| Sumario: | A middle-aged man has rapid, pressured speech and labile shifting affects compatible with bipolar disorder. His speech is sometimes tangential, not making sense. During a substance use assessment, he reports he drinks alcohol every day but only on weekends, in a way that makes it unclear if he is a good historian. He endorses that his judgment is not good when he drinks. He reports both blacking out and passing out. He reports he hears symphonies when he recovers. He denies driving when he drinks and denies medical problems due to drinking alcohol. He reports using cannabis and seeing pictures, but denies they are hallucinations. He reports cannabis makes his racing thoughts even faster, but then slows his thoughts for the following day. He denies opiate, IV drug, or stimulants use. He reports having been in rehabilitation for alcohol use. He reports good health, eating well, but strangely claims this is due to his drinking alcohol.
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