Wednesday, September 21, 2011

Hallucinations, vegetables and memories.

I was "grazing" through Medscape the other day - it's one of my online medical education resources - and came across the following case presentation: "A 12-year-old boy presented for psychiatric evaluation. He was referred by his school nurse because he had been describing complex visual hallucinations to his classmates. He reported seeing cartoonlike scenes of zucchini dressed like cowboys shooting at each other and eggplants dressed like clowns engaged in slapstick and acrobatic activities. He knows that these visions are not real and finds them mildly amusing and somewhat entertaining rather than threatening. He has had the visions intermittently, several times daily, over the past 3 months. The visions are purely visual and not accompanied by music, voices, or other sounds."

My mind went back to student days when I was attached to a psychiatric hospital and one of the patients was building a 12ft carrot for some reason that I now forget! But it reminded me that hallucinations happen, and when you first meet someone who is having them, you are almost convinced that they might be telling the truth! One long distance truck driver I looked after was overdoing the "uppers and downers" and was admitted to our small country hospital with hallucinations. When I visited him, he pointed out the window to the little men who were running along the telegraph wires and some were even riding small bicycles: I found myself looking out the window to see if I could see them too!

According to the authors at Medscape: "Hallucinations or perceptions in the absence of identifiable external stimuli are thought to reflect psychosis and underlying serious psychopathology. Hallucinations in children may reflect normal development or response to psychosocial stress, but it is important to rule out an underlying physical illness as well as to evaluate for psychiatric conditions."

The young lad at the beginning of this piece was found to have a small benign lesion in his brain that was removed at surgery and ended his hallucinations. His story had a happy ending, but many others suffer from life long psychoses that require medication and for them, life is not so funny.
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