How do you help someone with psychotic depression? When you haven't got a bloody clue yourself?

[MsAdorabelleDearheartVonLipwig]

I have asked for help on here before and been told that I don't understand. Well thanks for that, that's a great help. That's kind of the problem.

My DFil has depression and some sort of psychosis, I think. Utterly paranoid and delusional and suspicious. Lost all functional ability. Won't eat, won't cook anything, won't use the washing machine, won't write. We try and do things for him, shopping, feed him, bit of washing. He thinks his pills are poison. He thinks the neighbours sending him a Christmas card means they're going to kill him. He's having trouble going to the loo, walking, got no energy etc. Blames this on the pills he doesn't always take. In reality he sits in his armchair and doesn't eat enough or get any exercise of any sort. Shuffles round his house doing nothing. Lost all ability to do anything. You get the picture.

We don't know what to do. We have no idea. This has been going on for months. We know about as much about mental health as he does. We have had the crisis team out numerous times. They drive over every night at the moment to make sure he takes his meds otherwise he won't take them. He has weekly reviews at the hospital with the doctors but so far no tangible progress. He had a spell in hospital for a couple of days, got sent to a half way house for a week where because he perked up a bit they then sent him back home.

He won't have carers. Meals on wheels don't drive that far out. He is extremely isolated where he lives. We are now thinking that perhaps he needs to sell his house and move into a residential care home or something. Does that sound feasible?

We just don't know what else to do. He has a support network, family, friends, a care worker, doctors etc. Yet nothing has changed. We are in the same situation that we were months ago. His sons, my Dh and DBil, can't deal with him. They get cross and try and argue and explain and reason when he can't see reason or understand. I know the world seems different to him now and he genuinely believes black is white, etc but we don't understand it either and we can't help him.

Is this his life now? Is this it? He's only 69. Is this it for the next however many years? This is no way to live.

[annandale]

Call Rethink. They were incredibly helpful to me when dH had a psychotic episode. Good factsheets here

Ultimately there may not be a lot you can do, no. How long have the crisis team been doing that daily intervention with the medication? That sounds like good support tbh. Have they suggested that anyone could go with him to the review with his doctors? Would he agree to that? I used to just turn up with dh, it was helpful.

[ProfessorPreciseaBug]

Is he seriously mall nourished and dehydrated?

I ask because I know a woman who got into a downward spiral and went of her food.... became dehydrated, lost mental capacity.... began to think people were out to hurt her... The house became a tip and she collapsed. She was taken to hospital and social services condemend her home as not fit for habitation.

After a few days on a drip and proper feeding she became a human being again and is now sprightly and healthy....

in the end she was moved out her house and now lives with a daughter.

[MsAdorabelleDearheartVonLipwig]

Thank you for replying. I am at my wits end.

I think the crisis team have been going in for about a month but we're worried that they'll say ok, he's no longer an emergency, he takes his pills perfectly well, we don't need to go anymore. Because as soon as they stop supervising him he stops taking the pills.

The doctors do like us to go with him to his weekly review but we just can't manage it. Dh and DBil can't get away from work just like that, DSil has two small sickly babies and I've got small children. The hospital is about an hours drive away. The trouble is they don't ring us either. Unless we ring them we never know what's going on.

They've offered him electric shock therapy. Unfortunately this is something that he has to give his consent to, as he's still deemed to have mental capacity, so that won't happen because he'll just say no, he doesn't want to do it. Like he did repeatedly when they wanted to get his assessed for care. Sometimes when the crisis team turn up with his meds he doesn't let them in. How the hell he's deemed capable of making a rational decision about anything I just don't know.

I think he probably is a bit malnourished and dehydrated. I think that might explain some of his confusion. All he's eating, as far as I can tell, is shredded wheat with fruit and milk. He eats out with the family twice a week and some friends take him fish and chips once a week. We did get him some ready meals that he could heat himself but he's convinced that both the cooker and the microwave are faulty so he won't use them.

He won't light a fire because he thinks he'll get taken away any minute and it would be a waste. He doesn't watch tv because he thinks he hasn't paid the licence, despite us telling him several times that it's paid by direct debit, like it always has been. He sits there, on his own, in the dark. God knows what's going through his head.

Living with us would be out of the question unfortunately. I don't think my dh could cope with it. He gets quite stressed and anxious himself.

I'm sorry if it sounds like I'm being negative but that's exactly what we get, all the time. He won't accept carers, he won't take the pills when left to do so, he won't eat, he won't even write a shopping list so we know if he needs anything. It's like his world has just stopped and nobody knows what to do next.

[annandale]

Please please do call Rethink.

He sounds like someone who should be being treated under the Care Programme Approach. That means he should have a care coordinator who has written a plan for him. Do you think you could ring the crisis team and ask if there is a care coordinator and can you pass on some information? Then if you get through (write or email if you have to, it can be good to have a record) list all the ways in which you think his functioning is below where it used to be and all the things you are concerned about. Ask if they can get his permission to share information with you. Whether they can or not, it's another part of the picture. It would be interesting to know what's happening about his treatment. ECT can be truly amazing, DH is substantially better since having it a couple of years ago.

[hefzi]

Is there any chance he could have some kind of early onset dementia/Alzheimers etc? Only asking as his symptoms you describe here are strikingly similar to a friend with this condition - but even if not, could you arrange for the psychiatrist to come and assess him in his own home (we did this for friend)? He also had galloping paranoia and thought his pills were poison, but this was also connected with the dementia- there were other things as well, of course, but in the end, for his own safety and quality of life, it was recommended that he moved to a residential care home. Have you spoken with his care team at all?

If he only takes his tablets because they check, I wouldn't think that they will withdraw the service any time soon; however, if he is not really able to take care of himself independently apart from that eg eating etc, it might, for his own sake, be best to think about moving. However, that will be tricky if he doesn't consent and is deemed able to - hence my question about whether he's had a psych assessment in his own home etc

Sorry for your troubles, OP - it sounds miserable for you and your DH to deal with, not knowing what you can do to help etc: might be worth giving Age Concern a ring too, and asking their advice?