Hugh is a 44-year-old unemployed man with a childhood history of absence (petit mal) seizures.

He presents with a few months of bizarre olfactory, visual and auditory hallucinations.

He reports a heightened sense of smell, smelling carbon monoxide when he sits in public buses, being blinded by plastic sheeting in roofing, and having visits from green spirits that he feels could be aliens.

On examination, he has formal thought disorder and is very tangential.