Sudden Complex Hallucinations in a 14-Year-Old Girl: Schizophrenia Spectrum Disorders Versus Dissociative Disorders-The Influence of Early Life Experiences on Future Mental Health : "[RETRACTED]".

Abstract

A 14-year-old girl is taken to the pediatric emergency department (ED) by her parents because of sudden complex hallucinations.She shows moderate intellectual disability without a peculiar phenotype already evaluated by neuropediatrics (normal comparative genomic hybridization array and brain magnetic resonance imaging) and most likely related to affective deprivation at the orphanage. Adopted at 20 months from China, her parents reported that on arrival she had scars, allegedly from being tied to a chair for a long time, and that although she was able to stand, she could not walk. At 22 months, she had experienced several episodes of loss of consciousness with rigidity that were attributed to sobbing spasms. Her family history is unknown. She is up to date on all her vaccinations and had menarche a year ago.Adaptation to her new family was complicated at first, but thanks to their dedication, she established a strong family bond and managed to settle into an ordinary school with curriculum adaptation. She is good friends with her classmate and has not shown any behavioral problems.Her clinical history started 48 hours before the current visit when she told her parents that at school that day a classmate had hit her on the neck (an unfortunate incident later confirmed to be without malicious intent). From then on, she became increasingly agitated and unable to sleep, and so she was assessed the next day. On her first visit to the ED, she was distressed and presented with referred cervicalgia, showing lateralization of the neck suggestive of muscle contracture. Analgesia and diazepam were administered with good response in behavior and neck posture.Within hours of the first visit, she started having visual and auditory hallucinations. She complained of individuals threatening to harm her: "a man wearing a patch who wanted to gouge out her eye" and "a girl with a gun who wanted to shoot her." She stared and pointed fearfully toward where she could supposedly see them. Despite a further dose of diazepam, she stayed awake and soliloquized overnight, apparently responding to these individuals and expressing great fear of them (anxiously begging them "not to harm her," claiming to see "blood falling from her ear") and also displaying delirious interpretations (on meeting 2 men wearing gowns, she asked them for help). Aside from these, she displayed marked food refusal, was afebrile, and had no other symptoms. She had not taken any medication recently, had no access to drugs, and had not suffered any head trauma.