1
|
Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
Collapse
Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| |
Collapse
|
2
|
Bastek V, van Vliet M. A whole new world of healing: exploring medical hypnotherapy for pediatric patients : A review. Eur J Pediatr 2023:10.1007/s00431-023-04983-5. [PMID: 37145215 PMCID: PMC10160735 DOI: 10.1007/s00431-023-04983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
This narrative review aims to unravel the potential of medical hypnotherapy for the treatment of children with a variety of diseases and symptoms. Going beyond its history and assumed neurophysiology, the chances of success for hypnotherapy will be outlined per pediatric speciality, accentuated by clinical research and experiences. Future implications and recommendations are given on extracting the positive effects of medical hypnotherapy for all pediatricians. Conclusion: Medical hypnotherapy is an effective treatment for children with specified conditions such as abdominal pain or headache. Studies suggest effectiveness for other pediatric disciplines, from the first line up to third line of care. In a time in which health is defined as 'a state of complete physical, mental and social well-being', hypnotherapy stays an underrated treatment option for children. It is a unique mind-body treatment, which true potential still needs to be unraveled. What is Known: • Mind-body health techniques become a more relevant and accepted part of treatment in pediatric patients. • Medical hypnotherapy is an effective treatment for children with specified conditions such as functional abdominal pain. What is New: • Studies suggest the effectiveness of hypnotherapy in a high variety of pediatric symptoms and disease. • Hypnotherapy is a unique mind-body treatment which potential goes far beyond its current utilization.
Collapse
Affiliation(s)
- Vanessa Bastek
- Department of Child And Adolescent Psychiatry, Klinikum Region Hannover GmbH, Wunstorf, Germany
| | - Michel van Vliet
- Department of Social Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| |
Collapse
|
3
|
Niggemann B, Maas R, Suerbaum C, Spindler T, Kohl A, Koerner-Rettberg C, Burghardt R. "Psychological characteristics of functional respiratory disorders in children and adolescents-Pilot study". Pediatr Pulmonol 2022; 57:3027-3034. [PMID: 36114693 DOI: 10.1002/ppul.26129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Aim of our prospective, multicenter, nonrandomized study was to identify characteristic features and similarities of patients with functional respiratory disorders regarding socio-familial and behavioral aspects, in comparison with controls in a cross-sectional analysis using standardized psychological questionnaires. Furthermore, we investigated the longitudinal outcome of symptoms, effects of primary interventions and the stability of psychological traits 6 months after diagnosis and primary intervention. METHODS Initially, 106 patients (68 females, 27 males) and 58 controls (33 females, 25 males) were recruited for the study. Mean age was 12.6 years in patients and 11.9 years in controls. RESULTS The child behavior checklist (CBCL) showed significantly increased scores for anxious/depressed (p = 0.002) and schizoid/obsessive (p = 0.001) behavior in patients. A trend was evident for internalizing behavior (p = 0.009) and for a higher total score (p = 0.008). In the self-assessment youth self-report (YSR), there was a trend towards higher values for anxious/depressed behavior in patients (p = 0.06) and towards more externalizing behavior (p = 0.029) in the control group. After 6 months, 31% of the patients were free of symptoms, 42% had improved. For themselves, parents reported a decreased burden from 56% to 23% (p < 0.001) and decreased impairment from 57% to 30% (p < 0.008). For their children, parents reported a decrease from 45% to 16% (p < 0.0001) and from 74% to 37% (p < 0.0001), respectively. A longitudinal comparison from T1 to T2 showed no statistically significant changes in all three psychological questionnaires (CBCL, YSR, and SOMS-KJ). CONCLUSIONS In summary, we show that patients with functional respiratory disorders differ from healthy subjects, with internalizing behavior being a characteristic trait. The outcome in terms of symptoms, perceived psycho-familial burden and impairment after 6 months is encouraging. However, we are aware that our preliminary data offer thought-provoking impulses rather than firm findings.
