A psychotic experience during adolescence
reasoning about differential diagnosis. Case report
Keywords:
Psychotic disorders, Conversion disorder, Schizophrenia, Hallucination, Child psychiatry, Adolescent psychiatryAbstract
CONTEXT: The aim of the present clinical review was to illustrate the diagnostic difficulty associated with psychotic experiences during adolescence, in the light of the multiplicity of circumstances interplaying during this period. It was also intended to illustrate the observation that not all hallucinations occur in the context of a declared psychotic disorder. CASE REPORT: The patient was a 16-year-old adolescent girl who came to the Emergency Department of Coimbra Pediatric Hospital. On admission, she displayed mood and sensory perception disorders, with a bizarre gait abnormality. A diagnosis of conversion disorder was finally suggested, in accordance with the International Classification of Diseases, 10th edition. CONCLUSIONS: Conversive hallucinations are rare in the psychiatric literature. This diagnostic hypothesis only gained consistency over a long period of follow-up within a child and adolescent psychiatry outpa- tient service, which was fundamental for appropriate diagnostic clarification. The authors discuss psychotic experiences that can arise from a neurotic setting and share the reasoning that was constructed in relation to the differential diagnosis. The psychogenesis and phenomenology of this young patient’s conversive hallucinations and the therapeutic strategies adopted over the course of the follow-up are also discussed.
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References
Monteiro P. Psicologia e psiquiatria da infância e da adolescência. Lisboa: Lidel; 2014.
Stevens JR, Prince JB, Prager LM, Stern TA. Psychotic disorders in children and adolescents: a primer on contemporary evaluation and management. Prim Care Companion CNS Disord. 2014;16(2).pii: PCC.13f01514.
Sidhu KAS, Dickey TO. Hallucinations in children: diagnostic and treatment strategies. Current Psychiatry. 2010;9(10):53-61. Available from: http://www.mdedge.com/currentpsychiatry/article/64056/schizophrenia-other-psychotic-disorders/hallucinations-children. Accessed in 2017 (May 10).
Joshi PT, Towbin KE. Psychosis in childhood ans its management. In: Davis KL, Charneu D, Coyle JT, Nemeroff C, editors. Neuropsychopharmacology – 5th generation of progress. Philadelphia: Lippincott, Williams & Wilkins; 2002. p. 613-24. [chapter 45]. Available from: https://www.acnp.org/asset.axd?id=e0a9ab37-d17d-4e40-bfa2-b776a214daae. Accessed in 2017 (May 10).
van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L. A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med. 2009;39(2):179-95.
Klosterkötter J, Schultze-Lutter F, Ruhrmann S. Kraepelin and psychotic prodromal conditions. Eur Arch Psychiatry Clin Neurosci. 2008;258 Suppl 2:74-84.
Häfner H, an der Heiden W. The course of schizophrenia in the light of modern follow-up studies: the ABC and WHO studies. Eur Arch Psychiatry Clin Neurosci. 1999;249 Suppl 4:14-26.
International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry Suppl. 2005;48:s120-4.
Hanssen M, Bak M, Bijl R, Vollebergh W, van Os J. The incidence and outcome of subclinical psychotic experiences in the general population. Br J Clin Psychol. 2005;44(Pt 2):181-91.
The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research. Geneva: World Health Organization; 1993. Available from: http://www.who.int/classifications/icd/en/GRNBOOK.pdf. Accessed in 2017 (May 10).
Kozlowska K. The developmental origins of conversion disorders. Clin Child Psychol Psychiatry. 2007;12(4):487-510.
Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol. 1988;50:431-55.
Grattan-Smith P, Fairley M, Procopis P. Clinical features of conversion disorder. Arch Dis Child. 1988;63(4):408-14.
Quane T, Chambers CV, Snyderman D. Conversion disorder presenting as gait disturbance in an adolescent. Arch Fam Med. 1995;4(9):805-7.
Balkuv E, Basaran R, Caliskan M. Gait disturbance as conversion reaction accompanying anorexia nervosa in a young adult: a case report and literature review. Journal of Scientific Research & Reports. 2014;3(4):583-91. Article no. JSRR.2014.005. Available from: http://www.journalrepository.org/media/journals/JSRR_22/2013/Dec/Balkuv342013JSRR6783_1.pdf. Accessed in 2017 (May 10).
Levinson H. Auditory hallucinations in a case of hysteria. Br J Psychiatry. 1966;112(482):19-26.
Farley J, Woodruff RA Jr, Guze SB. The prevalence of hysteria and conversion symptoms. Br J Psychiatry. 1968;114(514):1121-5.
Goodwin DW, Alderson P, Rosenthal R. Clinical significance of hallucinations in psychiatric disorders. A study of 116 hallucinatory patients. Arch Gen Psychiatry. 1971;24(1):76-80.
Modai I, Sirota P, Cygielman G, Wijsenbeek H. Conversive hallucinations. J Nerv Ment Dis. 1980;168(9):564-5.
Andrade C, Srinath S. True auditory hallucinations as a conversion symptom. Br J Psychiatry. 1986;148:100-2.
Sirota P, Spivac B, Meshulam B. Conversive hallucinations. Br J Psychiatry. 1987;151:844-6.
Kasckow J, Maltbie A. Conversion hallucinations in a patient with pseudohypoparathyroidism. Jefferson Journal of Psychiatry. 1989;7(2). Article 6. Available from: http://jdc.jefferson.edu/jeffjpsychiatry/vol7/iss2/6/. Accessed in 2017 (May 10).
Zain AM. True hallucination as conversion symptom--a case report. Med J Malaysia. 1990;45(l):74-7.
Spivak B, Livnat E, Weizman A, Rabinowitz S, Mark M. True conversive hallucinations. Psychopathology. 1991;24(1):19-24.
Rack P. Race, Culture and Mental Disorder. London and New York: Tavistock Publications; 1982.
