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Pico M, Matey-Rodríguez C, Domínguez-García A, Menéndez H, Lista S, Santos-Lozano A. Healthcare Professionals’ Knowledge about Pediatric Chronic Pain: A Systematic Review. CHILDREN 2023; 10:children10040665. [PMID: 37189914 DOI: 10.3390/children10040665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Pediatric chronic pain is a common public health problem with a high prevalence among children and adolescents. The aim of this study was to review the current knowledge of health professionals on pediatric chronic pain between 15–30% among children and adolescents. However, since this is an underdiagnosed condition, it is inadequately treated by health professionals. To this aim, a systematic review was carried out based on a search of the electronic literature databases (PubMed and Web of Science), resulting in 14 articles that met the inclusion criteria. The analysis of these articles seems to show a certain degree of heterogeneity in the surveyed professionals about the awareness of this concept, especially regarding its etiology, assessment, and management. In addition, the extent of knowledge of the health professionals seems to be insufficient regarding these aspects of pediatric chronic pain. Hence, the knowledge of the health professionals is unrelated to recent research that identifies central hyperexcitability as the primary factor affecting the onset, persistence, and management of pediatric chronic pain.
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Affiliation(s)
- Mónica Pico
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Carmen Matey-Rodríguez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Ana Domínguez-García
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Héctor Menéndez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
- Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
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2
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Pal R, Romero E, He Z, Stevenson T, Campen CJ. Pediatric Functional Neurological Disorder: Demographic and Clinical Factors Impacting Care. J Child Neurol 2022; 37:669-676. [PMID: 35815864 DOI: 10.1177/08830738221113899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a multicenter retrospective EMR-based chart review of 88 patients aged 3-21 years admitted for evaluation of functional neurologic disorder (FND). We sought to establish characteristics associated with FND, calculate incidence of abnormal neurodiagnostic findings, and determine features associated with variability in workup and treatment. FND patients were 65% female, 40% White, 33% Hispanic, and 88% primarily English speaking with median 13.9 years. We detected variability in management by age, ethnicity, psychiatric comorbidity, and hospital site. Our findings suggest limited utility to CTs in this setting (100% normal) and that workup can be safely informed by physical exam, which predicted abnormal MRI and LP results. We favor screening for adverse childhood experiences in FND patients. Hospitalization may be a rare opportunity for psychiatry contact.
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Affiliation(s)
- Ria Pal
- Neurology, 6429Stanford University, Palo Alto, CA, USA
| | - Emira Romero
- School of Nursing, 7149University of San Francisco, San Francisco, CA, USA
| | - Zihuai He
- Neurology, 6429Stanford University, Palo Alto, CA, USA
| | - Terrell Stevenson
- Pediatrics, 6429Stanford University, Palo Alto, CA, USA.,14454Santa Clara Valley Medical Center, San Jose, CA, USA
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Rappaport LG, VanderVennen MC, Monroe KK, McCaffery H, Stewart DA. Weekend Admissions for Somatic Symptom and Related Disorders and Length of Stay. Hosp Pediatr 2022; 12:79-85. [PMID: 34889353 DOI: 10.1542/hpeds.2021-006039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate whether admission on weekends affects the length of stay (LOS) for patients hospitalized with somatic symptom and related disorders (SSRDs). METHODS Data from 2012-2018 was obtained for all patients aged 4 to 21 years (N = 5459) with a primary discharge diagnosis of SSRDs from 52 tertiary care pediatric hospitals in the United States. We obtained patient demographics, admission date and/or time, LOS, procedure count, and comorbid conditions. We defined a weekend as 3 pm Friday to 3 pm Sunday. The Wilcoxon rank test was used for unadjusted analysis. Multiple logistic regression was used to estimate the odds of having LOS >1 day, >2 days, >3 days, and >4 days in weekend versus weekday groups. RESULTS Weekend admission significantly correlated with increased LOS (P < .001). Compared with weekdays, a weekend admission was associated with increased odds of having LOS >1, >2, and >3 days. This remained statistically significant while adjusting for the number of chronic conditions, procedures, and individuals with Black or Hispanic ethnicity compared with White ethnicity. LOS was not associated with sex or age of the patients. CONCLUSIONS Patients with SSRDs admitted on the weekend have an increased LOS compared with those admitted on a weekday. This may be due to a decrease in multidisciplinary care available during weekends. In future studies, researchers should aim to better understand the specific factors that contribute to this disparity and test interventions that may close the gap in care, including expanding to 7-day services, increasing mental health resources, and working to decrease the need for inpatient admissions.
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Affiliation(s)
- Leah G Rappaport
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Kimberly K Monroe
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Harlan McCaffery
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
| | - David A Stewart
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Brunner R, Jägle H, Kandsperger S. Dissociative Visual Loss in Children and Adolescents. Klin Monbl Augenheilkd 2021; 238:1084-1091. [PMID: 34662923 DOI: 10.1055/a-1617-3193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Psychogenic vision disorders in children and adolescents are a common disorder primarily encountered by ophthalmologists at the onset because, as with other disorders of dissociation, the presentation suggests a neurologic or other somatic condition. Loss of visual acuity, blurred vision and visual field restriction-often described as tunnel vision-appears to be typical. The onset may be sudden, frequently related to a wide range of stressful life events (school failure, family conflicts, accidents). While the majority of these children quickly recover from their symptoms, a substantial percentage experience persistent symptoms or a fluctuating course. Due to the lack of efficacy studies of specific treatment protocols, diagnostic work-up and treatment suffer from a high degree of uncertainty. Differentiating dissociative visual loss from physical illness requires special expertise. The uncertainty of ophthalmologists and the other specialists involved in dealing with this clinical condition often delays the specialised treatment and may also trigger inadequate therapy with the iatrogenic risk of harming the patient. This article primarily describes the disorder-specific psychiatric diagnostic as well as the somatic differential diagnostic work-up and outlines the therapeutic principles of dissociative visual loss.
