Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings (original) (raw)
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Somatization in acute care pediatrics: Respecting the mind–body connection
Clinical Child Psychology and Psychiatry, 2020
Somatic symptom disorder is a complex condition linking distress in the mind to physical distress in the body. However, in addition to the disorder itself, experienced clinicians know that children and youth frequently experience somatizing symptoms. With an increasing prevalence of anxiety in the pediatric population, symptoms attributable to process of “somatizing” are common, and early identification and rapport building to address the root causes of a child’s distress are critical for a good outcome. In the acute care setting, clinicians are often reluctant to make the diagnosis of somatization. Part of the challenge is encouraging clinicians to see that somatization is not a “diagnosis of exclusion.” We want to encourage clinicians to routinely consider risk factors for somatization in their histories, actively discuss the mind–body connection with patients and families, and include somatization in a carefully considered differential diagnosis. The more we can break down the si...
JAMA Network Open, 2020
IMPORTANCE Somatic symptom and related disorders are highly prevalent mental health disorders among young people. Presentation can be varied, and patients often face long delays and see multiple practitioners to receive a diagnosis. OBJECTIVE To evaluate the health care use and costs in a population-based sample of children and young people with somatic symptom and related disorders in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used linked health and administrative databases in Ontario, Canada, where health services are funded through a universal single-payer health insurance plan. Participants included children aged 4 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 to 24 years residing in Ontario, Canada, during the period of April 1, 2008, to March 31, 2015. Included participants had a first health record diagnosis of somatic symptom and related disorders and were grouped based on the setting of their index somatic symptom and related disorders contact: outpatient, emergency department, or inpatient.
European Journal of Pediatrics
Somatic symptom disorders (SSDs) are a group of clinical conditions characterized by heterogeneous physical symptoms, not directly supported by a demonstrable organic process. Despite representing a growing problem in the pediatric age, the literature lacks studies assessing the psychopathological and clinical features of subjects with SSD, particularly during the SARS-CoV-2 pandemic. This is a retrospective, observational study, involving two historical cohorts of children admitted to a tertiary referral Italian hospital over the 2 years preceding and following the start of the SARS-CoV-2 pandemic. Demographic, clinical, socioeconomical, and psychological variables were investigated. Standardized tests for the developmental age were administered to assess psychopathological variables. Overall rates and trends of accesses for SSD, as compared to the total accesses for any cause at the Pediatric Emergency Room during the same periods, were reported as well. Fifty-one (pre-pandemic, 29; pandemic, 22) children with SSD were enrolled (age, 11.4 ± 2.4 years, F = 66.7%). Subjects in the pandemic historical cohort reported more frequently fever (p < 0.001), headache (p = 0.032), and asthenia (p < 0.001), as well as more chronic conditions in personal and family history, and fewer previous hospital accesses, as compared to the pre-pandemic cohort. Depressed mood and anxious traits were documented in both samples. None of them had an ongoing or a previously reported SARS-CoV-2 infection. During the pandemic, a clinical psychologist was more frequently consulted before the hospital discharge to mental health services, to support the diagnosis. Conclusion: This study showed the significant burden of SSD in children, highlighting the need to implement pediatricians' education to optimize the management of these patients. Children with SSD who accessed during the SARS-CoV-2 pandemic presented specific clinical features. Future studies, conducted on longitudinal and controlled samples, are indicated to further investigate children with these conditions. What is Known: • Somatic symptoms disorders (SSDs) are frequent in the pediatric age, especially in early adolescence. • Evidence remains scarce on the impact of the SARS-CoV-2 pandemic on SSDs in children. What is New: • Children with SSD who accessed during the SARS-CoV-2 pandemic presented specific clinical features. • The implementation of pediatricians' education and a multidisciplinary approach are needed to optimize the management of SSDs.
