Case Study Blog: Mrs. B's Deteriorating Dementia and Psychosis Symptoms

This case study discusses the deteriorating dementia and psychosis symptoms of Mrs. B, an 85-year-old woman. It covers her symptoms, concerns, diagnosis, and treatment options.

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Case study blog
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Table of Contents
Question 1:.......................................................................................................................................2
Question 2:.......................................................................................................................................3
Question 3:.......................................................................................................................................3
Question 4:.......................................................................................................................................4
References:......................................................................................................................................6

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Question 1:
This case study represents the case of Mrs. B who is a 85 year old woman suffering from
increased paranoia, visual hallucination, and agitation with a strong allegation of the general
physician trying to euthanase her. During her previous hospitalization three years ago, she had
been diagnosed with late onset Alzheimer’s type dementia with delusions, depressed mood, and
behavioural disturbance. The case study also indicates that the working symptoms of the patients
had been deteriorating and as a result she had worsening paranoid delusions, visual
hallucinations, severe restlessness, and difficulty in being redirected. Her son had confessed that
she had strange thoughts from as long as he could remember and her mental condition has
worsened considerably after the death of her husband five years ago which led her to develop a
major depressive disorder with psychotic symptoms.
It has to be mentioned that the case study is successful in providing a preliminary insight
on the condition of the patient, however, for a working diagnosis to be completed so that
treatment interventions can be provided, there is need for more extensive information (Stowell et
al., 2012). In this case, a thorough past medical history with exact account of her previous
medical illnesses and the medication or treatment that she had undergone will be required. Along
with that a family history analysis of any plausible mental illness will be beneficial input to be
added into the patient data. General observation of the patient is often the gateway to obtaining a
preliminary understanding of the stage of psychosis as a part of general information. Mental state
examination involving 15 elements to assess the mental state and cognitive functioning followed
by a direct patient interview will be required (Sink et al., 2015).

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Question 2:
There are various concerns that are prevalent in this case scenario for the patient under
consideration. For instance, it has to be mentioned that she had been suffering from many
symptoms of psychosis along with her worsening dementia. As per the case study information,
she had presented in the health care facility with the complaint of the general physical trying to
euthanase her and had been very anxious, agitated and restless. Hence, the paranoia and
deteriorating delusions or hallucination from the worsening dementia is one of the greatest
medical priorities or concerns for Mrs. B (Martin et al., 2014). her agitation and aggressiveness
that she has demonstrated is a huge risk to her health and her as well as anyone around her. The
impact of agitation and restlessness or irritability in a mentally ill older adult can lead to severe
consequences such as violence and self-harming tendencies, hence, it is also a grave issuer for
the patient to consider. Lastly, for patients with immense psychological symptoms and
depressive disorders, the risk of suicidality is also extremely high. Hence, as Mrs B is also
suffering from deteriorating dementia, possible onset of psychosis with worsening paranoia and
delusions along with depression, the risk for suicidality and self-harm is also a considerable risk
for her and is an important health issue (Stowell et al., 2012).
Question 3:
It has to be mentioned that the diagnosis of any psychotic disorder is a long and
complicated procedure and involves a variety of different factors and assessment data. The
psychotic symptoms that a mental patient suffers from is inherently unique for the patient,
although there is a link between the psychotic symptoms corresponding to the different psychotic
symptoms, the extent of clinical manifestations is individualized for each patient (Maust et al.,
2017). Hence, for a proper working diagnosis of the mental disorder an extensive range of

