A 24-year-old man presented to casualty having got into a fight as he thought he was being watched and felt threatened. His thumb was fractured but the patient was reluctant to let the doctor examine him or order an X-ray. He was very suspicious and wary. When asked about what had happened he said that over the last few months he has been hearing different voices calling him and planning things. The voices are not one that he recognizes.
Initially, the voice came and went but over the last few weeks it happened almost constantly, and he was not able to sleep because even when he sleeps the voice comments on what he is thinking. He was exhausted. Family history is not significant of any psychiatric illness. Mental state examination He was well orientated with the person but was unclear about the time. He seemed to be aware that he is in hospital but was not able to understand the reason…