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Affiliation(s)
- Romuald Brunner
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universität Regensburg, Deutschland
| | - Herbert Jägle
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
| | - Stephanie Kandsperger
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universität Regensburg, Deutschland
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5
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Hutson E, Thompson B, Bainbridge E, Melnyk BM, Warren BJ. Cognitive-Behavioral Skills Building to Alleviate the Mental Health Effects of Bullying Victimization in Youth. J Psychosoc Nurs Ment Health Serv 2021; 59:15-20. [PMID: 34039123 DOI: 10.3928/02793695-20210415-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bullying is a long-standing problem with relatively few intervention options for individual youth who have experienced it and have adverse mental health concerns. Depression, anxiety, and suicidal ideation are major consequences of bullying victimization. Although few evidence-based interventions have been put forth to address bullying victimization at the individual level, cognitive-behavioral therapy (CBT) and cognitive-behavioral skills building (CBSB) have been well researched for mental health concerns in youth. The purpose of the current article is to examine the theoretical framework of cognitive theory for individuals who have experienced bullying. Previous work that has addressed CBT for bullying interventions is described. Specific examples of how CBSB components could be applied to a bullying intervention program for youth are discussed. Ultimately, providing a theoretical framework to address this public health concern sets the stage for future intervention research. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 15-20.].
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Vesterling C, Koglin U. Somatoform complaints in middle childhood A developmental path-analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractRepeatedly occurring somatoform complaints often cause disruptions in children’s daily life, both in family and school settings. Associated with these complaints, there is an increased demand for medical help in the affected children. Despite the frequent occurrence of somatoform complaints in childhood, only a small number of studies have focused on this subject, and the development and maintenance of somatoform complaints have not sufficiently explained to date. Previous research suggests that many different factors are involved, including insecure attachment, a lack of emotion regulation (ER) strategies, and psychiatric behavior problems. The aim of this study is to examine possible pathways describing the interplay of aforementioned factors, in order to contribute to a deeper understanding of the underlying mechanisms. A nonexperimental cross-sectional study was conducted. Questionnaires were completed by 221 children (female n = 115; Mage = 9.70 years, SDage = .56) reporting on their attachment and ER strategies, and their parents reported on the behavior problems and somatoform complaints. Path analysis revealed a good model fit (Χ2 = p .798, Χ2/df = .415, NFI = .994, CFI = 1.000, RMSEA = .000). Results revealed that attachment anxiety predicted maladaptive ER strategies, and attachment avoidance predicted emotion control. In turn significant paths were found between ER strategies, behavior problems, and somatoform complaints. This study provides a first insight into the underlying mechanisms describing the occurrence of somatoform complaints. Results revealed two developmental pathways, based on attachment quality and mediated through different emotion regulation strategies.Clinical Trial Registration: The project “Impact factors and conditions of somatoform symptoms in childhood within familial and school contexts” is listed in the German Clinical Trails Register (DRKS-ID: DRKS00012444) and the WHO International Clinical Trials Registry Platform.
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Cozzi G, Lucarelli A, Borrometi F, Corsini I, Passone E, Pusceddu S, Morabito G, Barbi E, Benini F. How to recognize and manage psychosomatic pain in the pediatric emergency department. Ital J Pediatr 2021; 47:74. [PMID: 33766115 PMCID: PMC7992953 DOI: 10.1186/s13052-021-01029-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/15/2021] [Indexed: 01/19/2023] Open
Abstract
Aim Children and adolescents affected by somatization and somatic symptom disorder commonly refer to emergency services. Due to the absence of specific guidelines for the emergency setting and to a possible lack of knowledge, these patients are at risk of being unrecognized and mismanaged. This study aims at proposing a clinical practice to approach and manage these patients and their families in the emergency setting. Methods This manuscript derived from the work of a research group of italian pediatric emergency physicians and anesthesiologists, with an expertise in pain management, members of the PIPER group. The research group reviewed the literature about psychosomatic pain and somatic symptom disorder and developed a clinical practice specific for the pediatric emergency setting. Results The manuscript provides information about the main clinical features shared by patients with psychosomatic pain and about current diagnostic criteria and appropriate management in the emergency setting. Furthermore, it highlights the possible pitfalls in which the emergency physician may run into dealing with these patients. Conclusion This clinical practice should be seen as a starting point toward a better understanding of patients with psychosomatic pain and a standardization of care in the pediatric emergency setting.
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Affiliation(s)
- Giorgio Cozzi
- Pediatric Emergency Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137, Trieste, Italy.
