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Gibson RC, Lowe G, Lipps G, Jules MA, Romero-Acosta K, Daley A. Somatic and Depressive Symptoms Among Children From Latin America and the English-Speaking Caribbean. Clin Child Psychol Psychiatry 2024; 29:439-452. [PMID: 37230742 DOI: 10.1177/13591045231178890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The extent to which depression is associated with somatic complaints in children from the English-speaking Caribbean and Latin America is not well established. OBJECTIVE We sought to explore the association between depressive and somatic symptoms among children from the English-speaking Caribbean and Latin America, while accounting for age, sex, socioeconomic status, cultural background, and anxiety score. METHOD 1541 elementary school children, ages 9-12 years, from the English-speaking Caribbean and Latin America completed the Adolescent Depression Rating Scale (ARDS), the Numeric 0-10 Anxiety Self-Report Scale and the Children's Somatic Symptom Inventory-24 (CSSI-24). T-tests and ANOVA's were used to compare CSSI-24 and ARDS scores among countries, and the CSSI-24 scores of children with (ARDS ≥ 4) and without likely clinically significant depression. Regression analyses assessed possible predictors of CSSI-24 score. RESULTS Depressive and somatic symptom scores were highest among the Jamaican children and lowest among the Colombian children (p < .001). Children with likely clinically significant depression exhibited higher mean somatic symptom scores (p < .001). Depressive symptom scores predicted somatic symptom scores (p < .001). CONCLUSIONS Depressive symptoms were a strong predictor of reporting somatic symptoms. Knowledge of this association may facilitate better recognition of depression among youth.
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Affiliation(s)
- Roger C Gibson
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - Gillian Lowe
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - Garth Lipps
- Department of Sociology, Psychology and Social Work, The University of the West Indies, Kingston, Jamaica
| | - Mia A Jules
- Department of Education, The University of the West Indies, Cave Hill, Barbados
| | - Kelly Romero-Acosta
- Department of Psychological Research, Corporación Universitaria Del Caribe CECAR, Sincelejo, Colombia
| | - Avril Daley
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
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Ogrizek A, Ros T, Ludot M, Moro MR, Hatchuel Y, Gomez NG, Radjack R, Felix A. Asserting a Functional Neurological Symptom Disorder with a Complementary Diagnostic Approach: A Brief Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1601. [PMID: 37892264 PMCID: PMC10605693 DOI: 10.3390/children10101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Functional neurological symptom disorder (FNSD) is a common diagnosis among adolescents. However, we feel it is a difficult diagnosis to assess because of the diversity of its clinical manifestations, the rapid changes in its nosography over the years, and its common imbrication with established somatic diagnoses. We would like to illustrate this hypothesis through a case presentation and the original diagnostic process that emerged from it. METHODS We chose to present our diagnosis approach through the case of an 11-year-old boy who showed a progressive loss of motor and sensory function to the point of total dependency, and then suddenly switched between this state and a "normal" physical presentation, while deliriously claiming to be an angel. RESULTS All possible infectious, autoimmune, metabolic, and toxic disorders were ruled out. After the successive therapeutic failures of antidepressants and neuroleptics, FNSD was diagnosed. CONCLUSION The DSM-5-TR classification was insufficient to explain the full clinical picture and a complementary approach (biblical, psychoanalytical, and historical) was used to analyze the cause of this atypical presentation.
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Affiliation(s)
- Anais Ogrizek
- Department of Adult and Child Psychiatry, Martinique University Hospital, F-97200 Fort-de-France, France;
| | - Thomas Ros
- Department of Adult and Child Psychiatry, Martinique University Hospital, F-97200 Fort-de-France, France;
| | - Maude Ludot
- Department of Child Psychiatry, University of Paris, Hôpital Cochin, Maison de Solenn, F-75014 Paris, France; (M.L.); (M.-R.M.); (R.R.)
| | - Marie-Rose Moro
- Department of Child Psychiatry, University of Paris, Hôpital Cochin, Maison de Solenn, F-75014 Paris, France; (M.L.); (M.-R.M.); (R.R.)
| | - Yves Hatchuel
- Department of Pediatrics, Martinique University Hospital, F-97200 Fort-de-France, France; (Y.H.); (N.G.G.)
| | - Nicolas Garofalo Gomez
- Department of Pediatrics, Martinique University Hospital, F-97200 Fort-de-France, France; (Y.H.); (N.G.G.)
| | - Rahmeth Radjack
- Department of Child Psychiatry, University of Paris, Hôpital Cochin, Maison de Solenn, F-75014 Paris, France; (M.L.); (M.-R.M.); (R.R.)
| | - Arthur Felix
- Department of Pediatrics, Martinique University Hospital, F-97200 Fort-de-France, France; (Y.H.); (N.G.G.)
