Mrs. Tammy Polk was brought to the Emergency Department by her family who is concerned about her memory and ability to safely care for herself. Over the past week, the family have been worried that she is "developing Alzheimer's" because of memory problems and agitation. Her husband died 6 months ago and she has never really recovered. One month ago, her primary care physician started she was started on 12.5mg of quetiapine at bedtime to help with difficulty sleeping. Two weeks ago, she was given Oxybutinin (Ditropan) to help with some urinary incontinence, with good effect on her bladder problem. She was diagnosed with breast cancer 5 years ago and had a mastectomy at that time. She’s been taking paroxetine 20mg daily for many years for chronic depression, and has had intermittent sleep difficulties that are chronic and date back to her days as an alcoholic. She is admitted to hospital for further medical work-up. At 1:00pm the nurse notes, “quiet, resting comfortably, oriented x 3.”The results of CBC, serum electrolytes and urinalysis are pending.” The medical resident was paged to reassess at 4:05pm because the patient became tearful, upset, and was voicing suicidal ideation. They note, "Given history of depression and current suicidal ideation, consider psychiatry consultation." The psychiatric resident arrives at 5 pm and finds that the patient is visually hallucinating and disoriented.