“What if he went crazy?” What to do if your friend begins to behave inappropriately

• Classification and causes of dementia
• When an elderly relative ceases to be adequate: clinical picture
• Arrangement of living space for dementia
• Senile dementia - dementia. How can relatives not go crazy?
• How to deal with someone with dementia as a family member
• How to feed a person with dementia
• Features of caring for a bedridden patient with dementia
• What should relatives do? Benefits of going to a nursing home for people with dementia

Dementia is an acquired dementia. Most often it occurs between the ages of 60 and over. Dementia in older people is characterized as an irreversible decline in cognitive function with loss of short-term memory. Its appearance is associated with organic brain damage, a neurodegenerative disease. The disease greatly affects a person’s condition and completely changes his behavior. Let's take a closer look at what relatives should do if they have senile dementia.

Classification and causes of dementia

Senile dementia appears when there is organic damage to the brain (against the background of severe trauma or concomitant pathology). The most common cause of acquired dementia is Alzheimer's disease (occurs in approximately 65-70% of cases). About 15-20% are due to atherosclerosis and other severe cardiovascular diseases. Often there are two or more reasons at once. There are several factors that increase the likelihood of developing dementia. Among them:

• blood pressure surges;
• abnormalities of the endocrine system (diabetes mellitus);
• mental disorders;
• genetic predisposition;
• abuse of alcohol and tobacco products;
• traumatic brain injury;
• autoimmune diseases;
• old age (over 65 years).

Based on damage to specific areas of the brain, four types of dementia are distinguished. With cortical damage, the cerebral cortex is damaged. This often occurs in alcoholism and Alzheimer's disease. Subcortical affects subcortical structures, which leads to neurological disorders (in particular, tremors of the limbs and muscle stiffness). It is observed in patients suffering from Parkinson's disease and Huntington's disease. In the case of cortical-subcortical dementia, as the name implies, damage occurs to both the cortex and subcortical structures. It is typical for people who have been diagnosed with vascular diseases. With multifocal, multiple areas of necrosis and degeneration occur in several parts of the central nervous system.

Content:

1. What happens to the nervous system of an alcohol addict?
2. What to expect from a drinker
3. Patterns of the psychological portrait of an addict
4. The suffering of relatives
5. What to do if you live with an alcoholic. Adviсe

Alcoholism is a problem for society as a whole and for each individual person who, due to circumstances, is forced to come into contact with an alcoholic. He does not control his actions, goes beyond all limits - the fault is alcoholic drinks, which destroy the personality. But short-term communication is one thing. How to live with an alcoholic in the same apartment, what to expect, how to protect your psyche, health and life from his tricks?

When an elderly relative ceases to be adequate: clinical picture

Many people mistake the disease for ordinary whims, without seeking help from specialists. In most cases, it develops harmlessly. Sometimes you can hear stories about your neighbors or friends that they don’t feed him at home, they try to harm him, and they let dangerous gases into his home. The disease progresses rapidly, gradually the elderly no longer always recognize their relatives, begin to blame them for situations that did not occur (for example, theft, violence), and bring unnecessary garbage from the landfill. Some believe that this is done on purpose, simply to mock their loved ones.

Due to the destructive effect on the brain, the patient does not understand what he is doing. He is not able to fully assimilate and process the information received, and is hypersensitive to any criticism (reacts sharply to all comments). Relatives need to be patient, be attentive, and communicate in calm tones. When a patient feels aggression directed at him, he begins to consider his loved ones as enemies and communicate with them accordingly.

The exact clinical picture depends on the cause that provoked the disease and the location of the affected part. With mild dementia, a person remains critical of his own condition and does not lose the ability to self-care. Over time, the situation worsens, dementia progresses, the clinical picture becomes pronounced, the following are noted:

• Cognitive impairment. Can’t say exactly what day, month or year it is. Episodes of loss in space occur. The patient simply forgets who he is, where he is and where he is going. Speech in any form (oral and written) is perceived with great difficulty. Confusion of thinking occurs - the thread of the conversation is lost, by the end of the sentence the patient does not remember what happened at the beginning;
• Motor disorders. Characterized by a persistent gait and a tendency to fall. Due to disruption of the normal functioning of muscles and ligaments, difficulties with pronunciation may occur;
• Violation of neatness skills. The patient does not care what he looks like, does not wash his clothes, does not take a shower.