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assessment and patient interviewing is required. However, in this case, the case information
provides an array of information, proper analysis of which can provide a chance of assuming the
possible mental health condition that the patient under consideration is in.
As per the case information, the patient had been diagnosed with late onset Alzheimer’s
type dementia with delusions, depressed mood, and behavioural disturbance. Although she had
been progressing the living facility, her symptoms started deteriorating further and developed
more complicated symptoms such as the gradually worsening paranoid delusions, visual
hallucinations, severe restlessness, and difficulty in being redirected. In this case it can be
assumed that the burden of the dementia and depression had been delimiting on her and the loss
of her husband had a major impact on her already deteriorating cognitive health (Martin et al.,
2014). The major clinical manifestations that Mrs B had been exhibiting had been agitation,
delusions, paranoia and confusion. On an elaborative note, she had been adamant and restless
when admitted to the health care facility with the complaint of her general physician trying to
euthanase her which indicates at deteriorating delusions. As per her symptoms and the
information that is available about her, the patient seems to be suffering from signs of psychosis
developed from her deteriorating dementia, delusions and depression (Maust et al., 2017).
Question 4:
In light of the presenting symptoms that the patient in the case study is suffering from,
the health service will need to respond in a holistic manner addressing not just the mental health
needs of the patient but also the overall physical, emotional and spiritual needs of the patient
(Bowling & Iliffe, 2006). In order to address to her psychosis symptoms and her deteriorating
dementia she will need to be assessed and treated by a neurology special and psychotherapist.
Along with then pharmacological interventions, she will also need the assistance of cognitive

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behavioural therapies, mindfulness based therapies and related other psychotherapeutic
assistance. However, the health service addressing to the health issues of the patient ill also need
to consider the impact of aging in her life (Bowling & Dieppe, 2005). Successful aging is a
process that involves various modifications and coping, hence the approach taken for Mrs B will
also need to incorporated person centred and holistic successful aging models. There are
various models of successful aging such as Rowe and Kahn’s model of successful aging, SOC
model, lay model, and graceful aging model which can be incorporated into the care planning
and implementation procedure to ensure optimal health and wellbeing status and dignified living
for the aging patient (Wang, Chen & Shie, 2013). However, as Mrs. B is coping with the loss of
her husband and the resultant psychotic disorders, the life-span model of Selective Optimization
with Compensation model (SOC-model) that focuses on biological, psychological, and socio-
economic changes and learn to compensate for the losses, this model might be best suited for her
(Ouwehand, de Ridder & Bensing, 2007).

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References:
Bowling, A., & Dieppe, P. (2005). What is successful ageing and who should define
it?. Bmj, 331(7531), 1548-1551.
Bowling, A., & Iliffe, S. (2006). Which model of successful ageing should be used? Baseline
findings from a British longitudinal survey of ageing. Age and ageing, 35(6), 607-614.
Martin, P., Kelly, N., Kahana, B., Kahana, E., Willcox, B. J., Willcox, D. C., & Poon, L. W.
(2014). Defining successful aging: A tangible or elusive concept?. The
Gerontologist, 55(1), 14-25
Maust, D. T., Kales, H. C., McCammon, R. J., Blow, F. C., Leggett, A., & Langa, K. M. (2017).
Distress associated with dementia-related psychosis and agitation in relation to healthcare
utilization and costs. The American Journal of Geriatric Psychiatry, 25(10), 1074-1082
Ouwehand, C., de Ridder, D. T., & Bensing, J. M. (2007). A review of successful aging models:
Proposing proactive coping as an important additional strategy. Clinical psychology
review, 27(8), 873-884
Sink, K. M., Craft, S., Smith, S. C., Maldjian, J. A., Bowden, D. W., Xu, J., ... & Divers, J.
(2015). Montreal cognitive assessment and modified mini mental state examination in
African Americans. Journal of aging research, 2015
Stowell, K. R., Florence, P., Harman, H. J., & Glick, R. L. (2012). Psychiatric evaluation of the
agitated patient: consensus statement of the American Association for Emergency
Psychiatry Project BETA Psychiatric Evaluation Workgroup. Western Journal of
Emergency Medicine, 13(1), 11

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Stowell, K. R., Florence, P., Harman, H. J., & Glick, R. L. (2012). Psychiatric evaluation of the
agitated patient: consensus statement of the American Association for Emergency
Psychiatry Project BETA Psychiatric Evaluation Workgroup. Western Journal of
Emergency Medicine, 13(1), 11
Wang, K. M., Chen, C. K., & Shie, A. J. (2013). GAM: a comprehensive successful ageing
model. Theoretical Issues in Ergonomics Science, 14(3), 213-226.