1
|
Garralda ME. Commentary: Against the widespread use of other types of PD diagnosis - a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?). Child Adolesc Ment Health 2022; 27:250-252. [PMID: 35882434 DOI: 10.1111/camh.12587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/27/2022]
Abstract
Recent debate papers in Child and Adolescent Mental Health (Debate CAMH, May 2022) advocate a more widespread and appropriate use by CAMH clinicians of borderline personality disorder diagnoses. This paper makes the case against the widespread use of other types of PD diagnosis in children and young people. Nevertheless, it would be of interest to establish to what extent adult PDs have their roots in early neurodevelopmental anomalies, and ascertainment of personality traits can help clarify children's response to environmental or traumatic stresses in those presenting with problems such as at the interface between physical and mental health.
Collapse
Affiliation(s)
- M Elena Garralda
- Imperial College School of Medicine, Imperial College London, London, UK
| |
Collapse
|
2
|
Ingeman K, Frostholm L, Frydendal DH, Wright KD, Lockhart E, Garralda ME, Kangas M, Rask CU. A new measure of excessive parental worries about children's health: Development of the Health Anxiety by Proxy Scale (HAPYS). Nord J Psychiatry 2021; 75:523-531. [PMID: 33724904 DOI: 10.1080/08039488.2021.1900389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Health anxiety by proxy is a newly introduced term to describe parents' experience of excessive and unpleasant worries about their child's health. This article describes the development of a new measure, the Health Anxiety by Proxy Scale (HAPYS), for systematic assessment of health anxiety by proxy. METHOD The development of the HAPYS was performed over three phases. (1) Patients clinically assessed to have health anxiety by proxy participated in semi-structured interviews to elaborate their experience of worries regarding their child's health and their related behaviours, and to examine the face validity of items in an existing questionnaire: 'Illness Worry Scale - parent version'. (2) Based on the findings from Phase 1 the project group and a panel of experts selected and formulated questionnaire items and scoring formats. (3) The HAPYS was pilot-tested twice using cognitive interviewing with healthy parents and parents with health anxiety by proxy followed by further adjustments. RESULTS The final version of HAPYS consists of 26 items characteristic of health anxiety by proxy and of an impact section with five items. CONCLUSION Based on the pilot testing the HAPYS showed good face and content validity. It holds the potential to be a valid questionnaire to help clinicians across health care settings assess parents suffering from health anxiety by proxy.
Collapse
Affiliation(s)
- Katrine Ingeman
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Kristi D Wright
- Department of Psychology, Faculty of Arts, University of Regina, Regina, Canada
| | | | - M Elena Garralda
- Division of Psychiatry, Imperial College London, Burlington Danes, The Hammersmith Hospital, London, UK
| | - Maria Kangas
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Caspani G, Corbet Burcher G, Garralda ME, Cooper M, Pierce CM, Als LC, Nadel S. Inflammation and psychopathology in children following PICU admission: an exploratory study. Evid Based Ment Health 2018; 21:139-144. [PMID: 30301824 PMCID: PMC6241628 DOI: 10.1136/ebmental-2018-300027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/21/2018] [Accepted: 08/13/2018] [Indexed: 12/27/2022]
Abstract
Background Survivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions. Objective This exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge. Methods We performed a prospective observational cohort study on 71 children with septic illness, meningoencephalitis and other critical disorders admitted to two PICUs between 2007 and 2010. 3–6 months following discharge, subjects were assessed for global psychiatric risk (ie, presence of emotional and behavioural difficulties on the parental Strengths and Difficulties Questionnaire (SDQ)), and for PTSD risk using the child-rated Impact of Events Scale (IES-8). Inflammatory and related biological markers were transcribed from PICU admission notes (white cell count, lymphocytes, neutrophils, C reactive protein (CRP), platelets, fibrinogen and lactate). Findings Global psychiatric risk at follow-up was associated with abnormal lymphocyte count during admission (χ2=6.757, p=0.014, n=48). In children with sepsis, partial correlation analyses controlling for age and gender highlighted associations between (i) SDQ scores and low lymphocyte count (r=−0.712; p=0.009, n=14), and (ii) IES-8 score and high CRP levels (r=0.823; p=0.006, n=11). These associations remained after correction for multiple comparisons. Conclusion These results support the hypothesis that acute inflammation may play a role in determining the development of psychopathology following PICU admission. Clinical implications If the findings are replicated, they may help to better highlight which children are at risk of post-PICU psychopathology and appropriately target follow-up.
Collapse
Affiliation(s)
- Giorgia Caspani
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Mehrengise Cooper
- Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christine M Pierce
- Department of Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Lorraine C Als
- Centre for Psychiatry, Imperial College London, London, UK
| | - Simon Nadel
- Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
4
|
Corbet Burcher G, Picouto MD, Als LC, Cooper M, Pierce CM, Nadel S, Garralda ME. Post-traumatic stress after PICU and corticosteroid use. Arch Dis Child 2018; 103:887-889. [PMID: 29175821 DOI: 10.1136/archdischild-2017-314157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 11/04/2022]
Abstract
AIM To examine the association between corticosteroid use in paediatric intensive care units (PICU) and subsequent symptoms of post-traumatic stress disorder (PTSD). METHODS The subjects were children aged 8-16 years admitted to PICU with sepsis, meningoencephalitis (ME) and other disorders. Illness information was extracted from case notes; 3-6 months post discharge children completed a PTSD symptom questionnaire (eight-item Impact of Events Scale (IES-8)) assessing intrusion and avoidance symptoms. Saliva samples were also collected for cortisol profile analysis. RESULTS 53 children completed the IES-8 questionnaires. 33 provided saliva samples. 19 (36%) received corticosteroids. In children with sepsis (n=15), corticosteroid use was associated with significantly lower PTSD intrusion symptom scores. There was a trend towards an association between corticosteroid use and lower evening cortisol levels. There was a comparable but weaker trend in children with ME. DISCUSSION Corticosteroid use may be associated with fewer PTSD symptoms and lower evening cortisol levels following PICU admission in children with sepsis.
Collapse
Affiliation(s)
| | - Maria D Picouto
- Coslada Mental Health Service, Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| | - Lorraine C Als
- Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
| | - Mehrengise Cooper
- Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christine M Pierce
- Department of Paediatric Intensive Care, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Simon Nadel
- Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M Elena Garralda
- Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
| |
Collapse
|
5
|
Abstract
Epidemiological research has revealed that psychiatric disorders in children and adolescents are common, persistent and handicapping. Only 1 in 10 of those with a disorder is seen in specialist mental health services. However, the majority of children and adolescents see their general practitioner (GP) every year. Although the majority present with physical complaints, there are indications that rates of psychiatric disorder in those attending are increased and that psychiatric disorder is associated with increased consulting. These findings raise questions about the role of primary care in the promotion and management of mental health in young people.
Collapse
|
6
|
Abstract
Aims and methodTo carry out a survey to ascertain the role of academic clinical fellowship posts within the integrated academic training programme for academic training in child and adolescent psychiatry. Questionnaires were sent to UK academic child psychiatric units.ResultsA total of 18 units returned questionnaires; this identified eight university lecturers and two academic clinical fellows in post.Clinical implicationsIntegrated academic training pathways seem unlikely to contribute substantially to academic training and to maintaining the pool of academic clinicians in child and adolescent psychiatry. It may need reappraising with regard to psychiatric specialties.
Collapse
|
7
|
Abstract
SummaryHallucinations (erroneous percepts in the absence of identifiable stimuli) are a key feature of psychotic states, but they have long been known to present in children with non-psychotic psychiatric disorders. Recent epidemiological studies of child populations found surprisingly high rates (about 10%) of hallucinatory experiences. These hallucinatory phenomena are most likely to occur in the absence of psychiatric disorder and are usually simpler, less elaborate and less distressing than those observed in children with psychiatric disorders. This article details the clinical assessment of hallucinations in children and adolescents, taking into account developmental considerations and paediatric organic associations. It describes hallucinations in young people with psychoses (schizophrenia spectrum and mood disorders) and non-psychotic psychiatric disorders (emotional and behavioural disorders), and it addresses therapeutic aspects.
