Medications May Have Increased Paranoia

Reader’s Question

My fiance’s mother is having serious paranoid episodes. She has always had some form of paranoia, but her doctor has given her new pain medication for her back and it has triggered full paranoia. She is convinced people are in her attic waiting to come down and attack her; she’s called the police several times for this and they come out and investigate and there is never anyone there. She thinks people are listening in on her cell phone conversations, so she’s always changing the number. She thinks people are watching her and hiding in bushes watching her. She gets violently angry at the drop of a hat, especially when you try to talk to her about what she’s doing. She won’t call the doctor to let him know what’s happening with this medication and she hides the bottles from us so we can’t call. She tells stories of how she just knows her brother took her cat and got rid of it to hurt her, and she says that her mother tried to kill her when she was a child by putting ice down her throat. The stories like that go on. She’s also become very religious all of a sudden and says she’s seen angels in the clouds playing harps, and she is trying to push her religion onto other people. She also has a son that is very mentally disabled. He is being taken care of by the state and she refuses to acknowledge that she’s had him. She says she only has one son, and to be honest with you, that really breaks my heart to hear that.

She’s become out of control and we don’t know what to do for her. We’ve tried talking to her about checking into a hospital to get some treatment, but she refuses to go. We’re afraid that she’s going to hurt someone on accident when she’s having one of her episodes. Is there anything that we can do?

Psychologist’s Reply

What you describe is paranoia — no question about it. There are several forms of paranoia however. Some folks have “paranoid personality” where they always feel cheated, feel others are out to manipulate them, and assume evil motives in the behavior of others. There is also “Delusional Disorder” were the individual develops very organized and complex delusions (false beliefs). Another form is Paranoid Schizophrenia where the delusions are also accompanied by hallucinations (voices), visions, and confused thought processes.

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From your description, it sounds like an acute paranoid state prompted by medication changes. Many pain and steroid-like medications can create a paranoid state, often increasing the paranoia if the individual has already been paranoid for some other reason such as paranoid personality or delusional disorder. Medications can also interact and create significant psychiatric symptoms. I have a chronic pain patient who was placed on pain “patches” as well as her regular medications. Two days later she awoke to find four bears playing Euchre on the picknick table in her backyard. These medication interactions can produce visual hallucinations as well as auditory hallucinations.

Her symptoms are nearing the “danger to self and others” criteria for psychiatric intervention. For a start, I’d:

  1. Inform the physician prescribing the medications of her behavior. The physician may not be able to share information about her due to confidentiality but he/she will clearly appreciate the information.
  2. Remove items from the home that might be impulsively used to harm herself or others (firearms, axes, etc.).
  3. Ignore her confused statements about having only one son, etc. That’s part of her confusion.
  4. Some local mental health agencies have community intervention specialists. You might want to see if those agencies have someone who can conduct an assessment.
  5. Challenging her paranoia will be unsuccessful. Rather, focus on the stress she must feel, the sleeplessness, and other physical symptoms that might make her uncomfortable enough to see a physician or mental health professional.
  6. Keep an emergency bag with documents regarding all her medications, doses, who prescribed them, etc. Also keep a small log of her behaviors. If an opportunity presents itself to take her to the emergency room, you want to have your homework done and be able to supply all the information needed in an assessment. Many paranoid and very ill folks talk their way out of the hospital because relatives don’t have the information needed to keep them for assessment.

You didn’t mention her age and that’s very important. This type of generalized, vague, and disorganized paranoia is often associated with the onset of dementia. Gaps in her memory, in this situation, are filled in with paranoia. If she loses her purse, someone stole it. When she is unable to make sense of her environment, she feels someone has drugged her — that sort of thing.

The bottom line is the need for medical and psychiatric assessment and treatment. If she becomes totally out of control, try to get her to the emergency room and then request (if not demand) psychiatric consultation. Keep in mind that this sort of situation is very heart-breaking.

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