Assessment

       Attention Deficit

Delirium

My child is depressed. What's the best way to treat this?

There are three major approaches to treating depression in kids or adults. One is medication. Currently, there is a large controversy as to whether anti-depressant medication in children may cause an increase  in suicide risk.  The question has yet to be definitively answered. Many parents are naturally concerned about such a possibility, and are leery about using the drugs as a result.

A second treatment approach is cognitive-behavioral talk therapy.  Research done on adults at least dates back to the 1970's. It has found that this form of therapy is comparable in effectiveness to medication.  However, the number of sessions recommended for it often range between 8-13. Managed care companies may not always permit that amount to be received, and there has been a strong trend for insurance plans to push people to use medication in that it requires fewer doctor's office visits.

A third approach to treating depression is physical exercise, or 'running around having fun' as kids might put it.  This can range from riding a bicycle to playing team sports, or a game of tag.  Research on the anti-depressant effects of exercise also dates back to the 1970's. It continues to find it helpful in reducing or eliminating depressive patterns. Studies have found that physical exercise is comparable to medication as to its anti-depressant effects, and that those who continue such a regimen have a lower rate of reoccurrence than individuals who take only medication.  Increasing physical activity also has the added benefit of it usually involving other kids in play. This affords the opportunity to develop more friends and social skills, which can be valuable in mitigating depression too. Plus, kids who are active are less able to sit around the house, mope and feel sorry for themselves, and in the process spiral further down in to a depressed state.

A final point to keep in mind is that depression can be serious if left untreated.  Suicide is the third leading cause of death among teens in the U.S. The Centers for Disease Control (CDC) did a survey in 2003 and found that approximately 1 of every 12 high school students had attempted suicide in the preceding twelve months. Consequently, when a child is depressed, you should seek the help of a trusted professional.

What is neuropsychological testing?

Traditional psychological testing involves assessing skills such as IQ, academic achievement (as in reading or math), and personality issues like depression or anxiety. Neuropsychological evaluations involve what are called brain/behavior relationships.  This can encompass a very wide array of issues, such as brain damage that results from a blow to the head as in car accidents, strokes or Alzheimer's, or issues like attention deficit disorder (ADHD).

There is considerable overlap between the traditional types of psychological evaluations, and neuropsychological ones. For instance, personality problems such as depression can arise from situational difficulties like going through a divorce - as well as from brain functions being impaired.  In obtaining a better understanding of how brain impairment may be adversely affecting someone's daily life, there is the possibility of determining ways to help the individual such as through behavioral techniques, psychotherapy, or medication.

How long does neuropsychological testing take, and what does it cost?

The amount of time required to do neuropsychological testing can vary tremendously, depending on the nature of the problem and the age of the individual being evaluated.  For instance, assessing someone who is 80 or 90 years old, in frail health and may have dementia will typically require a much shorter evaluation, such as perhaps just 2 hours or so.  Compare that to assessing a teenager who is energetic and who is accustomed to taking tests in school. A teen may accept 6-8 hours of evaluation, which could be spread out over two or more sessions.

The cost of such an evaluation also varies widely. Insurance will often cover most of the cost if it has been preauthorized.  There are situations, such as when done as part of a lawsuit like those arising in car accidents, where insurance may not cover the cost.  In those instances, with a lengthy evaluation the cost can be as high as $1500. to $2500.

I'm afraid of using medication to treat my child who has ADHD. What are your thoughts on this?

Many parents are concerned about their children taking psychiatric medication for any reason. Drugs that are used for attention deficit disorder (ADHD) in particular have come in for a considerable amount of bad press over the last twenty or so years. In deciding whether or not you as a parent feel comfortable having your child on such medication, you have to remember one fact: everything involves risk.

In every decision that is made - or postponed - by a parent in behalf of a child, there is always risk.  Use of drugs for any problem carries risk, which are their known as well as yet to be determined side effects.  But, not treating a child for a problem such as ADHD also carries a risk.  Research has found that ADHD kids who are not effectively treated for the condition have a much higher rate of:

• dropping out of school, which has implications for the rest of their lives

• becoming involved with abusing substances. Cigarette smoking in particular is known to be more common. Alcohol abuse is probably a greater problem, and illicit drug use might be one too.

