Paranoid delusions?

[CloudySue]

Hi, I'm a pediatric private duty nurse, and I need advice from nurses in the psychiatric field who can help me help my dad and step-mom.

My dad's wife is 92, he is 79. They live independently in their privately owned home. They live 3000 miles away from me. For the last 6 months, my step-mom has been like Jeckyl and Hyde- she can act completely lucid to medical professionals, neighbors, her own children, etc. but she's become increasingly delusional and verbally abusive to my father. She's convinced he has another wife and kids who live down the street, she thinks her own dog is not hers but was swapped with his "other wife's" dog that looks exactly like hers, she believes people live on her roof and urinate off the side of the house (as evidenced by water on the windows, which really come from the lawn sprinklers), she rants and raves in the night, hits her call bell while she's asleep and hears it and thinks it's dad's "other wife" sending him messages, etc. She's also threatened to set fire to her bed if anyone tries to make her leave her home.

She's seen doctors but she's a perfect angel to them, she's been in the ER, they've had a social worker to the house, but she's given nobody any evidence that she's having problems. Meanwhile, my dad is at wits' end, I'm so worried about his own health. He's too old to be dealing with the stress this sort of life is giving him.

I did visit for a week in December, she was such an angel to me the first two days that I seriously thought my dad was the one who was delusional. But on the third day she let down her guard and let her delusions out. I saw and documented lots of erratic behavior.

Tonight my father asked me to come out again and help me take care of her. I work PRN so I can get away from work for a while. Can any of you point me in the right direction once I'm out there staying with them? Thank you for any advice you can offer.

[DanaerysTargaryen]

Contact a geri psych unit. They should have a process for taking inquiry calls, and it sounds like based on your stepmom's symptoms there is a good chance she would meet admission criteria. If not they may be able to refer you to another unit or psychiatrist who can help. Depending on your geographic area I might be able to point you in the direction of a few programs. Or you could just google "your area + geri psych inpatient unit" or similar and see what you find. Trying the ER again and going with your dad so he has backup and support in reporting just how severe her symptoms have become is also an option. Going to her primary care doctor and doing the same is also an option. If her behavior becomes dangerous toward your dad or herself in the meantime he can call 911 for assistance. I have seen patients with similar symptoms become violent, and have seen well-trained staff decades younger than your father get hurt due to these behaviors, which is why I mention this option. Out of curiosity does your stepmom have a dementia diagnosis or any other diagnosed psych issues?

Very best of luck in dealing with these issues. You sound like a good and devoted daughter/ step daughter and your dad and stepmom are lucky to have you in their lives.