Jellinek Michael S, Hirst Jeremy, Stein Martin T
Harvard Medical School, Chief of the Child Psychiatry Service, Massachusetts General Hospital, Boston, MA, USA.
J Dev Behav Pediatr. 2007 Jun;28(3):241-4. doi: 10.1097/DBP.0b013e3180674e61.
Scott, a 13-year 7-month old white male with no prior psychiatric history, presented to the emergency department after three days of decreased attention span and increased distractibility. An initial examination revealed that he was internally preoccupied (focused on responding to auditory hallucinations), displayed thought blocking (sudden interruption in the flow of his thoughts that prevented him from completing an idea), and he had periodic vague suicidal ideation due to intense guilt. He noted hearing two to three voices accusing him of being rude during an incident with a peer at school. He could not accept reassurance from his mother and grandparents that this incident had not actually occurred. Scott found evidence of his wrongdoing by misinterpreting words on signs and medical equipment that he felt indicated that others also knew of his malicious actions. A recent stressor included the conclusion of his active football season a day prior to the onset of his symptoms. Scott and his family denied a history of prodromal symptoms, mental or medical illnesses, including head injury. After a physical/neurological examination, a negative urine drug screen, and a normal complete blood count and metabolic panel, Scott was transferred to a psychiatric hospital. Scott returned to the emergency department two days later with worsening psychotic symptoms despite a trial of olanzapine. He had deteriorated dramatically from his initial presentation. He was now rigid, unable to speak, move his body, follow directions, eat, drink, or provide any additional history. After being admitted to the pediatrics floor an extensive medical workup was completed that included neurology and infectious disease consults, brain magnetic resonance imaging and angiography studies, a 24-hour electroencephalogram, lumbar puncture, urinalysis, complete blood count, comprehensive metabolic panel, ceruloplasm, anti-nuclear antibody, anti-DNAase, erythrocyte sedimentation rate, heavy metal screen, ammonia, rapid plasma reagin (RPR), and human immunodeficiency virus. All laboratory studies were normal.
斯科特是一名13岁7个月大的白人男性，既往无精神病史，在注意力持续时间缩短和易分心三天后前往急诊科就诊。初步检查发现他内心专注（专注于回应幻听），表现出思维中断（思维流突然中断，使他无法完成一个想法），并且由于强烈的内疚感而有周期性的模糊自杀念头。他提到在学校与一名同学发生的一次事件中听到两到三个声音指责他粗鲁无礼。他无法接受母亲和祖父母的安慰，即这件事实际上并未发生。斯科特通过曲解他认为表明其他人也知道他恶意行为的标志和医疗设备上的文字，找到了自己 wrongdoing 的证据。最近的一个压力源是他活跃的足球赛季在症状出现前一天结束。斯科特和他的家人否认有前驱症状、精神或内科疾病史，包括头部受伤史。经过体格/神经学检查、尿液药物筛查阴性、全血细胞计数和代谢指标正常后，斯科特被转至一家精神病医院。尽管试用了奥氮平，但两天后斯科特因精神病症状恶化又回到了急诊科。他的病情与最初就诊时相比急剧恶化。他现在身体僵硬，无法说话、移动身体、听从指示、进食、饮水或提供任何更多病史。入住儿科病房后，完成了广泛的医学检查，包括神经内科和传染病会诊、脑磁共振成像和血管造影研究、24小时脑电图、腰椎穿刺、尿液分析、全血细胞计数、综合代谢指标、铜蓝蛋白、抗核抗体、抗DNA酶、红细胞沉降率、重金属筛查、氨、快速血浆反应素（RPR）和人类免疫缺陷病毒检测。所有实验室检查均正常。
