Psychiatrymiddle twist
An 84-year-old woman is brought to a Perth general practice by her daughter, with whom she lives, for a third presentation this year with dehydration. She has lost 7 kg since January. Her daughter holds her bank card and says her mother refuses to eat. Her frusemide and risperidone were last dispensed in March. She does not drink alcohol and her Mini-Mental State Examination score is 26 of 30. Seen alone she talks freely, is not sad, and says she is often left without food or tablets when her daughter works nights. Which one of the following best explains her presentation?