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Rock Street, San Francisco

Myles was a 20 year-old man who was brought to the emergency room by the campus police of the college from which he had been suspended several months ago. A professor had called and reported that Myles had walked into his classroom, accused him of taking his tuition money and refused to leave.

Although Myles had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. His sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from his room and ask his family to be quiet even when they were not making any noise.

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Myles began talking about organized crime so often that his father and sister brought him to the emergency room. On exam there, Myles was found to be a poorly groomed young man who seemed inattentive and preoccupied. His family said that they had never known him to use drugs or alcohol, and his drug screening results were negative. He did not want to eat the meal offered by the hospital staff and voiced concern that they might be trying to hide drugs in his food.

His father and sister told the staff that Myles’ great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Myles’ mother left the family when Myles was very young. She has been out of touch with them, and they thought she might have been treated for mental health problems.

Myles agreed to sign himself into the psychiatric unit for treatment. His story reflects a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible. In the case of Myles, he was having persecurtory delusions, auditory hallucinations and negative symptoms that had lasted for at least one year. All of these symptoms fit with a diagnosis of schizophrenia. It is key for the treating doctor to quickly rule out other causes of the problem, such as substance use, a head injury or a medical illness. Treatment for these conditions differs from that for schizophrenia and may be lifesaving.

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