Greetings, NeuroTalkers. I have a puzzle for you, and I genuinely need a clue. I’d be grateful for any guesses, educated or not. What's wrong with this lady?

The story starts in the mid-1980s. The lady had a challenging, demanding, rigid personality, but it was arguably within normal range. She tended to accumulate clutter in a few places in her house, but it was also arguably within normal range.

By the mid-90’s the cluttering had advanced to the point where you could legitimately call it hoarding disorder. She also exhibited some irrational thoughts, such as blaming her husband for irrational reasons (“You failed to predict the future and take steps to prevent this accident, so it’s your fault.”)

By the mid-2000’s the hoarding had progressed; the couple lost the use of multiple rooms in their house. It had caused several tripping accidents and a few injuries. Her personality had become more aggressive, hostile, and paranoid. I began to wonder if she had a personality disorder. After reviewing the diagnostic criteria for cluster B disorders, I remember thinking, “Is all of the above one of the choices?” I began to suspect a long-term, degenerative organic brain disorder.

By the mid-2010’s, she had become increasingly aggressive, hostile, paranoid, and threatening (“I’ll call the police and accuse you of [[crimes you haven’t committed]]. I’ll call Child Protective Services and have you removed from the home.”) Her husband filed for divorce, and with legal help and a judge’s approval, got the kids out of the house. By this time, the clutter prevented the normal use of any rooms in the house, and about half the house had been abandoned.

Now it’s 2020, and her condition is even worse. The police and other authorities have been called several times this year. She was hospitalized, held for 72-hours, and given a diagnosis of “psychosis, with extreme delusions and paranoia”. She spent two 10-day periods in a residential psychiatric facility and was given addition diagnoses of “bipolar disorder” and “schizophrenia”. A neighbor had a restraining order issued against her, after she broke into her neighbor’s house and started babbling nonsense.

So the puzzle is, “What could be wrong with this lady?” Whatever it is has taken 35 years or more to get to this point, and has caused consistent, progressive psychological, emotional, and cognitive deterioration, and eventually, social isolation. I suspect it’s something organic.

Do you have any guesses?