• becoming involved in car accidents.  These can range from minor fender benders to something far worse, such as where the child and/or other people may be injured or killed. It should be appreciated that the increased risk of being in such car accidents is measured against other teen drivers - who are notoriously bad to begin with, and not against the adult rate of collisions.

• having unprotected sex which can lead to unwanted pregnancy and/or contracting various diseases such as HIV.

• difficulty in getting and holding a job in their adult years, which has implications for being able to support themselves as well as a family.

Something else to consider is that parents bring their ADHD child to a doctor's office for a reason. Typically it is over issues like failing grades, problematic behavior in school and/or home, and having few if any friends. Such issues are commonly long standing, and the various approaches to solving the problems that have been tried by the parents to date have not been effective. What are you going to do now? More of the same serves no constructive purpose.  Medication is not perfect. It does not help everyone. Nor does it alleviate all the problems that ADHD brings with it.  But for now no other form of treating ADHD has been proven to be as effective.

Having said this, there are still a number of people who remain uncomfortable with the idea of using medication. Or, they have tried it and not found it effective and/or the side effects have been too troublesome.  Other approaches to then consider might include dietary changes, exercise, over-the-counter (OTC) substances (e.g. herbs and other supplements), and acupuncture.  Research on these methods has been limited.  At best, results of any of them suggest 'possible' effectiveness in improving ADHD issues. At worst, they have been found to be of no benefit.   Use of OTC supplements should be discussed with a medical doctor such as a pediatrician.  Substances that are 'natural' are by no means always safe. Ephedra is an example of a well-known natural product, which was recently pulled from the market as a diet aide, due to serious health complications and some deaths among its users.

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I feel that my childhood sexual abuse is in the past, and since I can remember everything, I feel it is behind me and I don't need to go over it again. Is that a misconception?

It is understandable to not want to revisit childhood trauma and especially if you suspect that you will have to confront  family and friends now with what happened years ago. What is important to understand is that childhood trauma affects so many aspects of our lives that we don't always recognize the full impact of the pain that occurred. As adult survivors, we deserve to live full, emotionally rich lives in which we make the best decisions for ourselves.  That takes revisiting the trauma through a therapeutic relationship, sometimes with the aid of creativity/art, music or dance; and integrating parts of ourselves that may have been cut off.

When dealing with the death of a loved one, such as a child or spouse, what is the normal amount of time to grieve? Or, after what point does prolonged grief become a clinical concern?

The loss of a child is always difficult for parents.  Generally, it takes longer to adjust to the death of a child than it does to the death of other loved ones.  Parents may grieve for years.  The pain of the loss may linger for two or more years, although there should be some decrease in grief during that period.  If the intensity of the pain remains constant for more than two years, consider consultation with a psychologist.  When the death has been unexpected, and the product of violence, some parents have found that becoming part of a group aimed at preventing future violence is helpful.

The loss of a spouse usually involves a shorter period of mourning. Critical times, however, are at the three month and twelve month anniversary, when there may be a return of the intensity of the pain of the loss.  Except for the return of intense pain at those critical times, there should be a decrease in the grief for the departed.  If the decrease is absent, consultation with a psychologist is appropriate.

I'm overweight and can't stop eating, even when I'm full. Do I have a psychological problem?

Just about everyone eats to excess once in a while (think Thanksgiving dinner). If you do so more than occasionally, then mindless eating might be triggered by emotional factors such as stress, depression, emotional distress or binge eating. It's difficult to lose weight and especially to maintain a weight loss if there are emotional pressures involved, especially binge eating.

People who binge eat are likely to have difficulty maintaining any weight loss they accomplish by dieting. While about 4% of people in general have binge eating disorder, up to 50% of obese people struggle with this problem.  Binge eating could be a problem if one eats large amounts of food in a short period of time until feeling physically uncomfortable.  Another indicator is if one frequently loses control over what or how much is eaten and then feels guilty afterwards.

