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Clinical Crossroads | Clinician's Corner

A 23-Year-Old Man With Schizophrenia

Donald C. Goff, MD, Discussant
JAMA. 2002;287(24):3249-3257. doi:10.1001/jama.287.24.3249.
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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 insurance.

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.

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