Somatic Symptoms in Children and Adolescents Referred for Emotional and Behavioral Disorders
Psychiatry, 2000
MEDICALLY unexplained physical symptoms are frequently endorsed by children and adolescents in both clinical and community samples. The aim of this exploratory study is to examine the prevalence of somatic symptoms in a sample of 162 Italian children and adolescents consecutively referred to a Division of Child Neurology and Psychiatry from emotional and/or behavioral disorders. The role of age, gender, and psychiatric status was considered as a variable. Each patient received a DSM-N assessment, including a diagnostic structured interview (DICA-R). The sample was divided according to gender (96 males, 66 females), age (70 children younger and 92 adolescents older than 12 years), and psychiatric diagnosis (Anxiety, Depression, Depression! Anxiety, Other). The presence of medically unexplained somatic symptoms was based on the responses to the DICA-R. Somatic complaints were reported in 69.2% of the patients. Headache was the most frequent somatic symptom (50.6%). Younger children showed higher rates of abdominal complaints than adolescents. No gender differences in frequency of somatic complaints were reported. Subjects with anxiety and/or depression reported significantly higher rates of somatic complaints, namely headache, than subjects with other mental disorders. No differences in frequency of somatic symptoms were evident between patients with anxiety, depression, and comorbid anxiety-depression. Our data suggest that an unexplained somatic symptom can be often considered as indicative of a neglected anxiety and/or depressive disorder. A collaboration between primary care physicians, pediatricians, and child psychiatrists may promote early diagnoses and timely treatments and prevent negative social and scholastic consequences.
The Soma Assessment Interview: New parent interview on functional somatic symptoms in children
Journal of Psychosomatic Research, 2009
Objective: Medically unexplained or functional somatic symptoms (FSS) in children constitute a major clinical problem. Epidemiological studies of this phenomenon are, however, hampered by a lack of good standardized measures. The objective of this study was therefore to (1) develop a parent-report measure of FSS in children aged 5-10 years and (2) perform an initial validation. Methods: A parent interview, the Soma Assessment Interview (SAI), for FSS detection in young children was developed for lay interviewers with subsequent clinical assessment. A preliminary validation was based on interview tests of the parents of 54 children with well-defined physical disease, 59 with likely functional disorder and 105 from the community. Independent measures of the somatic complaints were completed before the interview, and children from the clinical samples were also assigned independent FSS diagnoses based on medical record review. Results: The Kappa value for two clinical assessors' agreement on FSS recognition was 0.86. Good discrimination was obtained between a community sample and a clinical sample with an expected high prevalence of FSS. In the former convergent validity with independent measures of somatic complaints was found. In the latter substantial agreement (89%) appeared between a medical record diagnosis of FSS and SAI detection of FSS. Conclusion: The SAI offers comprehensive description of FSS in young children in population-based studies and may also prove useful in clinical settings. It is readily accepted and relatively quickly completed, and preliminary assessment of its validity is promising.
Functional Somatic Symptoms and Consultation Patterns in 5- to 7-Year-Olds
PEDIATRICS, 2013
Functional somatic symptoms (FSS) in children account for 10% to 15% of visits in medical services. Few studies have investigated the full range of pediatric FSS and factors linked to the medical help-seeking for young children with these symptoms. WHAT THIS STUDY ADDS: More parental worries, higher symptom severity and impact, and previous contact to medical services are found among the children with FSS who seek medical consultation. Putative risk mechanisms include the early pattern of health care use and parental worries.
Somatic Symptoms in Primary Care: Etiology and Outcome
Psychosomatics, 2003
Although somatic complaints are the predominant reason for seeking general medical care, their etiology and prognosis remain poorly understood. In a random sample of the records of all patients visiting an urban primary care clinic during four 1-month periods, 289 patients had one or more somatic symptoms, a total of 433 symptoms. Using explicit criteria, physician raters classified nearly half (48%) of the symptoms as either psychiatric or idiopathic in etiology. Reviewing follow-up notes for 12 months after the index visit, raters found that at least one-fourth of the symptoms persisted. Independent predictors of symptom persistence were prior visits for the same symptom, symptom type (i.e., headache or back pain), male gender, and greater medical comorbidity (i.e., seven or more medical diagnoses). Developing better management strategies for prevalent, medically unexplained, persistent somatic symptoms is a health care priority.
Somatic Symptom Disorder and the Physician’s Role
JAMA Pediatrics, 2020
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