Schizophrenia, Anxiety, and Dementia: A Caregiver's Guide

Schizophrenia / Anxiety Disorder / Dementia

Hello, doctor.
I apologize for the interruption.
My mother exhibited symptoms of delusions, hallucinations, and illusions earlier this year.
After seeking medical attention, the doctor diagnosed her with schizophrenia.
After over a month of medication, those symptoms have subsided, but she is now experiencing severe anxiety.
This anxiety has been a condition my mother has had for decades, with periods of improvement when she was not on medication.
However, it has resurfaced recently.
Currently, she is almost always restless, unable to sit for long periods, and her hands tremble, especially when she is nervous.
Additionally, her walking has slowed down, her gastrointestinal health has deteriorated (severe constipation), her gaze appears increasingly vacant, and she feels very depressed.

Moreover, her personality has become increasingly difficult to manage.
I am uncertain if this is due to her illness, but she now feels very insecure and is particularly dependent on our family.
Her ability to handle tasks has worsened (p.s.
my mother has also been diagnosed with borderline intellectual functioning).
She tends to get overly fixated on trivial matters and is very intrusive, even concerning how our neighbor manages their garbage.
She now requires assistance from others to make decisions about various matters (e.g., what time to take her bedtime medication), and she repeats herself multiple times, stating she cannot control this behavior.
She checks the gas stove and doors/windows repeatedly, which were habits she had before but have now intensified.
I would like to ask the doctor how long it might take for these symptoms to improve.
The anxiety symptoms have persisted for about five months, but it feels like the medication is not helping, and they may even be worsening.
Am I being too impatient? Additionally, I found that schizophrenia is rarely diagnosed in middle age.
Could this possibly be a precursor to dementia? (The psychiatrist did not mention dementia during her follow-up, and I found this information online.) Should I take my mother to a neurologist for further evaluation, or should we continue focusing on her psychiatric care for now? I appreciate your help in clarifying these concerns.
Thank you.

Cai Xiaojie, 20~29 year old female. Ask Date: 2023/08/30

Dr. Tang Jiahong reply Psychiatry

After middle age, if hallucinations or delusions occur, it is advisable to check the brain.
Visiting a neurologist is a good option to see if any reversible issues can be identified and addressed.
Tremors and slow movements can also be discussed with the neurologist to determine if they are due to primary or secondary Parkinson's disease.
As for when anxiety and depression will improve, some medications may take a few weeks to show effects.
If there is no improvement after several months, medication adjustments can be considered.
If multiple adjustments still do not yield improvement, it may indicate treatment-resistant depression, which might require the incorporation of some non-pharmacological therapies.

Reply Date: 2023/08/30

More Info

Hello! Thank you for reaching out with your concerns regarding your mother's mental health. It sounds like you are navigating a complex situation with her schizophrenia, anxiety, and potential cognitive issues. I will address your questions and provide some insights based on medical knowledge.

Understanding the Symptoms and Treatment
1. Duration of Symptoms and Improvement: It is not uncommon for symptoms of anxiety to persist even after the acute symptoms of schizophrenia have been managed with medication. Anxiety can be a chronic condition, and it may take time for the medication to stabilize her mood and anxiety levels. It’s important to maintain open communication with her healthcare provider about her symptoms and any changes you observe. Sometimes, adjustments in medication or therapy may be necessary to find the right balance.

2. Medication Efficacy: If your mother has been on medication for her anxiety for a while without noticeable improvement, it may be worth discussing with her doctor the possibility of changing her medication or adding therapy. Cognitive Behavioral Therapy (CBT) can be particularly effective for anxiety disorders and may complement her medication regimen.

3. Cognitive Decline and Dementia Concerns: You mentioned concerns about dementia, especially since schizophrenia is less common in middle age. While some symptoms may overlap, such as cognitive decline and difficulty with decision-making, it’s essential to differentiate between the two. Schizophrenia can sometimes present with cognitive symptoms that may mimic dementia, but they are not the same. A thorough evaluation by a neurologist or geriatrician can help rule out dementia or other neurodegenerative conditions. It might be beneficial to pursue this if you notice significant cognitive decline.

4. Behavioral Changes: The increased anxiety, compulsive checking, and difficulty with decision-making could be exacerbated by her anxiety disorder. These behaviors can be distressing for both her and the family. It’s crucial to approach these behaviors with patience and understanding. Encouraging her to engage in calming activities, such as mindfulness or gentle exercise, may help alleviate some anxiety.

5. Support and Resources: Caregiving for someone with mental health issues can be challenging. It’s essential to seek support for yourself as well. Consider joining a support group for caregivers, which can provide emotional support and practical advice. Additionally, involving a mental health professional who specializes in geriatric care could provide more tailored strategies for managing her symptoms.

6. Patience and Progress: Recovery from mental health issues is often not linear. There may be periods of improvement followed by setbacks. It’s essential to celebrate small victories and remain patient. If you feel that her anxiety is worsening, it’s crucial to communicate this to her healthcare provider, as they may need to reassess her treatment plan.

Conclusion
In summary, your mother's situation is multifaceted, involving schizophrenia, anxiety, and potential cognitive decline. It’s vital to maintain close communication with her healthcare providers, consider a referral to a neurologist for cognitive concerns, and explore additional therapeutic options for her anxiety. Remember to take care of yourself as well, as caregiving can be demanding. Support groups and professional guidance can be invaluable during this time.

If you have further questions or need clarification on any points, please feel free to ask. Wishing you and your mother the best in navigating this challenging journey.

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