Collapse
|
8
|
Garralda ME, Slaveska-Hollis K. What is special about a Paediatric Liaison Child and Adolescent Mental Health service? Child Adolesc Ment Health 2016; 21:96-101. [PMID: 32680370 DOI: 10.1111/camh.12146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The paediatric population is known to be at high risk for psychiatric problems. Paediatric liaison child/adolescent mental health services (PL-CAMHS) have been developed to help increase recognition and management of psychiatric morbidity in the paediatric setting. This report describes clinical activity by a psychological medicine PL-CAMHS and considers specificity by comparing this with community/general CAMHS activity. METHOD Clinical information was obtained on consecutive patients seen by a PL-CAMHS in a UK tertiary specialist hospital. Where feasible this was compared with published data on national/community CAMHS work. RESULTS Data was obtained on 800 patients (mean age 11.9, SD 3.8). Most referrals came from a variety of paediatric teams, nearly two-thirds were for psychosomatic problems or difficulties adjusting to physical illness. The majority had an ICD-10 psychiatric diagnosis (mostly adjustment, mood and anxiety, and somatoform disorders); problems were often complex and in about half, family difficulties were also noted; one-third had received prior mental health treatment. Virtually all children were seen by the PL service within a month of referral and only 2% of families failed to attend for assessment. Some level of clinical improvement was noted for the majority. There were indications of differences from national/community CAMHS work in referral source, take up rates and psychiatric diagnoses. CONCLUSIONS Paediatric liaison child and adolescent mental health services users commonly have characteristic psychiatric problems, interventions appear potentially effective and the work is specific and complementary of community CAMHS. Thus PL-CAMHS make a distinct contribution to the provision of truly comprehensive CAMHS.
Collapse
Affiliation(s)
- M Elena Garralda
- The Centre for Mental Health, Imperial College London, Hammersmith Campus, du Cane Road, London W12 0NN, UK
| | - Karmen Slaveska-Hollis
- Paediatric Liaison Service, Nottingham Children's Hospital, Department of Child and Adolescent Psychiatry, South Block, E floor, QMC Nottingham, UK
| |
Collapse
|
9
|
|
10
|
Abstract
There is a growing research interest in childhood hallucinations as predictors of psychotic states. This work appears to have limited direct relevance for clinical child psychiatric practice, but it highlights the continuing relevance of research into precursors of psychotic states and into the determinants of clinically relevant hallucinations in children.
Collapse
Affiliation(s)
- M Elena Garralda
- M. Elena Garralda, MD, MPhil, DPM, FRCPsych, FRCPCH, Imperial College London, Imperial College School of Medicine, St Mary's Campus, Academic Unit of Child and Adolescent Psychiatry, Norfolk Place, London W2 1PG, UK.
| |
Collapse
|
11
|
Als LC, Nadel S, Cooper M, Vickers B, Garralda ME. A supported psychoeducational intervention to improve family mental health following discharge from paediatric intensive care: feasibility and pilot randomised controlled trial. BMJ Open 2015; 5:e009581. [PMID: 26715482 PMCID: PMC4710808 DOI: 10.1136/bmjopen-2015-009581] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess feasibility and pilot a supported psychoeducational tool to improve parent and child mental health following discharge from a paediatric intensive care unit (PICU), in preparation for a large randomised controlled trial (RCT). DESIGN Feasibility assessment and single-centre, parallel group, pilot RCT. A concealed computer generated list was used to randomise participants, with an allocation of 2:1 in favour of the intervention. SETTING A PICU in an acute care hospital in London, UK. PARTICIPANTS 31 parents of children aged 4-16 years-old admitted to PICU. INTERVENTION Parents received a psychoeducational tool supported by a telephone call. The psychoeducational tool outlined the possible psychological reactions in children and parents alongside management advice. The telephone call addressed each family's postdischarge experience, reinforced the psychoeducational material and encouraged parents to put into practice the advice given. MAIN OUTCOME MEASURES The primary outcome was the number of feasibility criteria successfully met (linked to the intervention and the study design). Secondary outcomes were questionnaire data collected at 3-6-month follow-up assessing mental health in parents and children. RESULTS 31 parents were randomised (intervention n=22; treatment as usual, TAU n=9). 23 parents were included in the analysis of secondary outcomes (intervention n=17; TAU n=6). 3 (of 6) intervention and 1 (of 6) study design feasibility criteria were fully met. All unmet criteria could be addressed with minor or significant modifications to the protocol. At follow-up there was a tendency for parents who received the intervention to report lower post-traumatic stress symptoms in themselves and fewer emotional and behavioural difficulties in their children than TAU parents. This needs to be explored in a fully powered trial. CONCLUSIONS This feasibility and pilot RCT provided valuable information on the intervention and trial design for a full RCT. TRIALS REGISTRATION NUMBER NCT01737021; Results.
Collapse
Affiliation(s)
- Lorraine C Als
- Centre for Mental Health, Imperial College London, London, UK
| | - Simon Nadel
- Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - Mehrengise Cooper
- Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - Bea Vickers
- Adolescent Assertive Outreach Team, South West London and St George's Mental Health NHS Trust, London, UK
| | | |
Collapse
|
12
|
Abstract
Auditory hallucinations are uncommon paediatric presentations, but they can be alarming and lead to emergency consultations. This review outlines the phenomenology of auditory hallucinations, their assessment and clinical significance. Auditory hallucinations are seen in the course of acute medical disorders, often together with decreased levels of consciousness, as in febrile illness and in toxic, neurologically compromised states; they can also be a feature of episodic neurological conditions such as migraine and temporal lobe epilepsy. Auditory hallucinations are key symptoms in psychiatric disorders such as schizophrenic and other psychotic states, but they can also present with depressive and anxiety disorders, and in the context of virtually every psychiatric disorder of childhood. In fact hallucinations--usually simple and transient--are common in the general child populations. Auditory hallucinations become clinically significant when they occur as part of a medical disorder or in the context of acute psychotic states and schizophrenia, when they are frequent, complex, distressing and cause impairment. The treatment of clinically relevant hallucinations is that of the primary medical or psychiatric disorder. Occasionally they require treatment in their own right with psychological treatments, and only when these have been tried and fail, a careful trial of antipsychotic medication may be appropriate.
