A 16-year-old boy is brought to the emergency department by the paramedics, accompanied by his parents who called 911. The parents report that their son has been acting strangely off and on for the past couple of weeks. They say that he has been going to parties with his friends and comes home late. He often gets up and is irritable and at times makes inappropriate comments. When asked what he meant by the comments, he would just move on to another topic. In the past week he has been locking himself in his room, playing loud music, and talking loudly, even though there is no phone in his room. This morning he started talking about the great silver cross that can be found buried on the cemetery in the east side of town. He claimed that he was hearing God's voice telling him to fly like a bird through the window and get it. The parents grabbed him as he was reaching for the window. The patient has no prior psychiatric history. Medical history is significant for an appendectomy at the age of 11. The parents say that he was always a good student, and basically a good, somewhat introverted, child. The parents are confident that he is not on any drugs or prescription medication. The family history is negative for psychiatric disorders. The patient looks tired, sleepy, and unkempt. His blood pressure and pulse are slightly elevated, but other than that, his physical examination is unremarkable. He is cooperative with the examination, and oriented appropriately, but seems to be responding to internal stimuli and unable to carry on a meaningful conversation. The most appropriate first step in this patient's management is to
A. order a head CT
B. place the patient in 4-point restraints
C. prescribe an antipsychotic agent
D. send urine for drug screen
E. set up a psychology consult to do a Rorschach test
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