Collapse
Affiliation(s)
- Bodo Niggemann
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany
| | - Ronja Maas
- Pediatric Psychiatry, Psychotherapy and Psychosomatics, Children's Hospital, Klinikum Frankfurt/Oder, Frankfurt/Oder, Brandenburg, Germany
| | - Claudia Suerbaum
- Centre for Pneumology and Pediatric Pneumology, Düsseldorf, Germany
| | - Thomas Spindler
- Specialized Clinic for Pediatric Pneumology and Allergology, Wangen, Germany
| | - Andreas Kohl
- Pediatric Respiratory Medicine Practice, Kiel, Germany
| | | | - Roland Burghardt
- Pediatric Psychiatry, Psychotherapy and Psychosomatics, Children's Hospital, Klinikum Frankfurt/Oder, Frankfurt/Oder, Brandenburg, Germany
| |
Collapse
|
4
|
Kara MZ, Başaran AE. Psychological profiles, quality of life, and parental attitudes in children with Sighing dyspnea. Clin Child Psychol Psychiatry 2022; 27:769-781. [PMID: 35616347 DOI: 10.1177/13591045221094697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are a limited number of studies investigating the relationship of sighing dyspnea (SD) with psychiatric disorders and various mental states. METHODS This cross-sectional study enrolled 39 pediatric patients with SD, but free from apparent cardiopulmonary diseases, who presented to a pediatric pulmonology policlinic between June and December 2019 and age-gender matched 34 healthy children were recruited for comparison. Patient characteristics, psychological or physical trauma history, and cigarette smoke exposure were recorded. All the participants completed the "NOSE scale," "Modified Borg Scale," "Children Depression Inventory," "Screen for Child Anxiety Related Disorders," "Pediatric Quality of Life Inventory," "Stress Coping Style Scale," "Family Assessment Device," and "Parents Attitude Scale." RESULTS Compared to the control group, there was a statistically significantly higher rate in the SD group of physical or psychological trauma history (35.9% vs. 14.7%, p = .04) and passive cigarette smoking (60.5% vs.27.3%, p = .005). When the groups were compared in respect of depression and anxiety levels, the depression score, total anxiety level, somatic/panic, generalized anxiety and fear of school points were determined to be statistically significantly higher in the SD group. The QoL scores (total, physical, and psychosocial) in the SD group were found to be statistically significantly lower than those of the control group. CONCLUSION To the best of our knowledge, this is the first study to have examined the psychological profiles of SD patients and their families in detail, and to have evaluated the effect of SD on quality of life.
Collapse
Affiliation(s)
- Mahmut Zabit Kara
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Antalya Training and Research Hospital, Turkey
| | - Abdurrahman Erdem Başaran
- Department of Pediatrics, Division of Pulmonology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| |
Collapse
|
5
|
Papadopoulou A, Mermiri DZT, Gritzelas G, Tsouridi O, Dimara E, Yapijakis C, Chrousos GP. Increased Incidence of Stress-related Tic Habit Cough in Children During the Recent Greek Financial Crisis. In Vivo 2021; 35:1811-1820. [PMID: 33910867 DOI: 10.21873/invivo.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Tic habit cough (THC) is not easily recognized and requires a high index of suspicion. Since there is evidence for stress-related etiology, the study presents our experience during the eight-year period of the recent Greek financial crisis. PATIENTS AND METHODS This is a descriptive prospective cross-sectional clinical study using a consistent approach to diagnosis, possible triggers and treatment options. RESULTS Fifty-one children (26 girls, age 9.5±3.1y) from a total of 3,793 new referrals for chronic cough fulfilled the criteria of THC (1.34%). Incidence rates per 1,000 person-years were 1.34 (95%CI=0.34-5.40), 3.91 (95%CI=1.86-8.19), 4.03 (95%CI=2.01-8.06) and 14.60 (95%CI=10.43-20.44) for every two years. Poisson analysis showed an increased trend during the four time periods with an incidence rate ratio equal to 2.21 (95%CI=1.58-3.09, p<0.001). THC was mainly attributed to learning difficulties, as well as stress-related impact of peer or family bullying, family financial problems and child anxiety disorders. CONCLUSION The incidence of THC is associated with the negative aspects of stressors during a period of financial crisis. The potential underlining psycho-physiological mechanisms are discussed as well as the fact that prompt diagnosis may result in successful interventions.
