To the Editor: A 57-year-old woman with past medical history of paranoid schizophrenia (diagnosed during college), hypertension, and diabetes suffered multiple embolic cerebral vascular accidents (CVAs) resulting in right-sided hemiplegia with neglect, was admitted to the long-term care nursing facility for rehabilitation. The patient's vitals and complete blood count were within normal limits. She was fed via a gastrostomy tube. Within a week of her admission, patient started having episodes of restlessness and crying and wailing out loud. The episodes would start within seconds and last for 5 to 15 minutes nearly every hour throughout, without any clear precipitants; she had tears and was inconsolable. For the initial 2 months, she was given lorazepam and fluoxetine to control these episodes without any success. Fluoxetine was later replaced with valproate 750 mg at bedtime for irritability, mood lability, and crying spells, with slight though insufficient improvement. Because of her expressive and receptive aphasia, evaluation for any evidence of delusions or hallucinations was difficult. She was not noted to be responding to any internal stimuli and antipsychotics were not deemed necessary.