The psychiatrist came on Monday to evaluate Kari and basically just asked her a few questions for 10-15 minutes. He then went and talked to the doctor, whom I talked to at length after their meeting. The psychological analysis wasn’t really anything that we didn’t already know: that Kari, while alert enough to know where she is and who is around her most of the time, is experiencing a kind of delirium where she often sees or experiences things that are not happening, such as seeing someone in the room who is not there, is not able to choose the right words to convey her meaning, and experiences a high level of anxiety. He was very clear that this was NOT a form of dementia and that Kari did not show any of dementia’s normal signs in his diagnosis or in the brain MRI that was performed a few weeks ago. The basic difference between dementia and delirium is that dementia occurs when brain cells are actually damaged or are dysfunctional, such as in Alzheimer’s or stroke patients, where as delirium is a sudden change in mental status resulting in confusion or abnormal behavior. Also, we are not any closer at this point to figuring out the exact cause of Kari’s mental state. The only thing that we can point a finger at as a factor would be a severe lack of sleep and extreme pain, which is what we were already thinking. The psychiatrist did suggest that the doctors take Kari her valium and her three sleeping medications along with the risperdal (her anti-psychotic) not because he believed that these medicines had anything to do with the cause of her delirium, but because it can be very hard to evaluate a drug’s effectiveness when it is being given with a combination of other drugs. Also suggesting that this was not induced by drugs was that none of Kari’s meds were changed prior to her slipping in to her current mental condition.
That evening, they made the changes to here drug sheet and started her on Ziprasidone, another antipsychotic that has sedating properties. The feeling was that they could get both effects from one drug and then would be able to evaluate its effectiveness. So far, nothing much has changed. Kari did not sleep at all Monday or Tuesday night, and from last night into today, she seems to be having increased anxiety, mostly about things that are not actually happening. She always seems to be more relaxed during the day, so yesterday we tried to keep her from sleeping so that she would sleep at night. Because that didn’t work, today we are letting her sleep when she wants—there is no guarantee that she’ll sleep at night no matter what we do. The doctors expected that there would be an adjusting period to the new medication and going off the valium and sleeping medications, but also admit that she is one of the most puzzling cases they’ve dealt with. I think at this point that it is fair to say that it is impossible to make any clear judgments or conclusions about what is actually happening. There is no consistency with anything. It’s fairly obvious to me that most of her thoughts and the things she panics over are simply random places her mind is going—sometimes they have a link to reality, sometimes they don’t. Is there significance to what she says? Maybe, but to try to figure out any type of meaning from it will inevitably be inaccurate and ultimately be only a frustrating exercise. Simply because something works once doesn’t mean anything for next time. At night when Kari is having bad anxiety or spasms, I’ve tried just being ultra calm and soothing, I’ve tried “tough love”, the logical approach, distraction, any combination of the above and also just plain ignoring her. Every now and then one will work, most of the time they don’t. So the general plan here is to keep trying to get her to relax and sleep. We don’t have a time frame for when we think she’ll come out of this, and the nature of delirium makes it hard to figure out its exact causes. The bottom line is that we need to get her to rest both mentally and physically. Sleep is pretty much the only thing that should work for her—we just haven’t figured out how to get her to do it.