of paranoia towards neighbors, evidenced by persecutory delusions and subsequent threatening behavior. The patient was also reportedly approaching multiple practitioners, requesting prescriptions of benzodiazepines. During the hospital course, the patient displayed drug-seeking behavior demanding benzodiazepines “every 4 hours”. Patient was non-compliant with treatment during hospitalization stating she will only take Metformin and Klonopin, and a court order for treatment over objection was obtained. Once treated with Depakote, Invega, and Invega Sustenna the patient improved as she was notably less delusional and eventually stabilized for discharge. Issues which impacted discharge planning included potential homelessness if the patient was not allowed to live with her mother in her current senior housing; caregiver support to elderly; reluctance of elderly mother to have patient evicted from her apartment. Eventually a plan was formulated that included the patient returning to live with her mother in senior housing, court ordered outpatient treatment connection to assertive community treatment. A referral was also made to Adult Protective Services for the patient’s mother. Conclusions: This case highlights the importance of an interdisciplinary approach, including the coordination of mental health services between inpatient and community support services, consideration of approaching the court system for court-ordered medications in an older patient and managing geriatric psychiatric patients with comorbid substance abuse and history of violence. It is important to keep in mind that substance use disorders may be underdiagnosed and under-recognized in the aging population (Chhatre et al., 2017). Withdrawal from benzodiazepines may be unrecognized and complicate immediate and ongoing treatment of co-occurring conditions. Homelessness and impending homelessness due to interpersonal conflicts stemming from disruptive and aggressive behavior may further impact the care of this subgroup of patients. This research was funded by: Not applicable Poster Number: NR - 37 COMBINATORIAL PHARMACOGENETIC TESTING IMPROVES RESPONSE AND REMISSION FOR PATIENTS OVER 65 WITH DEPRESSION WHO HAVE FAILED ONE MEDICATION TRIAL Brent P. Forester 1 ; Sagar V. Parikh 2 ; Sara Weisenbach 3 ; Olusola Ajilore 4 ; Ipsit Vahia 1 ; Anthony J. Rothschild 5 ; Micheal E. Thase 6 ; Boadie W. Dunlop 7 ; Charles DeBattista 8 ; Charles R. Conway 9 ; Francis M. Mondimore 10 ; Richard C. Shelton 11 ; Matthew Macaluso 12 ; James Li 13 ; Lisa Brown 13 ; Brian Dechairo 14 ; John F. Greden 2 1 McLean Hospital, Division of Geriatric Psychiatry, 115 Mill St, Belmont, MA 02478; Harvard Medical School 2 University of Michigan Comprehensive Depression Center and Department of Psychiatry, and National Network of Depres- sion Centers, 4250 Plymouth Rd, Ann Arbor, MI 48109 3 University of Utah, Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108 4 University of Illinois at Chicago, School of Public Health/Psychiatric Institute, 1603 W Taylor St, Chicago, IL 60612 5 University of Massachusetts Medical School and UMass Memorial Healthcare, 55 N Lake Ave, Worcester, MA 01655 6 Perelman School of Medicine of the University of Pennsylvania and the Corporal Michael Crescenz VAMC, 3400 Civic Cen- ter Blvd, Philadelphia, PA 19104 7 Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 12 Executive Park Dr. NE #200, Atlanta, GA 30329 8 Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305 9 Washington University School of Medicine, Department of Psychiatry, and the John Cochran Veteran’s Administration Hos- pital, 660 S Euclid Ave, St. Louis, MO 63110 10 Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Balti- more, MD 21287 11 The University of Alabama at Birmingham, Department of Psychiatry and School of Medicine, 1720 2nd Ave S, Birming- ham, AL 12 University of Kansas School of Medicine-Wichita, Department of Psychiatry and Behavioral Sciences, 1010 N Kansas St, Wichita, KS 67214 13 Assurex Health, Inc./Myriad Neuroscience, 6960 Cintas Blvd, Mason, OH 45040 14 Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108 Introduction: Six million people in the U.S. experience depression after age 65. Major depressive disorder (MDD) in later life is associated with longer length of illness, increased number of MDD episodes, and a greater risk of comorbidities. Challenges facing clinicians when making prescription decisions for older adults include increased drug-drug interactions, lower adherence, and higher rates of adverse events. Medication trials for MDD can be difficult to navigate in older patients due to increased polypharmacy for multiple conditions. As the aging population grows, the demand for data-driven tools to optimize medication Poster Abstracts Am J Geriatr Psychiatry 28:4S, April 2020 S151