Is there any hope for maintaining weight loss long-term? I've read about a genetically determined 'set point,' which if one drops below results in inevitably regaining the lost weight.

Early studies theorized that people might be genetically predisposed to become overweight. Some have suggested that those who drop below their genetically determined 'set point' weight will therefore face intense psychological pressures to regain the lost weight.

The National Weight Control Registry (NWCR) tracks successful maintainers of long-term weight loss. The registry keeps tabs on over 4,000 people who've kept off 30+ pounds for at least a year; many are long-term maintainers.  Researchers at NWCR have studied the levels of psychological symptoms among registry members - all of whom are likely to be below their 'set point' weight.  Among these maintainers, the researchers found lower levels of depression, general emotional distress, binge eating and self-induced vomiting than seen in people who seek mental health services. The levels of these emotional factors were similar to those seen among the general population. Therefore, it seems that someone not struggling with emotional pressures is more likely to succeed in losing weight and keeping it off.

My family thinks I'm depressed and should see someone. I'm afraid if I get therapy, the therapist will make me take medication.  I really don't want to use any for a problem that I think I should be able to manage. What should I do?

Many patients resist using medication as part of the process of getting out of a depressed state. It is understandable that one might have concerns.  You owe it to yourself to seek as much assistance as you need. Many forms of depression can be managed without the assistance of medication (see the FAQ on depression and children. The general advice in it applies to adults with depression too).  Others are so severely depressed that the patient must be hospitalized.

Seek out a therapist with whom you feel your wishes are respected.  Gather as much information as possible on whether use of a short-term medication protocol, while you are doing talk therapy, is warranted for your particular situation. Not everyone needs to be on anti-depressants. If you choose not to use medications after investigating them, explore the use of natural supplements and/or nutrition and exercise with your physician and/or therapist.  One of the best antidotes to depression is 20-30 minutes of aerobic exercise a day.  I have found with my patients that it is a wonderful holistic treatment for depression. Engaging in exercise is not advised, however, for those folks who have physical limitations.  If you are unsure as to the personal safety of an exercise routine, you should consult with your family physician.

A single answer to this question, as how to best treat depression and whom should use medications, is not easy. People are different.  Find a therapist who is willing to listen to your concerns and respect your choices.

I've been looking for a therapist. My insurance company has given me a lot of names to consider. How do I know what to ask for? How do I determine if I've chosen a good therapist? What kind of questions should I ask of a prospective therapist?

You can interview the therapists you are considering through a phone call and have them answer your primary questions and concerns. During this process you can get a general feel for the way they respond to you.  It is even better if they are willing to meet with you in person for fifteen minutes or so. Something to remember about choosing a therapist is this: the number one factor that determines whether therapy will be successful or not is how well the therapist and you get along with each other, such as in regards trust, respect, and feeling comfortable with each other.  The 'bedside manner' of a therapist, and how well you feel in your gut about them, should be what you pay attention to the most.  If you don't feel that they are interested in you, find another.

There are other considerations to finding a therapist. These include asking about the amount of experience the therapist has had in treating people with issues like yours.  You can ask about any preferred ways that they like to work. For example, are they opposed to offering any directions or guidelines to you? Many therapists have been trained to believe in the Socratic approach that answers questions with a question. Others are quick to give advice. It is best to have a sense of what will feel good to you.  Still other issues that may be important to you include their educational background, and how soon they can see you initially, as well as the fit between their schedule and yours for ongoing purposes.

I believe my child may qualify for an Individualized Education Program (IEP). How do I access these services?

Whether or not your child has already been evaluated through a private practitioner, the first step is to contact the Student Support Team (SST) chairperson at your child's school.  The SST chairperson should ask you if you have met with your child's teacher regarding any learning or behavior problems your child has been experiencing.  There is a requirement that steps be taken by the teacher in the regular classroom in conjunction with the parent prior to referral.  If the child continues to have difficulties a Request for Intervention  Assistance is completed. Data is then gathered from the records, and the SST chairperson invites the parent to a meeting to develop two or more school interventions which must be carried out over a minimum of a three to six week period.  At the end of that time period, the interventions are reviewed.  If the child has made little or no progress, the SST may request educational diagnostic assessment if it has not already been completed and/or design a Formal Elation. (It should be noted that there is no requirement that the decision to complete a Formal Evaluation has to be completed at the second or third meeting of the SST.)

