A 31-Year-Old Man Is Brought to the Emergency Department by the Police

A 31-year-old man is brought to the emergency department by the police after he assaulted a stranger who he thought was following him.  The police report indicates that when the patient was arrested, he was shouting, "You don't understand, I'm the one who needs protection-the Russians are after my secrets!"  In the emergency department, the patient is diaphoretic and tremulous.  He is very easily distracted and cannot give a clear history.  Temperature is 37 C (98.6 F) , blood pressure is 164/102 mm Hg, and pulse is 112/min with a normal rhythm.  Extraocular movements are intact, and the pupils are dilated.  His speech is loud, rapid, and difficult to interrupt.  Which of the following is the most likely diagnosis?

A) Anticholinergic toxicity
B) Bipolar disorder, manic episode
C) Cocaine intoxication
D) Delusional disorder, persecutory type
E) Opioid withdrawal
F) Phencyclidine intoxication
G) Schizophreniform disorder

Correct Answer:

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