| | - Annunziata Lucarelli
- Department of Paediatrics and Emergency, Giovanni XXIII Children's Hospital, University of Bari, Bari, Italy
| | - Fabio Borrometi
- Pediatric Pain Service and Palliative Care, Department of Oncology, Pausilipon Hospital, AORN Santobono Pausilipon, Naples, Italy
| | - Ilaria Corsini
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eva Passone
- Pediatric Clinic, Department of Clinical and Experimental Sciences, DAME, ASUFC S. Maria Della Misericordia, University of Udine, Udine, Italy
| | - Sara Pusceddu
- Pediatric Department, Ospedale S. Maria della Scaletta AUSL, Imola, Italy
| | - Giuliana Morabito
- Pediatric and Neonatology Division, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Egidio Barbi
- Pediatric Emergency Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Franca Benini
- Paediatric Palliative Care - Pain Service Department of Women's and Children's Health, University of Padua, Padua, Italy
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8
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Jenkins W, Smart K. Somatization in acute care pediatrics: Respecting the mind-body connection. Clin Child Psychol Psychiatry 2020; 25:604-609. [PMID: 32070126 DOI: 10.1177/1359104520905065] [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] [Indexed: 11/16/2022]
Abstract
Somatic symptom disorder is a complex condition linking distress in the mind to physical distress in the body. However, in addition to the disorder itself, experienced clinicians know that children and youth frequently experience somatizing symptoms. With an increasing prevalence of anxiety in the pediatric population, symptoms attributable to process of "somatizing" are common, and early identification and rapport building to address the root causes of a child's distress are critical for a good outcome. In the acute care setting, clinicians are often reluctant to make the diagnosis of somatization. Part of the challenge is encouraging clinicians to see that somatization is not a "diagnosis of exclusion." We want to encourage clinicians to routinely consider risk factors for somatization in their histories, actively discuss the mind-body connection with patients and families, and include somatization in a carefully considered differential diagnosis. The more we can break down the siloing of physical from mental health, the better we will serve our patients.
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Watson C, Sivaswamy L, Agarwal R, Du W, Agarwal R. Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children's Hospital. J Child Neurol 2019; 34:325-331. [PMID: 30819032 DOI: 10.1177/0883073819830193] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not. STUDY DESIGN Single center, retrospective review of 222 children who presented to the emergency department of a children's hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015. RESULTS Out of 222 visits (females = 156, African Americans = 130, mean age = 13.9 years), neurodiagnostic tests were performed in 102/222 (46%) visits. The most commonly performed investigations were magnetic resonance imaging (MRI) of brain (n = 37) and electroencephalogram (EEG) (n = 56) and were noted to be unremarkable in all instances. Neurodiagnostic tests were more likely to be performed in patients who (1) were non-African American (54% vs 40%; P = .03), (2) presented with new-onset symptoms (55% vs 31%; P < .01), (3) underwent hospitalization (61% vs 17%; P < .01), and (4) were evaluated by a neurologist (59% vs 9%; P < .01) or a psychiatrist (58% vs 28%; P < .01). Common clinical presentations included seizurelike or strokelike symptoms. Short-term follow-up was possible in 20%, with an alternate diagnosis of syncope, noted in only 1 child. CONCLUSIONS Most children who presented with a functional neurologic symptom disorder in our study were noted to have seizurelike or strokelike presentations and were adolescent females. Caucasians were more likely to undergo neurodiagnostic investigations. Radiologic and neurophysiological tests were more commonly performed when neurology and psychiatry consultations were sought. Such investigations had low diagnostic utility.
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Affiliation(s)
- Carla Watson
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Roshani Agarwal
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,4 Divisions of Hospital Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Wei Du
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rajkumar Agarwal
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
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Ibeziako P, Brahmbhatt K, Chapman A, De Souza C, Giles L, Gooden S, Latif F, Malas N, Namerow L, Russell R, Steinbuchel P, Pao M, Plioplys S. Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings. Hosp Pediatr 2019; 9:147-155. [PMID: 30782623 PMCID: PMC11034856 DOI: 10.1542/hpeds.2018-0205] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. There is, however, a lack of standardization of care across institutions for youth with these disorders. These patients are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. SSRDs are associated with significant health care use, cost to families and hospitals, and risk for iatrogenic interventions and missed diagnoses. With sponsorship from the American Academy of Child and Adolescent Psychiatry and input from multidisciplinary stakeholders, we describe the first attempt to develop a clinical pathway and standardize the care of patients with SSRDs in pediatric hospital settings by a working group of pediatric consultation-liaison psychiatrists from multiple institutions across North America. The authors of the SSRD clinical pathway outline 5 key steps from admission to discharge and include practical, evidence-informed approaches to the assessment and management of children and adolescents who are medically hospitalized with SSRDs.
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Affiliation(s)
- Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts;
| | - Khyati Brahmbhatt
- Langley Porter Psychiatric Institute
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Andrea Chapman
- Department of Psychiatry, British Columbia Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Claire De Souza
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Lisa Giles
- Department of Psychiatry and Behavioral Health, Primary Children's Hospital and School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Shanti Gooden
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Finza Latif
- Department of Psychiatry and Behavioral Sciences, Children's National Medical Center and The George Washington University, Washington, District of Columbia
| | - Nasuh Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, C.S. Mott Children's Hospital, University of Michigan Hospital Systems, Ann Arbor, Michigan
| | - Lisa Namerow
- Department of Psychiatry, Connecticut Children's Medical Center and Institute of Living, School of Medicine, University of Connecticut, Hartford, Connecticut
| | - Ruth Russell
- Department of Psychiatry, Montreal Children's Hospital and McGill University, Montreal, Canada
| | - Petra Steinbuchel
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Maryland Pao
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland; and
| | - Sigita Plioplys
- Department of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Bolger A, Collins A, Michels M, Pruitt D. Characteristics and Outcomes of Children With Conversion Disorder Admitted to a Single Inpatient Rehabilitation Unit, A Retrospective Study. PM R 2018; 10:910-916. [DOI: 10.1016/j.pmrj.2018.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/26/2018] [Accepted: 03/04/2018] [Indexed: 11/16/2022]
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12
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Sharma N, Daley M, Vente T. Pediatric Somatic Symptom Disorder: An Overview. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170831-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Abstract
Somatic symptom disorder (SSD) is a common disorder encountered in pediatric medicine. It involves the presentation of physical symptoms that are either disproportionate or inconsistent with history, physical examination, laboratory, and other investigative findings. SSDs result in significant impairment with considerable increase in healthcare utilization, school absenteeism, and the potential for unnecessary diagnostic evaluation and treatment intervention. Patients and families often feel dismissed and may worry that a serious condition has been missed. Primary care providers are frequently frustrated due to a lack of a successful approach to patients and families impacted by SSD. The result is often a cycle of disability, frustration and missed opportunities for collaboration towards enhanced patient functionality. This review summarizes the current evidence-based understanding, as well as insights from clinician experience, on the evaluation and management of pediatric SSD.