The Formal Evaluation may include data already available such as private assessment. However, the Formal Evaluation design must include all screenings and evaluations required by the State of North Carolina for placement.  Following completion of the required screenings and evaluations, the SST will meet to determine eligibility for specialized education services.  Qualification will depend on meeting state requirements including need for the service as defined by inability to make adequate progress without specialized instruction. Adequate progress is typically defined as average/typical, such as being able to make C's or better in the regular classroom.

How do I determine if my child is eligible for an Individual Accommodation Plan under 504 legislation?

The process is very similar to how the determination of need for an Individualized Education Plan (IEP) is made, as discussed directly above.  However, a Formal Evaluation may not be required. The issue under 504 is whether the student has a disability; e.g. a physical or mental impairment that substantially limits a major life function.  Major life functions include learning, walking, breathing, performing manual tasks, seeing, hearing, speaking, working, and/or caring for oneself.  It also requires that accommodations are needed for the child to access the regular education program.  Again, any evaluation completed privately will be considered as part of the Student Support Team process. The need for accommodations depends on the Team's ability to document that the accommodations are necessary for the student to perform adequately in the regular education program.  The necessity for specific accommodations is documented through use of interventions and review of the impact of these accommodations on the student's performance.

How is grief treated? Taking a pill seems pointless; my doing so is not going to bring my love back to life.

Grief from the death of a loved one can push a person in to depression.  But, it is also somewhat different than the common form of depression. When grief, or bereavement becomes more complicated, such as it lasting too long, it can involve issues such as

• a sense of disbelief that the person is dead and gone
• anger or bitterness over the loss
• intense yearning to be reunited
• being overly preoccupied with thoughts of the loss, which can include distressing thoughts of the death

If you are not interested in using medication, talk therapy can be helpful. When dealing with such complicated grief, talk therapy can help the bereaved focus on several issues.  These can include

• the grief and loss, and how it effects personal life goals
• adjustment to the loss
• how to go about restoring satisfaction to one's own life
• retelling the story of the death with an eye to confronting certain issues that the bereaved may be trying to avoid

Such an approach has been found to be effective in helping those struck by grief to feel better about the loss and themselves.

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How do I know if I, or someone I love, has an eating disorder?

There are three primary eating disorders: anorexia nervosa, bulimia nervosa, and binge eating.  The signs and symptoms vary for each. Anorexia consists of overly restrictive eating and significant weight loss.  Bulimia consists of consuming large quantities of food followed by vomiting, taking laxatives or diuretics, fasting, or exercising to compensate for food intake. Binge eating consists of compulsive and emotional eating, without compensating for food consumer.

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How do you distinguish between a true eating disorder and more normal eating and body image concerns?

For people with eating disorders, the restrictive eating, binging and purging, and emotional and compulsive consumption of food satisfy psychological needs, such as soothing oneself or providing a sense of control. Food intake and weight affect the person's feelings about their work, school, relationships and self.  Their body image and desire to lose weight become the basis for their decisions.  Ultimately, their desire to engage in eating disordered behaviors becomes more important than anything else and gives meaning to their life.

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How do I help a loved one with an eating disorder?

What to do:

• Learn more about eating disorders
• Engage in activities that don't involve food
• Listen in a supportive, nonjudgmental way
• Talk openly with the person about their problem - ignoring it won't make it go away
• If you live with the person, figure out division of chores involving food and cleaning up after purging
• Remember that recovery is the person's responsibility, not yours
• Take care of and get support for yourself

What not to do:

• Don't force the person to eat or fight about eating
• Don't comment on food intake, weight, or appearance -  yours, theirs, or others'
• Don't blame or get angry with the person for their eating problem
• Don't give opinions and advice about recovery
• Don't assume the person will get better overnight
• Don't act like the person's food monitor, counselor, nutritionist, doctor, etc.

