History
A 90-year-old woman has been a patient of the Beacham Ambulatory Care Center since 2000.  Chronic conditions are pernicious anemia, osteoarthritis, and urinary incontinency.  She is fully functional and fully independent.  She provides care for the home bound husband who has severe COPD.  They live in a row home specifically “close to the hospital” to ensure access to house calls for her husband.

In September 2000, the husband dies as a result of respiratory arrest.  Her only relative is a nephew who talks with her about once a month.  In October 2002, her home is broken into and our patient is raped and robbed.  She was taken to a local hospital specializing in rape.  Here, she is distressed, delusional, and is reported to be very emotionally distraught.

(top of page)
 
Presentation and Examination
We see the patient about 3 weeks after the rape in a community nursing home, where she was moved after a 4 day stay at the hospital.  She was very distressed, delusional and confused.  She slowly improved over 2 months and was discharged to a senior living building in a community in eastern Baltimore County. 

In March of 2003, the patient is seen in the office. She is still very ill emotionally.  She is crying, depressed (not suicidal), and stressed about her new home.  She wants to move to a new Senior Housing unit because it would be on the bus route making it easier to get around.  She has also hired a middle aged woman as a caregiver.

In November 2003, 9 months after moving to a new facility, she becomes acutely ill with psychotic symptoms and severe paranoia.   She hallucinates that men and women are in her bed and calls others all hours of the day.  She is hospitalized on a psychiatric unit and improves over about 14 days without antipsychotic medication.

One week following discharge from the hospital, symptoms rapidly recurred when she returned to the senior apartment.  She was disruptive and threatened with eviction unless something was done rapidly.  An emergency petition was prepared as she refused medical care.  With the help of her companion, we were finally able to persuade her to take a neuroleptic drug (Haloperidol 0.025 – 1.0 mg/day) for her recurrent incapacitating hallucinations.  Our office nurse and staff called her daily to guide her through the process of taking her medicines.  She slowly but steadily improved and became stabilized.