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14
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Tøt-Strate S, Dehlholm-Lambertsen G, Lassen K, Rask CU. Clinical features of functional somatic symptoms in children and referral patterns to child and adolescent mental health services. Acta Paediatr 2016; 105:514-21. [PMID: 26666703 DOI: 10.1111/apa.13310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 10/12/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Abstract
AIM Functional somatic symptoms (FSS) are common in paediatric patients who are referred to Child and Adolescent Mental Health Service (CAMHS), but little is known about current referral practices. The aim of this study was to systematically investigate clinical features of paediatric inpatients with FSS referred to CAMHS and to describe why paediatricians referred them. METHODS The study population comprised 60 children with FSS admitted to a large Danish paediatric department during 2012. We compared medical record data on the clinical characteristics and paediatric management of 16 children who had been referred and 44 children who had not. RESULTS Most paediatric records lacked information on psychosocial factors and symptoms. Referred children were significantly more multisymptomatic of FSS (p < 0.01) than the controls, had longer symptom duration, underwent more clinical investigations, had longer paediatric admissions of at least two weeks and received more treatment elements before referral. The most frequently stated referral reason was inadequate treatment response. CONCLUSION Paediatric inpatients with more severe FSS were more likely to be referred to CAMHS, but referral reasons were generally vague and psychosocial information was frequently missing. Clinical guidelines are needed to improve and systematise mental health referrals for children with FSS.
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Affiliation(s)
- Simone Tøt-Strate
- Department of Child and Adolescent Psychiatry Odense; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Gitte Dehlholm-Lambertsen
- Department of Child and Adolescent Psychiatry Odense; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Karin Lassen
- Department of Paediatrics; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics; Aarhus University Hospital; Aarhus Denmark
- Regional Centre for Child and Adolescent Psychiatry; Risskov; Aarhus University Hospital; Aarhus Denmark
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15
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Scheer P, Kamper A. Umgang mit Kindern und Jugendlichen mit nichtspezifischen, funktionellen und somatoformen Körperbeschwerden. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-015-3481-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Ibeziako P, Choi C, Randall E, Bujoreanu S. Bullying Victimization in Medically Hospitalized Patients With Somatic Symptom and Related Disorders: Prevalence and Associated Factors. Hosp Pediatr 2016; 6:290-6. [PMID: 27073256 DOI: 10.1542/hpeds.2015-0207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study is to describe the prevalence of bullying victimization among medically admitted patients with somatic symptom and related disorders (SSDs) and to compare demographic, diagnostic, and psychosocial characteristics of bullied versus nonbullied patients. METHODS Medically admitted patients at a tertiary pediatric facility referred to the Psychiatry Consultation Service with somatic concerns were assessed via a quality improvement (QI) initiative, the SSD Standardized Clinical Assessment and Management Plan (SSD-SCAMP). Retrospective chart and QI data on adolescent and young adult patients assessed via SSD-SCAMP from May 2012 - December 2014 were reviewed. RESULTS Medical records of 282 patients (aged 12-22 years) diagnosed with SSDs were reviewed. Approximately 37% had a history of bullying victimization. Compared with nonbullied patients, bullied patients had higher somatization scores, more functional neurologic symptoms, and longer admissions. Bullied patients also had higher rates of comorbid anxiety, suicidal histories, and family psychiatric histories. Furthermore, bullied patients also had higher rates of learning disabilities and school accommodations and endorsed more significant life events within the year before hospitalization. CONCLUSIONS This study describes the unique health and psychosocial challenges experienced by medically hospitalized bullied adolescents and young adults with SSDs. The findings highlight the importance of a multidisciplinary approach to assessment and management. By implementing QI initiatives such as the SSD-SCAMP, providers can bridge the gap between the clinical needs and long-term management of patients with SSDs.
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Affiliation(s)
- Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Christine Choi
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
| | - Edin Randall
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Simona Bujoreanu
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
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Hinton D, Kirk S. Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:12-26. [PMID: 25684117 DOI: 10.1111/hsc.12184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Abstract
Children and young people frequently report physical complaints that have no observable physical pathology known as medically unexplained symptoms (MUS). Research suggests that MUS are associated with substantial physical and psychological impairments and may have a negative impact on children's and young people's functional status and well-being in the long term. Due to the potentially complex needs of this group, children and young people with MUS may require timely access to suitable health and social care services to effectively manage symptoms and achieve their academic, social and personal potential. Families and professionals can offer important insights into the availability and appropriateness of current community and specialist health and social care services. This review is the first critical evaluation and synthesis of research that has examined families' and healthcare professionals' (HCP) perceptions of healthcare services for children and young people with MUS. A systematic search of electronic databases and manual searches of key journals and reference lists identified 17 papers from 15 studies for inclusion in the review. The review highlights the paucity of rigorously conducted research on this topic. Studies have been narrowly focused on the views of a homogeneous group of mothers and young people attending single centres. There has been some attempt to examine doctors' views, but the perceptions of children, fathers and health and social care professionals are absent or under-represented, and multi-site and longitudinal studies are lacking. Thematic analysis of the results from the included studies suggests that knowledge, communication, health beliefs and healthcare settings are factors that influence families' and HCPs' perceptions of services. Families report dissatisfaction with some HCPs' approach to managing MUS. The findings suggest that children and young people with MUS are at risk of receiving suboptimal care and support because there is insufficient research to inform high-quality, evidence-based practice.
