Mr. Jock

Mr. Jock is a 24 year old Caucasian man who was brought to the ER mute and rigid.  Friends who brought him reported that he was playing basketball when he suddenly put his head down on the floor, made sounds as if he were praying and became “frozen.”  When interviewed an hour later he said “I am communicating directly with God.”

Mr. Jock’s friends said that he had been getting “hyper” lately, but stated he did not use drugs or alcohol.  They reported that he had been doing well up to one week before admission, working and going to school.  One week before admission he began saying “odd” things usually religious in nature, stopped sleeping and became sexually demanding on his girlfriend.  He began working out more at the gym to “burn off extra energy.”  His friends remembered that he had similar symptoms a year before, was hospitalized, but left AMA and later became increasingly depressed for 3 months.  He withdrew from socializing and slept all the time.  He spontaneously returned to his normal self and reinvested himself in his daily activities.

Lab and medical tests were all negative and his physical status was fine.  During his hospital stay Mr. Jock alternated between “rigid posturing” and “mild hyperactivity.”  He would become “unstuck” and begin pacing around the unit talking about his newfound faith in religion to anyone who would listen.

Questions:

1.  What is his diagnosis?
2. What are the symptoms that helped you make this diagnosis?  What diagnostic criteria do they relate to?
3. What are two other possible diagnoses and why did you not choose them?
4. What kind of treatment approaches would be effective in this case?
5. What is his prognosis?