Case Presentation: Agitation in a Patient Suffering from Mania with Psychotic Features in the Ward Setting
In June 2015, Mr. B. was brought to the emergency department by the police after being found outside their department displaying “bizarre behavior.”
Past Medical, Psychiatric, Substance Use History
Mr. B. is twenty-two years old, single, and studying at college. He lives with his parents and his brother. Neither our patient nor his family had any history of psychiatric or medical disorder. Premorbid personality was described as well adjusted.
Current Clinical Situation
When he arrived at the emergency department, Mr. B. reported auditory hallucinations consisting of communications with God. Upon presentation to the emergency department, he was combative. Police also reported that the patient was discovered screaming in public, he was agitated with rapid speech, had delusional ideas about being God's son, and demonstrated grandiosity.
Once the family was contacted, they reported that Mr. B. was well until May 2015, when he developed an unusually “optimistic” state, followed by a decrease in the need for sleep (two to three hours in twenty-four hours), decreased appetite, and increased religious activities. Later in his course, he was noted to have irritability and was frequently found “walking around.”
Mental Status Exam at Admission
Upon assessment of his mental status, Mr. B. was alert and well oriented. Dress and hygiene were fair. He appeared preoccupied and anxious. During the interview, he was impatient and restless, frequently changing seats. Despite these observations, Mr. B. reported that today was the best day of his life because he had decided to reveal that he was God's son. His speech was loud, pressured, and over-elaborative. He exhibited loosening of associations and flight of ideas. Mr. B. described grandiose delusions regarding his healing skills. He also reported auditory hallucinations (God had told him to quit his job and become a spiritual healing leader) with religious delusions about being God's son. He presented with elevated mood, decreased sleep, and demanding behavior with irritability, suspiciousness, and assaultive and hallucinatory behavior (talking to himself). He denied suicidal and homicidal ideation. He refused to participate in intellectual or memory-related portions of the examination.