A young man was admitted from prison to a psychiatric facility after reports that he had been acting in a bizarre manner. He had been arrested for stealing motor vehicles and assaults with weapons. At interview he was found to be experiencing the delusion that he was a player inside a computer game (adult-certificate game, widely available) in which points are scored for stealing cars, killing assailants and avoiding police vehicles. Psychotic symptoms had emerged slowly over two years. His family had noticed him becoming increasingly withdrawn and isolated from social activities. He developed delusions that strangers were planning to kill him and also experienced auditory hallucinations, constantly hearing an abusive and derogatory voice. Previously a computer enthusiast, he began to play computer games incessantly. He felt that the games were communicating with him via the headphones. In a complex delusional system he came to believe he was inside one of these games and had to steal a car to start scoring points. He broke into a car and drove off at speed, believing he had `invulnerable' fuel and so could not run out of petrol. To gain points he chose to steal increasingly powerful vehicles, threatening and assaulting the owners with weapons. Later he said he would have had no regrets if he had killed someone, since this would have increased his score.

Schizophrenia is characterized by abnormalities of thinking, perception and emotion.⁴ Paranoid schizophrenia is the commonest subtype and initial symptoms typically include bizarre delusions, auditory hallucinations and interference with thinking. In the chronic form, blunting of emotion, social withdrawal and avolition can become more obvious. Age at onset is usually the late twenties or early thirties with equal distributions between the sexes. Current cultural beliefs have been consistently found to determine the content of delusions in schizophrenia⁵. Often the background is religious (`I am God') but a common secular delusion is that of being pursued by secret agents.