GIVING IN TO THE PATIENT

A 52-year old married woman, whose paranoia has been reasonably stable for 18 years, lives with her husband and a niece. Her only psychiatric hospitalization occurred 2 years ago when she was treated with antipsychotic medication. It is not clear what benefit, if any, she obtained from the medication, but she developed a feeling of “heaviness” in her right leg about that time, which she attributed to it. She has since been quite unwilling to take medication.

Two days before the present admission, the patient's home was raided by the police, who were under the mistaken impression that it was a hangout for an escaped drug dealer. The patient was quite shaken by this experience. She became agitated and much more delusional than usual, particularly about her family as well as people in the neighborhood. Although the admission form alleges that she threatened and kicked her husband and niece, it is unclear whether she was ever actually aggressive toward them. They may have fabricated this story to ensure that she would be admitted to the hospital. However, it is clear that she was quite agitated, taking off her clothes repeatedly, and having difficulty getting to sleep. She was evaluated the day following the police raid and was thought not to be committable at that point. But the following day, after a sleepless night, the family obtained an order for commitment.