An individual is referred to your office by his parole officer.  This 19-year-old male, named Sam, was recently arrested for a “psychotic break” that caused him to throw a chair through the neighborhood drug store window.   Sam’s parents arrive and Sam agrees to have his parents present during the interview.

His parents state Sam recently withdrew from college after experiencing a “resounding moment” in which he changed his major from engineering to philosophy and increasingly had reduced his sleep, spending long hours engaging individuals in the commons in conversations about the nature of reality and how he is gaining an appreciation “for all life”. He had been convinced about the importance of his ideas, stating frequently that he was more learned and advanced than all his professors. He told many that “I should be the one teaching these courses, after all, I understand it much better than my professors”. Sam has also increased the number of high-risk behaviors – drinking and engaging in sexual relations in a way that was unlike his previous history.  He also has spent a considerable sum of money on “projects to help the world” – unfortunately, he has never completed a project.

Sam’s parents also state that Sam was diagnosed previously by his PCP with MDD and GAD.  “These new behaviors are just that – new – since he went to college”.

Further discussions with Sam and his parents reveal that he has never experienced hallucinations and you believe that he currently is not experiencing any delusions.  Sam states “I am what I am”.

1. What diagnosis do you believe may apply to this individual?
2. What classifications of medications can be used to treat this disorder?  Which medication do you recommend and why?