Advice to help mother with delusional disorder

I'd just like to ask if anyone has any advice to offer me concerning the present situation with my mother, who is in her late sixties. She has had a previous episode of delusional disorder
many years back soon after my father died, but made a virtually complete recovery from this (substantially without medication) which has lasted for 16 years. Sometime back in the summer of this year, she was, unbeknown to myself, prescribed Amitryptiline anti-depressants, which she took for about one week before she discontinued these herself. It is difficult to determine whether the taking of these instigated the subsequent behaviour, but from about this point in time,
strong delusional behaviour started to appear. At first her behaviour was characterised mainly by anxiety, but then came paranoia about being targeted, poisoned by her doctor, mistrust of her partner of recent years (who she has now virtually rejected) and the belief that he was conducting an affair, and deep suspicion about virtually every aspect of daily life (ie. seeking out the most bizarre explanation for trivially ordinary daily happenings in order to build up her "conspiracy" view of the world).

When we realised the severity of her delusions, my sister and I, who live locally to my mother contacted her doctor to explain our concerns. She had a range of blood tests carried out, which I believe showed nothing abnormal, and she was then seen by two psychiatrists. It was initially recommended that she be taken into psychiatric hospital, but because this was a very difficult decision for our family to make (and for mother this would have completed the self-fulfilling prophecy that the “authorities” were out to get her) , we asked that we might try and manage the situation at home, and to that end she was prescribed Olanzapine (Zyprexa) 5mg daily. As she is convinced that there is absolutely nothing wrong with her mental health, it was extremely difficult to get her to take her daily medication, but we were initially succeeding, and it did seem to have a beneficial effect over the very short time that we succeeded in getting her to take it. Things took a downward turn when her brother who had initially shown little interest in the situation, began to positively undermine our efforts to administer her medication, by saying he didn't agree with her taking anti-psychotics, and following up by printing out all manner of stuff from the internet and showing this to her, and then almost physically intervening to prevent her taking her tablet. It thus became totally impossible for us to continue with the Olanzapine.

The situation at present is that my mother is visited once a week by the local psychiatric nurse (who is fully aware of everything that has happened), and who is basically monitoring her condition. Although some of the delusions have eased a little, the core delusional behaviour and beliefs appear as strong as ever. She complains each day of how ill she feels, and that nobody has any sympathy for her, which is of course the opposite of what is true. The whole family is enveloped by the stress that this ongoing situation has caused, on so many levels - the distress of seeing one's mother in this state, and the anger at being powerless to make her follow a logical course of action that might help her recover. As many others are all too familiar, practically every conversation ends up returning to some aspect of the delusions. I've been finding this increasingly difficult of late, especially when she constantly states that "nobody is concerned about her" (I should add that she's changed her GP several times - usually in response to each time one of them suggests that she has a mental health issue). She visits our house most days, which is generally beneficial as she is greatly improved in the company of our two young children, but it can all to often create a mix which deteriorates into argument when she begins to complain that nobody cares about her or uses other highly charged emotional language which is the total opposite of the truth of the matter (which is quite upsetting in front of our two small children).

I've spent some considerable time reading through many posts on this forum, and have already found a great deal of help from reading the posts of others dealing with similar delusional disorder behaviour. My mother holds on to her delusions with the usual unshakeable conviction, and it seems completely impossible to change her view of the world despite no end of patient conversation. For example, my mother claims that the psychiatric nurse that visits each week “isn’t a real nurse” and that myself and my sister are “very naive” for believing otherwise. I wonder though if anybody might have some further thoughts or even small hints on any way that might help us to gain some improvement in the situation, given that medication is just not a possibility unless she is taken into care against her own wishes.

Sincere thanks for any help!

hello dd. very sorry to hear about your situation. i also have a mother who has had DD(P), though i never remember her not having it (i.e. it hasn't been variable, as it was for your mum). if you click on my username you can go back among my posts, which are almost all on this topic.

two observations:

dave_danger wrote:deep suspicion about virtually every aspect of daily life (ie. seeking out the most bizarre explanation for trivially ordinary daily happenings in order to build up her "conspiracy" view of the world).

same. little odd events, or even perfectly normal ones, are not shrugged off with a sensible explanation. they are springboards for her to go to the limits of rationality, and even into pure fantasy, to find a reason that will allow her to see a conspiracy against herself and to insult the intelligence and decency of all involved (including her son here).

dave_danger wrote:My mother holds on to her delusions with the usual unshakeable conviction, and it seems completely impossible to change her view of the world despite no end of patient conversation. For example, my mother claims that the psychiatric nurse that visits each week “isn’t a real nurse” and that myself and my sister are “very naive” for believing otherwise. I wonder though if anybody might have some further thoughts or even small hints on any way that might help us to gain some improvement in the situation, given that medication is just not a possibility unless she is taken into care against her own wishes.

in my experience DDP has been unreachable. i am surprised to read in your account that medication had helped your mum. no approach i have ever taken, and i've tried every one i was capable of, has gone anywhere. it was only last summer that i finally admitted to myself that i would never and could never get through, and that has helped me deal, though the situation will never be alright.

good luck, and i'd like to hear if you can get her back on the meds and how they help.

Dave_Danger:

I can sympathize with your situation, as mine is somewhat similar. My wife's delusion isn't as bad as some others that I have read, but it is enough for me!

dave_danger wrote:he whole family is enveloped by the stress that this ongoing situation has caused, on so many levels - the distress of seeing one's mother in this state, and the anger at being powerless to make her follow a logical course of action that might help her recover.

