This week in clinical I assessed a client with a history of Bipolar who was displaying symptoms of severe anxiety and depression. She was experiencing delusions and signs of early dementia as well. Consult was written for catscan which was negative. Patient was stating her husband was poisoning her and that she is going to get fired from her job for breaching security Once collaboration was made with the social worker, employer, and family we were able to conclude that she was extremely delusional. Patient was on Effexor and this medication doesn’t do well for someone with her symptoms so we begin a taper down from 112.5 she was placed on Abilify 10 mg we will begin tapering down on Effexor and up on Abilify until she stabilizes. Patient is being referred for ECT.