What to expect when...your mom has been involuntarily committed.
July 15, 2015 9:41 PM   Subscribe

My 62-year-old mom with "pseudodementia" was taken to the hospital last night after a psychotic episode, and now she's in the neuro wing of the hospital under involuntary commitment...what should I expect to happen, and what could be wrong with her?

Sorry, this is long and super complicated:

Short version: I am an adult only child whose mother (age 62; dad is deceased) suffered some sort of mental break back in January when my grandpa died. She was diagnosed as having "pseudodementia" but it is getting much worse. Last night the cops were called to her house when her alarm system went off; my uncle showed up (I live on the other side of the country) and she was incoherent, delusional, and didn't know where she was (she had triggered the alarm). Now she's under involuntary commitment in the neurology wing at the hospital undergoing a battery of tests to see if there is a physiological cause (such as stroke) for her dementia/psychosis. If she "passes" these tests, I'm under the assumption she will be admitted to the psych ward, which terrifies me, even though I'm relieved she is under SOME care and not sitting at home alone. I know YANAD, but roughly what should I expect to happen here? Am I doing the right thing?

Since this original psychotic episode in January, I have not been satisfied with the pseudodementia diagnosis, or with her doctor's treatment plan (very passive, not super concerned, has her on Paxil, Xanax and Ambien in addition to cholesterol and meds for her high blood pressure).

She has been an alcoholic all my life, and also smokes weed every day.

She barely eats and I'm convinced goes days without consuming anything but Oatmeal Cream Pies and White Russians. I suspect this is a BIG part of her problem, especially in light of all the medication, but she absolutely refuses to eat.

She generally has NO interest in getting actual mental/medical help and is currently under sedation and in restraints because she has been physically threatening the hospital staff and tried to escape twice. She believes she is perfectly fine and that we are all plotting to have her locked up.

She has some good days where she seems totally lucid and aware of her surroundings, but more not-so-good days. Some of her symptoms include: Putting her clothes on backwards, speaking gibberish, huge memory lapses, inability to do basic math, doesn't know what month/day of the week it is, incontinence, suspicion/paranoia, and lifelong debilitating depression, anxiety and agoraphobia.

She was fired from her job in September 2014 due to increasing incompetence. This really floored her and I think that's when the break first happened, though it had obviously been slowly building. Apparently she had been turning in total nonsense.

She and I have never had a great relationship and I consider her to have been a very toxic, psychologically abusive parent. For years I've toyed with the idea of cutting off communication with her, but now I feel that I'm the only person she has, so I'm in for the long-haul, I suppose.

If ANYONE has any experience with something like this, I'd love to hear your thoughts!!
posted by straycatinthewildwest to Health & Fitness (13 answers total) 6 users marked this as a favorite
Alcoholism is one disease. Alcoholism with anorexia makes it worse. Cirrhosis of the liver can also have paych effects. A big dose 60 mg of Lipitor can make it difficult to clear the meds out and make room for more. 62 is relatively young for full out dementia or Alzheimer's but you should be able to find some stats on that.

When my mom first went into a facility after a similar full meltdown, they told me to stay away for a couple of months until they could stabilize her. She was 82, not 62.

You might try talking to her, if you can calm her, if you think that will help her. Sometimes there is no safe distance from some people, and or the situations they create. Mental illness is the most difficult illness for adult children to approach.

I wish you and your mom the best. I would say don't fail to contact her, soon, as she may make a sudden exit, it is best to make contact, it will sit better with you later. You might also have medical history to add to the diagnostic process.
posted by Oyéah at 11:51 PM on July 15, 2015 [3 favorites]

Best answer: She is being held involuntarily because she either would not or could not agree to be admitted of her own cognition. Which is OK...sounds like she definitely needs the treatment and this isn't a negligent decision.

With what you said about her alcoholism, I would be asking about the doctors ruling out Wernicke-Korsakoff Syndrome. https://en.m.wikipedia.org/wiki/Wernicke–Korsakoff_syndrome I'm not a psychiatrist, but her current psych meds you listed sound like they are all wrong (DISCLAIMER: I work in a psych hospital doing admissions, so I have learned things along the way but am not a licensed psychiatrist). I expect those meds will be changed. There are antipsychotics they can prescribe that can help clear up her thinking but may not be a cure all, especially if there's something organic going on causing the hallucinations, etc.

I would reach out to her if you want. Don't engage in an argument about who is trying to lock her up or anything like that. Reassure her that she is safe and being taken care of and feel free to end the conversation if she gets angry or confused or too delusional.

I wish you and her the best. Remember to take things one step at a time and know that it may take a bit to get the right treatment going.
posted by MultiFaceted at 12:59 AM on July 16, 2015 [4 favorites]

Long-term, active alcoholism with a side order of pot smoking -- those two alone can get someone twisted out of control, sometimes to the point of no return.

