A 27-year-old male graduate student in molecular biology was brought to the emergency room by his fiancee, who explained that over the preceding 2 weeks he had become increasingly irritable and suspicious and had undergone a “personality change.” She noted that he had not slept at all for the past 3 nights and had become preoccupied by the belief that his research thesis would be regarded as the “new bible of the computer age.” Fearing that his ideas might be stolen by government agents, he had constructed an elaborate mathematical code that would allow only him and his appointed “prophets” to understand the documented work.
The patient was dressed in a mismatched three-piece suit he claimed was a disguise that would enable him to elude agents assigned to follow him. Although during the initial stages of the interview the patient refused to speak, he suddenly observed that since the interviewing physician was on the faculty of the university, he might be better able to understand the meaning of his research than the resident physician who screened him at the admission desk. He also remarked that the interviewing physician’s name contained a syllable similar in sound and spelling to the Latin word for “trust” and suggested that their meeting must have been preordained. Throughout the remainder of the interview, the patient paced around the room, interrupting his responses to questions with associations to the interviewer’s style of dress, a paperweight on the desk, and a book whose title he misread.
The history obtained from the fiancee revealed that the patient had never had any symptoms similar to these, but that for about 3 months during the past 12-month period he had felt too tired to go to class and had spent much of the day sleeping. She recalled that the patient had an aunt who was hospitalized twice following the birth of her two children and that an older brother had been married four times and was “quite moody.”
After some urging by his fiancee, the patient agreed to enter the hospital and began taking medication, which he called “thought pills.” Neuroleptic medication resulted in marked amelioration of symptoms within 5 days. After 2 weeks of treatment with lithium, his suspiciousness and grandiose beliefs diminished significantly. With partial recovery, the patient was mildly depressed and embarrassed about his recent behavior, but still seemed excessively concerned about the possible need to protect his research from industrial spies in the future.