An 18-year-old high-school senior was brought to the emergency room by police after being picked up wandering in traffic on the Triborough Bridge. He was angry, agitated, and aggressive and talked of various people who were deliberately trying to "confuse" him by giving him misleading directions. His story was rambling and disjointed, but he admitted to the police officer that he had been using "speed." In the emergency room he had difficulty focusing his attention and had to ask that questions be repeated. He was disoriented as to time and place and was unable to repeat the names of three objects after 5 minutes. The family gave a history of the patient's regular use of "pep pills" over the past 2 years, during which time he was frequently "high" and did very poorly in school.