Mrs. Tammy Polk is very difficult to interview. She is an extremely vague and difficult historian. Her family tell you that she was diagnosed with breast cancer 5 years ago and had a mastectomy at that time. Her husband died 6 months ago and she has never really recovered. Over the past week, the family have been worried that she is "developing Alzheimer's" because of memory problems and agitation. Past psychiatric history is notable for mild depression, treated with paroxetine 20mg daily, and sleep difficulties that are chronic and date back to her days as an alcoholic. One month ago, she was started on 50 mg of quetiapine at bedtime for sleep by her family doctor. Two weeks ago, she was given Oxybutinin (Ditropan) to help with some urinary incontinence, with good effect on her bladder problem. She is admitted to hospital for further medical work-up. The 1 pm nursing note reads: "quiet, resting comfortably, oriented x 3." The results of CBC, serum electrolytes and urinalysis are pending. The medical resident calls for psychiatric consultation at 4:05 pm because the patient has become agitated and has voiced suicidal ideation. The consult note reads: "medically cleared, please transfer to psychiatry for treatment of emotional instability and psychotic depression." The psychiatric resident arrives at 5 pm and finds that the patient is visually hallucinating and disoriented.