E.L. is a 84 year-old-woman who lives in her own home with a full-time caregiver and attends a day program on weekdays. E.L. has a history of bipolar disorder and moderate dementia. At baseline she is cantankerous and opinionated. More recently her caregiver reports that behaviors are agitated and oppositional.
E.L. is refusing most cares, is paranoid that, when her caregiver is on the phone, she is talking about E.L. She has been resisting sleep, staying up late and waking in the middle of the night.
Her caregiver denies aggressive behaviors, but E.L. is arguing with other participants in her day program and is at risk of being kicked out of the program.
Current medications are depakote 1500 mg daily (last level was therapeutic), quetiapine 100 mg qhs, and bupropion 75 mg qd.