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Affiliation(s)
- Denise Hinton
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Susan Kirk
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Basch MC, Chow ET, Logan DE, Schechter NL, Simons LE. Perspectives on the clinical significance of functional pain syndromes in children. J Pain Res 2015; 8:675-86. [PMID: 26504406 PMCID: PMC4605245 DOI: 10.2147/jpr.s55586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Functional pain syndromes (FPS) characterize a subset of individuals who experience pain and related symptoms and disability without clear structural or disease etiology. In the pediatric population, FPS hold high clinical importance due to significant prevalence rates and potential to persist into adulthood. Although extensive research has been executed to disambiguate FPS, the syndromes that fall within its spectrum remain conceptually complex and sometimes ill-defined. This paper provides an overview of available research on the classification and multifaceted etiology of FPS in youth and their effects on interpersonal, psychological, and familial function. Vital aspects of a successful multidisciplinary approach to treating this population are described; however, it is evident that future research requires more longitudinal studies.
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Affiliation(s)
- Molly C Basch
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston Children’s Hospital, Center for Pain and the Brain, PAIN Research Group, Boston University, Boston, MA, USA
| | - Erika T Chow
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Deirdre E Logan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Neil L Schechter
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston Children’s Hospital, Center for Pain and the Brain, PAIN Research Group, Boston University, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Klineberg E, Rushworth A, Bibby H, Bennett D, Steinbeck K, Towns S. Adolescent chronic fatigue syndrome and somatoform disorders: a prospective clinical study. J Paediatr Child Health 2014; 50:775-81. [PMID: 24944088 DOI: 10.1111/jpc.12653] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2014] [Indexed: 11/27/2022]
Abstract
AIM To examine and compare the presenting characteristics and the change in the physical and psychosocial functioning of adolescents with chronic fatigue syndrome (CFS) or somatoform disorders who have received an adaptable multidisciplinary intervention over a 12-month period. METHODS Fifty adolescents presenting to the Complex Adolescent Clinic at The Children's Hospital at Westmead, Sydney, Australia were assessed. Their physical and psychosocial functioning was rated by the adolescents and their parents using the Child Health Questionnaire. Participants were assessed at baseline, 4 months and 12 months after initiating treatment. Analyses examined whether diagnosis and/or illness precipitants were related to treatment outcome. RESULTS Adolescents with both CFS and somatoform disorders demonstrated improvement in physical and psychosocial functioning over the first 4 months of treatment, sustained at 12-month follow-up. A diagnosis of CFS was associated with poorer physical functioning over time and a trend towards a longer illness time course compared with somatoform disorder. Adjustment for a physical precipitant reduced the association between diagnosis and physical functioning. Those who had a physical precipitant to their illness had significantly poorer physical functioning over time than those who did not, regardless of diagnostic category. Diagnosis and physical precipitant were not associated with psychosocial functioning. CONCLUSIONS Improvement in adolescent physical and psychosocial functioning over time suggests that a multidisciplinary treatment model may be effective for varied complex medico-psychosocial presentations, irrespective of diagnosis and illness precipitant. Illness precipitant may have a greater influence on treatment outcome than diagnostic category.
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Affiliation(s)
- Emily Klineberg
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Bujoreanu S, Randall E, Thomson K, Ibeziako P. Characteristics of medically hospitalized pediatric patients with somatoform diagnoses. Hosp Pediatr 2014; 4:283-290. [PMID: 25318110 DOI: 10.1542/hpeds.2014-0023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe demographic, diagnostic, and psychosocial characteristics of medically admitted patients diagnosed with somatoform disorders. METHODS Retrospective chart reviews were performed for pediatric patients (ages 3-18 years) seen by the Psychiatry Consultation Service in 2010 and 2011 on inpatient medical/surgical units and diagnosed with somatoform disorders. Data included demographic information; patient medical history, physical symptom characteristics, and service utilization; psychiatric diagnoses, history, and comorbidities, patient temperament, and coping style; family characteristics; and academic and social characteristics. RESULTS Mean age for the 161 identified patients was 14.4 years. The majority of patients were female (75%) and white (73%). Chief physical symptoms were pain (58%) and neurologic symptoms (40%); 73% of patients had medical diagnoses, and 66% had a history of prior psychiatric treatment. The most common somatoform diagnoses, using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, were pain (50%) and conversion disorders (28%). Psychiatric comorbidities were predominantly mood and anxiety disorders (42% and 29%, respectively). Mean hospitalization length was 4.9 days, with 14% of patients readmitted with psychiatric reinvolvement during the study period. Patients had sensitive temperaments (80%) and internalizing coping styles (76%) and were described as "good children" (72%). School absences (55%), academic pressures (51%), and learning difficulties (36%) were reported. CONCLUSIONS Clarifying the prevalence and nature of such characteristics can help pediatric providers improve patient care and minimize unnecessary medical interventions with early detection of risk for somatoform processes, provision of psychoeducation for patients and families, and early referral to mental health clinicians.
