Abstract
In the growing field of geriatric psychiatry, the "3 Ds"-depression, dementia, and delirium-are a complex clinical challenge, especially in patients with medical comorbidities. This is a case report of a 96-year-old Saudi woman with chronic kidney disease, heart failure, and recurrent hyponatremia presented with worsening sleep, depression, persecutory delusions, and hallucinations following an intensive care unit (ICU) stay for urinary tract infection. Examination revealed cognitive decline and depressive symptoms, with sodium at 123 mmol/L. After a psychiatric evaluation, she was diagnosed with major depressive disorder with psychosis, likely exacerbated by hyponatremia and ICU-related stress. She was treated with sertraline, olanzapine, and sodium correction. One-month follow-up showed significant improvement in mood, sleep, and resolution of psychotic symptoms, restoring her quality of life. In conclusion, this case highlights the challenges between these conditions and the importance of comprehensive assessment in geriatric care.