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Milano BA, Moutoussis M, Convertino L. The neurobiology of functional neurological disorders characterised by impaired awareness. Front Psychiatry 2023; 14:1122865. [PMID: 37009094 PMCID: PMC10060839 DOI: 10.3389/fpsyt.2023.1122865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
We review the neurobiology of Functional Neurological Disorders (FND), i.e., neurological disorders not explained by currently identifiable histopathological processes, in order to focus on those characterised by impaired awareness (functionally impaired awareness disorders, FIAD), and especially, on the paradigmatic case of Resignation Syndrome (RS). We thus provide an improved more integrated theory of FIAD, able to guide both research priorities and the diagnostic formulation of FIAD. We systematically address the diverse spectrum of clinical presentations of FND with impaired awareness, and offer a new framework for understanding FIAD. We find that unraveling the historical development of neurobiological theory of FIAD is of paramount importance for its current understanding. Then, we integrate contemporary clinical material in order to contextualise the neurobiology of FIAD within social, cultural, and psychological perspectives. We thus review neuro-computational insights in FND in general, to arrive at a more coherent account of FIAD. FIAD may be based on maladaptive predictive coding, shaped by stress, attention, uncertainty, and, ultimately, neurally encoded beliefs and their updates. We also critically appraise arguments in support of and against such Bayesian models. Finally, we discuss implications of our theoretical account and provide pointers towards an improved clinical diagnostic formulation of FIAD. We suggest directions for future research towards a more unified theory on which future interventions and management strategies could be based, as effective treatments and clinical trial evidence remain limited.
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Affiliation(s)
- Beatrice Annunziata Milano
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
- Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michael Moutoussis
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
| | - Laura Convertino
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- *Correspondence: Laura Convertino,
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Salmon M, Sibeoni J, Harf A, Moro MR, Ludot-Grégoire M. Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur. Front Psychiatry 2022; 13:897002. [PMID: 35958663 PMCID: PMC9358691 DOI: 10.3389/fpsyt.2022.897002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Aims Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade. Methods This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult. Results The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria. Conclusion This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research. Protocol PROSPERO registration number CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.
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Affiliation(s)
- Mathilde Salmon
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Aurélie Harf
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Maude Ludot-Grégoire
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
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Bodily expression of psychological distress in adolescents: a qualitative study. Child Adolesc Psychiatry Ment Health 2022; 16:40. [PMID: 35659270 PMCID: PMC9166518 DOI: 10.1186/s13034-022-00476-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The bodily expression of psychological disorders is one of the leading motives for consultations in adolescent medicine. The diagnostic entity corresponding to DSM-5 "Somatic symptom and related disorders" is sparsely used in the English-language literature, especially for adolescents. Qualitative studies on this topic mostly concern the experiences of healthcare professionals. This study seeks to explore the experience of adolescents expressing psychological distress through their body. METHODS This exploratory research took place in a Paris hospital department of adolescent medicine. Our sampling method was purposive. For inclusion, patients had to be aged 11-24 years, with a "somatic symptom disorder" meeting the DSM-5 criteria. Semi-directive interviews were proposed with visual narration inspired by photoelicitation. Thematic analysis allowed us to explore the data with an inductive approach. RESULTS Thirty adolescents were interviewed; they were 14-22 years old and mostly had somatic symptom or functional neurological disorders. Three principal themes emerged from our analysis of the interview contents: the personal, including bodily, experience of the disorder, the experience of relationships, and the question of what is visible through the body. CONCLUSION This research allowed us to discuss the reversal of generations, the function of the DSM-5 diagnosis, illuminated by sociology, and finally, cultural pathways. It shows the importance of recognizing the reality of the adolescents' bodily feelings, reassuring them by ruling out serious causes, and supporting their search for meaning. It is important to think about a specific framework of family therapy that can make effective use of this experience of the reversal of generations.