Collapse
Affiliation(s)
- Athina Papadopoulou
- Allergology and Pulmunology Unit, Penteli's Children Hospital, Athens, Greece;
| | | | | | | | - Eleni Dimara
- Allergology and Pulmunology Unit, Penteli's Children Hospital, Athens, Greece
| | - Christos Yapijakis
- Unit of Orofacial Genetics, 1 Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
6
|
Abstract
Functional respiratory disorders (FRDs) are those characterized by respiratory symptoms without anatomic or organic etiology. Clinicians caring for children encounter these disorders and should be familiar with diagnosis and treatment. FRDs encompass the habit cough syndrome and its variants, vocal cord dysfunction, hyperventilation disorders, functional dyspnea, and sighing syndrome. Failure to identify these disorders results in unnecessary testing and medication. This article reviews the clinical presentation, manifestation, and treatment of respiratory FRDs in children. How health care providers can successfully identify and treat these reversible conditions in the clinical setting is discussed.
Collapse
|
7
|
Pedersen ESL, Ardura-Garcia C, de Jong CCM, Jochmann A, Moeller A, Mueller-Suter D, Regamey N, Singer F, Goutaki M, Kuehni CE. Diagnosis in children with exercise-induced respiratory symptoms: A multi-center study. Pediatr Pulmonol 2021; 56:217-225. [PMID: 33079473 DOI: 10.1002/ppul.25126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments. DESIGN An observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC). PATIENTS We included children with EIS as the main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2-17, 54% males) referred for EIS. RESULTS The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%-CI 46%-60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise-challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy. CONCLUSIONS Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow-up differed between clinics and diagnostic groups highlighting the need for evidence-based diagnostic guidelines and harmonized procedures for children seen for EIS.
Collapse
Affiliation(s)
- Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | | | - Carmen C M de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Anja Jochmann
- Division of Paediatric Pulmonology, University Children's Hospital, University of Basel, Basel, Switzerland
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, Zürich, Switzerland
| | | | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital Lucerne, Switzerland
| | - Florian Singer
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.,PedNet, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| |
Collapse
|
8
|
Lindenhofer M, Roth L, Mädel C, Götzinger F, Kainz K, Lex C, Frischer T, Reinweber M, Zacharasiewicz A. Wheeze and cough measurements at night in children with respiratory symptoms. BMC Pediatr 2020; 20:556. [PMID: 33308199 PMCID: PMC7733140 DOI: 10.1186/s12887-020-02455-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background Nocturnal cough and wheeze are important symptoms when diagnosing any respiratory disease in a child, but objective measurements of these symptoms are not performed. Methods The aim of our study was to analyze the use of an automated detection system to assess breath sounds objectively in comparison to cough and wheeze questionnaires and to evaluate its feasibility in clinical practice. Results Forty-nine recordings of thirty-nine children were processed (asthma n = 13; cystic fibrosis n = 2; pneumonia n = 5; suspicion of habit cough n = 7; prolonged, recurrent or chronic cough n = 13), and cough and asthma scores were compared to the objective nocturnal recordings. Time for audio-validation of recordings took between 2 and 40 min (mean: 14.22 min, (SD): 10.72). Accuracy of the automated measurement was higher for cough than for wheezing sounds. Nocturnal cough readings but not wheeze readings correlated with some of the corresponding scores. Conclusion To our knowledge this is the first study using a new device to assess nocturnal cough and obstructive breath sounds objectively in children with a wide variety of respiratory diseases. The assessment proved user friendly. We obtained additional information on nighttime symptoms, which would otherwise have remained obscure. Further studies to assess possible diagnostic and therapeutic benefits of this device are needed.
