Clinique des hallucinations acoustico-verbales chez les enfants et les adolescents dans les suites d’un trouble de stress post-traumatique : illustration en cas cliniques

Abstract

Auditory-verbal hallucination (AVH) has a prevalence rate of 12 % in children and adolescents. It is considered to be a transient and benign developmental phenomenon. Its persistence into adolescence may be associated with more severe psychiatric diagnoses. Post-traumatic stress disorder (PTSD) is defined by repetitive intrusive traumatic memories associated with symptoms of sensory reliving (flashbacks). Although hallucination is not described as a symptom of PTSD, the literature reports a greater risk of developing AVH in individuals with PTSD. The clinical aspect of hallucinations associated with PTSD is a topic of study. We propose to study the mechanisms involved in the development and evolution of AVH in the context of PTSD in a pediatric population. Four clinical cases are presented to illustrate this topic from children and adolescents with a diagnosis of PTSP (DSM 5) associated with AVH without associated schizophrenia spectrum disorder (DSM 5). The AVH presented by our patients can be associated with traumatic reliving but also with other types of more elaborate hallucinations. They represent several malevolent voices with negative content. Thematic and emotional links can be established between these hallucinations and the traumas in question. They allow us to understand the hallucination as an indirect “re-experience” of the trauma. We propose a model of a continuum of symptoms between sensory re-experiencing and hallucination whose future risk is the progressive constitution towards a psychotic disorder. The identification of the hallucination in the pediatric population is a major challenge for the clinician. Hallucination is an experience wrongly considered as belonging to the schizophrenia spectrum disorder and is not sufficient to retain this diagnosis.