QUESTION:
Dear Dr. Heller,
Hi. First I would like to thank you for your time and efforts on this delicate matter. I'm concerned about my Dad. He's 75 and has had a few "mini strokes" and is on heart meds to regulate his "flutter". He is also taking some blood thinners. He has been behaving erratically. It started when there were bouts of his "temper" (nonviolent) occasionally. And now it has progressed to where its quite often and stretching social boundaries.
Like a woman with PMS...He would be fine one minute and his anger would spike out of control the next. Then he'll go into deep remorse and depression afterwards. Then he seems to forget or extremely minimize the course, intensity and absurdness of his actions. Example 1: My 12 year old niece evidently used the wrong Band-Aid for her cut. He yelled at her. My Aunt, who was vacationing at the our house at the time calmly said, "Hey, it's only a band-aid. If you are that offended I'll go out and buy more - But that's no reason to yell at her." My dad promptly yelled at my Aunt to hysteric tears and kicked her and her husband out of the house. Example 2: He was hooking up the dishwasher and wanted to break down the wall to loop the tube up and around, then reroute the plumbing to compensate. He blamed it on the shoddy workmanship of Kenmore and that it was the only way to do it. My Mom and I thought this sounded a bit extreme and read the directions and told him to do what they say and simply hook it up to the disposal. He accused me of prying into his marital affairs and then left the house in just a flannel shirt and pants and slippers muttering, "I just want to die....I just want to die!" (January in Minnesota). My Mom drove down the street and somehow calmed him down enough to bring him home and warm him up. You never know what will set him off.
My Mom is getting so exhausted from walking on eggshells. My Aunt never wants to visit again and my sister no longer is in contact with my parents. Everybody seems to be bailing out but me. I love my Mom and Dad and will not bail just because times are challenging. I can't help thinking that this is some type of disorder. If we can find out more about it WE could manage it better and not go insane ourselves!
ANSWER:
Assuming these problems only began after the strokes, there are two things that should
be done:
1) Make certain some other biological process isn't going on such
as a subdural hematoma, low blood oxygen, anemia, low thyroid or other problem.
2) He'll likely need two medications: An antipsychotic medication
like Seroquel and likely an antidepressant. Sometimes a stimulant such as Ritalin may be
useful.