Collapse
Affiliation(s)
- Markus Lindenhofer
- Klinikum Favoriten, Wiener Gesundheitsverbund, Wien, Austria.,Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Lena Roth
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Clemens Mädel
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Florian Götzinger
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Katharina Kainz
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Christiane Lex
- Department for Pediatric Cardiology and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Thomas Frischer
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | | | - Angela Zacharasiewicz
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria.
| |
Collapse
|
9
|
Lee J, Denton E, Hoy R, Tay TR, Bondarenko J, Hore-Lacy F, Radhakrishna N, O'Hehir RE, Dabscheck E, Abramson MJ, Hew M. Paradoxical Vocal Fold Motion in Difficult Asthma Is Associated with Dysfunctional Breathing and Preserved Lung Function. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2256-2262. [PMID: 32173506 DOI: 10.1016/j.jaip.2020.02.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/13/2020] [Accepted: 02/23/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many patients with difficult asthma also have coexisting vocal cord dysfunction (VCD), evident by paradoxical vocal fold motion (PVFM) on laryngoscopy. OBJECTIVE Among patients with difficult asthma, we sought to identify clinical features associated with laryngoscopy-diagnosed PVFM. METHODS Consecutive patients with "difficult asthma" referred by respiratory specialists underwent systematic assessment in this observational study. Those with a high clinical suspicion for VCD were referred for laryngoscopy, either at rest or after mannitol provocation. Statistical analyses were performed to identify clinical factors associated with PVFM, and a multivariate logistic regression model was fitted to control for confounders. RESULTS Of 169 patients with difficult asthma, 63 (37.3%) had a high clinical probability of VCD. Of 42 who underwent laryngoscopy, 32 had PVFM confirmed. Patients with PVFM more likely had preserved lung function (prebronchodilator forced expiratory ratio 74% ± 11 vs 62% ± 16, P < .001); physiotherapist-confirmed dysfunctional breathing (odds ratio [OR] = 5.52, 95% confidence interval [CI]: 2.4-12.7, P < .001), gastro-oesophageal reflux (OR = 2.6, 95% CI: 1.16-5.8, P = .02), and a lower peripheral eosinophil count (0.09 vs 0.23, P = .004). On multivariate logistic regression, independent predictors for PVFM were dysfunctional breathing (OR = 4.93, 95% CI: 2-12, P < .001) and preserved lung function (OR = 1.07, 95% CI: 1.028-1.106, P < .001). CONCLUSION Among specialist-referred patients with difficult asthma, VCD pathogenesis may overlap with dysfunctional breathing but is not associated with severe airflow obstruction. Dysfunctional breathing and preserved lung function may serve as clinical clues for the presence of VCD.
Collapse
Affiliation(s)
- Joy Lee
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ryan Hoy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tunn Ren Tay
- Department of Respiratory & Critical Care Medicine, Changi General Hospital, Singapore
| | - Janet Bondarenko
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Fiona Hore-Lacy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Robyn E O'Hehir
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Respiratory Medicine, Allergy and Clinical Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Eli Dabscheck
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael J Abramson
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
10
|
Orengul AC, Ertaş E, Ustabas Kahraman F, Yazan H, Çakır E, Nursoy MA. Psychiatric comorbidity in children with psychogenic and functional breathing disorders. Pediatr Pulmonol 2020; 55:462-467. [PMID: 31710164 DOI: 10.1002/ppul.24565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/24/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study aims to assess psychiatric diagnoses in children with psychogenic and functional breathing disorders (PFBD), which consist of children with psychogenic cough, throat-clearing tics, and sighing dyspnea, and compare them to a control group without any diagnosis of chronic medical problems. METHODS The participants consist of 52 children with PFBD and 42 children without any chronic medical problems. Psychiatric diagnoses were assessed via semistructured psychiatric interviews in both groups. RESULTS The two groups did not differ on age (PFBD group 11.25 ± 2.61, control group 11.17 ± 2.58; t = 0.14, P = .88) or sex (48.1% of the PFBD group were female, 61.9% of the control group were female; χ2 = 1.79, P = .18). 55.8% of the PFBD group and 28.6% of the control group had at least one psychiatric diagnosis according to the semistructured interviews (χ2 = 6.99, P = .008). The most common psychiatric diagnoses in the PFBD group were attention deficit hyperactivity disorder (ADHD; 17.3%), tic disorders, (15.4%), and specific phobia (15.4%). 11.5% of the cases in the PFBD group were diagnosed with somatic symptom disorder and more than half of the patients (n = 27 (51.9%)) showed clinical characteristics of tic disorders. CONCLUSION Psychiatric diagnoses are common in children with PFBD, and teamwork involving child psychiatrists may be essential for the management of children with PFBD.
