His Roommate Brings a 20-Year-Old College Student to the Emergency

His roommate brings a 20-year-old college student to the emergency department. The patient is terrified and thinks that campus police are tailing him and plotting his death. His roommate claims that the patient appeared "completely normal" until a few days ago, when he began staying up all night studying for final exams. Although the patient has no documented medical or mental background, his father suffers from schizophrenia. The blood pressure is 150/95 mm Hg, and the pulse rate is 110 bpm. The examination reveals clean lungs and tachycardia with normal S1 and S2 rhythms. The abdomen is nontender and soft. The pupils are dilated and the extraocular motions remain intact. The patient is sweating profusely. He seems hypervigilant, paces during the test, and speaks with a slight strain. Which of the following is the most likely diagnosis in this patient?

A) Bipolar disorder, manic episode
B) Brief psychotic disorder
C) Delusional disorder
D) Schizophreniform disorder
E) Substance-induced psychotic disorder

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