Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
Background
A 65-year-old man is brought to the emergency department by military police. The patient, who had been armed with a shotgun, refused to allow his spouse to leave their domicile. During the event, the patient's relatives contacted the authorities. The patient insisted to his relatives that cell phone towers were beaming in rays that were worsening his wife's dementia and rheumatoid arthritis. To counter this, the patient placed tin foil on the walls of his house. The patient would not let his spouse leave because he was concerned that government agents were attempting to attack her. The patient stated that he had been "reactivated" to his military duties. After a brief standoff with local police, the patient agreed to cooperate if the military police were contacted. Once the military police arrived, they were able to convince the patient to come out of his home unarmed and brought him to the hospital for treatment.
Upon his initial presentation, the patient refused to answer questions. He only provided his name, his military serial number, and his rank. He responded exclusively with this information to all questions posed to him.
During a follow-up interview the next day, the patient again reported that he had been "reactivated" and had "found some classified files." The patient stated that he had to report this information and had called the commanding general of the US Army. He stated that his orders were to stay in place and secure the area. He acknowledged having a 16-gauge shotgun during the prior day's events.
Information was then obtained by telephone from the patient's son. The son reported that, several years prior, his father had taken his mother to a nearby city for safety because he thought "drones were flying above him" and that he and his wife were not safe. The patient had rented an apartment and placed his spouse inside a closet for safety. The son reported that the patient had been completely irrational at the time. When the son attempted to speak to his father, his father felt that the conversation was being tracked by phone and ended the call. After that incident, the patient's wife and son came up with a "code word" that she could use on the phone with her son should the patient become irrational again. On the day of the patient's admission, the patient's spouse called her son and used that code word.
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Cite this: Jeffrey S. Forrest, Alexander B. Shortridge. A 65-Year-Old Man Brought to the ED by Military Police - Medscape - Aug 06, 2019.
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