A 36-Year-Old Man with Agitated Behavior, Psychosis

The patient was a single, 36year-old white man. He was admitted to our institution due to agitated behavior and psychosis, with a diagnosis of bipolar I disorder from his most recent episode, which was mixed and severe with moodincongruent psychotic features. He presented with depressed mood of 3 weeks’ duration, associated with early and intermittent insomnia, decreased energy, racing thoughts, and psychomotor agitation. Furthermore, he exhibited persecutory delusions, believing that people were “out to get him,” and was thus physically aggressive to those he encountered. He denied any suicidal or homicidal ideations, and substance abuse screens returned with negative results. The patient was diagnosed with myasthenia gravis at 19 years, but because he was “living on the streets,” he failed to receive adequate treat-