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What kind of treatments are available for eating disorders?

A multidisciplinary approach is usually indicated. Different components of treatment include individual, group, and family therapy, nutritional counseling, medical evaluations, and psychiatric care.  The level and frequency of care should be determined on an individualized basis. Because eating disorders are such a specialized problem, it is essential to go to providers with training and experience in this area. It is also very important that your treatment team collaborates closely with each other.

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Everyone talks about the common effects of ADHD, being poor attention and hyperactivity. Are there other effects to it as well?

Yes, there are a number of common 'co-morbid disorders' as they are often referred to.  In my experience, learning difficulties affect at least 50-75% of kids who have ADHD.  What I see the most is poor reading skill. Sometimes this may be due to nothing more than the child is so unfocused, and their mind going in so many directions, that they can not stay attuned to what they are trying to read. They typically say that they have lost their focus after a paragraph or two, or at most a few pages. Handling chapters at a time is impossible for them.  Given the importance of reading as a means to learn, especially in the higher levels of education like high school and college, being a weak reader takes a serious toll on their ability to do well in school. When the ADHD is appropriately treated such as through medication, their reading skill improves. 

Other kids may have reading difficulties like dyslexia, which can exist in their own right independent of poor attention span.  Less common learning disabilities include poor math or writing skills.

Still other common effects of ADHD include increased risk of substance abuse.  Cigarette smoking in particular is increased.  Nicotine can calm the nervous system, and some kids are probably smoking in an attempt to self-medicate their hyper qualities. Use of alcohol and/or marijuana, both known to depress the nervous system, are also probably a more common problem with ADHD. They too may be used for self-medication purposes.  Others will abuse the stimulant drugs, like amphetamines or cocaine, which may also be another attempt at self-medication in an attempt to make themselves more attentive.

Under age drinking and/or use of illicit drugs also creates risk of legal problems, coupled with the damage that those substances can take on the body. And, such self-medication inevitably fails relative to effectively treating the poor attention or hyperactivity. 

Yet another problem that occurs with ADHD is an elevated risk for depression and/or anxiety.  This may arise as a reaction to doing poorly in school. Consider how a child must feel when they get D's and F's in school, and the teacher and other kids berate the kid for being 'stupid.' Parents may add to the psychological toll inadvertently when they harp on the poor grades too.  Taking another test in school, where the child expects to get a poor grade yet again, also can create a lot of anxiety and further destroy their self-confidence.

Overall, I almost never see ADHD exist in isolation. There is inevitably one or more other problems, be it with learning, substance abuse, anxiety or depression, or legal problems.  Older kids, from perhaps age 12 and up, more frequently have the latter three categories as co-morbid disorders, while young kids are mostly affected by the learning disabilities.

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What are the effects of dyslexia? When is it best to diagnose and treat it?

Dyslexia refers to problems with reading. The classic symptoms that everyone probably recognizes and knows about are the reversals of letters like 'b' and 'd' or 'p' and 'q'. Numbers also can be reversed, in how they are written and/or their sequence (e.g. '107' might become '017'). The other common effects of dyslexia beyond reading fluently and being able to comprehend written material, are in writing and spelling.  There can be a tremendous breakdown in spelling, which impacts on writing. For instance, 'queen' might be spelled as 'tzrl' - which will leave anybody who sees it utterly confused.  At least with phonetic misspellers (e.g. 'queen' becoming 'kween')  the intent of written language is still being communicated.

There is a second common effect of dyslexia that is not talked about as much, which I see in virtually all adults who have the disorder.  And that is the shame and embarrassment they feel for not being able to read.  I have had dyslexic adults tell me that their 6 year old child has helped them fill out job applications. Or, that their little kids are reading Dr. Seuss books to them. I also hear all too often that the schools they attended 'pushed them through the system' without their ever mastering how to read. With such statements come unexpressed anger and frustration over that having occurred.