It'll be an extraordinary thing for her to even stop drinking,much less find herself, find her way.

She's being held because she is "a danger to herself." DTS/DTO -- Danger To Self / Danger To Others -- Someone fits either or both of those criteria they can be committed. And should be committed, too, until things are sorted out, if they *can* be sorted out. She's a long way down the road.

Hard for me to believe any doc would right her those scrips when she's unable to benefit form any of it until she is able to set down drinking and drugging. *If* she is able to set down drinking and drugging.

I wish you both all the luck in the world. You're going to need it.
posted by dancestoblue at 3:21 AM on July 16, 2015 [1 favorite]

I can't speak to what you should expect, but please immediately inform her doctors/the hospital about her drinking. My elderly grandmother accidentally detoxed (long story) and ended up in the ICU. We all thought SHE had told the hospital that she was downing a liter of vodka a day, but she hadn't. Her doctors had no idea why she was disoriented and seizing and the whole episode ended up with her having permanent neurological damage.

Good luck with your mom. I hope she gets the care she needs.
posted by PorcineWithMe at 4:01 AM on July 16, 2015 [7 favorites]

"62 is relatively young for full out dementia or Alzheimer's"

FWIW: 62 would be entirely possible for early-onset Alz. Can't speak to the likelihood that these symptoms correspond, but full-blown dementia with paranoia at 62 can happen, even without alcoholism added.

(I've read conflicting things about early-onset, but I *think* they've now decided that it is less likely to be inheritable. So early-onset can be a valid concern even if there's no history of dementia in your family.)

You're in a tough place. So sorry.
posted by galadriel at 5:30 AM on July 16, 2015

I would recommend calling the social worker assigned to your mother and discussing all of the concerns you listed above with them-- social workers are generally easier to get a hold of than doctors and one of their roles is helping collaborate with the important people in the patient's life. Ask about the discharge process and what kind of services she'll be linked with after treatment. You can decide the level of involvement you want in her treatment/discharge. Best of luck.
posted by fox problems at 5:39 AM on July 16, 2015 [5 favorites]

Something to think about, but given her very poor diet they might also want to check her Vitamin B12 levels as well. A long standing severe deficiency can have bad neurological consequences.
posted by gudrun at 6:26 AM on July 16, 2015 [2 favorites]

Quick answer, because I'm between patients: make sure they have her history, including the alcohol and drug use and not eating, a sense if how long this has been going on (that is, this doesn't sound *all* sudden, but a sudden worsening), and any other family history of mental health.

Inpatient is good, because they can get her stabilized on better medications. Memail me if you like, and if you're in the us northeast, I can give you even more specifics of the 'long haul'
posted by cobaltnine at 6:59 AM on July 16, 2015 [3 favorites]

For years I've toyed with the idea of cutting off communication with her, but now I feel that I'm the only person she has, so I'm in for the long-haul, I suppose.

Just stepping in to say that this is an option that is on the table for you, cutting communication. You don't have to and there are certainly some people who will consider it unfeeling and callous, but you absolutely don't need to let your life revolve around someone who will not taker care of themselves, so I'd give this option a good think because it's a choice you can make, not a situation that has been thrust on you which you are powerless to prevent. Speaking as the adult child of an alcoholic who died after a few years of emotional-pain-induced-worsening it's a really difficult thing to step up to do and I don't regret my decision to stay at more arm's length from the whole thing, maintain my own boundaries.

Being admitted to the psych ward would be much better for her than staying at home unable to care for herself.

Things you will want to think about/manage

- if she's in there long-term she'll need someone to manage/handle her home life from emptying the fridge to stopping/forwarding the mail to paying bills. That's a thing you can focus on which is more straightforward than everything else
- if there are other people in her life even people she is not close with, you may want to give them some sort of idea of what is going on (not disclose private details but "is in the hospital" in case there might be some additional support network available)
- you may want to talk to the hospital social worker about what your options are. There are a lot of laws about what doctors can and can't tell you and sometimes wiggle room for what they will tell family members, etc.

I don't know the specifics of hospital/medical/legal stuff but have a partner with an adult son who is occasionally hospitalized and there's always a bunch of hoops to jump through as far as what the doctors can tell him if the son refuses to let his medical information be shared. I'm not telling you this to scare you, just so that you're not surprised if this comes up.

