Quetiapine/Seroquel-dosage question because of a change in meds after hospital visit. Any suggestions?

Thanks for the update, onlychild82. Continue to keep us posted, please.

      I just got back from visiting my mother where she lives with my father in a nursing facility. Last month she was hospitalized for some gastric disorder and apparently, during her hospital stay, her psychiatric medication for Bipolar disorder was changed. We noticed that she was getting manic and aggressive (we know the signs to look for when her medication is off or needs to be adjusted). When we inquired about her medication, we found out that she was still getting the prescription she was given in the hospital, not the dosages her psychiatrist had prescribed. Now she has an emergency meeting with her psychiatrist in order to avoid a stay in a psychiatric ward to stabilize her meds. 
     We are drafting a letter for the nursing home that says that her medication can only be changed by her psychiatrist. I don’t know why it was changed in the hospital, but we have to make sure that there will be no medication changes in the nursing home unless authorized by her psychiatrist.
       OnlyChild, I have no experience with Schizophrenia, but I would never dream of adjusting my mother’s medication without having her seen by a psychiatrist. Sometimes he has called in a new prescription, but he has been her doctor for over ten years and knows her well. When my mother’s medication is proper she is a sweet, quirky. little old lady with a good sense of humor, but when the dosage is incorrect and she goes into a Bi-polar episode, watch out!
      As it is now past the 11th, I hope your mother was able to see her psychiatrist and get her medication adjusted. They will ask for a follow up, and I would keep it and continue with regular appointments with the psychiatrist. That way there will be a continuum of care. I would definitely not trust a general practitioner to properly medicate for schizophrenia.
      Please let us know how you and she are doing.  God bless you and your mother.  My mother has been Bi-polar all my life, so I know what you have gone through. 

Hospice is good idea. Also read about Hospital Induced Delirium. It may be that she has a bout of this. It's hard to determine if it's delirium or dementia, except that delirium comes on suddenly and has the potential to improve.
Blessings,
Jamie

Barb, true but here is can example.

Mom fractured her L1. She was in a lot of pain so her blood pressure went up. Normally she took 80 ml a day. The procedure done very little pain if at all, she never complained. Got her home, she couldn't get off the couch. Visiting Nurse checked her vitals, bp very low. The 160 ml were too much so nurse called primary and got the order to take back to 80ml. Same happened with DH. Never any BP problems till Afib. Bp med given him during the attack. Brought under control but they recommend bp meds. This hospital recommends seeing your primary in a week or two. My husband went back for release to work. Dr took his BP and she was surprised he was standing. So yes, it's for what is wrong while in the hospital but they don't seem to evaluate before discharged. I hate they take it upon themselves to discontinue or change a med that the patient is going to a specialist for. They refuse to consult with the specialist.

Just wanted to post an update.

Saw the psychiatrist today and he said to do 12.5 mg in the morning and 12.5 mg at 1:00PM and then the 25 mg at bedtime.
He also said I should look for placement for her because she is only going to get worse. I think I will ask the home health nurse for a hospice evaluation. I am not looking to "fix" anything at this point, I just want my Mom comfortable and at peace at home.

Thanks Jeanne. She is now snoring her little head off, so she "should" be asleep until 8AM.
I try to go along with it, but my patience wears thin...I always ask god for patience!

Well, yes, the white car needs a contract, and you are going to take care of it in the morning, right? You are working on finding her another place to sleep, but for tonight this is the only room available. What can you do to make it more comfortable for her?

Does this kind of "going along" work with your mother? It often does in dementia, especially if the person is not likely to remember the discussion the next day. What generally doesn't work is arguing or trying to convince them. "We don't have a white car," or "This is your home now and it is where you always sleep," are just not going to calm Mom down.

We'd love to hear whether the Seroquel eventually is helpful, and what the psych doc does.

Just wanted to update for future lurkers such as myself. The Dr. called and said that it can take anywhere from 4 to 6 weeks to get the full effect of a medication. She said to continue the dosage at night and in the morning if my Mom is agitated. I saw a small improvement tonight when I got home from work, but now she is saying that she is not sleeping here and that the white car needs a contract. I will update once we have the psychiatrist appointment in a few weeks and see what he thinks. I would like to get off this roller coaster ride now thanks!

