Parental Psychological Flexibility as a Mediating Factor of Post-Traumatic Stress Disorder in Children after Hospitalization or Surgery

BACKGROUND

Illness, surgery, and surgical hospitalization are significant stressors for children. Children exposed to such medical events may develop post-traumatic medical syndrome (PMTS, pediatric medical traumatic stress) that could slow their physical and emotional recovery.

OBJECTIVE

This study examined the relationship between the level of parental psychological resilience and the development of PMTS in young children.

METHOD

We surveyed 152 parents of children aged 1-6 who were admitted to the pediatric surgery department. Parents completed questionnaires in two phases. In the first phase, one of the parents completed the Acceptance and Action Questionnaire (AAQ-ll) and the Parental Psychological Flexibility (PPF) Questionnaire. In the second phase, about three months after discharge, the same parent completed the Young Child PTSD (Post Traumatic Stress Disorder) Checklist (YCPC) and the UCLA (Los Angeles, CA, USA) PTSD Reaction Index for DSM-5 Parent/Caregiver Version for Children Age 6 Years and Younger Evaluating Post-traumatic Disorder. In addition, the parent completed a Posttraumatic Stress Diagnostic Scale (PDS) questionnaire to assess the existence of post-traumatic symptoms in the parents.

RESULTS

The findings indicate that (1) a parent's psychological flexibility is significantly associated with the level of personal distress (r = -0.45, p < 0.001), (2) a parents' level of distress is significantly correlated with the child's level of PTMS, and (3) a parent's level of psychological flexibility is a significant mediating factor between the level of parental post-traumatic distress and the child's level of PTMS.

CONCLUSIONS

A parent's psychological flexibility may act as a protective factor against the development of the child's mental distress after hospitalization or surgery.

Risk factors for the development of medical stress syndrome following surgical intervention

BACKGROUND

Pediatric surgical procedures involve traumatic stress that may cause psychological distress, leading to decreased adherence to continued surgical follow-up and delayed physical recovery. Risk factors for pediatric medical trauma, however, have not been studied enough. We aim to define the risk factors detectable during hospitalization in pediatric surgery and characterize children at risk of developing PTSD, in order to focus preventive interventions on these children.

METHODS

The participants in this prospective study were parents of 235 children aged 1-13 years hospitalized in a pediatric surgical ward, who form a representative sample of patients of this age in the ward. They completed questionnaires measuring symptoms of psychological distress, 3-5 months after discharge.

RESULTS

Higher parental stress, parental concerns regarding family social support, and parental concerns regarding sibling problems had a significant positive correlation with the children's emotional distress measured 3-5 months after hospitalization. Among children aged 1-5 years, emergency (as opposed to elective) operation and a higher number of invasive procedures were also positively correlated with the children's PTSS.

CONCLUSIONS

There is a need to develop measurements for identifying children at high risk for developing posttraumatic stress following surgical intervention; guidelines for developing such a screening instrument are outlined.

TYPE OF STUDY

Prognosis study (level of evidence - 1).

Psychological aspects of employment instability during the COVID-19 pandemic

Psychological aspects that accompany employment instability because of the COVID-19 quarantine (lockdown) policy were investigated. Two hundred ninety-three Israeli participants completed a Brief Illness Perception Questionnaire, a Distress Thermometer, and a Perceived Stress Scale. People placed on furlough (unpaid leave of absence) by their employers demonstrated significantly higher distress (M = 5.34) than those who were unemployed prior to the pandemic (M = 3.79). The implications and coping modes with these results are detailed herein. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Traumatic Stress among School-Aged Pediatric Surgery Patients and Their Parents

INTRODUCTION

 Since hospitalization can be a traumatic event for children, many of them may suffer from a cluster of chronic psychological and emotional difficulties called Pediatric Medical Traumatic Stress (PMTS). Although PMTS causes considerable functional impairment and psychological distress and may decrease the children's compliance with post-surgical care, awareness of this condition is low and thus not enough effort is made to prevent it. The objective of this study is to assess prospectively the prevalence and characteristics of PMTS in school-age children following hospitalization in a general pediatric surgery ward and in their parents, which has not been documented before.