Collapse
|
13
|
Affiliation(s)
- Tami Kramer
- Westminster Child and Adolescent Mental Health Services, London NW8 0PJ, UK
| | - Lorraine Als
- Imperial College London, Centre for Mental Health, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - M Elena Garralda
- Imperial College London, Centre for Mental Health, Hammersmith Hospital Campus, Imperial College London, London, UK
| |
Collapse
|
14
|
Lochman JE, Evans SC, Burke JD, Roberts MC, Fite PJ, Reed GM, de la Peña FR, Matthys W, Ezpeleta L, Siddiqui S, Elena Garralda M. An empirically based alternative to DSM-5's disruptive mood dysregulation disorder for ICD-11. World Psychiatry 2015; 14:30-3. [PMID: 25655147 PMCID: PMC4329886 DOI: 10.1002/wps.20176] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- John E Lochman
- Department of Psychology, University of AlabamaTuscaloosa, AL, USA
| | - Spencer C Evans
- Clinical Child Psychology Program, University of KansasLawrence, KS, USA
| | - Jeffrey D Burke
- Department of Psychology, University of ConnecticutStorrs, CT, USA
| | - Michael C Roberts
- Clinical Child Psychology Program, University of KansasLawrence, KS, USA
| | - Paula J Fite
- Clinical Child Psychology Program, University of KansasLawrence, KS, USA
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health OrganizationGeneva, Switzerland
| | | | - Walter Matthys
- Department of Child and Adolescent Studies, Utrecht UniversityUtrecht, The Netherlands,Department of Psychiatry, University Medical Center UtrechtUtrecht, The Netherlands
| | - Lourdes Ezpeleta
- Department of Clinical and Health Psychology, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Salma Siddiqui
- Department of Behavioral Sciences, National University of Sciences and TechnologyIslamabad, Pakistan
| | | |
Collapse
|
15
|
Garralda ME. Measurement of environmental complexity by CAMHS. Psychiatr Bull (2014) 2014; 38:86. [PMID: 25237507 DOI: 10.1192/pb.38.2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
16
|
Garralda ME. Combined infant regulatory problems and early maternal psychiatric illness predict risk of functional somatic symptoms in later childhood. Evid Based Nurs 2014; 17:17-18. [PMID: 23696227 DOI: 10.1136/eb-2013-101324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
17
|
Kramer T, Iliffe S, Bye A, Miller L, Gledhill J, Garralda ME. Testing the feasibility of therapeutic identification of depression in young people in British general practice. J Adolesc Health 2013; 52:539-45. [PMID: 23608718 DOI: 10.1016/j.jadohealth.2012.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Depression in young people attending primary care is common and is associated with impairment and recurrence into adulthood. However, it remains under-recognized. This study evaluated the feasibility of training primary care practitioners (PCPs) in screening and therapeutic identification of adolescent depression, and assessed its effects on practitioner knowledge, attitudes, screening, and management. METHODS We trained PCPs in therapeutic identification of adolescent depression during general practice consultations. To assess changes in knowledge and attitudes, PCPs completed questionnaires before and after training. We ascertained changes in depression screening and identification rates in the 16 weeks before and after training from electronic medical records of young people aged 13-17 years. Post-training management of depression was recorded on a checklist. RESULTS Aspects of practitioner knowledge (of depression prevalence and treatment guidelines) and confidence (regarding depression identification and management) increased significantly (all p < .04). Overall screening rates were enhanced from .7% to 20% after the intervention and depression identification rates from .5% before training to 2% thereafter (29-fold and fourfold increases, respectively). Identification was significantly associated with PCP knowledge of prior mental health problems (Fisher's exact test, p = .026; odds ratio, 4.884 [95% confidence interval, 1.171-20.52]) and of psychosocial stressors (Fisher's exact test, p = .001; odds ratio, 17.45 [95% confidence interval, 2.055-148.2]). CONCLUSIONS The Therapeutic Identification of Depression in Young People program is a feasible approach to improving primary care screening for adolescent depression, with promising evidence of effectiveness. Further evaluation in a randomized trial is required to test practitioner accuracy, clinical impact, and cost benefit.
Collapse
Affiliation(s)
- Tami Kramer
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
18
|
Garralda ME, McConachie H, Le Couteur A, Sriranjan S, Chakrabarti I, Cirak S, Guglieri M, Bushby K, Muntoni F. Emotional impact of genetic trials in progressive paediatric disorders: a dose-ranging exon-skipping trial in Duchenne muscular dystrophy. Child Care Health Dev 2013; 39:449-55. [PMID: 22676208 DOI: 10.1111/j.1365-2214.2012.01387.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gene-modifying trials offer hope for improvement in chronic paediatric disorders, but they may also lead to disappointment and have an adverse emotional effect on families. This study aimed to examine emotional impact on participants in a paediatric exon-skipping trial. METHODS Nineteen male children with Duchenne muscular dystrophy (DMD), and their parents, taking part in a dose-ranging study of an i.v. administered morpholino splice-switching oligomer (which can restore the reading frame in DMD and induce dystrophin expression) underwent a psychosocial/psychiatric examination at trial entry. Emotional impact was assessed at trial completion using questionnaires. RESULTS The mean child age was 8.9 years (SD 2.1); 13(68%) were attending mainstream school. Most families were well adjusted psychosocially at trial entry. Post-trial median child emotional impact scores were 5/10 (n= 18), but impact was rated as positive by 6/14 (42%), neutral/mixed by 5 (35%) and negative by 3 (21%). Median post-trial psychosocial/psychiatric change scores in children and parents were minimal. Actual post-trial negative impact was statistically significantly associated with higher expected impact at trial entry, at which time the families of the three children displaying actual negative impact reported higher family stress levels in combination with a variety of other psychosocial risks factors. CONCLUSIONS In carefully selected families with low levels of psychosocial stress/distress at trial entry, and with good support from paediatric research units (including psychiatric input when required), genetic trials in progressive disorders such as DMD can have a predominantly positive or neutral emotional impact. Nevertheless, negative impact is reported by a minority of families and possible psychosocial predictors deserving further scrutiny have been identified.
Collapse
Affiliation(s)
- M E Garralda
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Vila M, Kramer T, Obiols JE, Garralda ME. Abdominal pain in British young people: associations, impairment and health care use. J Psychosom Res 2012; 73:437-42. [PMID: 23148811 DOI: 10.1016/j.jpsychores.2012.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/12/2012] [Accepted: 09/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the frequency and associations of abdominal pain in a sample of British secondary school young people and to examine predictors of impairment and health care use. METHODS Cross-sectional study of young people aged 11-16 years that completed questionnaires documenting abdominal pain, related impairment and health care consultations. They also provided information detailing other physical symptoms, health problems and mental health status. RESULTS 1173 students completed questionnaires; 598 (53%) reported abdominal pains in the previous 3 months (15% >once a week). Pains were significantly linked to reporting medical illness, to high levels of a broad range of physical symptoms and with students deeming these symptoms to be stress/mood sensitive. They were also linked to depressive and other emotional and behavioural problems and with medical help seeking (seeing a health professional in the previous year and contact ever with mental health practitioners). Considerable impairment was reported by 36%; this was independently predicted by abdominal pain frequency, higher levels of concurrent physical symptoms and symptom stress/mood sensitivity. In 18% of students the abdominal pains had led to medical consultations; this was independently predicted by pain related impairment. CONCLUSIONS Frequent abdominal pains are common in British secondary school adolescents; they are linked to emotional symptoms and are often impairing and lead to medical consultations. Impairment was associated not only to pain frequency but also to reporting other physical symptoms and symptom stress/mood sensitivity, and impairment was a strong predictor of medical help seeking.
Collapse
Affiliation(s)
- Mar Vila
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, Norfolk Place, London, UK.
| | | | | | | |
Collapse
|
20
|
Kramer T, Iliffe S, Gledhill J, Garralda ME. Recognising and responding to adolescent depression in general practice: developing and implementing the Therapeutic Identification of Depression in Young people (TIDY) programme. Clin Child Psychol Psychiatry 2012; 17:482-94. [PMID: 22523137 DOI: 10.1177/1359104512442639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rates of depressive disorder in adolescents attending primary care are increasing. Most presentations are for physical complaints and concurrent depressive symptoms go unrecognised and untreated. Primary care practitioners describe reluctance to intervene due to lack of confidence and skills. This paper describes the development and implementation of TIDY (Therapeutic Identification of Depression in Young people), a programme designed by child psychiatrists and general practitioners to improve detection and intervention for depression within ordinary consultations. The paper describes the integration of educational principles and current evidence into the development of the training programme and the intervention package. The content of the intervention is described. For cases of mild to moderate depressive disorder, where patients do not require referral for specialist treatment, practitioners are trained to deliver self-help and coping strategies within a single consultation.