Onlychild82,
Your mom suffers from schizophrenia and Alzheimer's. I'm so sorry.

I wonder why they took her off the Risperidone after so many years. Was it because she developed the stated symptoms?


The symptoms of confusion, calling out for her sisters or difficulty articulating a sentence are signs of BOTH schizophrenia and dementia.

To check out the drugs for schizophrenia See WebMD-Schizophrenia -Medications that treat it.

No one here should recommend stopping, starting, increasing or decreasing medication doses. I understand your frustration in having to wait but the office should get back to you within 24-48 hours.
She might fare better with what she was taking or another antipsychotic.

It's funny you say that JoAnn; mom's discharge orders ALWAYS read "please follow up with your primary care physician as soon as possible".

In my view, the meds prescribed in the hospital were for THAT environment; sometimes the hospital's formulary was different than what was available outside of the hospital. Mom's docs almost always adjusted her meds after a hospitalization, but rarely to what the hospital had discharged her with. I never thought of that as being "the hospital doing something wrong"; it was more like "mom got sent to the hospital with an acute condition which was different from the stable one that she was in a week ago; there needs to be a change in meds, brought back to stability and, upon discharge, gotten back to her primary for a long term adjustment.

Me and hospitals...I don't trust them changing meds. They never check with the primary doctors to make sure they r not screwing up the primary. I have gotten to the point as soon as I am home, I call my doctor and get an appt with him to go over what the hospital recommended.

I'm sorry; I misread what you wrote. I would call the prescribing doc tomorrow about her change in behavior, as Jeanne suggests.

Thank for your responses. I think I am just so tired of dealing with Doctors that I just wanted to get some ideas from actual caregivers.
-I emailed psychiatrist -but I doubt he will say anything until her appointment on April 11th since he hasn't seen her in 2 years
-I called the Dr's office (primary care) to ask the Dr. what to do. She was the one that changed her medication.

I was typing while others were. So the doctor prescribing the Seroquel is not a specialist in dementia or schizophrenia? Since the psychiatrist hasn't seen her recently and didn't prescribe the drug in question, I'm not sure contacting that doctor would be useful at this point. Definitely discuss it at the appointment! Meanwhile, contacting the prescribing doctor might be helpful. But plan on taking the pysch doc's recommendations after the appointment.

Seroquel made my husband so sleepy I only gave it to him in the bedroom, after his pajamas were on. I had a very short window to work in! But as he was taking it for dementia agitation that was preventing him from sleeping that was perfect for us. Other people in my support group had differing reactions to that drug. Many were able to take it in the daytime.

That dosage seems very low for Schizophrenia. (Not that I am qualified to judge! Just from what I've read and heard from others.) This kind of drug often starts at a very low dose and builds up. Is her psychiatrist intending to gradually increase it?

I think you should contact the doctor with your question, either by leaving a phone message or using the patient portal if the clinic has one. You can discuss it at greater length at the appointment, but a quick question now is appropriate.

What doctors "always say" she has dementia? Based on what? Has she been tested? The symptoms "confusion/not being able to sleep or articulate a cohesive sentence, calling out for her sisters" could be UTI related, and they also could be related to dementia. Could they also be related to the underlying schizophrenia? I'm not familiar with those symptoms.

I am so glad you are having her see a psychiatrist. The next appointment would be a good time to discuss the possibility of dementia, and request testing if this doc thinks she has dementia and tests have not been done yet.

Since your mom has been treated for schizophrenia for 17 years I imagine you have been through a lot with her. Hang in there! Please come back and let us know how this progresses. We learn from each other.

Thank you Midikid-I apologize the new medication was prescribed by her primary care doctor after following her at hospital and saw improvement. I see improvements, but not enough to be know what to do?

Do call the doc. Seroquel makes you sleepy--well, it actually helps you go back to sleep when you wake up too frequently in the night. I take between 25-50 mgs at night only. I don't feel groggy or out of it next day. Just grateful I can fall back asleep b/c I wake up so much and have such violent dreams.

Can't believe a dr would just continue to prescribe this w/o seeing the patient. Sometimes we have to be our own advocates in our health care.

Just emailed him Barb. She hasn't seen him in 2 years. That is why I posted on here just to see what people would say. I will see what he says. Thanks.

I would call the psychiatrist for advice tomorrow.