“Health was affected both by the fear of infection and by the disease itself”

Polina, 30 years old

Panic disorder, recurrent depressive episodes, specific phobias

I was sick with Covid in May 2021 and I remember it was very scary. I constantly came across news about how someone suddenly fell seriously ill and ended up on a ventilator after a week of a relatively mild illness. But there was something besides anxiety, amid fear for health. The worst thing mentally was when the smells disappeared for a week - it felt like all hope and joy in life had been pumped out of me. Constant weakness also added to apathy and a feeling of helplessness. As a result, after the illness itself, I experienced a severe exacerbation of anxiety disorder and pre-depression. It took about a month to recover, both physically and mentally.

Later, after the vaccine was administered, all the somatic symptoms were standard: the temperature reached 39, chills, aches, joint pain, pain at the vaccination site, headache. Mental ones include severe panic attacks every day for several days after vaccination (starting immediately after the injection). The extrasystoles were very frightening - they often caused panic.

It’s better now: the anxiety remains, but at the usual level. Panic attacks are common - which I can control. I feel the same as before the vaccination, even better, since I’m waiting for antibodies.

PolinaPhoto: Alena Agadzhikova

My health, including my mental health, was affected by both the fear of infection and the disease itself a year ago. But I think I got off easy overall, given my severe hypochondria. One of my main fears is suffocation. Therefore, the disease scares me quite a lot. And also the inaccessibility of normal medicine: all efforts are being devoted to Covid, I’m afraid that this will drag on for several years. And, of course, I’m afraid that my family will get sick.

If we talk about the risks of exacerbation of [mental disorders] after vaccination: it is necessary to “spread a straw”, that is, reduce all possible factors that negatively affect you even before vaccination. If you have already done so, well done and acted super responsibly towards health and society. I advise you to take responsibility for restoring your mentality after vaccination (or Covid), so that if it does occur, this exacerbation will be as short as possible.

Arrangement of living space for dementia

It is important to carefully consider how to arrange the living space so that the patient is not only comfortable in it, but also safe. If possible, remove all electrical and gas appliances from the access area. You should turn off the gas valve before leaving home, as people with dementia have a habit of lighting the stove and forgetting about it.

At the initial stage of the pathology, the pensioner becomes very forgetful and inattentive. As dementia progresses to the first stage, he will no longer be able to always be alone - one of his relatives will have to live with him. Many surrounding objects, in particular piercing and cutting objects, pose a serious danger. It is recommended to choose dishes and cutlery made of plastic rather than glass and porcelain. It will be necessary to remove all household chemicals and medications from reach (there have been cases when patients drank a lot of pills that were not prescribed, which led to poisoning).

Furniture in the apartment should be arranged in such a way that there is no risk of injury from sharp corners. The bathroom must have an anti-slip mat. To prevent the old man from falling, it is important to organize good lighting throughout the house. If there are several floors in a private house, you need to install handles along the wall on the stairs.

If possible, it is worth adjusting the interior design of the house. So, the color of the furniture in the living room should be in contrast to the color of the walls. It is recommended to purchase tables and other pieces of furniture with adjustable height. It would be good if the windows from the living room face the street. It is recommended to keep the patient’s personal belongings on the shelves for decoration, for example, a frame with a photo of loved ones. It is worth hanging curtains with the ability to control the glare of sunlight.

The bedroom should be located on the quiet side of the building, away from the elevator. It is important to pay special attention to acoustics and reducing noise pollution. The kitchen should have windows with maximum light. Doors on cabinets should be designed in such a way that the contents are clearly visible.

To minimize shaded areas in the bathroom, it is worth placing at least two lamps on the ceiling. It is not recommended to use white for walls and furniture. It would be good if the appearance of the taps would be familiar to a person with dementia. It would not be superfluous to use a baseboard that contrasts with the floor and walls (this will allow you to show the end of the floor and the beginning of the wall).

Senile dementia - dementia. How can relatives not go crazy?

