Psychiatry Rounds

Depression in a Patient with Alzheimer’s Disease

Case Presentation

Mrs. D is an 85-year-old widowed woman who resides with her granddaughter, Ms. S. Mrs. D was diagnosed with dementia of the Alzheimer’s type 8 months ago and is currently being treated with donepezil 10 mg daily. She also has hypertension, coronary artery disease, and osteoarthritis. Her other medications include losartan 50 mg daily, aspirin 81 mg daily, and acetaminophen 650 mg 3 times daily. Mrs. D receives 4 hours daily of home attendant services 5 days per week. Ms. S moved in with her 6 months ago to help with her care. Mrs. D raised her granddaughter after her mother was sent to prison for drug-related crimes. Ms. S is very devoted to her grandmother, but works long hours as an event planner.

Agoraphobia: When an Older Woman Refuses to Leave Home

Case Presentation

Ms. M is a 45-year-old divorced woman who makes an appointment for her 78-year-old mother with a psychiatrist. On the day of the appointment, Ms. M arrives alone, asking to meet with the psychiatrist. Ms. M appears distressed and worried. She explains that her mother, Mrs. S, has not left her apartment in the past four years. Ms. M has arranged for food to be delivered and has hired a housekeeper who performs cleaning and laundry tasks. She has tried numerous times to take her mother out, but Mrs. S refuses.

Ms. M describes her mother as an “anxious person”

Prescribing Error in a Geriatric Outpatient Due to Patient Misidentification

Case Presentation

AG, a 75-year-old Hispanic female, was informed by the receptionist in the waiting room of her primary care clinic that the physician with whom she had an appointment was available to see her. She had been attending this multispecialty teaching clinic regularly and was accustomed to seeing new resident physicians from different specialties. AG was sent to the office of the psychiatry resident who had recently started the clinic rotation and was scheduled to see a patient “AG” that afternoon. The resident had reviewed AG’s chart prior to asking the receptionis

Treatment Refusal: Does Depression Affect Decision-Making Capacity in End-of-Life Issues?

Case Presentation

Mr. K is a 58-year-old Caucasian male with a long-standing history of diabetes mellitus, hypertension, and chronic kidney disease who has been on continuous ambulatory peritoneal dialysis for 3 years. Initially, treatment achieved good adequacy of dialysis, and the patient reported a feeling of well-being. During the last 6 months, however, his dissatisfaction with dialysis increased, which he attributed to the increased time needed to perform exchanges and his weight gain. Mr. K underwent right lower-extremity, below-knee amputation secondary to gangrenous foot as

Who Cares for the Caregiver?

Case Presentation

Mrs. S is a 55-year-old married woman who is employed in the Finance department of a community college. She has two children. Her older son recently graduated from college and moved across the country to attend graduate school; her younger son, age 20, has Down’s syndrome, lives at home, and attends a daily workshop program where he is learning life skills with the goal of eventually moving to his own apartment. Mrs. S has been married for 35 years. Her husband had been recently diagnosed with prostate cancer and underwent surgery followed by radiation therapy

Working with Interpreters in Psychotherapy: A Case Report Using the Therapist-Interpreter Team Approach

Introduction

In 2005, On Lok Senior Health Services, a comprehensive long-term care health plan for the frail elderly, took on the challenge of offering in-house mental health services for its senior population.1 The On Lok Lifeways mental health team faced the complex task of providing quality mental healthcare to an extremely diverse population. To illustrate the enormity of this challenge: On Lok serves more than 1100 elderly persons who speak over 30 different languages. Cultural and linguistic diversity render it nearly impossible to offer mental health services to patients in

Obsessive-Compulsive Disorder in a 62-Year-Old Male

Case Presentation

Mr. X is a 62-year-old divorced male who presented for psychiatric evaluation with concerns regarding flying in an airplane and “claustrophobia.” His worries began approximately 4 months prior to evaluation when he had a scheduled plane trip with a friend. He noted significant anxiety leading up to the flight, which he identified as a fear of losing control. He knew these thoughts were irrational but was afraid he would become anxious while in the enclosed area of the plane cabin and have no escape. As a result of his fear, Mr. X canceled the flight and his vac

An Older Widower Struggling to Cope with Loss and Health

Case Presentation

Mr. Y is a 68-year-old widowed man brought to the Emergency Department (ED) by his daughter, Ms. S. Ms. S came to see her father while on a business trip and found him to be weak and lethargic. She found very little food in the house and was concerned by the excessive number of bottles of whiskey in the kitchen and living room. Ms. S tells the ED staff that her father had a myocardial infarction 5 years ago and has hypertension. He is supposed to be taking medication for hypertension and heart disease, but Ms. S does not know the names of the medication. Mr. Y has

Borderline Personality Disorder in an Older Woman

Case Presentation

Mrs. N is a 63-year-old divorced white woman who presents to her psychologist at a local mental health center for weekly psychotherapy. Mrs. N appears clearly distressed and tells the psychologist that she saw her third ex-husband in a restaurant a few days ago having lunch with a young, attractive woman. Mrs. N reports that since then she has felt ugly, unattractive, and has resumed previous self-destructive behavior of sticking pins into her thighs. Mrs. N has a prior history of cutting herself with a small knife but had stopped this after she married her third h

Domestic Violence in an Older Couple

Case Presentation

Mr. and Mrs. C are brought to the local hospital Emergency Department in an ambulance accompanied by the police. This older couple is well known to the Emergency Department staff due to their frequent visits for injuries. Mr. C is a 68-year-old retired construction worker who has been admitted several times to the hospital’s Chemical Dependency unit for alcohol withdrawal. Mrs. C is 64 years old and still works part-time as a bartender in a local pub. The couple has been married for 44 years and has three adult sons. Their youngest son, Mr. DC, frequently moves b