Q:

A parents came to your clinic complaining that their 5-year-old boy had attacks of frightening with imagination of a snake crawling over him and he is acting as trying to remove it

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A parents came to your clinic complaining that their 5-year-old boy had attacks of frightening with imagination of a snake crawling over him and he is acting as trying to remove it. You assessed the child and find no acute physical illness and he is cooperative and quite intelligent. Of the following, the MOST appropriate explanation for the child behavior is


  1. acute phobic hallucination
  2. early sign of schizophrenia
  3. delusional infestation
  4. night terror
  5. bipolar disorder

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(A). In children with non-psychotic hallucinations, the symptoms of psychosis are absent; normal mental status examination is the key for it is diagnosis. Non-psychotic hallucinations commonly occur in the context of severe traumatic stress, developmental difficulties, social and emotional deprivation. Hallucinations related to fantasy, culture believes, grief, hypnogogic hallucinations, night terrors, fever, and acute phobic hallucinations all are considered normal. In this scenario, the case typically has an acute phobic hallucination which is benign, common and occurs in previously healthy preschool children. The hallucinations are often visual or tactile, last 10-60 minutes, and occur at any time but most often at night. The child is quite frightened and might complain that bugs or snakes are crawling over him or her with attempt to remove them.The cause is unknown. The differential diagnosis includes drug overdose or poisoning, high fever,encephalitis, and psychosis. The child's fear is not alleviated by reassurance by the parents or physician, and the child is not amenable toreason.Findings on physical and mental status examinations are otherwise normal, Symptoms can persistfor 1-3 days, slowly abating over 1-2 wk

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