MATERIALS PATIENTS AND METHODS

 We recruited parents of 88 children aged 6 to 13 years old, hospitalized in a pediatric surgery ward and which form a representative sample of the children of this age in the ward. Three to five months after discharge from the hospital, the parents completed questionnaires measuring symptoms of psychological distress.

RESULTS

 About 26.4% of children displayed symptoms of PMTS, and 11.6% of parents suffered from posttraumatic stress disorder following their child's hospitalization. Moreover, we found a medium high positive correlation between the parents' level of distress and that of their child.

CONCLUSION

 In view of the prevalence of PMTS among school-aged children following surgical intervention, it is necessary to promote increased awareness, preventive interventions, and early identification and treatment of this condition.

Should parents share medical information with their young children? A prospective study

BACKGROUND

As psychiatric consultants to pediatric wards, we are often asked whether to disclose to young children full information about the invasive medical procedures they face. To date, no studies have been published offering an evidence-based answer to this question. This prospective study examined whether sharing medical information with young children regarding invasive interventions correlates with the development of chronic post-traumatic stress three to five months after hospitalization.

METHOD

The participants in this prospective study were parents of 151 children aged 3-13 who were hospitalized in a pediatric surgery ward. The sample was representative of the population hospitalized in this ward during that year. Independent of the study, parents of 104 children chose to share with them information regarding the procedure they were about to undergo, while parents of 47 children chose not to do so. t-Tests were used to assess the correlation between the children's exposure to medical information and their level of long-term post-intervention stress.

RESULTS

Findings show an inverse correlation between the children's exposure to medical information and their level of post-traumatic stress several months after their medical episode. The correlation is significant in both preschool children and school-aged children.

CONCLUSIONS

We suggest the implementation of psychoeducation programs among both medical staff and parents in order to increase awareness of the importance of sharing medical information with young children facing medical challenges.

Surgical procedures and pediatric medical traumatic stress (PMTS) syndrome: Assessment and future directions

INTRODUCTION

Surgical procedures involve traumatic stress. Children may develop chronic psychological distress and dysfunction after surgery, with consequent reluctance to comply with medical follow-up care. A literature review of this topic shows that it has been understudied. Our study aims to assess the frequency and characteristics of symptoms of persistent psychological distress in children following surgery, which have not been documented before, in order to promote its awareness and its early identification.

METHODS

Parents of 79 children (aged 1-6) that were hospitalized in a pediatric surgical ward, comprising a representative sample, completed three validated questionnaires assessing their children's psychological symptoms 3-5months after the hospitalization.

RESULTS

A significant portion of children suffer from psychological distress 3-5months after hospitalization. Moreover, 10.39% of the children exhibited symptoms of PTSD, and 28.6% of parents reported that the child's distress causes dysfunction. Additionally, our findings emphasize the parents' concerns regarding the child's behavior, function, and health following hospitalization.

CONCLUSION

Since a significant prevalence of hospitalization-related traumatic stress is documented, the awareness to it has to be improved, in order to reduce its frequency and increase adherence to medical follow-up care.

TYPE OF STUDY

Prognosis study.

LEVEL OF EVIDENCE

1.

Cognitive Dysfunction: Part and Parcel of the Diabetic Foot

OBJECTIVE

The presence of a foot ulcer increases the self-treatment burden imposed on the individual with diabetes. Additionally, this condition increases the cognitive demands needed for adherence to medical recommendations. A potential gap could exist between medical recommendations and the individual's ability to implement them. Hence, the goal of this study was to examine whether the cognitive profile of people with diabetic foot ulcers differs from that of people with diabetes without this complication.

RESEARCH DESIGN AND METHODS

This was a case-control study. Ninety-nine individuals with diabetic foot ulcers (case patients) and 95 individuals with type 2 diabetes (control subjects) (age range 45-75 years), who were matched for diabetes duration and sex, underwent extensive neuropsychological evaluation using a NeuroTrax computerized battery, digit symbol, and verbal fluency tests. A global cognitive score after standardization for age and education was computed as well as scores in the following six cognitive domains: memory, executive function, reaction time, attention, psychomotor abilities, and estimated premorbid cognition.

