am considering these two options as etizolam part of ezolent plus and mitrtazepine itself causes sedation and subsequent bed wetting.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.
Please read below
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I think there is need to review two more medicines which I did not discuss last night.
First is emollient plus. In this I think escitalopram should be continued while the etizolam part should be removed. I mean to say that it can be replaced with either Nexito or Rexipra or C pram S as it contains only escitalopram.
The second is Mirtaz. In case the earlier option do not give results I think Mirtaz should be removed.
I am considering these two options as etizolam part of ezolent plus and mitrtazepine itself causes sedation and subsequent bed wetting.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks
we have stopped giving etizola . and he is doing some activities like bathing eating. but about bed wetting, he is not doing it . but when he get up for toilet , he does a little while on the way to toilet or while opening zip. i dont know whtether it is due to weak control or due to weak cognition. this problem has been since months.
second thing is , he is stubborn sometimes. like when we try to guide him to eat food proper way. he stop eating and says, XXXX
Please advice.
we have stopped giving etizola . and he is doing some activities like bathing eating. but about bed wetting, he is not doing it . but when he get up for toilet , he does a little while on the way to toilet or while opening zip. i dont know whtether it is due to weak control or due to weak cognition. this problem has been since months.
second thing is , he is stubborn sometimes. like when we try to guide him to eat food proper way. he stop eating and says, XXXX
Please advice.
Brief Answer:
I think we need to wait for few more days
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
As I can see that he is doing some positive activities such as bathing and eating while there is less negative activities such as bed wetting. I think the kind of response we have seen over last one day is good sign and we can expect more changes over time.
Regarding dribbling of urine while going to toilet is most probably due to urgency associated with some other issues like prostate gland enlargement as it is not due to some weakness. I must acknowledge that poor cognition can be responsible for this part but it is important to get san USG abdomen to get prostate size checked.
Regarding stubbornness In my opinion we need to tackle it softly and not with medications. I mean to say that behavioral approach is better idea to control stubbornness rather than the medications as there is potential for side effects.
I hope you will agree with me on this part as decrease in medication has helped us in last five months on many occasions.
I hope this assists you further.
Thanks and regards.
I think we need to wait for few more days
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
As I can see that he is doing some positive activities such as bathing and eating while there is less negative activities such as bed wetting. I think the kind of response we have seen over last one day is good sign and we can expect more changes over time.
Regarding dribbling of urine while going to toilet is most probably due to urgency associated with some other issues like prostate gland enlargement as it is not due to some weakness. I must acknowledge that poor cognition can be responsible for this part but it is important to get san USG abdomen to get prostate size checked.
Regarding stubbornness In my opinion we need to tackle it softly and not with medications. I mean to say that behavioral approach is better idea to control stubbornness rather than the medications as there is potential for side effects.
I hope you will agree with me on this part as decrease in medication has helped us in last five months on many occasions.
I hope this assists you further.
Thanks and regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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