Review Question - QID 215019

A 21-year-old college student is brought to the emergency department by ambulance after he crashed his car into a tree. He explains that he was trying to escape from federal agents who were attempting to frame him for murder. The patient was at a house party when the police showed up due to a noise complaint. Empty bottles of fluoxetine and clonazepam were found on the passenger seat along with multiple empty bags of potato chips. Despite having several facial lacerations, the patient states, “I feel great!” He denies hallucinations or suicidal ideation. His past medical history includes depression and anxiety. The patient’s temperature is 98.2°F (36.8°C), blood pressure is 132/88 mmHg, pulse is 80/min, and respirations are 16/min. Physical exam reveals a pleasant, non-agitated young man. A neurologic exam shows normal muscle tone without involuntary muscle movements. The patient’s oral mucosa appears dry, and his eyes are shown in Figure A. What is the most likely diagnosis?