"Murder!" she said: a case of iatrogenic delirium

This case study discusses the psychotherapy of an elderly woman who presented with anxiety and depression manifest by psychosomatic symptoms. At the termination of what had appeared to be a successfully completed therapy, the patient revealed a longheld secret. An iatrogenic delirium resulted in the patient's having "witnessed a murder." Unaddressed and unresolved feelings of anger, shame, and guilt led to years of anguish. This study illustrates the destructive potential of secrecy in both personal and professional relationships. It emphasizes the importance of the nurse's role in acquiring and applying knowledge of pharmacology, especially as it applies to the elderly; the need to discuss delirious episodes without delay; the wisdom of listening to a person's story as a lived experience; the value of applying the nursing process toward problem resolution; and the benefit of providing holistic nursing care.