The University of Texas System
Resources

CPAN: Case of the Month

Each month, PCPs call the Child Psychiatry Access Network with a wide variety of mental health questions.

October 2022

Patient demographic:
8 year old male being treated for auditory hallucinations

Case:
The patient’s mother reported that the patient was hearing voices about hurting others and hurting
or killing himself. The symptom began after losing his father to a long illness. The patient is doing
well in school, has several close friends and has not had behavioral changes. He appears
bright and engaged despite the loss of his father. The patient has been diagnosed with ADHD and
Generalized Anxiety Disorder in the past and has a tendency toward somatization. He is currently
taking Fluoxetine 10 mg daily and Atomoxetine 25 mg daily.

The pediatrician was planning to refer him to a grief support group for children but wondered if she
should be concerned about the reported auditory hallucinations and their content. The pediatrician and the CPAN psychiatrist discussed the patient’s functioning and agreed that he was still functioning well academically and socially.

CPAN discussed that schizophrenia is extremely uncommon in an 8 year old, but the type of symptoms the pediatrician described were common in children that are under stress. CPAN recommended an increase in Fluoxetine as his mother reported that even though he is functioning well, his anxiety is elevated compared to baseline. In addition, individual therapy was recommended to help the patient process the loss of his father.

Reason for CPAN consultation:
Pediatrician requested consultation to discuss behavioral management of the patient.

Take Home Point:
“Auditory hallucinations, harm to self and harm to others are probably the three most nerve-wracking
symptoms to treat in the outpatient setting, whether you are a psychiatrist or a primary care
physician. Discussing the symptoms with someone trusted and who has a lot of experience with
these symptoms can help patients feel calmer and more confident, thereby avoiding the potential
harm of over reaction, which in this case might be the harm caused by separating a young child
from their family at the time they need the support of the remaining parent. Reactive hospitalization
can also have the long term effect of producing avoidant and secretive thoughts and behavior in a
child, thereby preventing them from seeking help in the future. Hospitalization can save someone’s
life, but it can also be interpreted as a negative consequence to sharing feelings. Discussions with
colleagues has helped me reduce any over reaction on my part, thereby allowing more of my
patients to heal at home with their loving family member’s for support.” — CPAN psychiatrist