Psychiatrists working with older adults frequently encounter suspicious or paranoid behaviors, especially in patients with agitation. In fact, such ideation is not very uncommon in community populations of elderly adults. In a community study of elderly persons in San Francisco, 17% of the subjects reported that they were highly suspicious, and 13% reported delusions (Lowenthal and Berkman 1967). Another study that included elderly persons in both urban and rural areas of North Carolina found that 4% of older adults experienced a sense of persecution by those around them (Christenson and Blazer 1984). Perceptions of a hostile social environment or ideas of persecution lead to greater stress, vigilance, and agitation among elderly persons, resulting in alienation from families and friends. Such individuals represent a challenge for clinicians who care for them.