When a loved one develops dementia, it becomes very difficult to come to terms with it and get used to it. First there is a feeling of despair and anger, and then apathy sets in. To avoid problems with your own health and not to fall into depression, it is recommended to take the advice of psychologists:

• Seek help from a specialist when the first signs of dementia appear;
• Come to terms with the disease (if necessary, make an appointment with a psychologist);
• Do not try to forcefully pull the patient out of his imaginary world;
• Do not prescribe treatment yourself;
• Do not entrust care to minor family members;
• Don't expect gratitude from your relative. due to the specifics of the disease, he will not appreciate all the efforts, and even on the contrary, he may accuse his relatives of inattention, anger and cruelty.
• Don’t get hung up on care, ignoring your needs;
• Use the help of specialists.

If a patient has an outburst of anger, it is important to try not to show fear, listen and try to calm him down, and not respond with anger.

“Anxiety, tearfulness, hysterics appeared”

Ksenia, 21 years old

ADHD, anxiety-depressive disorder

As soon as I got sick, weakness appeared in my body. Obvious mental problems appeared a week later, when I was in the hospital. I have ADHD and anxiety-depressive disorder. During Covid, I stopped taking my antidepressant. I can’t trace exactly whether it was after or before, but it hit my nervous system hard: wild tremor, trembling, constant anxiety, I had a couple of hysterics in the hospital, and they injected me with an antipsychotic to calm me down. I don’t know what to call it correctly, but I was shaking all over for another three or four days after being discharged.

KseniaPhoto: Alena Agadzhikova

In the hospital, I began to have vivid, but very negative, disturbing dreams. And at home I now dream of horror films with my participation. Anxiety, tearfulness, and hysterics appeared. Depression set in again, but, as I mentioned above, this can be affected by drug withdrawal. On the other hand, I lowered it smoothly, as the psychiatrist said.

Now I am worried about headaches that radiate to my eyes. I'm waiting for a new scheme and hope that this whole nightmare will end. My diagnosis after discharge was astheno-neurotic syndrome - I think Covid contributed.

How to deal with someone with dementia as a family member

Many people wonder if a loved one is diagnosed with dementia, what should relatives do in such a situation. Unfortunately, there is no remedy that can eliminate this disease. But do not neglect vitamin-mineral complexes and other medications prescribed by the doctor: they increase blood circulation and stimulate brain activity. Experts advise doing simple exercises for attention and fine motor skills every day. Art therapy, crossword puzzles and other activities can slow the progression of dementia and maintain mental activity.

It is important for relatives of a patient who has been diagnosed with dementia to be able to adapt to his wishes. It is necessary to engage in “games” with him, even if they are annoying. For example, a grandfather may begin to complain to neighbors that he is not being fed, and even ordinary crackers cannot be found in the house. This will upset the grandson, who regularly brings him various products. But there is no reason to be upset. In such a situation, you should really bring crackers. So, the grandfather will understand that they are in the house, which means the grandson takes care of him, and will stop complaining to strangers.

It is important to always enter into dialogue with the patient. Even if you experience senile insanity, you cannot refuse communication. It is worth sharing the latest news, talking about personal events and what is happening in the world. This way he will constantly listen and delve into reality, switching less to imaginary objects. You should speak in short and simple sentences (as with small children). Questions should be formulated in such a way that they can be given monosyllabic answers: “yes”, “no”, “I don’t know”. Before starting a conversation, it is worth making eye contact. It is also recommended to give pleasant surprises (for example, buy something he has long dreamed of).

Another important point when caring for a patient with dementia is a clear organization of the daily routine. It is not recommended to sleep long in the morning; it is better to set an alarm clock for the same time. You should also go for a walk at approximately the same hours.

How to feed a person with dementia

As the disease progresses, the elderly often forgets how to use cutlery. Because of this, it is recommended to introduce food into the diet that can be easily picked up by hand. It should be at a comfortable temperature (neither cold nor hot). In advanced cases, when the old man is unable to eat on his own, he is given liquid meals. Sometimes there is a refusal to eat. In such situations, the root cause should be identified. It may be associated with a lack of appetite due to depression, incorrectly selected dentures, fear of poisoning, and a number of other reasons. Having found the cause, it will be possible to eliminate it, and the problem will be solved.

