ABSTRACT
This chapter presents a case of a 24-year-old postgraduate student who has been admitted to the inpatient psychiatric unit for the past 4 days following a relapse of schizophrenia. Over the last 2 days he has been getting increasingly agitated and paranoid, accusing the nursing staff and other patients of poisoning him. He has refused food and drink and has attacked a member of staff. He was disorientated and had no insight. He has a number of clear paranoid delusions and is responding to auditory hallucinations but is unable to describe them. Central nervous system examination revealed extrapyramidal muscle rigidity assumed to be secondary to antipsychotic medication, with a generalized tremor that was attributed to agitation and anxiety. Diagnosis is facilitated by a high index of clinical suspicion. The presence of any other feature such as fever, confusion or autonomic dysfunction should lead to a detailed physical examination and investigations to rule out the above differentials.