Everyone in the family experiences DD, including the kids. We all get to wade through it. Often the spouse gets to be the "reality manager" in the family, which can lead to ugly arguments from the DD spouse -- especially concerning what activities the children should be involved in etc. If the kids happen to hear all this, we have a truly awful situation for all.

dave_danger wrote:For example, my mother claims that the psychiatric nurse that visits each week “isn’t a real nurse” and that myself and my sister are “very naive” for believing otherwise.

Yes, my wife is the one "in the know" and I am "checked out" and "naive" because I don't see the plethora of evils out there as she does. Using reason with her is often unwise, so the option is to say nothing or try to insert reality -- just a bit -- but going too far in the "reality direction" leads to a blow up and a fight, and you will never get anywhere cramming reality down a DD throat. The best you can do is just throw out a little reality now and then -- I do, but more for my sanity than hers.

dave_danger wrote:My mother holds on to her delusions with the usual unshakeable conviction, and it seems completely impossible to change her view of the world despite no end of patient conversation.

Not even the Gods could shake my wife from her conviction. She is a Christian, so at one time talked to the object of her delusion and actually said "Sorry" for thinking so badly of him. This is the Christian part of her. I marked time, thinking: "if it comes back in six months, it's DD. If it doesn't, it's something else." I was happy for a while, thinking we had escaped DD, with all its destructions. It was over. We were done with it. Yahoo! But at the five month mark, it came back, with the usual crazy cause-and-effect connections that only a DD person can make, and we were back in it. How could I be so stupid, thinking it was gone? It will never be gone. Never. Why? Because she is not fully in touch with reality, so her mind can just make up anything to support her view. That's why it's a severe mental illness.

Just these thoughts. I hope all in your family can get through this, and perhaps your mother can get help also. (My son, who has schizophrenia, was on Zyprexa for quite a while and it really helped him.)

MrSicily

Very many thanks Sal and MrSicily for your replies – it’s incredibly helpful for me to learn from other people’s experiences and to gain comfort from the fact that there is support available through the knowledge and experience of other people and their families who have to cope with similar difficulties that can be shared on a forum such as this excellent one. I would like to reciprocate my sympathies to your personal situations also; despite the differences in the circumstances, the same DD behaviour and the types of stresses that it places the family under do seem very similar in so many instances.

I think that on a personal level, the one aspect that has caused me some of the greatest stress has been when things seem to be moving in a positive direction, and then all of a sudden they return back to a really bad state once again; the roller-coaster ride through optimism, then to total despair at the situation, and then back to optimism again is very tough. I believe that I do need to “adapt” the way that I emotionally deal with my mothers illness and start to be more accepting of DD being part of her make-up from now on – whilst remaining optimistic that a certain level of improvement might occur – rather than constantly secretly hoping for the day to arrive where she will “snap out of it”. I think that if I can make this adjustment in myself, then I can be more supportive and am less likely to become angry and upset due to the frustration when dealing with the illness.

Although it’s taken me a while to learn, there is absolutely no point in arguing against DD – might as well talk to the wall. The only exception seems to be when it is very easy to 100% demonstrate that there is a very obvious and apparent explanation to an event that is otherwise “explained” by a delusion. I now also make a point of not responding to any of the more esoteric delusional thoughts, and either say nothing or change the subject. In fact, normal conversation, as I’m sure you’ll agree is a tricky matter, since I’ve learned that if I talk about my normal daily events, these can often get turned around and interpreted back to me in a way that supports the delusional conspiracies – so I also try and limit conversation to stuff which cannot be twisted around, which does make the range of topics up for discussion somewhat limited!

I’ve been carrying on a bit further with my reading, and one thing that I did happen to notice was that DD type of psychosis can often be triggered (by events / certain drugs) in people who have Bipolar disorder. The more I look at the criteria for something like rapid-cycling Bipolar, the more that this seems to have a reasonable degree of fit to my mother in many ways – I am of course absolutely no expert, but part of me does feel that maybe she has actually had some degree of undiagnosed bipolar throughout her life? This also seems to be a better fit for why the events that have happened in her life have been transients (albeit the present one is lasting rather long in that case) that she has made a recovery from, and might explain why the DD behaviour began immediately following the Amitryptiline (incidentally, when the fisrt psychiatrist who saw her discovered that she’d been prescribed Amitryptiline, she told her to stop immediately and throw any remaining tablets away – which appears to me at least that they had a fair suspicion that the drug might have caused the onset of the illness)

Finally, thanks again for taking the time to reply – it’s very kind, and great to feel that you’re not having to fight this all alone, and that there are others out there who will share thoughts, advice and ideas.

Very best,
D.

dave_danger wrote:In fact, normal conversation, as I’m sure you’ll agree is a tricky matter, since I’ve learned that if I talk about my normal daily events, these can often get turned around and interpreted back to me in a way that supports the delusional conspiracies – so I also try and limit conversation to stuff which cannot be twisted around, which does make the range of topics up for discussion somewhat limited!

this is a keen insight, and, on reflection, the first clear sign i had, when i was very young, that there was some kind of problem, was that i would tell my mother the most innocuous things, only to have the topic hijacked and turned into a sometimes red-faced rampage. it took endless times to learn the lesson, not to tell her anything, or to make up something that i knew she'd want to hear.

Hey Dave, you got me thinking about your thery about amitryptiline. I can't remember which antidepressants my mum took, but when her delusions became really apparent the Dr said she needs to stop her antidepressants. My sister and I suspected she was bipolar...I'm wondering if people with bipolar who are on the wrong antidepressants can develop DD...hmmm.

As somebody who has suffered with Bi-polar Disorder for the past twenty years, I can confirm that the "normal anti-depressants" did not work for me at all, in many cases making me feel worse. It was not until my crisis point when I got properly diagnosed , that I was put on the correct medication for bi-polar disorder. I do think that when I was very ill (and therefore untreated) I did suffer from some delusional beliefs about myself and did not realise how ill I really was.