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A 23-year-old woman is brought to the ED by police officials who state that they found the patient in the middle of a busy intersection screaming.

A 23-year-old woman is brought to the ED by police officials who state that they found the patient in the middle of a busy intersection screaming. Upon arrival, you see a disheveled woman who is yelling, “You can’t get away with this! I’m the Queen of England!” She does not allow for the triage nurse to obtain her vitals, but you can see a young woman who is of normal habitus without any signs of trauma. Her speech is pressured, she is easily distracted by the commotion of the ED, and begins to answer your questions but then continues to describe grandiose ideas about her social status. Given this patient’s acute presentation, what is the most likely etiology of her symptoms?

a. Hypothyroid disorder

b. Manic episode

c. Benzodiazepine overdose

d. Anticonvulsant overdose

e. Barbiturate overdose

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