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Dr. Steve
Dr. Steve, Psychologist
Category: Mental Health
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Experience:  19 years conducting therapy; book author; newspaper columnist; former co-host of radio show
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My daughter is heaing voices. Her doctor has put her on seroguell.

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My daughter is heaing voices. Her doctor has put her on seroguell. Previously she was on Concerta for ADHD and has been treated for ALL. Do you have any advice? How can I know we are on the right track for her?
Submitted: 6 years ago.
Category: Mental Health
Expert:  Dr. Steve replied 6 years ago.

Greetings:

 

Great question, but such an unfortunate situation for your daughter. Here is my impression: (and I give this with the knowledge that having active hallucinations in an eight year old is REMARKABLY uncommon)

 

The main neurotransmitter that is affected by the Concerta is called dopamine. ADHD is a general lack of Dopamine, so Concerta kick-starts the brain to make more. I have seen it happen (although this is somewhat rare as well) that a kiddo on an ADHD stimulant can actually have the dopamine levels overshoot the mark and will wind up creating some psychotic features (hallucinations, generally).

 

So here is my advice: talk to the prescribing doc and ask if your daughter can get all the way detoxed from the Concerta before her ultimate evaluation. As I mentioned, florid psychosis in eight year olds is almost unheard of - especially if there is not a family history of psychotic disorders (NOT impossible, but rarer than the side effect of stimulant meds, in my experience). That is the only way we can accurately assess what is driving the hallucinations. I assume they are a new symptom, by the way.

 

In any event, the medication prescribed to her is appropriate if she is hallucinating, but we really need to know if the symptoms are organic or if they have been created by the medication.

 

If you are satisfied with the response, please hit "Accept." That is the only way I can receive credit for my answer. Thank you-

Dr. Steve

Customer: replied 6 years ago.

 

She had been off the Concerta for four weeks when she first saw the psychiatrist. She said she still heard the voices then. He started her on 50mg of Seroquell. She says she is still hearing the voices and is on 150 mg (for three days).

I have little family history for her, she is adopted.

Expert:  Dr. Steve replied 6 years ago.

Hello again:

 

Got it. She should have been adequately detoxed by the time the physician made the medication change then. I will say this, the Seroquel will curb the hallucinations - if they are indeed just that. In children, I would work to first rule out a few other possibilities (the Concerta being the first in line). Other examples: I would also look at the potential for the reports to be manipulations - to assess this, we look at what is called "secondary gain" (i.e., what would she have to gain by virtue of falsely reporting hallucinations?). Mental capacity is also a possibility - if she is challenged in any way, she could be having a difficult time separating her internal thought processes from external stimuli (a current theory of auditory hallucinations in adults too, BTW). Finally, given that she is adopted, I would also look into the possibility of an imaginary friend being a part of her life. Often times kids under stress will "dissociate" as a means to coping with an unmanageable situation. Over time, the "friends" could transform into visceral reactions from her, again dependent upon her level of historical trauma.

 

Sorry to be so scattered in my response, but there are a few roads that could be explored when presented with this symptom. Seroquel is relatively mild with regard to side effects, but it does have to be monitored because there are a couple bad ones that could crop up if she has to take the med over a long period of time.

 

Best of luck. If you are satisfied with the response, please hit "Accept." That is the only way I can receive credit for my answer. Thanks-

Dr. Steve

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