A 19-year-old man is brought to the emergency department with disorganized behavior for two days. He has had multiple episodes of agitation during the last six months. He was previously employed at a retail store where his behavior became progressively bizarre. He told customers that his employer had planted numerous miniature video cameras to detect his mistakes and that the CIA was “out to get him.” He resigned from his job a few days ago after accusing his employer of monitoring him via the television screens in the shop and surreptitiously observing him at home. He has been hearing voices who claim that he is “a bad person.” His medical history is unremarkable. There is no family history of psychiatric disorders. His growth and development has been normal. He consumes alcohol only in moderation and denies recreational drug abuse.