One lady in a care home, with advanced dementia, has a rather feisty disposition. Her daughter's more vehement in her assertions, saying, "She's a vile creature, she's always been evil, really evil!"
As her dementia has progressed, so her frontal lobe function's deteriorated and she's become more disinhibited, her natural demeanour has come to the fore, with any veneer of civility or decorum being long lost, now.
The care home staff describe her as being an active soul. She fills her time to her amusement and satisfaction, "Tormenting other residents with wicked words and abuse," through throwing food she doesn't like from her plate onto the floor, or at carers, grinning as she does so, snatching food from other folks plates if she wants it, saying hurtful things just to get a response, "That's your daughter going, is she? Must be bored with you, what with you saying the same things to her all the time, I expect she's glad to be away."
My nursing colleagues saw her a number of times. I saw her once to establish diagnosis, capacity and exclude a treatable mood disorder.
I use risperidone as a depot medication for a number of folk but I can't think, in the last couple years, of anyone I've prescribed oral risperidone for. My nursing colleague discussed this lady's presentation with me and sought to start a low dose of oral risperidone. She persuaded me it was a reasonable plan to try then review, so we did. She also gave the home advice on how to handle this lady's interesting presentation.
Just 2 weeks on when she was reviewed, the care home staff say she's cured! All the malicious talk's stopped. She's still swearing like a trooper and nipping and scratching when staff try and help her bathe, but she's no longer biting. At meals and in the lounge she watches everything and grins to herself but can now bite her tongue and remain, if not prosocial, at least asocial rather than being antisocial.
A good result.