Features of caring for a bedridden patient with dementia

Senile dementia often occurs in bedridden patients. In such situations, it is much more difficult for relatives, since in addition to the increased physical activity associated with caring for a bedridden patient, psychological problems arise. Due to being in a motionless state, the old man ceases to control the natural processes of the body.

Relatives are required to carry out many activities: carrying out sanitary and hygienic procedures, preventing bedsores, administering medications prescribed by a doctor, feeding from a spoon or through a tube. Often, caring for a bedridden patient with dementia is entrusted to professional caregivers who have all the necessary knowledge and skills.

Panic attacks. Modern diagnostic methods.

Only a qualified neurologist-vegetologist can diagnose panic disorder, which manifests itself as panic attacks, identify its symptoms and prescribe optimal treatment.

At the initial examination, the vegetarian doctor must examine the patient’s normal reflexes, his muscular system, sensory organs, cognitive functions (memory, speech, perception), assess the general psycho-emotional state of the patient, taking into account all his complaints in order to collect a complete picture of the disease.

Next, there are several methods for diagnosing autonomic nervous disorder. One of them is the study of heart rate variability.

The patient performs a simple load: first he lies on his back, and after a few minutes he gets to his feet. In this way, we simulate a standard everyday situation when the minimum load is placed on our body. During this time, sensors attached to the patient's chest record the rhythm of his heart, and the doctor then compares the changes in rhythm in both positions. Such a study shows how adapted the human body is to the usual minimum load, which our autonomic nervous system normally copes with every day without the slightest difficulty.

How it works?

In a healthy state, our body responds adequately to any “stress”, any load (mental, physical, emotional). Therefore, when a healthy person gets up, the sympathetic part of the autonomic nervous system is activated in his body and the hormone adrenaline is produced, which means the heartbeat quickens. When a person lies down, his body should normally be in the mood for rest and relaxation. At the physiological level, this manifests itself as follows: the parasympathetic department of the autonomic nervous system becomes active and the hormone acetylcholine is released, which extinguishes the activity of adrenaline, and a phase of relaxation and replenishment of the body’s reserves begins.

But in patients with symptoms of panic attacks, an abnormal change in heart rhythms is observed: that is, when a person lies down, his pulse quickens and becomes faster and faster. That is, when a person gives his body the command to tune in to rest, the body understands the opposite - and prepares to run a short distance race. This is why people with disorders of the autonomic nervous system so often cannot sleep at night and never feel rested and alert.

Thus, the doctor concludes that the harmonious functioning of the sympathetic and parasympathetic parts of the nervous system is disrupted. This means you can move on to the next stage of the examination.

Among the innovative methods for diagnosing panic disorder are studies of the autonomic nervous system using infrared thermography. In an infrared image, a thermal imager clearly shows in which nodes (ganglia) of the autonomic nervous system the work is disrupted. It is with these vegetative nodes that the neurologist-vegetologist will subsequently work.

“Serious scientific research over the last decade has shown the high reliability and reliability of thermography. This allows this method to be used in medical practice to make a diagnosis in complex cases,” James Mercer, Professor, President of the European Thermography Society (EAT).

After treatment, you can take a repeat infrared photo, in which you will notice progress from the completed course. Areas with abnormal temperatures (bright red or dark blue) will change color in the image because their temperature regime is closer to normal.

What should relatives do? Benefits of going to a nursing home for people with dementia

Unfortunately, the disease will inevitably progress. Relatives will find it increasingly difficult to cope with this and will experience great stress as they watch their loved one’s personality gradually disintegrate. In addition, the need to look after a patient 24/7 takes a lot of time and effort. You don't have to bear this burden yourself. The Hearts of Generations network of boarding houses for the elderly accepts patients with dementia. For guests there are:

• Daily health check;
• Constant supervision by professionals;
• Six meals a day;
• 24/7 care;
• Comfortable rooms;
• Monitoring the treatment prescribed by the doctor.

