A 13-Year-Old Boy Is Brought to the Office by His

A 13-year-old boy is brought to the office by his parents after being involved in a fight with another student at school.  His parents say, "He has never gotten into fights before, and we are getting worried because his grades have been declining as well.  He seems irritable and moody, stays in his room for hours at a time, and no longer invites friends home."  When interviewed alone about the incident, the patient says, "The wall people warned me that he was trying to poison my lunch."  The patient has no significant medical history; there is a family history of bipolar disorder in a paternal aunt.  Temperature is 37.2 C (99 F) , blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 14/min.  Physical examination shows a postural tremor on extension of the arms and a broad-based gait.  Mental status examination is significant for slurred speech, sad mood, and distractibility.  Laboratory studies reveal elevated serum transaminases.  Which of the following is the most likely diagnosis?

A) Acute intermittent porphyria
B) Alcohol abuse
C) Bipolar disorder with psychotic features
D) Hemochromatosis
E) Major depressive disorder with psychotic features
F) Prodromal schizophrenia
G) Wilson disease

Correct Answer:

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