Clinical vignette of an adult psychiatric patient

Tim is a $24$‍ year-old PhD candidate at a large university. Over the past six months, his behavior has changed and become increasingly bizarre. Though originally very enthusiastic about graduate school, he states that he is no longer interested in pursuing a degree and has no motivation to continue with school. He used to drink alcohol socially, but has withdrawn his friends and is not currently using any substances. He has no history of drug or alcohol abuse. He is unable to concentrate on work and tells friends and family that he believes someone has been following him when he leaves the house, and spying on him in his bedroom at night. Police bring him to a state psychiatric hospital after he throws his cell phone against a bus window and causes a public disturbance. Hospital staff members comment that they often hear him whispering frantically when he is alone, as though he is having a conversation with another person.

When asked about his behavior, Tim states the following:

“ I couldn’t. I couldn’t use my phone anymore – they’re listening... and I just couldn’t.”

“The agents are listening. They’re after me and I can’t get away.”

“I am wanted by the government. I’m sitting in an office building right now and I see tear gas coming up from the floor. Can you smell the poison they’re releasing into the air?”

“The president wants to kill me, the agents all tell me it’s useless to fight it... I can’t go on.”

“I was born to end the world and bring down the government in this dismal country.”

“I had to stop drinking because my cups are all poisoned by government agents.”

The psychiatrist diagnoses Tim with schizophrenia and prescribes an antipsychotic. After $5$‍ weeks on the medication, Tim shows minor improvements but the changes are not drastic. He continues to claim that he is a target of the government and is meant to bring down the country’s infrastructure. He occasionally claims to see agents hiding under the floorboards and above his head in ceiling tiles. In addition, he refuses to drink any beverages because he believes they have been poisoned. He is required to stay at the psychiatric hospital and receive treatment as an inpatient, because his psychiatrist believes he is a danger to himself and others.