The best time to diagnose and treat a child with dyslexia is as early as possible. Realistically, that means by 2nd or 3rd grade, when reading skills should be developing very quickly.  For families where one or both parents have reading difficulties, a child in 1st grade who is not progressing should be considered very carefully. It is hard to know for sure with 1st grade kids what is happening, because not everyone progresses at an average rate. That is, a child may not have dyslexia but can still be a bit slow to develop the skill in 1st grade.  But, genetics do take a toll here as they do with any other medical or psychological problem, and family history of dyslexia increases the risk of a child having the same problem.

It becomes much harder to treat dyslexia past about 4th or 5th grade.  It is not impossible, but the percentage of kids who can close the reading deficit gap shrinks appreciably.

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What are seizures, or epilepsy? And do they have an impact on intelligence or personality?

Seizures involve an abnormal electrical discharge in the brain. Epilepsy can be thought of as involving two or more seizures due to the same underlying cause. Roughly two-thirds of seizures occur for unknown reasons. They just happen.  For the third of seizures that occur for known reasons, there are numerous possible causes.  Some of the more common include blows to the head (e.g. from car accidents; sports-related injuries; falls such as out of a tree, off a ladder or down stairs;) high fevers; strokes; use of various legal and illegal substances (e.g. alcohol, cocaine, amphetamines); and brain tumors.

There are a number of different types of seizures. Perhaps the best known are often referred to as 'grand mal' and involve loss of consciousness for a brief period of time, and a lot of jerking and contraction of the limbs.  'Petit mal' are less obvious to the observer, and are also fairly common. They are a situation where the person remains conscious but in an altered state of awareness. They may be described as having staring spells and being unresponsive such as to others talking to them.  There may be a paranoid quality, turning one's head in an odd way as if to check on something that is not there. Drooling sometimes occurs.  These types of seizures are also fairly brief.

A third type of seizure, which I see most frequently, are more controversial. They are called 'sub-clinical' seizures, or what I call 'little electrical blips.' That is, the electrical activity in the brain is not normal, but it is also not at the stage of being a full blown seizure. It is somewhere between these two states.  Various sensory oddities may be reported, such as hearing one's name called out when no one is speaking to the person. Or, seeing shadowy ghost-like images out of the peripheral vision.  Smells may be noticed that others can not detect, or a feeling that bugs are crawling on one's skin when nothing is there.  Such sensory oddities typically last just seconds at a time.

As to the effect of seizures: most individuals who have them lead normal lives.  Medication is available and helps most people control the seizures entirely or fairly well. When medication does not work, there are alternative approaches, but most of these involve brain surgery, and so are not undertaken lightly.  Individuals who have more severe cases, such as having many seizures per day or per week, can become disabled by them, in that their lives are less functional.

However, even with people who have seizures that are nominally well controlled, there can be a subtle price exacted.  There is an elevated rate of depression among individuals with seizures.  Manic episodes also occur at a higher than expected rate, although not as frequently as depression.  Other problems can include impaired memory, altered sexuality (having too much or too little drive for instance), slower thinking, and sometimes reduced IQ. 

Neurologists, and neurological tests such as EEG's, are generally the best way to diagnose seizures. However, other professionals such as family doctors, pediatricians, psychiatrists, or psychologists, may alert an individual that seizures are occurring.

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What is Asperger's?

Asperger’s Syndrome (AS) is one of the autism spectrum disorders. It is characterized by social and communication difficulties and a tendency to focus on interests that are more narrow than would typically be expected. People with AS may also experience the sensory world differently (e.g., be especially sensitive to light or noise), have difficulty with organization and planning, and experience some motor clumsiness. AS is a lifelong disorder caused by an atypical pattern of brain development but the specific cause is unknown. Symptoms are usually present by the age of 3 although many people with AS are not diagnosed until much later as their learning and behavioral difficulties are often ascribed to other disorders, such as mood disorders, ADHD, learning disabilities, or just being odd. People with AS have IQs in the average to above average range, often have excellent memories, and an eye for detail. AS used to be considered an uncommon disorder. Currently autism spectrum disorders are thought to occur in 1:250 people and 10-20 percent of those people may meet criteria for AS. It is possible that the incidence is even higher as some people with AS are never diagnosed. There is no cure for AS. The primary treatment has two components: 1) Education for the person with AS to help him or her develop strategies to compensate for AS symptoms, and 2) Education for the people who know the individual with AS so that they can understand and provide appropriate accommodations for that individual. With this treatment, most people with AS live relatively typical lives both personally and professionally. Below is a list of common characteristics seen in people with AS. These examples are seen in some but not all people with AS and it should be emphasized that all people with AS are different.