Collapse
Affiliation(s)
- Tami Kramer
- The Academic Unit of Child and Adolescent Psychiatry, Imperial College School of Medicine, UK.
| | | | | | | |
Collapse
|
21
|
Iliffe S, Gallant C, Kramer T, Gledhill J, Bye A, Fernandez V, Vila M, Miller L, Garralda ME. Therapeutic identification of depression in young people: lessons from the introduction of a new technique in general practice. Br J Gen Pract 2012; 62:e174-82. [PMID: 22429434 PMCID: PMC3289823 DOI: 10.3399/bjgp12x630061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 07/07/2011] [Accepted: 10/26/2011] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Mild-to-moderate depression in young people is associated with impaired social functioning and high rates of affective disorder in adult life. Earlier recognition of depression in young people has the potential to reduce the burden of depression in adulthood. However, depression in teenagers is underdiagnosed and undertreated. AIM To assess the usability and usefulness of a cognitive-behavioural-therapy-based technique for Therapeutic Identification of Depression in Young people (TIDY). DESIGN AND SETTING A qualitative study of four group practices in northwest London. METHOD Face-to-face semi-structured interviews were conducted with practitioners who had been trained in the use of the TIDY technique. RESULTS Twenty-five GPs and six nurses were interviewed. The key themes that emerged from the interviews were: practitioners were 'making sense of teenage depression' when interpreting signs and symptoms; the training in the technique was variable in its impact on practitioners' attitudes and practice; and time factors constrained practitioners in the application of the technique. CONCLUSION The TIDY technique is usable in routine practice, but only if practitioners are allowed to use it selectively. This need for selectivity arises partly from concerns about time management, and partly to avoid medicalisation of psychological distress in young people. The perceived usefulness of the TIDY technique depends on the practitioner's prior knowledge, experience, and awareness.
Collapse
Affiliation(s)
- Steve Iliffe
- Department of Primary Care and Population Health, University College London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Vila M, Kramer T, Obiols JE, Garralda ME. Adolescents who are frequent attenders to primary care: contribution of psychosocial factors. Soc Psychiatry Psychiatr Epidemiol 2012; 47:323-9. [PMID: 21170515 DOI: 10.1007/s00127-010-0326-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 12/01/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frequent attendance to primary care services has shown an association with psychosocial factors in adult and child populations. Little is known about the psychosocial correlates of attendance in adolescents. AIMS OF THE STUDY To study the contribution of psychosocial factors to frequent primary care attendance in a community sample of young British people. METHOD The method used was a cross-sectional survey of 1,251 secondary school pupils, using self-report questionnaires for socio-demographic, physical and psychological health data. RESULTS A total of 1,116 pupils [mean age 13.51 years (SD 1.5), 52% female] completed questionnaires and provided information about contact with their general practitioner (GP) in the previous year; 30% were frequent attenders (≥4 appointments). Frequent attenders were significantly younger; they were more likely to come from lower socioeconomic backgrounds, report significantly more past and current physical problems, have more hospital visits in the previous year, have more recent intense somatic symptoms made worse by stress and causing impairment, and have more days off school. Frequent attendance was also significantly associated with the presence of emotional symptoms and a history of mental health consultations. Logistic regression analysis identified seeing a hospital doctor, current illness, having days off school, a history of mental health consultations and younger age as independent predictors of frequent attendance. CONCLUSION In addition to physical health problems, social factors and psychiatric difficulty are linked to and require attention in young people who are frequent attenders at primary care health services.
Collapse
Affiliation(s)
- Mar Vila
- Academic Unit of Child and Adolescent Psychiatry, 3rd Floor QEQM Building, Imperial College, St.Mary's Campus, Norfolk Place, London, W2 1PG, UK.
| | | | | | | |
Collapse
|
23
|
Read J, Kinali M, Muntoni F, Garralda ME. Psychosocial adjustment in siblings of young people with Duchenne muscular dystrophy. Eur J Paediatr Neurol 2010; 14:340-8. [PMID: 19850502 DOI: 10.1016/j.ejpn.2009.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 09/01/2009] [Accepted: 09/27/2009] [Indexed: 11/27/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a progressive, impairing, life-limiting disorder of childhood. Little is known about how siblings adapt to this. The aim of this study is to document psychosocial adjustment in siblings of patients with DMD. Healthy siblings (11-18 years old) of young people with DMD attending a specialist paediatric centre and their parent/main carer took part. Parents, siblings and teachers completed a battery of questionnaires: (i) to assess psychiatric risk the Strengths and Difficulties Questionnaire (SDQ), General Health Questionnaire (GHQ), Hospital Anxiety and Depression Scale (HADS); (ii) to measure general wellbeing: SF-36; (iii) to document DMD illness disability: Functional Disability Inventory (FDI); (iv) to assess family function and life stresses for the unaffected sibling: Family Assessment Device (FAD), Family Burden Interview Schedule and Life Events Checklist. Forty six/77 eligible siblings (24 females/22 males); (mean age 14 years (SD 2.3)) took part. Although their mean psychological functioning and wellbeing questionnaire scores were comparable to normative data, there was a trend for more siblings scoring at high-risk for psychological (mainly emotional) problems. Weak/moderate associations with psychological symptoms in siblings varied according to informant and included the following factors: closeness in age to the affected sibling; older sibling age; extent of wheelchair use, burden of illness on family interactions, and siblings reporting high impact of illness on their lives. Psychological symptoms were also associated with less sibling involvement in patient care, with broader psychosocial and family disadvantage and with life stresses. Siblings have an increased risk for emotional problems, which appears influenced by specific illness factors.
Collapse
Affiliation(s)
- Joy Read
- Institute of Neurology, University College London, London, UK
| | | | | | | |
Collapse
|
24
|
Abstract
Unexplained physical complaints are common in children, and form the basis for childhood somatization (the manifestation of distress through somatic symptoms) and somatoform disorders. Emotional symptoms and anxiety disorders are often comorbid with both unexplained physical symptoms and somatoform disorders. Risk factors include stress sensibility and probably biologic vulnerability in the child, mood and somatization disorders in the family, parental overinvolvement, and possibly limited psychological "mindedness" in relation to physical symptoms. The best evidence of efficacy is for family behavioral cognitive treatments, but for especially severe cases a multidisciplinary, carefully coordinated approach has been found to be clinically helpful.
Collapse
Affiliation(s)
- M Elena Garralda
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London St Mary's Campus, London, UK.
| |
Collapse
|
25
|
Fernandez V, Kramer T, Fong G, Doig A, Garralda ME. Depressive symptoms and behavioural health risks in young women attending an urban sexual health clinic. Child Care Health Dev 2009; 35:799-806. [PMID: 19508316 DOI: 10.1111/j.1365-2214.2009.00982.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adolescence is a time of increased health risk behaviours and depressive symptoms and disorders. Most young people with depressive disorders, however, are not under the care of specialist child and adolescent mental health services, and there is increasing interest in identifying alternative appropriate settings which are acceptable for young people and may attract those at high risk for depressive disorders. AIM To assess depressive and behavioural health risks in attendees to a sexual health clinic (SHC) for young people. METHOD Cross-sectional controlled study of women attending a SHC and school attendees, using questionnaires on depressive symptoms and mental health problems, sexual activity and substance use. RESULTS 115/178 attendees 14-19 years old completed questionnaires. In the comparison between 66 women aged 16-18 years and 49 socio-demographically group-matched school controls, SHC attendees reported higher levels of sexual activity and substance use. They were significantly more at risk for depression (20/65 or 30% vs. 4/46 or 8%; chi(2)P < 0.01) on the Beck Depression Inventory, for emotional (12/66 or 18% vs. 1/49 or 2%; chi(2)P < 0.01), hyperactivity (11/66 or 16% vs. 2/46 or 4%; chi(2)P < 0.05) and conduct (8/66 or 12% vs. 0/49; chi(2)P < 0.05) problems on the Strengths and Difficulties Questionnaire. High depressive scores were significantly associated with a history of self-harm, earlier alcohol use and having tried cannabis, but not with sexual risk behaviours. Earlier age at first sexual intercourse was linked to higher sexual and substance use risks. CONCLUSION We have found high levels of depressive symptoms among attendees to a SHC for young people, which seem an appropriate setting for screening and providing guidance for depression and other health risk behaviours.
