Question:
My mother-in-law is 63 years old. She is on a variety of medications,including:

DepakoteProzacRisperdalClonazepam

Our goal is to reduce the number of medications she is taking. She hasrecently moved closer to my family so we are taking her to a newpsychiatrist and having her care evaluated from scratch.

Her former psychiatrist also prescribed oxycontin, and oxycodone formanagement of chronic pain. Is it appropriate for a psychiatrist toprescribe pain medication? Based on her behavior, we feel my mother inlaw is addicted to narcotics and were surprised that they wereprescribed by her psychiatrist.

Answer: She sounds like she is faced with an overwhelming situation - griefover her son and husband, chronic pain, perhaps a depressive illness,perhaps an addiction of some sort, and - given the drugs she wasprescribed - perhaps a history of bipolarity, on top of recently beingdisplaced to a retirement community - which can be traumatic in and ofitself.

I can't imagine how I'd cope with all of that. I don't think I would beable to cope.

Given the context, if she is abusing medications, and/or behaving oddlyit may be as much a cry for help or out of a sense of despair asanything else.

One of the issues you bring up is the times of "slowness" versus timeswhen she is "ok." I do know that depression in older people cansometimes manifest as a "pseudo-dementia" in which confusion, cognitiveslowing and memory problems are so severe that they appear more likethey have dementia than depression. When the depression is treated,though the "dementia" disappears.

But you're absolutely right to consider the overmedication ormedication abuse as a possible cause for her behavior. Have you askedher directly about her medication use?

If you're concerned about the pain management, I agree with you that acompetent psychiatrist should point your towards a specialist who istrained to deal with these issues, instead of trying to treat itthemselves.