A 21-year-old man is brought to the emergency department after he became belligerent at a party, and started screaming and throwing punches at other guests. In the emergency department, the patient is unable to provide any kind of history and is so agitated, paranoid, and hostile that he requires placement in four-point leather restraints. One of the patient’s friends claims that the patient is normally “a really nice guy” and that his current behavior is completely out of character. The mental status examination is limited because of the patient’s extreme hostility and lack of cooperation.
He struggles fiercely against the restraints, his speech is mildly slurred, and he appears to have vertical nystagmus. The patient refuses to answer questions about his mood, although he appears to be extremely angry. It is impossible to assess his thought process or thought content. What is the…