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Affiliation(s)
- Simona Bujoreanu
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Edin Randall
- Boston Children's Hospital and Harvard Medical School, Boston, MA
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21
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Rousseau S, Grietens H, Vanderfaeillie J, Hoppenbrouwers K, Wiersema JR, Baetens I, Vos P, Van Leeuwen K. The association between parenting behavior and somatization in adolescents explained by physiological responses in adolescents. Int J Psychophysiol 2014; 93:261-6. [PMID: 24862009 DOI: 10.1016/j.ijpsycho.2014.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 05/01/2014] [Accepted: 05/17/2014] [Indexed: 01/30/2023]
Abstract
INTRODUCTION This study adds to the knowledge on somatization in adolescents by exploring its relation with parenting behavior and the mediating/moderating role of physiological responses in adolescents to parenting behavior. METHOD Eighteen adolescents with high and 18 adolescents with low somatization scores and their mothers completed a discussion task, from which observed parenting behavior scores were derived. Skin conductance in adolescents was measured before and during the discussion. RESULTS For adolescents with high levels of physiological responses, unadaptive parenting was related to a higher chance of high somatization scores. For low physiologically responsive adolescents, the relation between parenting behavior and somatization was not significant. CONCLUSION Parenting behavior is not univocally related to somatization in adolescents, but the association depends on physiological responses in adolescents.
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Affiliation(s)
- Sofie Rousseau
- Parenting and Special Education Research Unit, University of Leuven, L. Vanderkelenstraat 32, 3000 Leuven, Belgium.
| | - Hans Grietens
- Centre for Special Needs Education & Youth Care, University of Groningen, Grote Rozenstraat 38, 9712 TJ Groningen, the Netherlands.
| | - Johan Vanderfaeillie
- Department of Clinical & Life Span Psychology, University of Brussels, Pleinlaan 2, 1050 Brussels, Belgium.
| | - Karel Hoppenbrouwers
- Centre of Youth Health Care, University of Leuven, Kapucijnenvoer 35 blok d, Belgium.
| | - Jan R Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Imke Baetens
- Clinical Psychology Research Unit, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
| | - Pieter Vos
- Parenting and Special Education Research Unit, University of Leuven, L. Vanderkelenstraat 32, 3000 Leuven, Belgium.
| | - Karla Van Leeuwen
- Parenting and Special Education Research Unit, University of Leuven, L. Vanderkelenstraat 32, 3000 Leuven, Belgium.
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Leaver CA. Visiting again? Subjective well-being of children in elementary school and repeated visits to school health nurses. THE JOURNAL OF SCHOOL HEALTH 2014; 84:294-301. [PMID: 24707923 DOI: 10.1111/josh.12150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 04/10/2013] [Accepted: 05/05/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Children with vague complaints are without chronic illness, and who repeatedly visit the school nurse may be at risk for limited academic success. This study compares student reports of subjective well-being between children who do and do not repeatedly visit the school nurse with vague complaints. METHODS Children in grades 4 through 6 completed the School Well-Being Profile-American English (SWBP-AE), a questionnaire with 4 well-being subscales: health status, school environment, social relationships, and school as a means of self-fulfillment. School nurses extracted data on clinic visits from clinic records. Logistic regression explored associations between well-being subscales and repeated visits to the school nurse. RESULTS Of the 320 students participating in the study, 33 (12.04%) students made repeated visits to the school nurse. Perception of health status (OR = 2.072; 95% CI = 1.037, 4.163) was the only significant (p < .05) predictor of repeated visits to the nurse. CONCLUSION Children with poor perception of their health status are more likely to repeatedly visit the school nurse. Children's perceptions of their school environment, social relationships, or school as a means of self-fulfillment are not statistically significant predictors of repeated visits to the school nurse.
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Affiliation(s)
- Cynthia A Leaver
- National Institute of Nursing Research, National Institutes of Health, Division of Intramural Research, 10 Center Drive, 2-1339, Bethesda, MD 20892
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23
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Imran N, Ani C, Mahmood Z, Hassan KA, Bhatti MR. Anxiety and depression predicted by medically unexplained symptoms in Pakistani children: a case-control study. J Psychosom Res 2014; 76:105-12. [PMID: 24439685 DOI: 10.1016/j.jpsychores.2013.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 11/26/2013] [Accepted: 11/29/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore association between medically unexplained symptoms in children in Pakistan with emotional difficulties and functional impairments. METHODS We conducted a matched three-group case-control study of 186 children aged 8-16 years in Lahore, Pakistan. Cases were 62 children with chronic somatic symptoms for which no organic cause was identified after investigations. Two control groups of 62 children with chronic medical paediatric conditions, and 62 healthy children were identified. Cases and controls were matched for gender, age, and school class. Somatisation was measured with the Children's Somatisation Inventory (CSI-24) while anxiety and depression were measured with the Spencer Children's Anxiety Scale and the Short Mood and Feelings Questionnaire respectively. All questionnaires were translated into Urdu. RESULTS Mean age was 11.7 years (SD=2.1). Cases scored significantly higher on somatisation (CSI-24), anxiety and depression than both control groups. Paediatric controls scored significantly higher than healthy controls on all three measures. Two hierarchical linear regression models were used to explore if somatisation predicted depression and anxiety while controlling for several confounders. Somatisation (higher CSI-24 scores) independently and significantly predicted higher anxiety (β=.37, p=.0001) and depression (β=.41, p=.0001) scores. CONCLUSION This is the first study to show an association between medically unexplained symptoms and anxiety and depression in Pakistani children. This highlights the importance of screening for emotional difficulties in children presenting with unexplained somatic symptoms in this region.
