Forensic Psychiatry Competency Evaluation of an Elderly Depressed Woman with Signs of Early Alzheimer’s Disease
Forensic Psychiatry Competency Evaluation
Helen presented to our offices as an attractive and eloquent 82 year old woman. She was feeling agitated and depressed over a legal battle with her guardian, and complained of “problems with my memory.” Helen had retired following a long and successful career as an attorney. She and her husband (now deceased following a lengthy illness) had accumulated a number of significant assets over their many years of marriage, including three homes, a sizeable stock portfolio, and valuable works of art. The couple had no children, and it had always been their desire to donate their assets to charity upon their demise.
During the period when her husband’s health had been deteriorating due to Parkinson’s disease and dementia, Helen had become depressed, and her condition had worsened in recent times due to persisting struggles with a series of guardians over the disposition of her assets. Two years prior to first being seen by us, she became the victim of a telephone fraud scheme, whereby the caller had convinced her that he was her grandson and was in dire financial straits. The “grandson” had pleaded with Helen to wire him money and, sadly, he fleeced her out of $25,000. Helen’s unfortunate lapse of judgment became apparent to some of her friends, who filed a petition with the courts to have a guardian appointed to assist her in managing her affairs.
Initially, her sister and niece were appointed as guardians. And over Helen’s objections they attempted to liquidate some of her assets and receive a commission upon the sale. At one point, they presented Helen with a bill for $80,000 for their “services rendered.” Helen and her attorney filed a motion to have her sister and niece removed as guardians. The court granted their motion and appointed a local attorney to be the new guardian.
The newly appointed guardian actually turned out to be worse than Helen’s sister and niece. He immediately began trying to liquidate Helen’s various properties, planning to pay himself a fee of 10% from the proceeds of the sales. At the time Helen presented to us for evaluation and treatment, she was depressed, anxious, had memory impairment, and was extremely agitated over her relationship with her guardian. We assigned two doctors to her case.
One became the treating physician, who evaluated her dementia and depression, and uncovered evidence that Helen had a number of vitamin deficiencies, and an untreated thyroid condition, that contributed to her dementia. Appropriate vitamin supplements were prescribed along with two additional supplements that improve brain function and cellular energy production. Brintellix, a medication that treats both depression and cognitive impairment, was also prescribed. The consulting endocrinologist placed her on thyroid medication. Helen’s mood and memory function began improving on this regimen.
Concurrently, one of our forensic psychiatrists conducted a civil capacity evaluation to determine Helen’s mental capacity. He also recommended that she retain a new attorney, to work with her existing attorney to attempt to remove the guardian who Helen so vehemently mistrusted, and whose presence had worsened her preexisting depression. The forensic psychiatrist testified in court that Helen had the capacity to determine who was eligible to serve as her guardian. The attorney who was serving as her guardian vigorously objected, and aggressively cross-examined our forensic psychiatrist. The court ruled in favor of Helen, and removed the guardian, appointing instead a woman attorney who met with Helen’s approval.
If Helen’s mood and cognitive functioning continue to improve, she may reach the point where she can once again manage her own affairs. We will do everything within our power to return to Helen as much of her dignity and autonomy as possible.
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