A 17-Year-Old With Hallucinations About Martians and Paranoia

Raheel I. Shaikh; Neal T. Patel; Alexander Martinek; Imran Shaikh, MD

Disclosures

September 28, 2021

Physical Examination and Workup

The patient weighs 145 lb (65.8 kg), and his height is 5 ft 10 in (177.8 cm). His temperature is 97.8 °F (36.6 °C). His blood pressure is 146/94 mm Hg, and his pulse is 96 beats/min and regular. His respiration rate is 22 breaths/min, with rapid shallow breaths. His general presentation is acutely excitable and paranoid.

He is aloof and suspicious during the interview. His affect is flat while describing encounters with martians. He also states that he believes his sister is stealing from him. His speech is coherent, and he is oriented to time, place, and person. He denies thoughts or plans to hurt himself or others. His recall (immediate, recent, and past) is good.

The laboratory workup consists of several analyses to either confirm or rule out multiple causes of his psychosis. To detect metabolic and drug-induced psychosis, a urine drug test with specificity for marijuana, heroin, amphetamines, and cocaine is performed. The results are negative for the use of all these drugs.

A complete blood cell (CBC) count, measurement of vitamin B12 levels, and renal and liver function tests all show values within the normal ranges. A thyroid profile is ordered to detect hyperthyroidism-induced psychosis; the patient's thyroid-stimulating hormone (TSH) level is within the normal range, at 2.2 mIU/L (reference range, 0.358-3.74 mIU/L). His triiodothyronine (T3) and thyroxine (T4) levels are also normal. A copper panel is ordered to check for psychosis induced by Wilson disease; however, copper levels are in the normal range.

CT of the brain is conducted to rule out an intracranial mass or increased intracranial pressure due to trauma. No lesions or evidence of trauma is noted on the CT scan. The figure below shows similar CT findings in a different patient.

Figure 1.

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