Review Question - QID 213364

A 34-year-old man was brought into the emergency room after he was found running in the streets. Upon arrival to the emergency room, he keeps screaming, “they are eating me alive," and swatting his hands. He reports that there are spiders crawling all over him. His girlfriend, who arrives shortly after, claims that he has been forgetful and would forget his keys from time to time. He denies weight loss, fever, shortness of breath, abdominal pain, or urinary changes but endorses chest pain. His temperature is 98.9°F (37.2°C), blood pressure is 160/110 mmHg, pulse is 112/min, respirations are 15/min, and oxygen saturation is 98%. He becomes increasingly agitated as he believes the healthcare providers are trying to sacrifice him to the “spider gods.” What is the most likely explanation for this patient’s symptoms?