Review Question - QID 212501

A 24-year-old man is brought to the emergency department for bowling at a local bowling alley while inappropriately dressed. The patient refused to speak with police and was seen conversing with inanimate objects in the back of the police car. The patient states that his clothes were contaminated by assassins who have been tracking him for years. The patient refuses to answer any further questions, and continues to whisper toward someone else. The patient has a past medical history of homelessness, alcohol abuse, marijuana use, and cocaine abuse. Physical exam is notable for a healthy young man who seems mistrustful of all hospital personnel. The patient is started on a medication and is transferred to the psychiatric inpatient unit. The patient’s condition improves, but he still often speaks of a contamination that is on his clothes and skin that is coming from external parties. The patient is started on a new medication. He is then sent to group therapy, followed by physical activity in the yard. The physician is called over when the patient is found down in the recreation yard while he was exercising. The patient is not responsive, and his limbs seem to resist passive force. His temperature is 104°F (40°C), pulse is 112/min, blood pressure is 140/90 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. Which of the following best describes the most likely diagnosis?