1
|
Tyson JW, House EM, Donovan AL. Assessing Youth with Psychotic Experiences: A Phenomenological Approach. Child Adolesc Psychiatr Clin N Am 2020; 29:1-13. [PMID: 31708039 DOI: 10.1016/j.chc.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Psychotic experiences may be part of normal development or indicate a wide range of mental disorders. This article shows how a systematic, domain-based, phenomenological approach to assessing psychotic symptoms in youth facilitates the gathering of the nuanced clinical information necessary to understand a child's specific experience. Mapping this information onto a narrative timeline, while understanding the evolution and developmental context of psychotic experiences, is essential in making an accurate diagnostic formulation and appropriate treatment plan for youth presenting with psychotic experiences.
Collapse
Affiliation(s)
- John W Tyson
- First Episode and Early Psychosis Program, Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA 02114, USA.
| | - Ellen M House
- Augusta University/University of Georgia Medical Partnership, Health Science Campus, Russell Hall, 1425 Prince Avenue, Athens, GA 30602, USA
| | - Abigail L Donovan
- First Episode and Early Psychosis Program, Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA 02114, USA
| |
Collapse
|
2
|
Maijer K, Palmen SJMC, Sommer IEC. Children seeking help for auditory verbal hallucinations; who are they? Schizophr Res 2017; 183:31-35. [PMID: 28277308 DOI: 10.1016/j.schres.2016.10.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Auditory Verbal Hallucinations (AVH) in children and adolescents are a relatively common and mostly transient feature in community samples. However, it should not be regarded as a merely benign phenomenon, as childhood AVH are associated with psychopathology. Little is known about the clinical group of children seeking help for AVH. This brings uncertainty on how to assess and treat these children. METHODS This study describes the characteristics of 95 help-seeking children (aged 6 to 18years) with AVH attending an outpatient clinic specifically dedicated to help youth with this complaint. We aim to provide pointers regarding diagnostic assessment and interventions. RESULTS Children seeking help for AVH suffered from a diversity of co morbid psychiatric diagnoses and consistently experienced high stress from AVH. When the DSM-IV-TR criteria for psychotic disorder NOS were used, all 95 children obtained this diagnosis. However, when a psychotic disorder was defined using the A-criterion of schizophrenia, only a minority of 11 cases (11.6%) was diagnosed as having a psychotic disorder. All children were in need of psycho-education and coping strategies and only the minority (11.6%) fulfilling criteria for a more narrowly defined psychotic disorder was prescribed antipsychotic medication. CONCLUSIONS Children seeking help for AVH form a heterogeneous group with high stress and reduced functioning. Even though only a minority (11.6%) suffers from a psychotic disorder, all children warrant clinical care due to their burden and multi morbid psychopathology.
Collapse
Affiliation(s)
- Kim Maijer
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Heidelberglaan 100, 3485CX Utrecht, The Netherlands.
| | - Saskia J M C Palmen
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Heidelberglaan 100, 3485CX Utrecht, The Netherlands
| | - Iris E C Sommer
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Heidelberglaan 100, 3485CX Utrecht, The Netherlands
| |
Collapse
|
3
|
Vareilles D, Bréhin C, Cortey C, Chevrin AL, Hamon T, Vignes M, Chaix Y, Claudet I. [Hallucinations: Etiological analysis of children admitted to a pediatric emergency department]. Arch Pediatr 2017; 24:445-452. [PMID: 28242149 DOI: 10.1016/j.arcped.2017.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/17/2016] [Accepted: 01/15/2017] [Indexed: 11/24/2022]
Abstract
Children's hallucinations pose the dual challenge of diagnosing a possible medical emergency and a possible psychiatric disorder. PURPOSE The main objective was to analyze the causes of such hallucinations in children presenting to a pediatric emergency department. MATERIAL AND METHODS We conducted a single-center, observational, retrospective study including all children aged less than 15 years experiencing hallucinations and admitted to our tertiary level pediatric emergency department between 1 January 2007 and 31 December 2015. The data collected were demographic; medical: previous medical or psychiatric history, current medications, associated clinical or psychiatric symptoms, type and character of hallucinations, length and recurrence of hallucinatory phenomena; and other biological, radiological and neurological explorations. RESULTS Sixty-eight patients were included (29 boys). The mean age was 9.1±3 years (range, 2-14 years and 10 months; median, 9.2 years). Admissions were seasonal with a bimodal distribution (a peak during springtime and another one during fall). Hallucinations were mainly visual (90%), acute (77%) and complex (63%). Visual hallucinations were associated with other types of hallucinations: auditory (n=17), somatosensory (n=7). Fifteen children had a psychiatric history and had already experienced hallucinatory phenomena (93%). Among 47 patients (69%), these hallucinations were associated with other symptoms: agitation (41%), headaches (28%), hyperthermia (21%) and negative symptoms of the schizophrenia spectrum (15%). On admission, 20 patients (29%) had one or more treatments under way (34 drugs, 41% known for hallucinogenic adverse effects). Neurological explorations were undertaken in half of the cases. Toxicological analysis prescribed in 19 children was positive in five cases (26%). Fifty-three percent of patients were hospitalized and 51 children received a specialized follow-up (by a neurologist and/or a psychiatrist). A nonpsychiatric origin of these hallucinations was diagnosed in 29 patients (43%): neurological causes (n=10), infectious diseases (n=10), intoxications (n=5) and a medication side effect (n=4). CONCLUSION Hallucinations with a suspected underlying psychiatric cause differed on several factors: chronic duration (p=0.02), an onset after 10 years of age (p=0.004), previous identical episodes (p=0.014) and a parental psychiatric history (p=0.036), auditory hallucinations (p=0.0009), absence of fever (p=0.005), headaches (p=0.036) and the presence of negative symptoms of the schizophrenic spectrum (p=0.02).