Collapse
Affiliation(s)
- V Fernandez
- Academic unit of Child and Adolescents Psychiatry, Imperial College, London, UK.
| | | | | | | | | |
Collapse
|
26
|
Ferrin M, Gledhill J, Kramer T, Elena Garralda M. Factors influencing primary care attendance in adolescents with high levels of depressive symptoms. Soc Psychiatry Psychiatr Epidemiol 2009; 44:825-33. [PMID: 19247561 DOI: 10.1007/s00127-009-0004-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although depression is common amongst adolescents attending general practice, little is known about factors which influence consultation. This study aims to identify factors that contribute to GP attendance in adolescents with high levels of mood symptoms. METHODS Case-control study of 13 to 17-year-olds attending (cases, N = 156) and not attending (controls, N = 120) an urban general practice during a 6-month period; questionnaires on depressive symptoms (Mood and Feelings Questionnaire), physical symptoms (Child Somatisation Inventory), socio-demographic data and attitudes were completed. RESULTS Attenders had significantly more depressive and physical symptoms. In the comparison between 63 attenders and 34 non-attenders with a high level of depressive symptoms, attendance was significantly linked to lower socio-economic status, non-White ethnicity, non-intact families, and not believing that doctors are only interested in physical symptoms. On logistic regression analysis, attendance in males with depressive symptoms was predicted by more physical and less marked depressive symptoms; in females by non-White ethnicity and not believing doctors are only interested in physical symptoms. CONCLUSION Both socio-demographic factors and adolescent attitudes influence general practitioner attendance in adolescents with high levels of depressive symptoms. These findings may help inform interventions to facilitate help seeking in primary care for young people with high levels of depressive symptoms.
Collapse
Affiliation(s)
- Maite Ferrin
- Unidad de Psiquiatria Infanto-Juvenil, Complejo Hospitalario de Jaen, Carretera Bailen-Motril s/n, 23009, Jaén, Spain
| | | | | | | |
Collapse
|
27
|
Naguib JM, Kulinskaya E, Lomax CL, Garralda ME. Neuro-cognitive performance in children with type 1 diabetes--a meta-analysis. J Pediatr Psychol 2008; 34:271-82. [PMID: 18635605 DOI: 10.1093/jpepsy/jsn074] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To conduct meta-analyses of neuropsychological performance in young people with type 1 diabetes. METHODS Meta-analysis of 24 studies. Studies published between 1980 and 2005 were identified. The inclusion criteria were: young people who were < or =19 years of age with type 1 diabetes, a case-control design and standardized neuropsychological tests of seven cognitive domains. RESULTS Diabetes was statistically associated with poorer performance on visuospatial ability (d = -0.29), motor speed (d = -0.26) and writing (d = -0.28), on sustained attention (d = -0.21) and reading (d = -0.23). Smaller effects were identified on full IQ (d = -0.14), on performance (d = -0.18) and verbal IQ (d = -0.15). Severe hypoglycemia was linked to deficits in short-term verbal memory (d = -0.14; Confidence Interval: -0.318, 0.024; p =.04). CONCLUSIONS This meta-analysis indicates that children with type 1 diabetes have mild cognitive impairments and subtly reduced overall intellectual functioning.
Collapse
Affiliation(s)
- Justine M Naguib
- Academic Unit of Child and Adolescent Psychiatry, Imperial College, St Mary's Campus, Norfolk Place, London W21PG, UK
| | | | | | | |
Collapse
|
28
|
Elison S, Shears D, Nadel S, Sahakian B, Garralda ME. Neuropsychological function in children following admission to paediatric intensive care: a pilot investigation. Intensive Care Med 2008; 34:1289-93. [PMID: 18392607 DOI: 10.1007/s00134-008-1093-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 03/10/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about neuropsychological status following acute severe paediatric illness. This pilot study explored the effects on memory function of severe acute paediatric illness and associations between memory functioning and psychiatric sequelae. DESIGN AND SETTING Case control study of children after paediatric intensive care unit (PICU) discharge and healthy volunteers. PATIENTS AND PARTICIPANTS 16 PICU discharged children comprised of 11 boys and 5 girls (mean age 9.44 +/- 2.85 years) tested a mean of 4.8 +/- 1.4 months following hospital discharge, and 16 age- and sex-matched controls. MEASUREMENTS AND RESULTS Visual-spatial memory and attention were assessed using the CANTAB battery (visual memory) and verbal memory with the Children Memory Scale; Intelligence Quotient was tested using the Wechsler Abbreviated Scale of Intelligence. Emotional and behavioural function was measured with the Strengths and Difficulties Questionnaire and Impact of Event Scales. Children admitted to PICU displayed statistically poorer performance on tests of spatial memory (spatial working memory) sustained attention (rapid visual information) and verbal memory (word pairs learning and delayed recognition). Septic illness was specifically associated with poorer pattern recognition memory on the CANTAB. There were significant correlations in the PICU group between cognitive functioning and emotional/behaviour scores. CONCLUSIONS Our results suggest impaired memory and attention in children following acute severe paediatric illness, a specific deficit in children with septic illness and links between memory anomalies and emotional/behavioural problems. The findings and their clinical significance require replication and clarification in a larger sample.
Collapse
Affiliation(s)
- Sarah Elison
- Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, UK
| | | | | | | | | |
Collapse
|
29
|
Affiliation(s)
- Amina Tareen
- Academic Department of Child and Adolescent Psychiatry, Imperial College School of Medicine (St Mary's Campus), London, UK.
| | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE To assess psychiatric status after meningococcal disease. METHOD Cohort study of 66 children (34 boys, 32 girls) ages 4 to 17 years admitted to pediatric hospitals with meningococcal disease. The main outcome measure was psychiatric disorder (1-year period and point prevalence on the Schedule for Affective Disorders and Schizophrenia for School-Age Children interview for children 6 years or older; point prevalence in younger children on the Behavior Screening Questionnaire). RESULTS During the course of the year after discharge from hospital, psychiatric disorders were identified in 23 of 40 (57%) children ages 6 years or older. The most common primary disorders were depressive, oppositional defiant, and anxiety disorders. At the time of 12-month follow-up, psychiatric disorders were present in 13 of 40 (32%) of those ages 6 or older and in 7 of 26 (26%) under 6 years old. Two children had a diagnosis of posttraumatic stress disorder. Logistic regression analysis showed that global meningococcal illness severity score, clinical shock on admission, and impairing premorbid emotional and behavioral problems in the child were independent predictors of psychiatric disorder at 12-month follow-up. CONCLUSIONS Psychiatric disorders are common in the year after meningococcal disease. Especially at risk are children who are severely medically ill and those with more impairing premorbid emotional and behavioral problems.
Collapse
Affiliation(s)
- Daniel Shears
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - Simon Nadel
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - Julia Gledhill
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - Fabiana Gordon
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - M Elena Garralda
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service..
| |
Collapse
|
31
|
Abstract
Functional or unexplained medical symptoms (physical symptoms that are not adequately explained by organic factors and where a major role for psychological factors is assumed) are common amongst children in the general population but can also be an expression of somatisation and somatoform disorders. Co-morbid psychopathology is common. We describe measures mostly used in research into problems related to somatisation in children and adolescents that may be helpful to clinical researchers. Some address the nature and severity of physical symptoms, others document illness attitudes, beliefs and functional impairment, and a third group assesses emotional symptoms. Questionnaires can be helpful for clinicians in quantifying (i) the nature and severity of somatic symptoms and associated functional impairment, (ii) contributory health attitudes and illness beliefs and (iii) co-morbid or primary anxiety and depressive disorders. Together with pain and activity diaries and careful documentation of school attendance, these measures may also be helpful in monitoring treatment response.
