Case Lab · Type B · Boundary

F23

Acute, dramatic — and a substance history

Marcus, 24, was brought to an emergency department after friends reported he became suddenly paranoid, was seeing 'shadows moving' that were not there, and was speaking rapidly and incoherently over the past 18 hours. His friends confirm he took a large dose of a stimulant drug at a party the night before his symptoms began, and that he has used stimulants heavily on and off for the past year, with similar (though milder and shorter) reactions twice before, each time resolving within a day of the drug wearing off. He has no psychiatric history outside these episodes.