Collapse
Affiliation(s)
- Abdurrahman C Orengul
- Department of Child and Adolescent Psychiatry, Bezmialem Vakıf University, Istanbul, Turkey
| | - Erdem Ertaş
- Department of Child and Adolescent Psychiatry, Bezmialem Vakıf University, Istanbul, Turkey
| | | | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Mustafa A Nursoy
- Department of Pediatric Allergy and Immunology, Bezmialem Vakıf University, Istanbul, Turkey
| |
Collapse
|
11
|
|
12
|
Niggemann B, Lehmann C, Pfeiffer-Kascha D, Weiss C. Therapeutic options for dysfunctional breathing in children and adolescents. Acta Paediatr 2017; 106:1067-1069. [PMID: 28316098 DOI: 10.1111/apa.13838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Bodo Niggemann
- Department of Pediatric Pneumology and Immunology; University Children's Hospital Charité; Berlin Germany
| | - Christine Lehmann
- Department of Pediatric Pneumology and Immunology; University Children's Hospital Charité; Berlin Germany
| | | | - Christa Weiss
- Department of Pediatric Pneumology and Immunology; University Children's Hospital Charité; Berlin Germany
| |
Collapse
|
13
|
Niggemann B, Hinrichs B, Lehmann C, Koerner-Rettberg C, Köster H, Spindler T, Weiss C. Habitueller Husten im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0193-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Choi SH, Song DJ, Yum HY, Park YM, Rha YH. Chronic cough in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.4.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sun Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hye Yung Yum
- Atopy Asthma Center, Seoul Medical Center, Seoul, Korea
| | - Yong Mean Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Yeong Ho Rha
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Therapie des unspezifischen Hustens bei Kindern. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
|
17
|
Karakaya I, Şişmanlar ŞG. Tic disorders in the differential diagnosis of chronic cough in children in relation to four cases. Turk Arch Pediatr 2015; 50:176-9. [PMID: 26568694 DOI: 10.5152/turkpediatriars.2015.1215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/04/2013] [Indexed: 11/22/2022]
Abstract
Chronic cough is a frequent reason for medical referrals in childhood. In patients who do not have signs or symptoms of an underlying respiratory system disease and who do not respond to experimental treatment, psychogenic cough should be considered. In this paper, four patients who were referred to our department with a prediagnosis of psychogenic cough, found to have tic disorder as a result of the assessments performed and improved with antipsychotic medication are presented. The differantial diagnosis of chronic cough in children should include tic disorders as well as psychogenic cough. Tic disorders can be diagnosed easily with detailed history and their response to medical treatment is rather satisfactory. Recognition of these disorders by pediatricians will minimize erroneous diagnoses and inappropriate therapies in children with a complaint of chronic cough.