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Affiliation(s)
- Nazish Imran
- Child & Family Psychiatry Department, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
| | - Cornelius Ani
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, St Mary's Hospital, Paddington, London, UK; Consultant Child and Adolescent Psychiatrist, Bracknell CAMHS, Berkshire Healthcare NHS Foundation Trust, Berkshire, UK.
| | - Zahid Mahmood
- Department of Clinical Psychology, University of Management and Technology, Lahore, Pakistan.
| | - Khawaja Amjad Hassan
- Department of Paediatrics, Paediatrics Unit II, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
| | - Muhammad Riaz Bhatti
- Department of Psychiatry& Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
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Potik D, Feldinger E, Schreiber S. Issues in psychotherapeutic encounters of patients suspected of post-traumatic stress disorder malingering. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2012. [DOI: 10.1080/13642537.2012.713185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kadıoğlu H, Şişman FN, Ergün A. Reliability and Validity of the Turkish Version of Children's Somatization Inventory. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:9-12. [PMID: 25030685 DOI: 10.1016/j.anr.2012.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 02/15/2012] [Accepted: 02/17/2012] [Indexed: 01/23/2023] Open
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26
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Affiliation(s)
- Mary Lynn Dell
- Division of Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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27
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Ouss-Ryngaert L. Expressions neurologiques des conversions de l’enfant et de l’adolescent. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rask CU, Borg C, Søndergaard C, Schulz-Pedersen S, Thomsen PH, Fink P. A medical record review for functional somatic symptoms in children. J Psychosom Res 2010; 68:345-52. [PMID: 20307701 DOI: 10.1016/j.jpsychores.2009.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 09/15/2009] [Accepted: 06/10/2009] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objectives of this study were to develop and test a systematic medical record review for functional somatic symptoms (FSSs) in paediatric patients and to estimate the inter-rater reliability of paediatricians' recognition of FSSs and their associated impairments while using this method. METHODS We developed the Medical Record Review for Functional Somatic Symptoms in Children (MRFC) for retrospective medical record review. Described symptoms were categorised as probably, definitely, or not FSSs. FSS-associated impairment was also determined. Three paediatricians performed the MRFC on the medical records of 54 children with a diagnosed, well-defined physical disease and 59 with 'symptom' diagnoses. The inter-rater reliabilities of the recognition and associated impairment of FSSs were tested on 20 of these records. RESULTS The MRFC allowed identification of subgroups of children with multisymptomatic FSSs, long-term FSSs, and/or impairing FSSs. The FSS inter-rater reliability was good (combined kappa=0.69) but only fair as far as associated impairment was concerned (combined kappa=0.29). CONCLUSIONS In the hands of skilled paediatricians, the MRFC is a reliable method for identifying paediatric patients with diverse types of FSSs for clinical research. However, additional information is needed for reliable judgement of impairment. The method may also prove useful in clinical practice.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
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30
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Shannon RA, Bergren MD, Matthews A. Frequent visitors: somatization in school-age children and implications for school nurses. J Sch Nurs 2010; 26:169-82. [PMID: 20065098 DOI: 10.1177/1059840509356777] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a gap in the nursing literature regarding children who frequently visit school nurses' offices with recurrent unexplained physical symptoms. A review of the scientific health literature was undertaken to examine the clinical presentation, associated variables, and implications for school nurses regarding children who are frequent school health office visitors with somatic symptoms. This subset of students with medically unexplained symptoms accounts for disproportionate use of primary care and school health resources. Common somatic complaints in school-age children, such as headache and stomachache, are associated with the psychosocial variables of anxiety and depression, childhood adversity, and school stress. Effective and practical treatment approaches to this complicated child health issue require accurate identification, appropriate referral, screening for associated conditions, and individualized treatment plans. Research to identify effective interventions for frequent health office visitors is needed.
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Development of a Scale to Assess the Attitudes of Paediatric Staff to Caring for Children with Medically Unexplained Symptoms: Implications for the Role of CAMHS in Paediatric Care. Child Adolesc Ment Health 2009. [DOI: 10.1111/j.1475-3588.2008.00507.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE It is common in health care settings for adolescent patients to report physical symptoms that are unexplained by physical disease or pathophysiologic processes. The diagnosis of conversion disorder is difficult to make as many of these patients present to primary care with complex, difficult-to-understand medical symptoms. Patients can present with a medical dilemma and a symptom model consistent with a conversion disorder, but there is a danger of misdiagnosis without a thorough medical work up. METHOD This case report describes a patient where the misdiagnosis of conversion disorder could have had devastating long-lasting neurologic sequelae. It appeared as if an unconscious conflict was being expressed through physical symptoms as she had ongoing family stressors prior to the onset of mysterious symptoms. CONCLUSIONS The patient was found to have a spinal cord arteriovenous malformation. This condition is relatively uncommon in the pediatric age group, and early diagnosis is rarely made.
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Affiliation(s)
- Eve G Spratt
- Medical University of South Carolina, Charleston 29425, USA.
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33
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Eminson DM. Medically unexplained symptoms in children and adolescents. Clin Psychol Rev 2007; 27:855-71. [PMID: 17804131 DOI: 10.1016/j.cpr.2007.07.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 06/04/2006] [Accepted: 02/07/2007] [Indexed: 01/30/2023]
Abstract
A review is presented of the range of medically unexplained symptoms (MUS) in children and adolescents, with an account of the main presentations that are recognised in clinical settings in paediatric and children's mental health services. A summary of both epidemiological and clinical studies of symptoms and their associations is given, followed by a brief overview of aetiological theories and of management interventions.
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Affiliation(s)
- D Mary Eminson
- Bolton Hospitals NHS Trust, Child and Adolescent Mental Health Services, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton BL4 OJR, UK.
