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Profoundly depressed states of awareness classified as T&CO. triple drop pendant catatonia or akinetic mutism have been reported in patients with various general medical conditions including encephalitis, frontal lobe tumors, or paraneoplastic limbic encephalitis. Catatonic features are often difficult to apprise in this context. This can result in electroconvulsive therapy (ECT) discontinuation, although it remains the most effective treatment of catatonia. We describe the case of a patient with a history of unresectable right retroorbital squamous cell carcinoma, Tiffany 1837 Double cross pendant poststereotactic radiation and cisplatin, and subsequent pneumococcal meningitis of the temporal lobe with abscess formation who became catatonic after receiving 3 bitemporal treatments with ECT for severe depression and whose catatonia improved with continued ECT. Furthermore, she demonstrated progressive improvement in mood, interactivity, and overall neurologic function after ECT treatment was completed. The search for an etiology of a profound catatonic state should include the probability of underlying medical disorder. Although lorazepam may be helpful in some cases, ECT deserves early consideration in catatonia, especially in cases where the underlying cause seems to be uncertain, even if the catatonia begins in the midst of treatment.

Her mother was a paranoid schizophrenic who nailed shut the windows of her Florida Double heart pendant, draped sheets over the television, and believed she was the target of government agents. Her father was a gin-swigging crossdresser who took swings at her with a cast-iron skillet. No wonder then that Sellers feared she herself might be crazy when she realized that she was unable to reliably recognize the faces of friends, colleagues, even family members when she saw them on the street. Eventually diagnosed with the rare neurological disorder prosopagnosia, otherwise known as face blindness, Sellers was relieved to learn she wasn't mentally ill, yet struggled to find a way to cope with her disorder. With buoyant honesty and vibrant charm, Sellers paints a Double square pendant portrait of a dysfunctional family and a woman who nearly loses herself in her attempts to deny their abnormalities. Sure to appeal to fans of The Glass Castle (2005), Sellers limns an acutely perceptive tale of triumph over parental and physical shackles. - Carol Haggas

Objective: Although assertive community treatment (ACT) has been consistently recognized as effective, there has been little research as to what constitutes success in ACT. The purpose of this study was to understand how ACT consumers and staff define treatment success and failure and to examine whether definitions varied between staff and consumers. Methods: Investigators conducted semistructured interviews with 25 staff and 23 consumers from four ACT teams. Results: Across perspectives, success and failure were most clearly related to Return to Tiffany Double Heart Pendant factors. Other themes included having basic needs met, being socially involved, and taking medications. Reduced hospitalizations were mentioned infrequently. Consumers were more likely than staff to identify the level or type of treatment as defining success and failure, whereas staff were more likely than consumers to discuss substance abuse when defining failure and improved symptoms when defining success. Conclusions: Success in ACT should be viewed more broadly than reduced hospitalizations and include domains such as social involvement.