Collapse
Affiliation(s)
- D Vareilles
- Urgences pédiatriques, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - C Bréhin
- Urgences pédiatriques, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - C Cortey
- Urgences pédiatriques, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - A-L Chevrin
- Urgences pédiatriques, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - T Hamon
- Urgences pédiatriques, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - M Vignes
- Équipe mobile de pédopsychiatrie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - Y Chaix
- Neurologie pédiatrique, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France; Inserm UMR 1214, Toulouse NeuroImaging Center (ToNIc), hôpital Purpan, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - I Claudet
- Urgences pédiatriques, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France; Inserm UMR 1027, université Paul Sabatier Toulouse III, 37, allée Jules-Guesde, 31000 Toulouse, France.
| |
Collapse
|
4
|
|
5
|
Jardri R, Bartels-Velthuis AA, Debbané M, Jenner JA, Kelleher I, Dauvilliers Y, Plazzi G, Demeulemeester M, David CN, Rapoport J, Dobbelaere D, Escher S, Fernyhough C. From phenomenology to neurophysiological understanding of hallucinations in children and adolescents. Schizophr Bull 2014; 40 Suppl 4:S221-32. [PMID: 24936083 PMCID: PMC4141307 DOI: 10.1093/schbul/sbu029] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 01/05/2023]
Abstract
Typically reported as vivid, multisensory experiences which may spontaneously resolve, hallucinations are present at high rates during childhood. The risk of associated psychopathology is a major cause of concern. On the one hand, the risk of developing further delusional ideation has been shown to be reduced by better theory of mind skills. On the other hand, ideas of reference, passivity phenomena, and misidentification syndrome have been shown to increase the risk of self-injury or heteroaggressive behaviors. Cognitive psychology and brain-imaging studies have advanced our knowledge of the mechanisms underlying these early-onset hallucinations. Notably, specific functional impairments have been associated with certain phenomenological characteristics of hallucinations in youths, including intrusiveness and the sense of reality. In this review, we provide an update of associated epidemiological and phenomenological factors (including sociocultural context, social adversity, and genetics, considered in relation to the psychosis continuum hypothesis), cognitive models, and neurophysiological findings concerning hallucinations in children and adolescents. Key issues that have interfered with progress are considered and recommendations for future studies are provided.
Collapse
Affiliation(s)
- Renaud Jardri
- Child & Adolescent Psychiatry Department,University Medical Centre Lille, Lille, France; Lille Nord de France University, UDSL, Functional Neurosciences & Disorders Lab, Lille, France;
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Martin Debbané
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jack A Jenner
- Jenner Consult Haren & Audito, Practice for Child & Adolescent Voice Hearers, Ten Boer, The Netherlands
| | - Ian Kelleher
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Yves Dauvilliers
- Sleep unit, Department of Neurology, Hôpital Gui-de-Chauliac, CHU Montpellier & National Reference Network for Narcolepsy, INSERM U1061, Montpellier, France
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Institute of Neurological Sciences, Bologna, Italy
| | - Morgane Demeulemeester
- Lille Nord de France University, UDSL, Functional Neurosciences & Disorders Lab, Lille, France; Lautréamont Clinic, ORPEACLINEA Group, Loos, France
| | - Christopher N David
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD
| | - Dries Dobbelaere
- National Reference Center for Inherited Metabolic Diseases in Child and Adulthood, University Children's Hospital Jeanne de Flandre, Lille, France
| | | | | |
Collapse
|
6
|
Abstract
OBJECTIVES Over the years, increasing numbers of children and adolescents have sought help for acute psychiatric problems. The responses to this treatment-seeking behavior are heterogeneous in different settings and nations. This review aimed to provide an answer to the questions "which care should be offered to children and adolescents presenting with a psychiatric emergency or crisis and how should it be organized." METHODS We committed a literature review to find out if any recommendations can be made regarding the organization of emergency care for children and adolescents with acute mental health problems. RESULTS The lack of a clear definition of emergencies or urgencies hampered this review; we note the differences between adult and child or adolescent psychiatry. The theoretical models of care found in the literature are built up from several process and structural components, which we describe in greater detail. Furthermore, we review the main service delivery models that exist for children and adolescents. CONCLUSIONS Currently, emergency psychiatric care for children and adolescents is practiced within a wide range of care models. There is no consensus on recommended care or recommended setting for this population. More research is needed to make exact recommendations on the standardization of psychiatric care for young people in emergency settings.
