A 34 year old woman is brought in by her family, after she became violent at home, and attempted to assault her mother. She “feels down,” is fatigued all the time, and has difficulty sleeping. She also claims that she won the first place in an international art competition, outperforming Pablo Picasso; and that she is an adoptee, with her real parents being the Queen of England and King Louis XVI of France. She denies suicidal ideation, or experiencing guilt, reduced self esteem, reduced interest in her usual activities, or reduced concentration. She had an episode of similar behavior around one year ago, which lasted for three weeks, and resolved spontaneously. During this episode, she attempted suicide via a self inflicted injury to the forearm. She has been observed talking to imaginary people on multiple occasions during the last 9 months. Her birth history is unremarkable, and all developmental milestones were age appropriate. Her surgical, drug and family histories are unremarkable. She does not smoke and only drinks socially. She denies recreational drug abuse; this is corroborated by her family.