Elderly Family Member Suffering Psychosis After High Fever
My 91 year old grandmother was rushed to hospital with fever over 105 degrees. She was unresponsive, nearly comatose, except for constant movement of her legs while lying in the bed. She also held her hand to her head frequently, as though she had a headache. She could not speak, would not open eyes or respond to requests to squeeze hand, etc.
After 4 days of IV antibiotics and fluids, began to come around, some recognition of people she knew and recent events. The leg thrashing slowed, eyes with track on objects, and appropriate response to requests for squeezing hand and verbalizing. Now three days later (1 week from precipitating event) she is exhibiting almost psychotic behaviors–conversations with ‘imaginary’ people, pretending to pick things up off of her bed and eat them (again imaginary), and picking fruit from imaginary trees. She does not recognize people (or thoughts are not organized enough to identify them); seems to have minimal, if any short term memory; and rambles incessantly, primarily about events in her younger years (we believe).
She has had several CT scans of the brain, and EEGs, all of which are said to be completely normal and inconclusive. She had a full blood culture panel, which identified no cause of infection. She is now on magnesium treatments (for her heart?) and potassium. Otherwise, her physicians are clearing her medically for discharge from the hospital.
Prior to this episode she was a completely self-sufficient, lucid adult, living independently and quite sharp. This situation is incredibly disturbing to the family, and is being somewhat discounted by medical professionals as she is ‘aged.’
We have all heard that people can suffer brain damage from high fevers. What kinds of effects can a high fever have, do these symptoms sound as though they have some connection, and if so, with their rapid onset, is there any hope for dissipation of the symptoms over time? We are hoping to get a psych consult, but again are concerned that they will consider these dementia symptoms, and pass it off as normal aging.
Please provide any resources, references or thoughts you may have that could help us in obtaining good treatment for my grandmother. I am a trained MSW, so have enough knowledge to question, but not the answers I am seeking. Any information you can provide will be greatly appreciated.
A. Dear fellow MSW, I am sorry to learn about your grandmother’s condition. From my perspective this is a medical issue. The bizarre behavior occurred immediately following a high fever in which she was almost comatose. The fever may have resulted in brain damage. It is also possible that her abnormal behavior is the result of an adverse medication side effect or medicine interactions. These are several possibilities that need to be explored.
If she had dementia before the fever incident occurred then it might be plausible that the event exacerbated the condition. But as you said there were no signs of dementia before the event. Because of this her current symptoms are more suggestive of brain damage than dementia. Full-onset dementia does not occur overnight.
If she has suffered brain damage please know that its effects may be reversible. But she’ll need to be assessed by a trained medical doctor to know what if any damage has occurred. People suffer strokes and parts of the brain are damaged but a good recovery is possible. That may be the outcome for your grandmother as well.
I would advise you to find a good, caring and competent physician to evaluate your grandmother’s condition. Inquire whether brain damage has occurred. If so ask whether it is reversible. Collect a list of her medications and bring it to the doctor’s appointment with you. Ask whether any of her medications could be causing her behavior. You could also call a pharmacy with a list of her medications and ask whether there are any known interactions. Also, don’t accept any physician who tells you that her condition is a result of age or dementia. Your grandmother was fine before this incident. As you said she was sharp and able to function independently. She showed no signs of dementia before this event and a rapid onset of the condition may not be possible.
I am not aware of any specific doctors to refer you to in your area. It’s best to either ask friends or family for the names of good physicians or to make appointments with several doctors and choose the one you like. You might want to also conduct a quick Internet search for a doctor referral service. Lastly, a call to her insurance company for a list of doctors may also help you locate a qualified physician.
I hope this helps you. I wish you and your grandmother luck. Please consider writing back to let me know how your grandmother is doing. Thanks for writing.
Randle, K. (2009). Elderly Family Member Suffering Psychosis After High Fever. Psych Central. Retrieved on April 2, 2015, from http://psychcentral.com/ask-the-therapist/2009/01/12/elderly-family-member-suffering-psychosis-after-high-fever/