As far as you doing the right thing? That's a moral compass question and I'd talk to some friends or trusted people in your life about what your options may be. I think life is always too short to spend it trying to keep someone alive who is trying to indirectly kill themselves but I have dealt with a lot of bullshit with the alcoholic in my life and have empathy fatigue. There are a lot of perspectives on this issue and I wish you strength and peace trying to find the one which works for you.
posted by jessamyn at 7:09 AM on July 16, 2015 [8 favorites]

Something I want to say, since I've watched a bunch of friends go through this with their parents in the past couple of years. Don't mistake this behavior:

She generally has NO interest in getting actual mental/medical help and is currently under sedation and in restraints because she has been physically threatening the hospital staff and tried to escape twice. She believes she is perfectly fine and that we are all plotting to have her locked up.

for a rational decision, or agency. This is how people act when their brains aren't working right. They are combative, they DO believe they are fine and so it is hugely bizarre and completely terrifying that everyone around them is making up all this shit about them.

There was a time when these behaviors were a decision your mother made. That time is long gone, and if you can find a reframing for this situation in which your mother is sick (and has been for a long time, and no longer has a choice to just stop being sick) rather than doing this on purpose, and doing this to you on purpose, it will make it easier for you to do the parts of this that are going to fall on you.

She is where she needs to be, and you don't actually have much say in that now that she's in the system, at least not until she comes out the other side. I do think a right thing to do is tell her care team what you know about her circumstances, just so they've got as much information as possible. I don't think you need to (or are required to, and possibly the care team doesn't want you to) communicate directly with her at this point, if you don't want to. If you *do* want to talk to her, talk to her care team first as there may be a specific way they'd like you to go about that.

There's a number of ways this could play out. Probably none of them result in you getting your mom fixed (and that's something you might talk about out loud to the care team or social worker, because they're going to assume that you think that's going to happen and it colors their communication with you), just more stable maybe. There's probably a decent chance she'll never go home again, or that if she does it's unlikely she'll be compliant.

Absolutely talk to the social worker and get the lay of the land. You're probably going to need to have a talk with your uncle, and maybe a conference call with the two of you and the social worker. Right this minute, the primary concerns are practical (her house/bills), legal (the social worker will probably be able to at least give you the bullet points, but probably you or your uncle are going to need to be her legal representative), and waiting and seeing what the neuro and psych evaluations say.

If you decide to walk away completely and not even be involved in the management of her care, at least say so to the hospital and your uncle so that your non-presence isn't a hindrance to her care. Your involvement may be required for long enough to legally disengage.
posted by Lyn Never at 9:10 AM on July 16, 2015 [3 favorites]

If you are comfortable sharing what state she is in, someone may be able to provide more detail on what is likely to happen with regards to involuntary commitment. Here's a PDF that explains California's procedures - I don't know how much they vary by state. NAMI can be a good resource - they have lots of local chapters in addition to the national organization.
posted by insectosaurus at 11:58 AM on July 16, 2015

Response by poster: Thanks, everybody, for all the thoughtful responses. I can't tell you how much better and reassured I felt after reading them, despite the scariness of it all. Some mundane housekeeping things like insurance, feeding her dog (poor guy!) and paying her bills are all taken care of, so some of the chaos has died down.

It's now been over 24 hours and I still haven't been able to talk to a doctor. Left messages, but no one has called me back. The waiting game is excruciating. I do know that she has seen both a neurologist and a psychiatrist, so that gives me hope that some progress is being made. I called her room but there was no answer; I know she's up and about and not sedated today, so I'm guessing she didn't want to talk to whomever was calling, which makes my heart hurt :(

To answer insectosaurus, she is in North Carolina. Any information specific to her state would be fantastic, but I'll look up NAMI too. When I finally speak to a doctor, I'm going to ask to be referred to her social worker, that sounds like a great resource that could potentially be very useful for me and the rest of the family right now.

To MultiFaceted—I was VERY intrigued to read about Wernicke–Korsakoff syndrome! There might not be a better description of her current mental state than "wet brain." I'm definitely going to make sure the doctors are informed of her alcoholism so they can take this into account.

Thank you all again, I appreciate it so much!
posted by straycatinthewildwest at 3:28 PM on July 16, 2015 [1 favorite]

Also ask the doctors about the possibility of her meds/drugs inducing delirium. I have a family member who was committed because he tried to kill himself during a particularly bad episode of delirium, after the delirium had been waxing and waning for months. It turned out that the sedatives and antipsychotics he'd been prescribed to control the anxiety and paranoia he'd been experiencing with the delirium were actually triggering and worsening the delirium. They tapered off the meds while he was hospitalized and he came back to reality.

This happened in North Carolina, so I looked up the involuntary commitment procedures at the time. Here is some good info from UNC.There is supposed to be a court hearing within ten days of the person being taken into custody, at which they must be represented by counsel (court-appointed if necessary). I'd ask the social worker about that. (I never heard that there was a hearing in my family member's case even though IIRC he was hospitalized for two weeks; I don't know why. I wasn't the next of kin though, so I wasn't told everything. There may have been a brief hearing that I didn't know about.)
posted by snowmentality at 3:31 PM on July 17, 2015

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