Y is a 55-year-old woman who was brought to the accident and emergency department, following an epileptic fit on the street. She had a known history of severe alcohol dependency and epilepsy. She had numerous past admissions, which were always terminated prematurely by her. She has not been adhering to the anti-epileptic treatment. Five days prior to admission her daughter found her in a grossly self-neglected state. There was evidence of recent heavy drinking and she had been incontinent of urine and faeces. Despite this the daughter had not requested help. At interview Y presented as a small unkempt lady, seemingly undernourished and frail. She had recently undergone a hip replacement and was found to have an infected suture wound on physical examination. There were no signs of acute confusion or intoxication. She was neither depressed, nor deluded. There were early signs of cognitive decline (short-term memory impairment). She refused voluntary psychiatric treatment and denied her self-neglect, in spite of her bad personal hygiene and infected wound.
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