A 26-Year-Old Man Is Brought to the Emergency Department by Police

question 20

Multiple Choice

A 26-year-old man is brought to the emergency department by police after assaulting customers in a restaurant.  He explains that he meant no harm and was just trying to talk to people and touch them to "heal their pain."  The patient has been up all night for the past 10 days devising a global strategy to end world hunger and has written a hundred-page manifesto documenting his ideas.  Over this same period, he began hearing a voice telling him that he is "God's true son" and will need to sacrifice his life.  The patient has no psychiatric or medical history.  He drinks alcohol socially but does not use illicit drugs.  Physical examination is normal.  On mental status examination, the patient paces continuously.  His mood is very irritable, and his speech is loud, rapid, and difficult to interrupt.  Which of the following is the most likely diagnosis in this patient?

• A)Bipolar I disorder with psychotic features
• B)Bipolar II disorder
• C)Brief psychotic disorder
• D)Delusional disorder
• E)Schizophreniform disorder
• F)Substance-induced psychotic disorder

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Definitions:

Unconscious Mental Activity

Psychological processes that occur without an individual's conscious awareness, influencing thoughts, feelings, and behaviors.

Simultaneous Processing

The cognitive ability to process multiple pieces of information at the same time.

Parallel Tracks

Situations or processes that occur simultaneously or side-by-side with little to no intersection or effect on each other.

Sleep Apnea

A sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep.