Somatoform Disorders In Children Research Articles

Study of Determinants of Somatoform Disorders in Children.

Somatoform disorders constitute a group of illnesses that present with predominant physical symptoms for which there is no demonstrable etiology, and psychological factors are implicated in initiating, exacerbating, and maintaining the disorder. The aim of this study was to study a host of factors, namely, the I.Q. of children, scholastic performance in the last three years, the past history of medical illness, psychiatric disorders in the family,and life stress in the last year, and to compare these factors with those in matched control subjects.This study looked at the effects of somatoform disorders on children's I.Q., scholastic performance in the previous three years, a history of medical illness, psychiatric disorders in the family, and life stress in the previous year. In this case-control study, a sample was selected from the child guidance clinic of the psychiatry outpatient department (OPD)of the University Hospital, Banaras Hindu University, Varanasi, India. The time period of study was from January 2011 to June 2012. All the patients who presented to the child guidance clinic of the psychiatry OPD with one or more somatic symptoms as among their chief complaints were screened. All subjects fulfilling the selection criteria were recruited into the study. An I.Q. test was administered to thechildren,and the raw score for the verbal and performance tests was calculated. Children above the age of 16 years were assessed with the Wechsler Adult Performance Intelligence Scale. One hundred fifteen cases that fulfilled the selection criteria were studied. About 14.6% (N = 11) of the patients had a history of significant physical illness as opposed to 12.5% (N = 5) in healthy controls. The scholastic performance in the last three years of the patients group was poorer than that of the control group. The mean number of stressful life events in the patients group was 5.95±1.77 (range: 1-10), and in the control group, it was 1.25±0.43 (range: 1-3). Compared to controls, patients hada significantly lower I.Q. and poorer scholastic performance in the last three years, a more frequent past history of medical illness, and a greater frequency of life stress in the areas of studies, health, family-related issues, and interpersonal issues.

Anxiety, depressive, and somatoform disorders in children and adolescents referred to paediatric cardiology with somatic symptoms.

Chest pain, palpitations, and syncope are among the most common referrals to paediatric cardiology. These symptoms generally have a non-cardiac aetiology in children and adolescents. The aim of this study was to investigate the rate of common psychiatric disorders in children and adolescents referred to the paediatric cardiology clinic with chest pain, palpitations, and syncope and the relationship between cardiological symptoms and psychiatric disorders. Children and adolescents aged 8-16 years who presented at the paediatric cardiology clinic with primary complaints of chest pain, palpitation, or syncope were included in the study. After a detailed cardiology examination, psychiatric disorders were assessed using the DSM IV-TR diagnostic criteria and a semi-structured interview scale (KSADS-PL). The Child Depression Inventory and Spielberger's State-Trait Anxiety Inventory for Children were also applied to assess the severity of anxiety and depression. The study participants comprised 73 (68.90%) girls and 33 (31.10%) boys with a mean age of 12.5 ± 2.4 years. Psychiatric disorders were determined in a total of 48 (45.3%) participants; 24 (38.7%) in the chest pain group, 12 (48.0%) in the palpitation group, and 12 (63.2%) in the syncope group. Cardiological disease was detected in 17% of the cases, and the total frequencies of psychiatric disorders (p = 0.045) were higher in patients with cardiological disease. It is clinically important to know that the frequency of psychiatric disorders is high in patients presenting at paediatric cardiology with chest pain, palpitations, and syncope. Physicians should be aware of patients' psychiatric problems and take a biopsychosocial approach in the evaluation of somatic symptoms.

Affective and somatoform disorders in children in clinical settings of pulmonary department, their prevalence and impact on patient’s life quality

Chronic respiratory diseases affect the personality and emotional state of the people who experience them. Purpose - to determine the incidence of hyperventilation syndrome (HVS) and depressive disorder in patients with organic and functional pathologies of the lungs at the pulmonary department and to assess their impact on the life quality of patients. Materials and methods. We have examined 131 patients aged 6-17, among them there were 54.9% (n=72) boys and 45.1% (n=59) girls. The patients were divided into three groups: the children with somatoform disorder (SD) from the respiratory system 33.6% (n=44), those with bronchial asthma (BA) - 34.3% (n=45) and those with pneumonia - 32.1% (n=42). For the diagnosis of depression we used a questionnaire for children’s depression by M. Kovacs (1992), for the diagnosis of HVS we used Nijmegen questionnaire. To determine the patient’s quality of life we used Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Results. The main structure of HVS 25 (19.1%) was composed of 17 (68%) children with SD, 5 (20%) children with BA and 3 (12%) children with pneumonia. Mild depression was determined in 56 (81.1%) sick children, an average one was found in 13 (19.9%) sick children. The severity of depression was significantly higher in the patients with SD in comparison to the patients with BA (95% CI: 6.5-15.5; p<0.0001) and in comparison to the patients with pneumonia (95% CI: 3.2-12.0; p<0.0009). The children with SD had the lowest rate of quality of life according to the PQ-LES-Q scale in comparison to the children with BA (95% CI: 5.4-14.6; p<0.0001) and the ones with pneumonia (95% CI: 6.2-12.6; p<0.0001). Conclusions. Hyperventilation syndrome occurs in 25 (19.1%) of the patients with pulmonary pathologies in childhood. In general, 69 (52.6%) of the children had depressive symptoms. Most likely, the basis of low satisfaction with the quality of life in patients with pulmonary pathology might be depressive disorders, as evidenced by the inverse and strong correlation between the data scales for depression and quality of life, whereby r=-0.773 (p<0.0001). The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent of the child’s parents was obtained for the research. No conflict of interests was declared by the authors. Key words: depression, bronchial asthma, pneumonia, somatoform disorder, quality of life, children.

Клінічні «маски» соматоформних розладів кардіореспіраторної системи і больових та неспецифічних соматоформних розладів, асоційованих з афективними станами, у дітей

Клінічні «маски» соматоформних розладів кардіореспіраторної системи і больових та неспецифічних соматоформних розладів, асоційованих з афективними станами, у дітей

Clinical Practice Guidelines for the management of Somatoform Disorders in Children and Adolescents.

Somatoform disorders are characterized by the repeated subjective experience of physical symptoms (hereafter somatoform symptoms) which are not explained by any physical disease. The types of somatoform disorders in International Classification of Diseases-10 (ICD-10) are listed in Table 1. All the disorder subtypes share one common feature, that is, predominance and persistence of somatic symptoms associated with significant distress and impairment. There are repeated requests by the child or adolescent (hereafter child unless specified) or family for medical investigations inspite of consistent negative findings and reassurances from medical professionals. Even if a physical disorder is present, it does not explain the nature and extent of the somatoform symptoms. These affected children often have a degree of attention-seeking behavior. They are usually diagnosed by excluding organic causes for the somatoform symptoms. Despite the absence of any physiological abnormality, these children show considerable distress and impairment. Table 1 International Classification of Diseases-10 categories of somatoform disorders

Somatoform disorders among children and adolescents in a tertiary hospital

Background: Somatoform disorders are common problem among children and adolescents. As children's verbal skills are relatively poorly developed to express their psychological problem, it is not surprising that they display somatic symptoms in response to life stresses.Objectives: The study aimed to explore the difference of somatoform disorders and symptoms between boys and girls the causal association of psychosocial factors.Materials & Methods: This is a cross-sectional descriptive study conducted at weekly Child Psychiatry Clinic of Psychiatry OPD and Pediatrics OPD in Bangabandhu Sheikh Mujib Medical University (BSMMU) of 6-16 years' age group from June to December' 2003. Total 450 respondents, 350 from Pediatric OPD & 100 from Child Psychiatry Clinic of Psychiatry OPD, were included in this study.Results: No significant gender difference was found in the diagnostic categories of somatoform disorders. Both boys and girls reported higher rates of undifferentiated somatoform disorders, 33.33% and 37.50% respectively. Abnormal psychosocial factors were found in majority of the cases and the most common was parental overprotection (26.42%). Overall, associated abnormal psychosocial situations were significantly higher among girls than that of boys (P<0.01). It was also revealed that higher rate of abnormal psychosocial factors was found to have causal relationship of higher rate of somatoform disorders among girls than that of boys.Conclusion: Findings suggested that somatoform disorders in children and adolescents were frequent in clinical settings and more in girls than that of boys due to more associated abnormal psychosocial situations among girls.KYAMC Journal Vol. 9, No.-2, July 2018, Page 69-72

