MR, age 17, is a white Hispanic male, admitted to
the psychiatric unit accompanied by his parents. The
admitting nurse noted that his hair was unwashed and
he was malodorous. He was talking to himself, mumbling,
and yelling out at times. His parents brought
him to the hospital because MR told them, “The voices
are telling me to jump out the window.” The parents
reported that during the last few months, MR’s behavior
has changed from an outgoing adolescent to a
recluse. Until recently, he had always participated in
sports and clubs at school, when suddenly he quit
everything and even stopped attending school.
During the initial assessment, it was difficult to
obtain any information from MR.
He was hypervigilant to his surroundings and
either mumbled or yelled out. His parents were very
concerned about MR and gave information regarding
an unremarkable medical history. A physical examination,
with laboratory and diagnostic tests, was completed
with the parents’ consent and were all within
normal limits. A toxicology screen also returned negative
results. The primary complaint of MR was the
“voices” that were often present and threatening,