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Kirkwood MW, Yeates KO, Taylor HG, Randolph C, McCrea M, Anderson VA. Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery. Clin Neuropsychol 2007; 22:769-800. [PMID: 17896204 PMCID: PMC2847840 DOI: 10.1080/13854040701543700] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Little scientific attention has been aimed at the non-acute clinical care of pediatric mild TBI. We propose a clinical management model focused on both evaluation and intervention from the time of injury through recovery. Intervention strategies are outlined using a framework encompassing four relevant domains: the individual youth, family, school, and athletics. Clinical management has primary value in its potential to speed recovery, minimize distress during the recovery process, and reduce the number of individuals who subjectively experience longer lasting postconcussive problems. With proper management, most children and adolescents sustaining an uncomplicated mild TBI can be expected to recover fully.
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Affiliation(s)
- Michael W Kirkwood
- Department of Physical Medicine, University of Colorado at Denver and Health Sciences Center and The Children's Hospital, Denver, CO, USA.
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35
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Hausteiner C, Bornschein S, Förstl H, Zilker T. Multiple Chemikaliensensitivität (MCS). Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-005-1182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Finney DA. Verbal therapy with a girl who could not hear. CLIN PSYCHOL-UK 2007. [DOI: 10.1080/13284200600939884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Deborah A. Finney
- Children's Hospital at Westmead , Westmead, New South Wales, Australia
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37
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Campo JV. Coping with ignorance: exploring pharmacologic management for pediatric functional abdominal pain. J Pediatr Gastroenterol Nutr 2005; 41:569-74. [PMID: 16254511 DOI: 10.1097/01.mpg.0000189326.65076.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- John V Campo
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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38
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Bailey BN, Delaney-Black V, Hannigan JH, Ager J, Sokol RJ, Covington CY. Somatic complaints in children and community violence exposure. J Dev Behav Pediatr 2005; 26:341-8. [PMID: 16222173 DOI: 10.1097/00004703-200510000-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Somatic complaints of children in primary care settings often go unexplained despite attempts to determine a cause. Recent research has linked violence exposure to stress symptomatology and associated somatic problems. Unknown, however, is whether specific physical symptom complaints can be attributed, at least in part, to violence exposure. Urban African-American 6- and 7-year-old children (N = 268), residing with their biological mothers, recruited before birth, and without prenatal exposure to hard illicit drugs participated. Children and mothers were evaluated in our hospital-based research laboratory, with teacher data collected by mail. Community violence exposure (Things I Have Seen and Heard), stress symptomatology (Levonn), and somatic complaints (teacher-and self-report items) were assessed. Additional data collected included prenatal alcohol exposure, socioeconomic status, domestic violence, maternal age, stress, somatic complaints and psychopathology, and child depression, abuse, and gender. Community violence witnessing and victimization were associated with stress symptoms (r = .26 and .25, respectively, p < .001); violence victimization was related to decreased appetite (r = .16, p < .01), difficulty sleeping (r = .21, p < .001), and stomachache complaints (r = .13, p < .05); witnessed violence was associated with difficulty sleeping (r = .13, p < .05) and headaches (r = .12, p < .05). All associations remained significant after control for confounding. Community violence exposure accounted for 10% of the variance in child stress symptoms, and children who had experienced community violence victimization had a 28% increased risk of appetite problems, a 94% increased risk of sleeping problems, a 57% increased risk of headaches, and a 174% increased risk of stomachaches. Results provide yet another possibility for clinicians to explore when treating these physical symptoms in children.
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Affiliation(s)
- Beth Nordstrom Bailey
- Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee 37614, USA.
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Diseth TH, Christie HJ. Trauma-related dissociative (conversion) disorders in children and adolescents--an overview of assessment tools and treatment principles. Nord J Psychiatry 2005; 59:278-92. [PMID: 16195132 DOI: 10.1080/08039480500213683] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A high proportion of patients in child and adolescent psychiatry with significant dissociative symptomatology after early childhood traumatization may go undiagnosed, be wrongly diagnosed and/or inappropriately treated. The diagnostics and treatment of dissociative disorders have been limited by lack of comprehensive, reliable and valid instruments and the ongoing polarization and fierce controversy regarding treatment. However, recent neurobiological findings of neurochemical, functional and structural cerebral consequences of early stressful childhood experiences point out a need for active, early and effective identification and treatment interventions. We present an update on assessment tools available in the Nordic countries, and an overview of different appropriate therapeutic intervention models for children and adolescents. A systematic overview of studies of dissociation in children and adolescent published over the last decade disclosed a total of 1019 references. The 465 papers describing aspects of assessment tools and/or treatment were studied in detail. Reliable and valid screening questionnaires and diagnostic interviews for children and adolescents now allow for effective early identification of dissociative disorders. A combination of individual psychotherapy, pharmacotherapy and family therapy are often required to handle dissociative disorders in children and adolescents. Cognitive-behavioural therapy, hypnotherapy, Eye-Movement Desensitization-Reprocessing (EMDR), psychodynamic therapy and an integrated approach are the main described psychotherapeutic approaches, but treatment of dissociation in children and adolescent does not require allegiance to any one particular treatment model. However, achievement of physical safety by providing a safe environment is a primary goal that supersedes any other therapeutic work. Assessments tools are now available, and appropriate therapeutic intervention models may hopefully contribute to reduce the risk of wrong diagnoses and inappropriate treatment of dissociative symptomatology in children and adolescents. However, controlled clinical trials of the various interventions and longitudinal outcome studies are needed.
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Affiliation(s)
- Trond H Diseth
- Department of Child and Adolescent Psychiatry, The National Hospital, NO-0027, Oslo, Norway.
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