Social Characteristics:

• May seem odd or unfriendly
• May have difficulty reading social cues or their own social behavior may be misinterpreted
• May understand and express emotions differently
• May be less motivated to participate in social activities or be bothered by some social settings, particularly among large groups
• May find it difficult to make friends

Communication Characteristics:

• May have trouble carrying on conversations or conversations may seem one-sided
• May not be as interested in social chat, such as sharing about the day
• Nonverbal communication such as eye contact and gesture may be used differently
• May need extra time to process the language of others

 Narrow Interests and Inflexible Behavior:

• May have one or two interests that are pursued to the exclusion of other interests
• Interests may seem unusual
• May prefer routines and be bothered by changes that don’t bother others
• May be bothered by unpredictable events

Other characteristics:

• Difficulties with organization and time management
• Problems with prioritization
• May prefer writing to talking
• Excellent memory for detail
• Good ability to focus on and develop skills in one area of specialty

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My elderly parent is claiming to see things that aren’t there, like bugs or people in the room. Or thinks there are people living under the bed or up in the attic. What’s going on?

There are different possibilities that may be responsible for such phenomena.  One is that when a person’s vision deteriorates such as from glaucoma, cataracts, or macular degeneration, their ability to see and distinguish what is around them will obviously be lessened.  With such poor eyesight shadows that do exist in the room, whether they are from interior objects, or cast by something outside like a tree’s branch may take on seemingly real shapes such as a person.  Couple the poor vision with an aging mind, that is not thinking as quickly or clearly as possible, and the type of complaint you mention, of ‘seeing people who aren’t there’ is easier to understand.

As to the ‘person living under the bed’ or ‘the family living in the attic’, one possible culprit is the presence of delirium.  What can bring on delirium? There are dozens of possibilities.

The biology of life requires a lot of stability, such as our body temperatures remaining fairly constant.  The blood levels of sodium and potassium, pH, sugar, and many other components also need to be tightly regulated.  Our organs, such as kidneys, liver, heart and lungs have to function well enough to supply nutrients like oxygen, and effectively remove toxins from our system. When any of those tightly regulated processes becomes defective we have problems.  Organs age and break down.  Infections including something as seemingly innocuous as one in the urinary tract (UTI’s) can throw a monkey wrench in to part of our biological processes. 

Still other possible causes of delirium include medication side effects. In my experience after roughly the age of 60 people are virtually guaranteed to have trouble with tolerating different prescription medications.  And the problem grows worse with increasing age, in to the 70’s, 80’s or beyond.  Unfortunately, as our bodies tolerate medication less well doctors are prescribing ever more pills to treat the increasing health problems that arise with advancing age.  At some point that becomes a recipe for pushing a person ‘over the edge’ and delirium results. 

Other common causes of delirium can include recent surgeries, even for seemingly routine issues like hip replacement, which is another way to stress an aged body too much.  Dietary problems arise, especially with individuals who live alone. Many elderly women have what I call ‘tea and toast’ diets which are far from being well balanced nutritionally. Others may eat better, but their bodies ability to digest and absorb food deteriorates with age, and so nutritional deficiencies still result. 

Determining what is occurring to cause the delirium is very important.  Delirium is symptomatic of some life threatening process being present, so that some needed biological stability has been lost.  An evaluation by a family doctor, psychiatrist or neuropsychologist is strongly advised, sooner rather than later.

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