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- Khadijah Abdul Kader, MBBS, MRCPCH*
- Xin Ying Ngiam, MBBS, MRCPCH*
- Pao-Tang Kao, MBBS, MRCPCH*
- *Khoo Teck Puat-National University Children’s Medical Institute, National University Health Systems, Singapore
AUTHOR DISCLOSURE
Drs Kader, Ngiam, and Kao have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Presentation
A 17-year-old girl is brought to the emergency department for unusual behaviors. On the day of presentation, her family members found her intermittently crying and talking to herself about angels, demons, redemption, and sins. She was speaking in a different voice and telling her family of "something evil within her." Her parents sought spiritual help from a priest, but this failed to improve her behavior. There were no recent changes in her mood, behavior, or academic performance.
The patient is overweight but otherwise well. For the past month she has taken slimming pills from an online store, but no other medications. She is a high-achieving student. She denies smoking, alcohol intake, or illicit drug use. There is no family history of psychiatric disorders.
On examination, she is clutching her crucifix, smiling, and laughing inappropriately. Her temperature is 98.6°F (37°C), heart rate is 101 beats/min, blood pressure is 120/61 mm Hg, respiratory rate is 18 breaths/min, and oxygen saturation is 99% on room air. Her weight is 167 lb (75.8 kg) (>97th percentile), height is 63.4 in (1.61 m) (75th-90th percentile), and BMI is 29.2. Her heart, lungs, and abdomen are normal. Findings from examination of the cranial nerves, tone, and reflexes are normal. She intermittently engages in conversation, describing multiple voices that interrupt her thoughts and tell her to hurt herself and her family.
She is admitted …
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