Collapse
Affiliation(s)
- Işık Karakaya
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Şahika Gülen Şişmanlar
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| |
Collapse
|
18
|
Zacharasiewicz A, Eber E, Riedler J, Frischer T. Evaluation und Therapie des chronischen Hustens bei Kindern. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
19
|
Benoist G, Bidat E. [Persistent coughs in children and adolescents]. Arch Pediatr 2015; 22:447-51. [PMID: 25669121 DOI: 10.1016/j.arcped.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/05/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Abstract
A persistent cough lasting more than 4-8weeks should lead to a diagnostic workup. A detailed history and a full clinical examination, with a chest X-ray, are essential for initial assessment. Most reported causes of chronic cough in children are post-nasal drip syndrome, cough variant asthma (a spirometry with test of bronchodilator responsiveness should be attempted in children old enough to perform the manoeuvres). GERD is often suspected but a causal relationship is difficult to establish. Protracted bacterial bronchitis, post-infectious cough (B. pertussis, Mycoplasma) and somatoform respiratory disorders (including hyperventilation syndrome) are also common. Signs which are pointers suggesting an underlying respiratory or systemic disease require further investigation: inhaled foreign bodies, cystic fibrosis and chronic lung diseases with bronchiectasis, airway abnormalities, interstitial lung diseases need to be considered. Recent reports of refractory coughs have identified features of a sensory neuropathy disorder, and might explain persistent cough triggers.
Collapse
Affiliation(s)
- G Benoist
- Service de pédiatrie générale, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France; Université Versailles - Saint-Quentin-en-Yvelines, 78280 Guyancourt, France.
| | - E Bidat
- Service de pédiatrie générale, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France
| |
Collapse
|
20
|
Barker N, Everard ML. Getting to grips with 'dysfunctional breathing'. Paediatr Respir Rev 2015; 16:53-61. [PMID: 25499573 DOI: 10.1016/j.prrv.2014.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 11/25/2022]
Abstract
Dysfunctional breathing (DB) is common, frequently unrecognised and responsible for a substantial burden of morbidity. Previously lack of clarity in the use of the term and the use of multiple terms to describe the same condition has hampered our understanding. DB can be defined as an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms. It can be subdivided into thoracic and extra thoracic forms. Thoracic DB is characterised by breathing patterns involving relatively inefficient, excessive upper chest wall activity with or without accessory muscle activity. This is frequently associated with increased residual volume, frequent sighing and an irregular pattern of respiratory effort. It may be accompanied by true hyperventilation in the minority of subjects. Extra thoracic forms include paradoxical vocal cord dysfunction and the increasingly recognised supra-glottic 'laryngomalacia' commonly seen in young sportsmen and women. While the two forms would appear to be two discreet entities they often share common factors in aetiology and respond to similar interventions. Hence both forms are considered in this review which aims to generate a more coherent approach to understanding, diagnosing and treating these conditions.
Collapse
Affiliation(s)
- Nicki Barker
- Department of Respiratory Medicine, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Roberts Road, Subiaco 6008, Western Australia.
| |
Collapse
|
21
|
Abstract
Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis.
Collapse
Affiliation(s)
- Joshua J McBride
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ran D Anbar
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA.
| |
Collapse
|
22
|
Cortes AA, Landaeta M, Silva C. An 11-year-old girl with up to 19,200 coughs per day: broadening therapeutic strategies. APPLIED NEUROPSYCHOLOGY. CHILD 2013; 4:72-78. [PMID: 24236826 DOI: 10.1080/21622965.2013.799036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
An 11-year-old girl was transferred to the Universidad de Chile Clinical Hospital after 2.5 months of persistent and unresponsive treatment for coughlike spasms. On arrival, the frequency of symptoms was 1 cough every 4 s, which disappeared during sleep. A multidisciplinary examination excluded allergic, viral, respiratory, epileptic, and other more usual causes of similar conditions. Two diagnoses (psychogenic cough and transient vocal tic disorder) and a mixed intervention were proposed leading to resolution in 12 days of treatment. No recurrence of symptoms was observed during several evaluations within 12 months of medical follow-up. An association between the 2 diagnoses is proposed and discussed.
Collapse
Affiliation(s)
- Aaron A Cortes
- a Section of Immunology, HIV, and Allergy , Universidad de Chile Clinical Hospital , Santiago , Chile
| | | | | |
Collapse
|
23
|
|
24
|
Niggemann B, Evers M, Härtl M. Psychogenic and functional disorders of the respiratory tract in children and adolescents--a pilot study. Pediatr Allergy Immunol 2012; 23:605-6. [PMID: 22906369 DOI: 10.1111/j.1399-3038.2012.01295.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|