Confusion and Representative Restraint: An Exercise in Clinical Reasoning

An 85-year-old man was brought to the emergency department by his daughter for evaluation of confusion. His daughter noted that for 3 months he seemed slightly paranoid whenever she called him, and in the last week began to voice persecutory thoughts, e.g., "I'm all packed up; they're coming to get me." On the day of presentation, she was unable to reach the patient by phone and so went to his house. Her father was sitting in his living room surrounded by overturned furniture and stated, "I don't know where I am."