Screening for Somatoform Disorders in Children and Adolescents

Until now, no German diagnostic instrument existed for somatoform disorders in children and adolescents. Therefore the Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) was developed based on the SOMS-2 (Screening for Somatoform Disorders 2) (Rief & Hiller, 2008). This study investigates to what extent the SOMS-CA can differentiate significantly between children and adolescents with clinically diagnosed somatoform disorders and a control group and whether the SOMS-CA is superior to the GSCL-C (Giessen Subjective Complaint List for Children) (Braehler, 1992). 30 patients (11 - 17 years) with somatoform disorders and a control group (n = 31) were examined with the SOMS-CA (N = 61). The results from the SOMS-CA in both groups were compared with one another by means of a contingency analysis (chi-square test). The sensitivity and specificity were calculated and an optimal cut-off value was determined (Receiver Operating Characteristic curve (ROC-curve) analysis). A comparison analysis of the ROC-curves of the SOMS-CA and the GSCL-C followed. The sum score of complaints in the patients was significantly higher than that in the control group. The ROC-curve for the SOMS-CA demonstrates its excellent ability to differentiate between the two groups with an AUC (area under the curve) = 0.983 (SE = 0.14; N = 61). The sensitivity was 97.6%, the specificity 96.8%. In comparison to the AUC of the GSCL-C the SOMS-CA shows a much higher result. The SOMS-CA successfully identifies patients with somatoform disorders from a paediatric population and differentiates from healthy test subjects. A comparison to the GSCL-C shows a considerable superiority of the SOMS-CA. Further studies on the validity of the SOMS-CA are necessary.

Systematik somatoformer Störungen des Kindes- und Jugendalters

Somatoform disorders in children and adolescents are common and can cause significantly reduced wellbeing and quality of life. Considerable subjective impairment leads to a high number of doctors' visits, which along with a reoccurrence of negative findings, often results in a sense of helplessness in the patient and a lack of trust towards the physician. The criteria for somatoform disorders are illustrated based on the classification scheme ICD-10 and in consideration of the DSM-V. Referring to Noeker (2008) the special role of the parents for the development of somatoform disorders is explained. The typical clinical profile of somatoform disorders in children and adolescents is described. As a diagnostic instrument the newly developed Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) (Winter, Pfeiffer, Köberle, Lenz, Lehmkuhl, 2008) is introduced. Furthermore it is demonstrated that patients with somatoform disorders are seen predominantly within consulting and liaison services of the paediatric clinic. The importance of interdisciplinary cooperation between paediatrics and child and adolescent psychiatry and -psychotherapy in early diagnosis and introduction of appropriate treatment is highlighted.

Headaches as somatoform disorders in children and adolescents.

Somatoform disorders are often the main cause for seeking professional advice and performing a number of specialist checks. The aim of the study was to determine the frequency of somatoform disorders in the form of headaches in children and adolescents neurologically diagnosed and the risk factors thereof. Analysis of the biological and situational risk factors were established. Somatoform disorders were diagnosed in 27 out of 276 children with headaches. We concluded that in the differential diagnosis of headaches, somatoform headaches should not be omitted as every 10th patient in the developmental age diagnosed on the neurological ward because of headache shows signs of somatoform headaches. In diagnostically difficult cases it is recommended that analysis of biological and situational risk factors be performed with special attention paid to chronic disease of the patient and/or in his immediate family, the patient’s psychological disorders and dysfunctional or low social status families. The creation of separate criteria for somatoform disorders of the developmental age should be considered.

Systematics of somatoform disorders

Somatoform disorders in children and adolescents are common and can cause a significant reduction in wellbeing and quality of life. Considerable subjective impairment leads to a high number of doctors’ visits which, together with recurrently negative findings, often results in a sense of helplessness in the patient and a lack of trust towards the physician. The criteria for somatoform disorders are discussed on the basis of the International Classification of Diseases and Related Health Problems (ICD)-10 and taking the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-V) into consideration. Parents play a particular role in the development of somatoform disorders in childhood and adolescence. The importance of the paediatrician’s role in early diagnosis and introduction of appropriate treatment is underlined. The newly developed Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) is presented. Patients with somatoform disorders are seen predominantly within consulting and liaison services of the paediatric clinic.

Familial Risk Factors for the Development of Somatoform Symptoms and Disorders in Children and Adolescents: A Systematic Review

The aim of this study was to examine whether familial risk factors for the development of somatoform symptoms and somatoform disorders in children and adolescents can be deduced from studies which investigated the intergenerational transmission of functional abdominal pain and somatoform disorders. A systematic review of articles published in English and German since 1990 was performed. Twenty-three relevant studies were found. The following putative familial risk factors for the development of somatoform symptoms and somatoform disorders were identified: somatization of parents, organic disease of a significant other, psychopathology of close family members, dysfunctional family climate, traumatic experiences in childhood and insecure attachment. Most of the putative familial risk factors are associated with many other psychiatric child disorders and are therefore mostly nonspecific. Further longitudinal studies, in which comorbidity and other putative risk factors are taken into account, are needed to identify specific familial risk factors for the development of somatoform symptoms and somatoform disorders.

Somatization Disorders: Diagnosis, Treatment, and Prognosis

1. Tomas Jose Silber, MD* 1. *Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Director, Adolescent Medicine Fellowship Program, Children's National Medical Center, Washington, DC. After completing this article, readers should be able to: 1. Identify the various manifestations of somatization disorders in children and adolescents. 2. Understand the association of psychosomatic disorders with personality traits and stressors such as physical and sexual abuse, bullying, parental anxiety, and pressure for a child to perform. 3. Recognize secondary gains of somatization disorders. 4. Explain why it is necessary to focus on school attendance and the management of school avoidance. 5. Develop a partnership with patients and their parents to address the symptoms of a somatization disorder. 6. Plan the treatment and management of somatization disorders Children and adolescents suspected of having somatization disorders present a challenge to pediatricians. Clinicians are often concerned about “missing something,” while also worrying about alienating both the patient and the family when explaining the condition. Many clinicians are baffled by the onslaught of symptoms, feel frustrated by the never-ending recurrent complaints, or become annoyed by the time consumed in caring for patients who might be perceived as “not really being sick.” The research on somatization disorders is neither easily available nor conclusive. Moreover, paradoxically, although somatoform disorders in children have been defined as psychiatric disorders, psychiatrists seldom see these patients. By default, most children and adolescents who have symptoms are seen by primary care physicians. (1)(2)(3)(4) This review focuses on understanding, assessing, and developing strategies for managing somatization disorders. Somatization is “the tendency to experience and communicate somatic distress and symptoms unaccounted by pathological findings.” (5) However, it must be stressed that somatization can coincide with another illness. Somatization is deemed to exist in conjunction with a physical illness whenever the physical …

Somatization Disorders: Diagnosis, Treatment, and Prognosis

Somatization Disorders: Diagnosis, Treatment, and Prognosis

Clinical Profile of Somatoform Disorders in Children

To study the clinical profile, socio-demographic features, psychosocial stressors and outcome of somatoform disorders in children Children up to the age of 18 year presenting with unexplained physical symptoms over a period of 6 months were evaluated. A detailed history and physical examination was carried out. Appropriate investigations were undertaken to exclude organic causes. Diagnosis was made according to DSM-IV-TR criteria. Forty-five children were diagnosed with somatoform disorders during the study period. The prevalence was 0.5% and 0.9% among outdoor and indoor patients, respectively. Conversion disorder (48.9%) was the commonest followed by other somatoform disorders (26.7%). Pseudoseizures and fainting attacks in conversion disorder and pain abdomen and general body pain in somatoform disorder were the commonest symptoms. Male to female ratio was 2.2:1. Urban children (25) were represented more than rural children (20). Stress factors were identified in 71.1% patients, which included fear of school or examinations. Thirty-three patients (73.3%) remained asymptomatic after counseling whereas, 8 patients (17.6%) had relapse requiring further counseling. Four patients (8.8%) showed no improvement and needed psychiatric evaluation. Early referral to mental health professional is required to avoid unnecessary investigations and delay in diagnosis of somatoform disorders in children.

Record attendance at Austrian EACLPP–ECPR meeting in Innsbruck

The joint meeting of the European Society of Consultation–Liaison Psychiatry and Psychosomatics (EACLPP) and the European Conference on Psychosomatic Research (ECPR) took place in Innsbruck, Austria, June 30 to July 3, 2010. The EACLPP conference was organized in cooperation with the Medical University of Innsbruck and the Austrian Psychiatric Association. The theme “Consultation–liaison service in different medical settings” was dedicated to foster the integrated multitude of specialized (liaison) services into the broad field of consultation–liaison psychiatry and psychosomatics. This theme was chosen to enable a broad interest for both conferences with nearly 500 participants from 27 countries from all continents, which constitute a record number of attendants. Preconference courses dealt with psychopharmacology in the medical ill, well-being therapy, somatoform disorders in children, and “How to organize and operate a C/L service?”, the last of which was sponsored by the European Psychiatric Association. The conference featured three plenary sessions concerning the main topic of C/L services in different medical settings. In discussions about specialized services vs generic C/L services, Michael Sharpe presented UK innovations, Monika Keller summarized the field of psycho-oncology, and Christoph Herrmann-Lingen introduced psychocardiology. The subject of addiction (still a taboo?) was considered by Michael Musalek and psycho-dermatology by Uwe Gieler. Somatoform disorders were considered from childhood (John Campo) to adulthood (Per Fink) up to the elder age (Gudrun Schneider). Ten parallel sessions discussed further aspects of C/L services on internal medicine wards, oncology, organ