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Ludot M, Breton S, Ibrahim N, Moro MR. [A case of long form Covid-19 reported by a suffering teenager]. SOINS. PEDIATRIE, PUERICULTURE 2022; 43:12-14. [PMID: 35164920 DOI: 10.1016/j.spp.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Long-term Covid-19 is now part of our lives and can be questioned by adolescents and their families when faced with long- lasting and unexplained symptoms. This is the case of Alice, a 16-year-old teenager treated at the Cochin Hospital's adolescent centre, who presents digestive disorders and strange body sensations mas-king anxiety-depressive affects.
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Affiliation(s)
- Maude Ludot
- Maison de Solenn - Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France.
| | - Sarah Breton
- Maison de Solenn - Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
| | - Nour Ibrahim
- Maison de Solenn - Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
| | - Marie Rose Moro
- Maison de Solenn - Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
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Zhang J, Pan Y, Hong J, Guo H, Wang M, Liu X, Dong Y, Wang D, Liu L, Tan S, Jiang R. Differences of medically unexplained symptoms among patients of different ages and sexes in the psychological clinic of a general hospital and the influencing factors of MUS: A cross-sectional study. Front Psychiatry 2022; 13:930212. [PMID: 35990083 PMCID: PMC9386342 DOI: 10.3389/fpsyt.2022.930212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyse differences in sex, age, depression, insomnia, psychological stress, resilience, and perceived social support among patients with medically unexplained symptoms (MUS) in a psychological clinic of a general hospital, and to explore the influencing factors of MUS. METHODS This is a cross-sectional study. Seven hundred forty-six first-time patients were assessed with the integrated psychosomatic comprehensive evaluation system (IPS) to evaluate their MUS, depression, insomnia, psychological stress, resilience, and perceived social support. The psychological characteristics were compared with regard to sex and age group (<25 years, low age group; 26-44 years, middle age group; >45 years, high age group). The relationships between age and MUS were explored, and how psychological stress affects MUS was analyzed using the mediator effect model. RESULTS Different age groups had significant differences in sex, MUS, depression, psychological stress, resilience, and perceived social support. In further pairwise comparison, no significant difference existed in depression, psychological stress, resilience and perceived social support in the middle and low age groups, depression and psychological stress were higher than those in the high age group, resilience and perceived social support were lower than those of the high age group. MUS were higher in the middle age group than in the low age group. No significant difference existed between the two groups and the high age group. Age, severity of MUS, and perceived social support were significantly different between the sexes. Differences in MUS between men and women in different age groups were analyzed using two-factor analysis of variance. It revealed no interaction between sex and different age groups on MUS. The main effect analysis showed that the effects of different age groups on MUS were statistically significant. Based on pairwise comparative analysis, the MUS score in the low age group was lower than that in the middle age group. To clarify a nonlinear relationship between age and MUS, threshold effect analysis was conducted. The results indicated that the piecewise linear regression model could better depict the relationship between age and MUS. The inflection point was at the age of 60 years. Before the age of 60 years, MUS increased with age. No significant correlation existed between age and MUS after the age of 60 years. To understand the influencing factors of MUS, the intermediary effect model was analyzed using MUS as the dependent variable, psychological stress as the independent variable, resilience as mediator variable M1, perceived social support as mediator variable M2, and depression as mediator variable M3. Resilience, perceived social support, and depression had significant mediator effects on the effects of psychological stress on MUS with a total indirect effect of 69.81%. CONCLUSION The middle age group had greater MUS than the low age group. Before the age of 60 years, MUS increased with increasing age. Women had more severe MUS than men. Resilience, perceived social support, and depression had significant mediating effects on the effects of perceived stress on MUS. These findings suggest that clinicians should make more comprehensive and detailed evaluations and timely intervention for middle-aged and female patients. Improving psychological resilience and social support can reduce the impact of psychological stress on MUS. Therefore, psychotherapy and multidisciplinary comprehensive treatment are very important for patients is very important for patients.
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Affiliation(s)
- Jie Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Yu Pan
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Jiangyue Hong
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Hong Guo
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Mengyu Wang
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Xiaolei Liu
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Yanbin Dong
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Dejun Wang
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Lu Liu
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ronghuan Jiang
- Department of Psychological Medicine, The First Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
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