Pediatric Psychosis and Hallucinations

–MD Edge

Kids with Psychosis and Hallucinations

Children may experience hallucinations due to trauma, abuse, genetics, intellectual disabilities, or medical conditions, though these experiences are uncommon without an identifiable cause. Early childhood hallucinations are rare and usually not related to psychosis or schizophrenia, which seldom manifests before age 15. Addressing such cases requires thorough assessments, tailored communication with families, and an adaptable treatment plan.

Family Discussions

  • Assess for Trauma or Abuse: Investigate behavioral changes, rule out external factors, and educate how possibly making small changes like treating sleep or the mood, can reduce the psych problems.
  • Educate and Reassure: Odd behaviors can be potentially part of a child’s imagination or development and can be self-limiting. However, emphasize how symptoms can improve with treatment and how stability is a process.
  • Explain Medications: Discuss with family how treatment can help manage the behaviors and reduce worsening symptoms. If the family is hesitant, express how the purpose of medications is to keep a person safe from themselves or others.

Treatment Plan

  • Genetic Testing: Helps tailor medication to the child’s unique biology, avoiding side effects and inefficacy.
  • Medications: Begin with FDA-approved options like risperidone or aripiprazole in small doses, increase dosage if necessary based on poor behaviors.
  • Address Sleep: low sleep worsens psych symptoms; low-dose olanzapine can aid sleep and reduce psych symptoms.
  • Assess Learning: Rule out ADHD and identify educational challenges contributing to the distress.
  • Safety Measures: Secure potentially dangerous items at home and consider a crisis plan -securing harmful objects at home.

Follow-Ups and Escalation

  • Monitor Symptoms: Watch for severe aggression or worsening psychotic behaviors. If these occur, inpatient care or intensive treatment may be necessary.
  • After Stabilization: Continue prescribed medications or discussed tapering while focusing on the mental health, educational/learning needs, and the overall quality of life.
  • Collaborate with Specialists: Consult colleagues for complex cases and involve collaborative staff as needed.

Key Takeaways
Hallucinations in children require careful assessment, family education, and a balanced treatment plan. Medications, safety, and collaborative care can significantly improve outcomes while reducing the risk of hospitalization. Communication with families is critical for ensuring understanding, adherence, and emotional support.

Additional References & Resources

Clinically Assessing Hallucinations 

TABLE 1. Psychopathology of human perception and sensory distortions:

TABLE 2. Hallucinatory experiences in 5 sensory modalities: description and differential diagnosis:

TABLE 3. The detailed exploration of hallucinations:

TABLE 4. Paediatric organic conditions that may present with hallucinations or related perceptual phenomena – with or without reduced levels of consciousness:

When evaluating hallucinations in children, here is a structured approach:

1. Clarify the Experience: Determine if the phenomenon is:
– An illusion (misinterpretation of sensory input),
– Related to fantasy (e.g., imaginary friends),
– Intrusive thoughts or images (e.g., obsessions),
– Post-traumatic flashbacks (vivid, involuntary recollections of trauma).

2. Assess Complexity: Simple, non-clinical hallucinations (e.g., hearing one’s name or seeing fleeting shadows) are distinguished from clinically significant ones.

3. Identify Context: Investigate if hallucinations are linked to altered awareness, such as:
– Sleep states (e.g., hypnagogic/pompic hallucinations),
– Fever, drugs, toxicity, epilepsy, migraines, or conditions like Alice in Wonderland syndrome.

4. Evaluate for Psychosis: Determine if hallucinations indicate psychotic states or stem from other vulnerabilities, stressors, or psychiatric conditions. Special consideration is required for younger children, those with intellectual disabilities, or uncommunicative individuals, emphasizing the need for skilled and possibly nuanced questioning.

–Cambridge.org

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