Collapse
Affiliation(s)
- Julia Gledhill
- The Academic Unit of Child and Adolescent Psychiatry, Imperial College London (St Mary's Campus), Norfolk Place, London W2 1PG, UK. E-mail:
| | - M Elena Garralda
- The Academic Unit of Child and Adolescent Psychiatry, Imperial College London (St Mary's Campus), Norfolk Place, London W2 1PG, UK. E-mail:
| |
Collapse
|
32
|
Garralda ME, Muntoni F, Cunniff A, Caneja AD. Knee-ankle-foot orthosis in children with duchenne muscular dystrophy: user views and adjustment. Eur J Paediatr Neurol 2006; 10:186-91. [PMID: 16931076 DOI: 10.1016/j.ejpn.2006.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 07/19/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of knee ankle foot orthoses (KAFOs) to prolong independent mobility is a widely used rehabilitation strategy for children with Duchenne muscular dystrophy (DMD). AIMS To explore views and adjustment of families with a child with Duchenne muscular dystrophy to the use of KAFOs. METHODS interviews with families of children aged 8-18 years with DMD; questionnaires on psychiatric adjustment (SDQ for children; GHQ for parents). RESULTS In total, 17 parents and 9 children took part. Families experienced the introduction of KAFOs as a signal for illness deterioration and a re-awakening of the feelings experienced at diagnosis. Nevertheless, the majority expressed a positive attitude and over two-thirds satisfaction with KAFOs use. High psychiatric risk was found in 2/17 children (12%; expected 10%) and 7/17 main carers (41%; expected 20-30%). CONCLUSION Most families were satisfied with KAFOs use, and its implementation was well tolerated especially by the children. However, mental distress was high in main carers who emphasized the importance of full preparation and support in this rehabilitation technique.
Collapse
Affiliation(s)
- M Elena Garralda
- Child and Adolescent Psychiatry, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, UK.
| | | | | | | |
Collapse
|
33
|
Abstract
We examined the use of a staff-completed measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), to record mental health problems in adolescents in local authority secure accommodation. It proved possible to train staff and implement completion of the HoNOSCA on 64 consecutive admissions. Interrater reliability was high. The HoNOSCA identified high levels of psychological problems on admission (mean 18.5, s.d.=5.5). Follow-up HoNOSCA ratings proved sensitive to change; however, correlation between HoNOSCA and adolescent-completed questionnaires was poor. We concluded that HoNOSCA can be helpful in documenting mental health problems among young people admitted to secure local authority units.
Collapse
Affiliation(s)
- Peter Yates
- Academic Unit of Child and Adolescent Psychiatry, Imperial College St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Although psychiatric morbidity is common amongst paediatric patients, little is known about the availability of CAMH paediatric liaison services. METHOD We surveyed all Trusts with specialist CAMH services and paediatric units in Greater London, enquiring about the nature of liaison that CAMHS provide. RESULTS We found that although liaison paediatric work was common, dedicated paediatric liaison services were provided by only a minority of specialist multidisciplinary CAMHS. Their work involved most aspects of child psychopathology, and included emergencies and children with joint physical and psychiatric problems. About 2/3 of paediatricians were satisfied with CAMHS liaison services, but virtually all desired to see them developed further. There were few indications of co-ordination between specialist multidisciplinary CAMHS and other paediatric psychosocial support services.
Collapse
Affiliation(s)
- Mark Woodgate
- Child and Family Consultation Service, Erme House, Mount Gould Hospital, Mount Gould, Plymouth PL4 7QD, UK. E-mail:
| | - M Elena Garralda
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| |
Collapse
|
35
|
Abstract
OBJECTIVE To examine clinical specificity in chronic fatigue syndrome (CFS) of childhood, by comparing clinical features in childhood CFS and in emotional disorders (ED). METHOD SAMPLE: 28 children with CFS; 27 with ED. MEASURES History of disorder; K-SADS psychiatric interviews; self-esteem and physical symptoms questionnaires; premorbid history, behavioural and personality assessments. RESULTS There were high levels of comorbid emotional disorders in children with CFS, and the two groups were comparable on self-esteem, but CFS children endorsed more fatigue and other somatic symptoms. The two groups were comparable on age at illness onset, but parents of children with CSF reported more biological illness precipitants, more pre-morbid recurrent medical problems and infections. The CFS group had fewer pre-morbid psychological problems and less psychiatric comorbidity than the ED group. CONCLUSION There is considerable clinical overlap between CFS and ED of childhood, but there are also differences in clinical presentation between these disorders.
Collapse
Affiliation(s)
- M Elena Garralda
- Academic Unit of Child and Adolescent Psychiatry, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
| | | |
Collapse
|
36
|
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is being increasingly recognized in children and adolescents. Yet comparatively little attention has been given in the literature to management. METHODS Description of the main features of the disorder, precipitating and maintaining factors and diagnostic assessment. Outline of different views on the nature and treatment of CFS in childhood. Description of a rehabilitation program based on cognitive behavior therapy and graded activity. RESULTS Using adult research criteria, CFS can be diagnosed in children and adolescents. In its severe form it is often triggered by infectious illness episodes. It is commonly associated with mood disorders in the child and with mental distress and high levels of emotional involvement in parents. A number of patient support groups hold the view that CFS is a medical disorder, contest a psychiatric contribution and advocate 'pacing' as an approach to rehabilitation which includes avoiding activities. To date there is no empirical evidence for the efficacy of this approach. Research in adults, open and clinical reports in children support the use of graded activity and family cognitive behavior therapy. The main aim is to enable children, with the help of their family, to carry out their own rehabilitation with some support and guidance from a health professional. Engaging the child and family in treatment and forming a therapeutic alliance is a continual process and a crucial aspect of management, as many families view the condition as a medical disorder and are initially ambivalent towards this approach. CONCLUSIONS There is controversy about the nature and management of CFS in childhood but a rehabilitation program based on family cognitive behavior therapy can be implemented and seems to hold most promise in the management of children with CFS. Family engagement is a crucial aspect of management.
Collapse
|
37
|
|
38
|
Rangel L, Garralda ME, Jeffs J, Rose G. Family health and characteristics in chronic fatigue syndrome, juvenile rheumatoid arthritis, and emotional disorders of childhood. J Am Acad Child Adolesc Psychiatry 2005; 44:150-8. [PMID: 15689728 DOI: 10.1097/00004583-200502000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare family health and characteristics in children with chronic fatigue syndrome (CFS), in juvenile rheumatoid arthritis (JRA), and emotional disorders. METHOD Parents of 28 children and adolescents aged 11 to 18 years with CFS, 30 with JRA, and 27 with emotional disorders (i.e., anxiety and/or depressive disorders) were recruited from specialty clinical settings and completed interviews and questionnaires assessing family health problems, parental mental distress, illness attitudes, and family burden of illness. RESULTS Parents of children with CFS were significantly more likely than those of children with JRA to report a history of CFS-like illness, high levels of mental distress, and a tendency to experience functional impairment in response to physical symptoms. Families of children with CFS were characterized by significantly greater emotional involvement and reported greater family burden related to the child's illness in comparison with families of children with JRA. CONCLUSIONS CFS in childhood and adolescence is associated with higher levels of parental CFS-like illness, mental distress, emotional involvement, and family illness burden than those observed in association with JRA, a chronic pediatric physical illness.
Collapse
Affiliation(s)
- Luiza Rangel
- Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK
| | | | | | | |
Collapse
|
39
|
Abstract
OBJECTIVE To assess short-term changes in child and parent psychiatric status following meningococcal disease. DESIGN Prospective cohort study; 3-month follow-up using parent, teacher, and child questionnaires. SETTING Hospital admissions to three pediatric intensive care units and 19 general pediatric wards. PATIENTS Sixty children aged 3-6 yrs, 60 mothers, and 45 fathers. INTERVENTIONS We administered measures of illness severity (Glasgow Meningococcal Septicaemia Prognostic Score, days in hospital) and psychiatric morbidity (Strengths and Difficulties Questionnaires, parent and teacher versions; Impact of Event scales; General Health Questionnaire-28). MEASUREMENTS AND MAIN RESULTS In children admitted to pediatric intensive care units, parental reports at 3-month follow-up showed a significant increase in emotional and hyperactivity symptoms and in related impairment; symptoms of posttraumatic stress disorder were present in four of 26 (15%) children >8 yrs old. Regarding the parents, 26 of 60 (43%) mothers in the total sample had questionnaire scores indicative of high risk for psychiatric disorder and 22 of 58 (48%) for posttraumatic stress disorder. In fathers there was high risk for psychiatric disorder in 11 of 45 (24%) and for posttraumatic stress disorder in 8 of 43 (19%). Severity of the child's physical condition on admission was significantly associated with hyperactivity and conduct symptoms at follow-up. Length of hospital admission was associated with psychiatric symptoms in the child and posttraumatic stress disorder symptoms in parents. There were also significant associations between psychiatric symptoms in children and parents. CONCLUSIONS Admission of children to pediatric intensive care units for meningococcal disease is associated with an increase in and high levels of psychiatric and posttraumatic stress disorder symptoms in children and parents. Length of admission is associated with psychiatric symptoms in children and posttraumatic stress disorder symptoms in parents. Pediatric follow-up should explore psychiatric as well as physical sequelae in children and parents.
