My sister-in-law, age 60, had a rt side basal ganglia hemorrhagic stroke on 11/6/24. Lost use of left arm and left leg. Speech not affected. Making good but slow progress with arm and leg in a skilled nursing facility rehab wing. Problem is she's been having psychotic delusions since about a week or two after the stroke, and they're getting progressively worse and more frequent as time goes by. She's extremely verbally abusive to her husband (my brother), also age 60. Even though he understands it's a result of the stroke, her words still hurt like heck. Although the PT/OT depts are wonderful, we've determined this facility doesn't have the means to deal with or treat the psychosis. Our goal is to hopefully find an in-patient rehabilitation hospital that will accept his insurance and that will have staff that are qualified and experienced in treating post-stroke psychosis. Any advice would be greatly appreciated.
Your loved one may require permanent placement due to this injury if she cannot improve.
What she needs now is the BEST diagnostic neuro-psychiatric diagnosticians.
As to where and how this is accomplished given she remains now in the acute rehabilitative stage is up to her medical care practitioners. They are the only ones who know who and what is available in your area. However, this will be costly and complex and may require transfer out of her area to better facilities.
She is quite young. This is quite a severe stroke which she may or may not recover from. Your first month or two will indicate how quickly she will physically and mentally recover (once all the swelling tissues are back more to normal). But given her age, if it is possible, I would be hiring now an Accredited Nurse Case Manager FAMILIAR WITH stroke rehab.
It is going to be very difficult here to diagnose what is pyschosis and what is brain injury.
That alone is going to mean she needs the best stroke center treatment with the best doctors that can be found-- and THAT is dependent on insurance and coverage.
I can only wish you the best of luck. I would myself not have a clue of where even to begin and I say that as a retired RN. This needs major help and expertise. Speak to her MD about the possibility of hiring a Accredited Nurse Case Manager familiar with this area of medicine.
Just want to add, I hope you will update us on where you go with this.
In one this young, just to have a diagnosis of "post stroke psychosis" is really awful.
You SIL needs such good diagnositic care, perhaps now at a university center specializing in brain injury and stroke. Whether this is mechanical injury from stroke itself or a mental psychosis (I suspect the former) just can't be known easily. Even a Nurse Case Manager should be specializing in stroke care to figure out a case this complex and where to go with it.
If any of you are up to doing the research for your area try to reach out to stroke centers in your area, to neuro-psychiatric specialist in bleeds and injury to this portion of the brain. You are down in the "primitive brain areas", where emotions are what it's all about. Go online and do all the research you can yourself into injury to basal ganglion areas.
Again, best of luck.
The director referred to a neuropsychiatrist for extensive testing. In this way it was finally determined that relative had standing psychiatric issues as well as post-stroke issues. Stroke rehab was continued on an outpatient basis as well as in home. Unfortunately, relative declined psychiatric care for a couple of (by then) diagnosed problems. Also declined treatment for addiction, and there was nothing that could be done about it because they were (somehow and I believe wrongly) deemed competent to make those decisions.
I hope you find the help you need for SIL.