Collapse
|
7
|
Abstract
Psychotic-like experiences (PLEs) have been observed worldwide in both adults and children outside the context of a clinical disorder. In the current study, we investigate the prevalence and patterns of PLEs among children and adolescents in Kenya. Among 1,971 students from primary and secondary schools around Nairobi (aged 8-19), 22.1 % reported a lifetime history of a psychotic experience, and 16.3 % reported this unrelated to sleep or drugs. Psychotic experiences were more common in males compared to females. LCA resulted in a three-class model comprised of a normative class (83.3 %), a predominately hallucinatory class (Type 1 psychosis: 9.6 %), and a pan-psychotic class (Type 2 psychosis: 7.2 %). These results indicate that PLEs are prevalent in children and adolescents, and the distributions of symptom clusters are similar to that found in adulthood. The relationship of specific PLEs to the future development of psychotic disorder, functional impairment or distress will require further study.
Collapse
|
8
|
Mertin P, O'Brien N. High emotional arousal and failures in reality monitoring: pathways to auditory hallucinations in non-psychotic children? Scand J Psychol 2012; 54:102-6. [PMID: 23252476 DOI: 10.1111/sjop.12019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent research has confirmed the presence of auditory hallucinations in non-psychotic children, with this research also suggesting that such hallucinations may be more common than previously thought. While auditory hallucinations in children have frequently been associated with high levels of emotional stress, there is still a poor understanding of how this stress may precipitate hallucinations, and why some children experience hallucinations while others seem not to. The current study assessed the association between high levels of trauma symptomatology, anxiety and depression, and the presence of hallucinations against matched controls. Results indicated that hallucinating children had significantly higher mean anxiety, depression and, in particular, re-experiencing scores than did the children in the control group. These results were examined within the framework of reality monitoring, that is, the ability to distinguish between externally or internally generated sources of information. The notion of high levels of emotional distress decreasing the efficiency of reality monitoring and leading to the possibility of confusion between internally and externally generated stimuli was discussed, with the conclusion advanced that the misattribution of an externally generated source--either held as a memory or as a traumatic re-experiencing--as an internally generated one, underlies hallucinatory experiences.
Collapse
Affiliation(s)
- Peter Mertin
- Legal Services Commission, Family Division, Adelaide, Australia.
| | | |
Collapse
|
9
|
Askenazy FL, Lestideau K, Meynadier A, Dor E, Myquel M, Lecrubier Y. Auditory hallucinations in pre-pubertal children. A one-year follow-up, preliminary findings. Eur Child Adolesc Psychiatry 2007; 16:411-5. [PMID: 17468968 DOI: 10.1007/s00787-006-0577-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aims of this study were to describe the phenomenology of auditory hallucinations in children, to establish links with DSM IV diagnoses and to explore development of the hallucinations over a 12-month period. METHODS Outpatients aged 5- to 12-year-old were consecutively recruited. They were interviewed using a questionnaire investigating auditory hallucinations. DSM IV diagnoses were determined. Follow-up assessments were performed at 3, 6, 9 and 12 months. RESULTS Ninety children were recruited. Sixteen reported auditory hallucinations. In 53% we observed children's full recovery from hallucinations within 3 months and all of these suffered from anxiety disorders. In 30% hallucinations persisted over 12 months and all showed conduct disorders at this point in time. None was diagnosed as having schizophrenia. CONCLUSIONS Our study provides further evidence of the high prevalence of auditory hallucinations in pre-pubertal children presenting to psychiatric clinics. Two different patterns of development were seen. In one group the hallucinations seem unrelated to psychosis although they may be a manifestation of anxiety. In the second, much smaller, persistence of hallucinations appeared linked to conduct disorders.
Collapse
Affiliation(s)
- Florence L Askenazy
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent Fondation LENVAL, 57 avenue de la Californie, 06200 Nice, France.
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
Clinicians need to consider a wide range of differential diagnoses when children and adolescents present with hallucinations. This includes considering whether it is a developmentally normal phenomenon or if there is a psychiatric, medical, or neurologic diagnosis. Nonpsychotic children with hallucinations can be differentiated from psychotic children. Nonpsychotic children who are at risk (or prodromal) for future psychosis can be differentiated from nonprodromal healthier children. We examine the epidemiology, prognosis, and neurobiological research. Lastly, we discuss treatment approaches, including medication and cognitive behavioral therapy.
Collapse
Affiliation(s)
- Morton D Sosland
- Thomas Jefferson University, 833 Chestnut Street, Suite 210-D, Philadelphia, PA 19107, USA
| | | |
Collapse
|