Collapse
Affiliation(s)
- Daniel Shears
- The Academic Unit of Child and Adolescent Psychiatry, Imperial College London (St. Mary's Campus), Norfolk Place, London.
| | | | | | | |
Collapse
|
40
|
Abstract
This paper addresses child and adolescent psychopathology as it presents to general practitioners and paediatricians, and explores psychosocial aspects of unexplained medical symptoms in children and adolescents. High rates of psychopathology have been identified amongst children and adolescents attending general practice and paediatric services, most of it ''hidden'' at presentation and emotional in nature. It is often linked to poor physical well being and to maternal stress focused on the child. It may be of special relevance to medical help seeking in socio-economically advantaged areas. Co-morbid psychopathology, mainly emotional disorders, is common amongst children with unexplained medical symptoms. However, there are specific psychosocial aspects that differentiate these children from those with emotional disorders. They involve disease beliefs, illness behaviour and predicament. The latter may be characterised by special reactivity to stress in children with personality vulnerability, in a context of parents with high levels of mental distress, unexplained medical symptoms and emotional over-involvement with the child. There is comparatively little interface work between CAMHS and primary health care. An important research priority would seem to lie in the development of interventions that can be adapted for use by primary care staff. Similarly, there are few dedicated CAMHS paediatric liaison teams. Their more extensive development should help attend in a more informed and focused way than at present to children and adolescents suffering from unexplained physical symptoms and disorders. Further research is needed into vulnerability mechanisms and maintaining factors, health beliefs, treatment engagement and interventions.
Collapse
Affiliation(s)
- M Elena Garralda
- Imperial College London, St. Mary's Campus, Norfolk Place, London
| |
Collapse
|
41
|
Rees G, Gledhill J, Garralda ME, Nadel S. Psychiatric outcome following paediatric intensive care unit (PICU) admission: a cohort study. Intensive Care Med 2004; 30:1607-14. [PMID: 15112035 DOI: 10.1007/s00134-004-2310-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Accepted: 03/26/2004] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether paediatric intensive care unit (PICU) admission is associated with greater psychiatric morbidity in children and parents as compared with general paediatric ward admissions. DESIGN Retrospective cohort study. SETTING Paediatric intensive care unit and two general paediatric wards of a London teaching hospital. PARTICIPANTS Children aged 5-18 years discharged from PICU (exposed cohort) and general paediatric wards (unexposed cohort) 6-12 months previously, together with their parents. MEASUREMENTS AND RESULTS Children: the Clinician Administered Post Traumatic Stress Disorder (PTSD) Scale for Children (CAPS-C), the Impact of Event Scale (IES), Strengths and Difficulties Questionnaire, Birleson Depression Scale, Revised Children's Manifest Anxiety Scale, Child Somatization Inventory. Parents: IES, General Health Questionnaire, Beck Depression Inventory, Hospital Anxiety and Depression Scale. Thirty-five of 46 (76%) PICU-discharged families and 33 of 41 (80%) from general paediatric wards participated. Valid CAPS-C data were obtained for 19 PICU-admitted children and 27 children admitted only to the general paediatric ward; 4/19 (21%) of PICU-discharged children developed PTSD (compared with none of 27 ward admissions), p=0.02. PICU children had significantly more PTSD features of irritability and persistent avoidance of reminders of the admission. Parents of PICU children were more likely to screen positive for PTSD (9/33 (27%) compared with 2/29 (7%) parents of ward-admitted children), p=0.04. There were no significant differences between the groups for other measures of psychopathology. CONCLUSION Post traumatic stress disorder diagnosis and symptomatology is significantly more common in families where a child has been admitted to the PICU. Consideration should be given to providing psychological support for children and parents after PICU admission.
Collapse
Affiliation(s)
- Gwyneth Rees
- The Academic Unit of Child and Adolescent Psychiatry, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Functional impairment is a key feature of chronic fatigue syndrome (CFS) of childhood. AIM To compare impairment, illness attitudes and coping mechanisms in childhood CFS and in other paediatric disorders. METHOD Participants were 28 children and adolescents with CFS, 30 with juvenile idiopathic arthritis (JIA) and 27 with emotional disorders (ED). The measures used were interviews with children and parents, with detailed enquiry on impairment, including the Functional Disability Inventory (FDI), Illness Attitudes Scales (IAS), and Kidcope to measure coping styles in relation to common problems, illness and disability. RESULTS Children with CFS reported significantly more illness impairment, especially in school attendance, than those with JIA and ED. They had higher 'worry about illness' scores on the IAS. On the Kidcope they named school issues (work, expectations, attendance) as illness- or disability-related problems more than the other two groups. Fewer CFS participants reported using problem solving as a strategy to cope with illness and disability than with other problems in their lives. More in the CFS than in the JIA group used emotional regulation to cope with illness and disability. Fewer in the CFS than in the ED groups used social withdrawal to cope with illness and self-criticism for disability, but more used resignation to cope with disability. CONCLUSION Severe illness-related impairment, particularly through school non-attendance, and high levels of illness-related school concerns appear specific to CFS. CFS may also have characteristically high levels of generalised illness worry and particular styles of coping with illness and disability.
Collapse
Affiliation(s)
- M Elena Garralda
- Academic Unit of Child and Adolescent Psychiatry, Imperial College, Faculty of Medicine, London, UK.
| | | |
Collapse
|
43
|
Bradley S, Kramer T, Garralda ME, Bower P, Macdonald W, Sibbald B, Harrington R. Child and Adolescent Mental Health Interface Work with Primary Services: A Survey of NHS Provider Trusts. Child Adolesc Ment Health 2003; 8:170-176. [PMID: 32797582 DOI: 10.1111/1475-3588.00067] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We document the extent, nature and predictors of interface work between secondary Child and Adolescent Mental Health (CAMHS) and primary services, through structured questionnaires sent to all Trusts with CAMHS in England (returned by 124/150 or 83%). RESULTS Two-thirds of CAMHS reported training and education to primary care services, about one-third a structured consultation service, one-fifth reported undertaking outpatient clinics in primary care settings and joint casework. One-third had developed primary mental health worker posts. Multiple regression analysis identified firstly specialist clinics within CAMHS, and secondly CAMHS size, as the strongest predictors of interface work across agencies. Interface work thus grows with more developed, larger CAMHS.
Collapse
Affiliation(s)
- Sally Bradley
- Academic Department of Child and Adolescent Psychiatry, Imperial College, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Tami Kramer
- Academic Department of Child and Adolescent Psychiatry, Imperial College, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - M Elena Garralda
- Academic Department of Child and Adolescent Psychiatry, Imperial College, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Peter Bower
- National Primary Care Research and Development Centre, University of Manchester, UK
| | - Wendy Macdonald
- National Primary Care Research and Development Centre, University of Manchester, UK
| | - Bonnie Sibbald
- National Primary Care Research and Development Centre, University of Manchester, UK
| | | |
Collapse
|
44
|
Abstract
Self-esteem is a widely used term in psychiatric referrals. It has been shown to be impaired in various physical and psychological disorders and to be improved by treatment. The availability in recent years of an easy-to-use questionnaire and normative data from a community study make measurement of self-esteem and comparison between clinical and community populations possible. The Harter Modified Self-Esteem Questionnaire was given at first clinic appointment to 132 children aged 8-15 years. Mean scores were calculated within six domains of self-esteem and compared within age and gender groupings with community data and across diagnostic groups. Self-esteem was lower in the clinical than community sample, especially in Global and Scholastic domains. Reductions in self-esteem scores were most striking in adolescent boys and in emotional/ psychosomatic disorders. Clinic girls had lower Physical Appearance self-esteem than clinic boys. We conclude that psychopathology severe enough to lead to clinic referral was associated with lowered self-esteem. Specific domains were affected in line with symptomatology, which has implications for treatment.
