117. Impact of A Multidisciplinary Management of Adolescents Presenting With Refractory Psychosomatic Symptoms: A One Year Follow-Up Study

Abstract

Chronic psychosomatic symptoms, and associated healthcare system overuse, constitutes a major public health issue and financial burden. Furthermore, interference with normal functioning is a major concern as school absenteeism can range as high as 16-51%. Multidisciplinary intervention has been proven effective to improve the functional impairment associated with this disorder. The aim of our study was to evaluate the impact of a multidisciplinary management for adolescents referred to our specialized adolescent medicine clinic for psychosomatic symptoms unresponsive to previous management. The multidisciplinary team was composed of an adolescent medicine specialist, a nurse clinician and a psychologist, involved either through individual therapy or through a pain and symptoms management group intervention. We conducted a retrospective charts review of 14-18 y.o adolescents referred to our clinic for psychosomatic symptoms between January 2016 and June 2017. We assessed their clinical evolution at first appointment and at 3-6 months, 6-9 months and 9-12 months follow-ups. 26/36 adolescents with psychosomatic symptoms had at least one follow-up, and were included in the study. The median age was 15.8 years old [14.9; 16.3] with 88.5% female. The median number of reported symptoms was 2. The most frequent complaints were headaches (50%), nausea/vomiting (46%), abdominal pain (39%), musculoskeletal pain (35%), fatigue (35%) and neurological symptoms (19%). At initial appointment, the median time span since appearance of the most prominent symptom was 13 months [5 ; 36], the median intensity on a self-reported numerical rating scale was 6/10 and symptoms were present everyday. The median number of medical consultations before consulting our specialized clinic was 3 [2 ; 6], including 78% of those in pediatric subspecialties. Initially, 85% of patients had significant school absenteeism, defined as more than 1 missed day of school per week , with a median of 25% of missed days of school [10 ; 50]. At 3-6 months follow-up, 73% reported an improvement of their symptoms, either in intensity or frequency, and 64% reported an improvement in their school attendance. Data at 9-12 months follow-up was only obtained for 10 patients. 80% of them presented with significant school absenteeism at initial visit down to 20% of them at 3-6 months and 6-9 month visits (p0.05). However, it wasn’t maintain at the 9-12 months follow-up as 2 patients showed an increase school absenteeism after an initial improvement. In a population of adolescents with longstanding psychosomatic symptoms, a specialized multidisciplinary team management improved the symptoms and school attendance in 2/3 of patients at 3-6 months follow-up. For patients followed for twelve months, there was a statistically significant decrease in school absenteeism at 3-6 months and 6-9 month follow-up, that didn’t persisted at 9-12 months follow-up. However, a small number of participants were followed for 12 months and they tended to have more persistent and refractory symptoms.