DR REYNOLDS: Mr X is a 23-year-old man with
a 5-year history of schizophrenia. He lives near Boston and has state health
Mr X began to have social withdrawal and isolation around age 16, when
he dropped out of school sports, went from being an excellent student to barely
passing, and began spending much of his free time alone watching videos. He
was using alcohol, cannabis, and LSD (lysergic acid diethylamide). He had
progressively paranoid delusions: he believed that the Mafia was going to
make him a movie star, that bystanders stared at him because they knew he
was famous, and that the Mafia was broadcasting to him and controlling his
mind. He also believed that his family members were out to get him, that he
might not be related to them, and that others questioned his sexual orientation.
When one day, at age 18 years, he told his mother of his increasingly tortured
thoughts, she brought him to the emergency department, where he was admitted
to an inpatient psychiatric hospital.