Collapse
Affiliation(s)
- Su Sukumaran
- West London Mental Health NHS Trust, Uxbridge Road Southall, UB1 3EU, Middlesex, UK
| | | | | | | |
Collapse
|
45
|
Gledhill J, Kramer T, Iliffe S, Garralda ME. Training general practitioners in the identification and management of adolescent depression within the consultation: a feasibility study. J Adolesc 2003; 26:245-50. [PMID: 12581730 DOI: 10.1016/s0140-1971(02)00128-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depressive disorders are common in adolescent general practice attenders. METHOD Adolescent attenders were screened/interviewed for depressive disorders, general practitioners (GPs) completed a checklist indicating recognition of psychopathology prior to and following GP training in the identification/management of adolescent depression. RESULTS One hundred and thirty consecutive adolescent attenders were screened before and 184 after training. Ten GPs completed the training. Psychiatric interviews with 38 adolescents with high depressive scores prior to and 44 following training identified 10 (26%) and 21 (48%), respectively, as clinically depressed. Sensitivity of GP identification improved from 2/10 (20%) to 9/21 (43%) without loss of specificity; predictive validity from 2/6 (33%) to 9/12 (75%). Adolescents interviewed appreciated the intervention. CONCLUSIONS Training GPs is feasible and may improve recognition of adolescent depression.
Collapse
Affiliation(s)
- Julia Gledhill
- The Academic Unit of Child and Adolescent Psychiatry, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London, UK.
| | | | | | | |
Collapse
|
46
|
Abstract
BACKGROUND High rates of psychopathology and of personality problems have been reported in children and adolescents with chronic fatigue syndrome (CFS). It is not clear whether this is consequent on the experience of chronic physical ill health. We compare psychiatric adjustment in children with CFS and in children suffering from another chronic physical disorder (juvenile idiopathic arthritis or JIA). METHOD Our sample consisted of 28 children with CFS and 30 with JIA attending tertiary paediatric centres (age range, 11 to 18 years, mean 15, S.D. 2.3). In order to assess psychiatric status and functioning, we used the K-SADS psychiatric interviews, CGAS and Harter Self-Esteem Questionnaire with child subjects; behavioural questionnaires (CBCL) and child personality assessment interviews (PAS) with parent informants. RESULTS Psychiatric disorders in the year prior to interview had been present significantly more commonly in the CFS group (72% v. 34% in JIA) and were more impairing to them (CGAS scores of 45 v. 77). Most common diagnoses in both groups were depressive and anxiety disorders. Personality problems were also significantly more frequent in CFS subjects (48% disorder and 26% difficulty v. 11% and 11% in JIA). There were few differences between the two groups in self-esteem. CONCLUSIONS Psychopathology and personality problems are common in children and adolescents with severe forms of CFS and cannot be explained strictly through the experience of chronic physical illness.
Collapse
Affiliation(s)
- L Rangel
- Academic Unit of Child and Adolescent Psychiatry, Faculty of Medicine, Imperial College at St Mary's Campus, London
| | | | | | | |
Collapse
|
47
|
Judge D, Nadel S, Vergnaud S, Garralda ME. Psychiatric adjustment following meningococcal disease treated on a PICU. Intensive Care Med 2002; 28:648-50. [PMID: 12029416 DOI: 10.1007/s00134-002-1237-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2001] [Accepted: 01/07/2002] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the psychiatric status of child survivors of meningococcal disease and their mothers. DESIGN AND SETTING Home interviews with 3-12 month follow-up.PATIENTS. 29 children aged 2-15 years admitted to a Paediatric Intensive Care Unit (PICU) with meningococcal disease. MEASUREMENTS AND RESULTS Questionnaires to assess psychiatric risk in children and parents. We found an overall risk for child psychiatric disorder in 20%. Symptoms of post-traumatic stress disorder (PTSD) were present in 62% of children, and 10% had the features of a stress disorder. In 40% of mothers there was an increased risk for psychiatric disorder, 48% experienced clinically significant PTSD symptoms, and 29% were seeking psychological help. Maternal stress symptoms were significantly associated with severity of their child's illness. CONCLUSIONS A significant proportion of children surviving meningococcal disease and their parents are likely to suffer psychological stress symptoms to a degree that warrants attention.
Collapse
Affiliation(s)
- Deborah Judge
- Academic Unit of Child and Adolescent Psychiatry, Imperial College School of Medicine, Norfolk Place, London W2 1PG, Institution: St Mary's Hospital, London, UK
| | | | | | | |
Collapse
|
48
|
Abstract
BACKGROUND Unexplained medical symptoms are common in children. They constitute the main feature of somatoform disorders of childhood (i.e. pain disorders, conversion disorder and chronic fatigue syndrome or neurasthenia). OBJECTIVE To describe assessment and treatment strategies for severe somatoform disorders of childhood. METHODS Review of recommendations for clinical practice and clinical trials. RESULTS A number of specific techniques have been described. Clinical accounts indicate that many children benefit and can recover. There is some empirical evidence supporting the beneficial effects of techniques such as family cognitive-behavioural therapy and relaxation technique for the less severe disorders. CONCLUSIONS Existing helpful clinical guidelines require empiric validation.
Collapse
|
49
|
Abstract
BACKGROUND Over the past two decades Chronic Fatigue Syndrome (CFS) of childhood has gained increasing prominence. A number of clinical reports and case-control studies have examined the nature of the disorder, its associations, response to treatment and outcome. METHOD A review of publications on childhood CFS was undertaken and reference to work on adult CFS made. Most studies on childhood CFS have been on markedly affected children attending specialist pediatric clinics and very little is known about the condition as it presents in the community or to general medical services. RESULTS The main symptom is fatigue in association with a variety of physical symptoms and with marked and prolonged functional impairment. CFS is commonly reported as being brought on by acute infections. Co-morbid psychiatric (usually mood) disorders are present in at least a half. Personality problems and health attitudes have been described as possible predisposing and maintaining factors. Clinical reports indicate that family work focused on engagement and on a rehabilitation programme (including graded increasing activity and treatment of psychiatric co-morbidity) can help even the more severely impaired children. Recovery may be expected in over two-thirds. CONCLUSIONS CFS presents as a distinct, markedly impairing disorder of childhood. In its severe form, it is often associated with mood disorders. Further research into milder forms and into the efficacy of different treatment interventions is specially needed.
Collapse
Affiliation(s)
- M Elena Garralda
- Academic Unit of Child and Adolescent Psychiatry, Imperial College School of Medicine, London, UK.
| | | |
Collapse
|
50
|
Abstract
The negotiation of stressful life cycle transitions may contribute to the higher prevalence of psychiatric disorders amongst people with intellectual disability (ID). It is possible that leaving school at the age of 16 years might place particular psychological demands on adolescents, increasing the risk of psychiatric morbidity at a time when they are vulnerable as a result of losing the links with health services sustained through school attendance. The present pilot study was designed as a prospective cohort study to investigate whether there is an increase of psychiatric morbidity [rated with the Strengths and Difficulties Questionnaire (SDQ), and through semi-structured interviews with parents] in adolescents with ID at the time of their transition from school to adult education and services. Although there was a high frequency (eight out of 10 subjects) of reported emotional and behavioural problems prior to transition, there was no increase or decrease in psychiatric morbidity for the group as a whole during the 6 months after leaving school. However, there were marked individual differences in scores on the SDQ, which may be worth investigating in a larger study.
Collapse
Affiliation(s)
- F Hepper
- Department of Child and Adolescent Psychiatry, St Mary's Hospital, London, UK
| | | |
Collapse
|