RESULTS

Individuals with diabetic foot ulcers had significantly (P < 0.001) lower cognitive scores than individuals with diabetes without this complication, in all tested cognitive domains, excluding estimated premorbid cognition. Individuals with diabetic foot ulcers demonstrated a significant difference between precognitive and current cognitive abilities, as opposed to the nonsignificant difference among control subjects. The differences persisted in multivariable analysis after adjusting for depression and smoking.

CONCLUSIONS

Individuals with diabetic foot ulcers were found to possess fewer cognitive resources than individuals with diabetes without this complication. Thus, they appear to face more self-treatment challenges, while possessing significantly fewer cognitive resources.

Complex regional pain syndrome, alexithymia, and psychological distress

OBJECTIVE

This study aims to elucidate the relationships between alexithymia, psychological distress, and pain in persons with complex regional pain syndrome (CRPS).

METHODS

Participants were 60 Israeli adults ages 19-65. This is a cross sectional study with a comparison group. Alexithymia, psychological distress, and pain were assessed in 30 individuals with CRPS in comparison to 30 gender- and age-matched persons with lower back pain (LBP). Assessments included the Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale, and two subscales of the McGill Pain Questionnaire.

RESULTS

Persons with CRPS had significantly higher ratings of psychological distress and of alexithymia when compared to LBP controls. Pain severity was significantly associated with higher levels of alexithymia and psychological distress among persons with CRPS, but not among controls. Alexithymia and pain severity correlations were significantly different between the two groups. In persons with CRPS, the relationships between alexithymia and pain severity and between difficulty identifying feelings and pain were not confounded by psychological distress.

CONCLUSIONS

To our knowledge, this is the first cross sectional study providing empirical evidence on the relationship between alexithymia and CRPS. From the perspective of conceptualizing alexithymia as an outcome of CRPS, findings highlight the importance of early CRPS diagnosis and support the provision of care that addresses pain-related psychological distress and alexithymia among CRPS patients. Also, findings underscore the need to generate alternative, non-physical avenues, such as learning to identify feelings for processing pain, in order to reduce pain among persons with CRPS.

Alternating hemiplegia of childhood in half-sisters

We present the family of two girls affected with alternating hemiplegia of childhood who were born to the same mother and different fathers. Previous reports suggested mitochondrial dysfunction as an etiologic mechanism for this disorder. Muscle biopsy, including a measurement of the respiratory chain enzymes, performed in one of the sisters showed no mitochondrial abnormalities. The mode of inheritance is not certain, but an autosomal-dominant gene is most likely.

A pharmacologic study of analgesia produced by stimulation of the nucleus locus coeruleus

Pharmacologic studies of analgesia produced by stimulation of the nucleus locus coeruleus (LC) were conducted using the rat hot-plate test. A correlation between self-stimulation and analgesia produced by stimulation of LC was found. Analgesia produced by LC stimulation was attenuated by naloxone, a morphine antagonist, cyproheptidine, a serotonin antagonist, and WB-4101, an alpha-adrenergic antagonist. The analgesia was absent in 6-OHDA-treated rats. Catecholamine synthesis inhibition by a combination of reserpine and AMT or more specific inhibition of noradrenaline synthesis by DDC elevated latency to paw lick and yet did not affect stimulation-produced analgesia. It is suggested that morphinergic, serotonergic, and alpha-adrenergic mechanisms mediate LC stimulation produced analgesia.

Myopathy with multiple central cores. A case with hypersensitivity to pyrexia

An eight-year-old male suffered from long-standing proximal muscle weakness, dramatically aggravated by febrile episodes. Neuromuscular work-up disclosed a myopathy with multiple central cores of non-familial nature. The presence of central cores in this patient as well as in the myopathy of malignant hyperpyrexia might suggest a pathophysiological basis common to both conditions.

Release of fluoride into saliva after topical fluoride application

Fluoride uptake by the surface enamel of teeth treated with fluoride solutions in vitro and fluoride release into saliva after topical applications in vivo were determined. The fluoride uptake after NaF + Na2HPO4 treatment was higher than that after NaF treatment. The fluoride release into saliva was less after NaF + Na2HPO4 than after NaF application, pointing to a greater permanent fluoride fixation.