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A 21-year-old student is brought to the emergency department at 3 am by his housemates. He has slept two hours in three days and has drunk eight cups of coffee. He is tearful and frightened. He reports hearing his own name spoken just as he drifts off to sleep, feeling as though he is watching his own body from the corner of the room, seeing shifting patterns in the ceiling lights, and being certain that his lecturer is putting whole sentences into his head. He is fully oriented and attends normally. Which one of the following features means he needs urgent psychiatric assessment rather than discharge with sleep advice?
Shared by Mornienmiddle twist

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