Somatoform and dissociative disorders in children and adolescents: A comparative study

Factors in the Development of Somatoform Disorders Among Children: A Case-Control Study

Introduction Somatoform disorders (SFDs) are a spectrum of diseases mainly manifesting with physical symptoms of no recognizable etiology. These disorders are believed to be primarily influenced and exacerbated by psychological factors. Given the connection between parental sociodemographics and psychological factors and SFDs, there is a pressing need to investigate this area further, particularly concerning parents and their children affected by somatoform disorders. Aims and objectives The aims and objectives of this study are as follows: i) study the determinants of SFDs, namely, parent handling of child, parent-child relationship, parenting with respect to attending to the needs of children, and intelligence quotient (IQ) of parents, and ii) compare host factors to the factors matched in control subjects. Materials and methods We adopted purposive sampling in our case-control study. The study sample was obtained from the psychiatry department of the Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India, from September 2020 to December 2022, once a week, every Monday. Children manifesting SFD manifestations that are among the chief complaints were included in our study. Results A total of 115 cases were included in our study based on inclusion criteria. The study compared sociodemographic characteristics, intelligence quotient (IQ), parental characteristics, parental handling, parent-child relationships, and parenting practices between a patient group and a control group. The results showed no significant differences in sex, religion, occupation, domicile, and socioeconomic status in both control and patient groups. However, significant differences were found in parental characteristics, such as lower mean age, education, and IQ, in the patient group. This difference between the patient and control groups with respect to the parental handling questionnaire was statistically significant for the domain of "praise," "talk," "feel better," "comes to you," "unduly strict" items, "frequently reprimanded," "tried to control everything," creative activities, protectiveness, education, neglecting, objective punishment, housing, medical care, demanding, symbolic reward, loving, objective reward, food, parent-to-child communication, clothing, support, routine, recreation, social activities, rules, managing problem behavior, guidance for career, and security. Conclusion Parents were deficient in terms of years of education, occupational status, IQ, parental handling, parent-child relationship, and parenting with respect to the children's needs. These findings offer insights into the sociodemographic and psychological factors contributing to the patient group's condition.

Study of Determinants of Somatoform Disorders in Children

INTRODUCTION

Somatoform disorders constitute a group of illnesses that present with predominant physical symptoms for which there is no demonstrable etiology, and psychological factors are implicated in initiating, exacerbating, and maintaining the disorder.

AIM AND OBJECTIVES

 The aim of this study was to study a host of factors, namely, the I.Q. of children, scholastic performance in the last three years, the past history of medical illness, psychiatric disorders in the family, and life stress in the last year, and to compare these factors with those in matched control subjects. This study looked at the effects of somatoform disorders on children's I.Q., scholastic performance in the previous three years, a history of medical illness, psychiatric disorders in the family, and life stress in the previous year.

MATERIALS AND METHODS

In this case-control study, a sample was selected from the child guidance clinic of the psychiatry outpatient department (OPD) of the University Hospital, Banaras Hindu University, Varanasi, India. The time period of study was from January 2011 to June 2012. All the patients who presented to the child guidance clinic of the psychiatry OPD with one or more somatic symptoms as among their chief complaints were screened. All subjects fulfilling the selection criteria were recruited into the study. An I.Q. test was administered to the children, and the raw score for the verbal and performance tests was calculated. Children above the age of 16 years were assessed with the Wechsler Adult Performance Intelligence Scale.

RESULTS

One hundred fifteen cases that fulfilled the selection criteria were studied. About 14.6% (N = 11) of the patients had a history of significant physical illness as opposed to 12.5% (N = 5) in healthy controls. The scholastic performance in the last three years of the patients group was poorer than that of the control group. The mean number of stressful life events in the patients group was 5.95±1.77 (range: 1-10), and in the control group, it was 1.25±0.43 (range: 1-3).

CONCLUSION

 Compared to controls, patients had a significantly lower I.Q. and poorer scholastic performance in the last three years, a more frequent past history of medical illness, and a greater frequency of life stress in the areas of studies, health, family-related issues, and interpersonal issues.

Longitudinal outcome of Functional Neurological Disorder in Children and Adolescents in a Tertiary Care centre from Northern India

FND is common in Indian children and adolescents. Outcome related factors are not well known. With objective to study short-term outcome of FND, prospective, longitudinal, nine months follow-up study of 6-16 years was planned. Socioeconomic, clinical variables, I.Q. and personality traits at baseline and new psychiatric/physical illness, psychosocial factors and comorbidities during follow-up were assessed. Out of 68 children, scholastic (64.7%) and family problems (23.5%) were common psychosocial factors. After nine months,73% achieved remission. Reasons for non-remission were persistence of psychosocial factors and psychiatric comorbidities. A need arises for increasing awareness among general practitioners for early identification and management.

Case Report: GABAergic and Serotoninergic Agents for the Treatment and Prevention of Prolonged Dissociative Stupor

Dissociative stupor is a common psychiatric disease lacking an established standard treatment. The lack of therapeutic options may be due to the spontaneous and quick complete remission of most patients. However, since some patients experience multiple relapses and prolonged stupor, investigating potential prevention and treatment options is critical. We reported the case of a 61-year-old Japanese woman who presented with intermittent dissociative stupor for several months. Despite her prolonged symptoms, the administration of lorazepam, escitalopram, and aripiprazole, which selectively enhance GABAergic and serotoninergic activity, improved her stupor and prevented relapse. These findings may help with the treatment of persistent dissociative stupor.

Clinical profile of somatoform disorders in children

OBJECTIVE

To study the clinical profile, socio-demographic features, psychosocial stressors and outcome of somatoform disorders in children

METHODS

Children up to the age of 18 year presenting with unexplained physical symptoms over a period of 6 months were evaluated. A detailed history and physical examination was carried out. Appropriate investigations were undertaken to exclude organic causes. Diagnosis was made according to DSM-IV-TR criteria.

RESULTS

Forty-five children were diagnosed with somatoform disorders during the study period. The prevalence was 0.5% and 0.9% among outdoor and indoor patients, respectively. Conversion disorder (48.9%) was the commonest followed by other somatoform disorders (26.7%). Pseudoseizures and fainting attacks in conversion disorder and pain abdomen and general body pain in somatoform disorder were the commonest symptoms. Male to female ratio was 2.2:1. Urban children (25) were represented more than rural children (20). Stress factors were identified in 71.1% patients, which included fear of school or examinations. Thirty-three patients (73.3%) remained asymptomatic after counseling whereas, 8 patients (17.6%) had relapse requiring further counseling. Four patients (8.8%) showed no improvement and needed psychiatric evaluation.

CONCLUSIONS

Early referral to mental health professional is required to avoid unnecessary investigations and delay in diagnosis of somatoform disorders in children.

Women psychiatrists in India: A reflection of their contributions

The increasing number of women joining psychiatry is a relatively new phenomenon in the field of medicine. Keeping with the trends world over, the number of women psychiatrists in India has been on the rise over the last two to three decades. The authors searched various volumes of the Indian Journal of Psychiatry, recent membership directories of the Indian Psychiatric Society, website of the Medical Council of India and personal communications for contributions of the women psychiatrists in India. Women psychiatrists have a number of contributions to their credit in India. They have played important roles in the affairs of national professional organizations like the Indian Psychiatric Society and have contributed to the psychiatry education and research. However, they also suffer limitations because of the absence of adequate institutional support and policies looking into their specific needs.