ADVERTISEMENT
How I Treat: Managing Paranoia and Aggression Case Presentation
The patient is a 73-year-old female who has been a resident at a local nursing home for the past 3 years. The patient is a widow who was married for 34 years. Her children visit weekly, and the patient is typically involved in participating in activities and socially involved with other residents of the nursing home. The patient has past medical history of hypertension, diabetes mellitus, depression, and dementia. You are requested to evaluate the patient by the director of nursing due to concerns of increased “behaviors.” Upon further conversation, the staff reports that the patient has been going throughout the facility “getting into arguments” and has been asked to stop attending bingo daily due to her verbal aggression with other residents and staff members. The patient did have an altercation with her roommate last night in regard to the television being too loud. The patient reportedly “slapped her roommate for not just turning it off and going straight to bed.”
The patient reports that she feels “everyone is out to get me, and I just try to stay to myself.” Patient feels isolated and has observable paranoia about the staff and other residents. She feels embarrassed that she is not allowed to attend bingo at this time and would rather just stay in her room to avoid being “picked on anymore.”
Vital signs are unremarkable during examination today. Here are her current medications:
- Metformin 500 mg twice daily
- Hydrochlorothiazide 12.5 mg daily
- Donepezil 5 mg nightly
- Citalopram 20 mg nightly
- Quetiapine 25 mg nightly