Progress in the etiology of somatoform disorders in children and adolesents

中国精神障碍分类与诊断标准第三版把躯体形式障碍定义为神经症的一种,其特征为患者反复出现各种躯体症状,但与主诉相应的各种医学检查阴性或与躯体主诉不相符.儿童和青少年患者会影响学习、人际交往等.躯体形式障碍的病因还未明确,认为是多因素的.该文从生物学、心理和社会因素三方面对儿童和青少年躯体形式障碍的病因进行综述。

Functional Symptoms and Somatoform Disorders in Children and Adolescents: The Role of Standardised Measures in Assessment.

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.

Somatization and somatoform disorders

Medically unexplained somatic symptoms are common in children and adolescents. They can be an expression of somatization (i.e. psychological difficulty/distress manifested through somatic symptoms which are attributed to physical illness), and/or of a somatoform disorder. The most common somatoform disorders in children are persistent somatoform pain disorder and dissociative/conversion disorder. Chronic fatigue syndrome – known as ‘neurasthenia’ in ICD-10 – shares the key features of somatoform disorders. This chapter outlines the main clinical characteristics of recurrent medical unexplained somatic symptoms and somatoform disorders in children. Onset is often insidious but some problems are brought on by a medical condition or injury. Psychiatric co-morbidity is common, especially emotional disorder. Risk factors in the child include certain personality features (ie sensitivity, anxiety-proneness and conscientiousness). Risk factors in the family involve a history of both physical and psychological problems and symptom reinforcement. Treatment involves taking the symptoms seriously and clarification of medical investigations and exclusions, psycho-education, reducing attention to the symptoms whilst relieving stresses and increasing supports for the child in school and at home as appropriate. It may involve family behavioural/cognitive work. Many children improve.

Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: somatization and other somatoform disorders.

This article reviews current knowledge about somatoform disorders in children and adolescents. Somatoform disorders are likely to occur more frequently in children and adolescents who have been severely maltreated than in others. The symptoms of somatoform disorders are reviewed, strategies for distinguishing somatoform disorders from other disorders are examined, and treatment strategies are explored.

Somatization disorders in children and adolescents.

1. Tomas Jose Silber, MD* 2. Maryland Pao, MD† 1. *Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Director, Adolescent Medicine Fellowship Program, Children’s National Medical Center, Washington, DC 2. †Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health; Clinical Assistant Professor of Psychiatry, The George Washington University School of Medicine and Health Sciences, Washington, DC After completing this article, readers should be able to: 1. Describe the various manifestations of somatization disorders in children and adolescents. 2. Delineate the association of psychosomatic disorders with stress, parental anxiety, or pressure for a child to perform. 3. Distinguish between primary and secondary gain. 4. Explain why school attendance should be assessed with every recurrent complaint. 5. Explain why pediatricians should establish a partnership with patients and their parents when addressing their symptoms. 6. Develop a cost-effective investigation of suspected somatoform disorders and an approach to insurance companies regarding reimbursement of services. The diagnosis and treatment of children and adolescents who have somatization disorders constitute a challenge for pediatricians: On one hand, they raise the specter of “missing something”; on the other, any “false step” in explaining the condition risks alienating both the patient and the family. Many clinicians rise to the challenge, but many more are baffled by the onslaught of symptoms, become annoyed by the time consumed in caring for patients who are “not really sick,” or feel frustrated by the never-ending recurrent complaints. To make matters worse, these disorders have been scantly researched; neither meta-analysis nor evidence-based medicine has contributed significantly to the field. Paradoxically, although somatoform disorders in children have been defined as psychiatric disorders, psychiatrists seldom see these patients except for the most extreme, unusual, and bizarre cases. Most children and adolescents who have functional symptoms are seen by primary care physicians. This review, therefore, focuses on understanding and assessing somatization as well as developing strategies for the day-to-day management of these conditions. Somatization has been defined as the occurrence of one or more physical complaints for which appropriate medical evaluation reveals no explanatory physical pathology or pathophysiologic mechanism. Somatization also can coincide with a physical illness. Somatization is deemed to exist in conjunction with a physical illness whenever …