'How I Treat': Managing Paranoia From Agitation in Alzheimer Disease Case Presentation

Background:

Betty is a 78-year-old female patient of mine who came in to the office with her husband Don and her son Mark after she started experiencing agitation and paranoia over the past 2 months. She was diagnosed with Alzheimer disease 2 years ago and lately her agitation symptoms have escalated.

Her husband and adult son, who are her caregivers, are very distressed as Betty is constantly verbally threatening them and thinks her husband is having an affair with their next door neighbor. She also believes the government is going to send someone to give her a shot that will kill her so he can have his affairs without her around. She is very angry and upset about having to come see me and states “all this is stupid and I don’t need to see you”. She is very confused and needs lots of prompting and redirect for her ADL care, medication management, and day to day activities. The redirection and prompting tend to set her off and for the past several months she has escalated to the point that her PCP can no longer manage her care and she has been brought in to see me. Her husband and son are in tears about how distressing this is at the home and they are considering having to put her in a nursing home or memory care facility if her symptoms cannot be controlled.

Based on this what would be the next course of action?

Amber Hoberg is a dedicated Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) with extensive experience spanning various clinical settings and populations. She holds a master’s degree in advanced practice nursing, specializing in Family Psychiatric Mental Health, obtained from the University of Texas Health Science Center at San Antonio in 2010. Her career is marked by a commitment to providing evidence-based, individualized psychiatric care to patients across the lifespan, including children/adolescents, adults, and geriatric populations.
Currently based in Hillsboro, Oregon, at Visionary Psychiatry, Amber serves as a PMHNP-BC, focusing on nursing home and group home settings. Her role includes collaborating with others on the treatment team to ensure comprehensive care and managing EMAR and e-Prescribing documentation. She also practices at Morning Star Family Medicine PLLC in Floresville, Texas, where she practices and manages medication regimens for residents across outpatient, nursing home, and group home settings. Here, she collaborates closely with case managers, nurses, and psychological care teams, overseeing care for a substantial patient load. Her diverse clinical background includes roles at Northeast/Downtown Baptist Hospital in San Antonio, where she manages acute psychiatric care in an inpatient setting, working closely with psychiatrists and medical staff to deliver comprehensive treatment plans.

© 2025 HMP Global. All Rights Reserved.
 
Any views and opinions expressed above are those of the author(s) and do not necessarily reflect the views, policy, or position of the Psych Congress Network or HMP Global, their employees, and affiliates.