The curse of the dolphins

Cognitive decline and psychosis

Randall Phelps, Anne Tsai, Arlene Hagen, Joseph Pinter, Raegan Smith, Martin T. Stein

Research output: Contribution to journalReview article

Abstract

CASE: Isela is an 11-year-old Mexican-American girl with mild intellectual disability. During a vacation with her family, she went swimming with dolphins. A few days later, Isela awoke at night with laughing spells; during the day, she was pacing, aggressive, and had a decline in self-care and communication skills. Her parents attributed the symptoms to the dolphins. She was evaluated by a pediatric neurologist. The sleepdeprived electroencephalogram, brain magnetic resonance imaging, lumbar puncture, and thyroid function tests were normal. A genomic microarray was sent. The neurologist initiated empirical therapy for seizures with lamotrigine, which caused a rash. It was discontinued. She was then treated with oxcarbazepine followed by topiramate for several months without any change in symptoms. Comparative genomic hybridization revealed a small deletion at 14q13.1, which includes the NPAS3 gene. Psychiatry was consulted after several months of persistent symptoms. Isela seemed to be laughing in response to internal stimuli. Owing to the decline in communication and her apparent preoccupation with visual and auditory internal stimuli, Isela could not be interviewed adequately to confirm that she was experiencing hallucinations, but her laughter seemed to be in response to hallucinations. Isela was diagnosed with disorganized schizophrenia with psychosis. Risperidone was prescribed. A psychology evaluation was completed a few months later. Parents noted significant improvement after starting risperidone with reduced inappropriate laughing spells, reduced pacing, as well as improved eating, sleeping, communication, and self-care. Cognitive assessment with the Wechsler Abbreviated Scale of Intelligence-II indicated the following: verbal estimated intelligence quotient (IQ) = 70, perceptual estimated IQ = 71, and full-scale estimated IQ = 68. There was no cognitive decline compared with testing at school 4 years previously. Although psychotic symptoms were significantly improved on antipsychotic medication and function appeared to have been restored to her previous level, her parents continued to perceive a significant decline of functioning, and they continued to attribute the psychosis to swimming with the dolphins.

Original languageEnglish (US)
Pages (from-to)S16-S18
JournalJournal of Developmental and Behavioral Pediatrics
Volume38
Issue number2
DOIs
StatePublished - 2017

Fingerprint

Dolphins
Intelligence
Psychotic Disorders
Risperidone
Parents
Hallucinations
Communication
Self Care
Disorganized Schizophrenia
Laughter
Thyroid Function Tests
Wechsler Scales
Spinal Puncture
Comparative Genomic Hybridization
Exanthema
Intellectual Disability
Antipsychotic Agents
Psychiatry
Electroencephalography
Seizures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

The curse of the dolphins : Cognitive decline and psychosis. / Phelps, Randall; Tsai, Anne; Hagen, Arlene; Pinter, Joseph; Smith, Raegan; Stein, Martin T.

In: Journal of Developmental and Behavioral Pediatrics, Vol. 38, No. 2, 2017, p. S16-S18.

Research output: Contribution to journalReview article

Phelps, Randall ; Tsai, Anne ; Hagen, Arlene ; Pinter, Joseph ; Smith, Raegan ; Stein, Martin T. / The curse of the dolphins : Cognitive decline and psychosis. In: Journal of Developmental and Behavioral Pediatrics. 2017 ; Vol. 38, No. 2. pp. S16-S18.
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