“Hearts of Generations” is located in a picturesque place with clean air, away from the bustle of the city, which has a positive effect on the health of the guests. You can find out more detailed information or leave a request on the website, indicating contact information for feedback.

For help, you can always contact our boarding house for the elderly, where we can help you.

“The psychiatrist said she has a lot of post-Covid clients”

Dasha, 26

Mixed anxiety-depressive disorder

Before the coronavirus, the only mental problems I had were burnout from work. Well, plus I was going through a breakup, which, of course, didn’t make me happy either. At the very beginning of the pandemic, panic attacks began, when it was very scary that everyone was locked at home and nothing was clear.

I got sick with Covid in December [last year]. Not hard, but unpleasant. I had a headache for a week and a half, had bilateral pneumonia, and severe weakness lasted for about a month. Since January, my mental state began to deteriorate. I cried often. I woke up and could cry for no reason, I didn’t want to get out of bed. Then I began to leave the house less often. I didn’t wash as usual, that is, not every day, but when I forced myself to. Then the thoughts began in my head: “I don’t see the point in anything” and “I don’t understand why everything is for.” I became irritable, exhausted, and even more tired. If I drank alcohol, it always ended in tears or a nervous breakdown. Hair began to fall out.

DashaPhoto: Alena Agadzhikova

Soon I realized that I was no longer doing anything at all: I didn’t wash my face, I didn’t walk the dog, I didn’t clean, I just forced myself to work and then went back to bed. Received a referral to a psychiatrist. The psychiatrist diagnosed mixed anxiety-depressive disorder and said that she has many post-Covid clients and I am among them. She also prescribed me two antidepressants, one for anxiety and one for sleep. By the way, with my hair, I went to a trichologist, and the doctor said that this was also the influence of Covid.

I got vaccinated in May. I don’t know what level of antibodies there was - I didn’t check. After the first and second, everything was fine, only my arm hurt at the injection site. Now I feel absolutely great! Very smooth, good condition.

Treat or “Leave Alone”?

— Victor, if a person has changed dramatically, broken with his usual circle of friends, lost his former interests, and become suspicious, are these symptoms of mental illness? Or does he just have a personal crisis, troubles at work, unhappy love?

“Only a doctor can understand this.” Changes in behavior can be caused not only by a mental disorder, but there are signs by which one can suspect it.

For example, a sharp change in social interaction: a person quit his job for no reason, changed his attitude towards relatives, relatives, friends - he began to isolate himself or, on the contrary, became extremely sociable. Perhaps a strange hobby has appeared: he began to read books on a certain topic, talks only about it, and finds it difficult to switch from it. Such a topic could be some kind of conspiracy or some kind of influence, other strange ideas that differ from everyday life and do not coincide with the real picture of the world.

— The first impulse in this case is to convince others, to appeal to logic. It makes sense?

- No, it is impossible to convince a mentally ill person. As a rule, this also turns your loved one against you.

You can answer neutrally: “Yes, yes, okay, that’s probably true. I understood you, I heard you. Let’s talk about did you eat today, how are you, what are you doing?” If it doesn’t switch, then end the conversation. Arguing with a delusional patient is more expensive for yourself, and convincing him is a waste of time. It's no use to him. Why then convince? To feel young? But this is some kind of stupidity.

— What else is worth paying attention to?

- Sleep disorders. Either sleepless nights or inversion: sleeps during the day and does not sleep at night or tries to sleep in fits and starts. Moreover, when you ask him about the reason for changes in sleep patterns, he replies that he is afraid for his life, the lives of loved ones, or throws out meaningful phrases in the spirit of: “Isn’t it clear?”, and goes away from the topic. A fairly typical situation for such cases is the patient reporting that he was “forbidden” to talk about it.

Also, patients often believe that they are being watched, that a conspiracy is being built against them. They try to find the pursuers, look for cameras and listening devices in the apartment, and may even open floors or electrical appliances.

- And if a person stops taking care of himself - he doesn’t wash, doesn’t comb his hair, becomes extremely sloppy, is this a characteristic symptom?

— Yes, this behavior is typical for the deterioration of some mental disorders. This may include schizophrenia, some dementias, or severe depression. Only a psychiatrist can finally figure it out, but the sign itself is alarming.