Recurrent abdominal pain in children: psychiatric diagnoses and parental psychopathology

Abdominal pain and irritable bowel syndrome in adolescents: a community-based study

OBJECTIVES

This study was undertaken to determine (1) the prevalence of gastrointestinal symptoms including abdominal pain in a community-based population of adolescents, (2) whether a subgroup of these subjects have symptoms resembling Irritable bowel syndrome (IBS), and (3) whether anxiety and depression are more commonly found in adolescents with IBS-type symptoms compared with unaffected adolescents.

METHODS

We collected data by administration of a gastrointestinal symptoms questionnaire, State-Trait Anxiety Inventory, and Children's Depression Inventory to middle school and high school students.

RESULTS

A total of 507 subjects participated (mean age of middle school students 12.6 years; mean age of high school students 15.6 years). Abdominal pain was noted by 75% of all students. The pain occurred weekly in 13% to 17% of the subjects and was severe enough to affect activities in approximately 21%. Irritable bowel syndrome-type symptoms were noted by 17% of high school students and 8% of middle school students (p <0.01) who reported abdominal pain (n = 381), representing 14% and 6% of all high school and middle school students (p <0.005), respectively. Anxiety and depression scores were significantly higher for students with IBS-type symptoms compared with those without symptoms. Eight percent of all students had seen a physician for abdominal pain in the previous year. These visits were correlated with abdominal pain severity, frequency, duration, and disruption of normal activities but not with anxiety, depression, gender, family structure, or ethnicity.

CONCLUSION

Recurrent abdominal pain and symptoms of IBS are commonly noted in a community-based adolescent population and frequently result in use of health care resources. Health care providers who work with this age group need to be able to recognize the symptom complex associated with IBS, as well as the possible relationship to anxiety and depression.

Somatization in children and adolescents

OBJECTIVE

To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment.

METHOD

One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization.

RESULTS

Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R-defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services.

CONCLUSION

Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.

The Children's Global Assessment Scale in clinical practice: an empirical evaluation

OBJECTIVE

The purpose of this study was to examine characteristics of the Children's Global Assessment Scale (CGAS) in the context of clinical practice.

METHOD

Ninety-five children admitted to a psychiatric inpatient unit were rated by their attending psychiatrist and by milieu staff on the CGAS. Measures of severity and type of symptomatology; social, behavioral, and school competence; intellectual level; social relatedness; and family stress were completed by parents and staff raters.

RESULTS

Results indicated that there was significant convergence in CGAS ratings by independent raters. CGAS ratings were unrelated to measures of symptomatology but were significantly related to indices of children's competence.

CONCLUSIONS

This pattern of results diverged from findings from highly controlled research settings and indicated that CGAS ratings obtained in clinical contexts may reflect evaluations of functional competence rather than severity of symptomatology.

The role of psychological factors in chronic pain. II. A critical appraisal

This paper, the second of two, concerning the study of psychological factors in chronic pain, presents a critical appraisal of the literature. Questionable assumptions, flawed methodology, and conceptual problems in earlier work are discussed, as are gradual improvements in methodological rigour and conceptual clarity. Methodological weaknesses in studies, including lack of control groups, selection biases, overinterpretation of correlational data, and use of inappropriate testing instruments are examined. Questions are raised about persisting tendencies to split mind from body by attributing pain to either organic or psychological causes. Despite advances in research and thinking in recent years, several issues remain unresolved in both the research enterprise and the clinical setting. These are discussed in relation to the respective needs of the researcher, the clinician, and the patient. Limitations on research conducted in clinical settings are considered and targets for improved methodology in studies are identified.

Elevated cholecystokinin concentrations in plasma in children with recurrent abdominal pain

The objective of the present study was to measure plasma concentrations of the gastrointestinal hormones gastrin, somatostatin and cholecystokinin in plasma of children with recurrent abdominal pain, since these hormones affect gastrointestinal function. Forty-four children (7-16 years old) with recurrent abdominal pain and 36 control children (matched for age and sex) participated in the study. In a blood sample collected after an overnight fast, gastrin, somatostatin and cholecystokinin concentrations were measured by radioimmunoassay. The children with recurrent abdominal pain had higher plasma cholecystokinin levels (p < 0.001) than the controls. Whether or not this aberration is related to the clinical symptoms of children with recurrent abdominal pain remains to be established.

Recurrent abdominal pain in child patients seen at a pediatric gastroenterology clinic. Observations of 50 children and their families

Recurrent abdominal pain is a common patient complaint in general pediatric and gastroenterology clinics. Various psychiatric problems have been noted in the children, adolescents, and parents of children who present with nonorganic recurrent abdominal pain. This article reviews the stressors, psychopathology, and biopsychosocial treatment of 50 patients with recurrent abdominal pain who were referred from a pediatric gastroenterology clinic to their psychiatric consultant over a 3-year period (1987-1990). The salient literature is also reviewed and thoughts for future research are outlined.

The role of somatic complaints in the diagnosis of depression in children and adolescents

The question of whether somatic complaints are a significant feature of depression independent of anxiety was explored. Structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children) and Child Behavior Checklist data from depressed and nondepressed psychiatric controls were analyzed to explore the interaction of somatic complaints, anxiety, and depression. Seventy percent of the children who met criteria for depression also had significant somatic complaints in contrast to 34% of the controls. Findings revealed that frequency of somatic complaints increased with severity of depression regardless of coexisting anxiety.