1
|
Panagi L, White SR, Dai X, Bennett S, Shafran R, Ford T. Risk of new onset and persistent psychopathology in children with long-term physical health conditions: a population-based cohort study. Eur Child Adolesc Psychiatry 2024; 33:439-449. [PMID: 36854983 PMCID: PMC10869380 DOI: 10.1007/s00787-023-02170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023]
Abstract
Children and young people (CYP) with long-term physical health conditions (pLTCs) have increased risk of psychopathology compared to physically healthier peers. We explored risk factors for new onset and persistent psychiatric disorders in CYP with pLTCs compared to CYP without pLTCs. This 3-year follow-up study involved a UK representative sample of CYP from the British Child and Adolescent Mental Health Surveys (N = 7804). We examined potential baseline predictors of new onset and persistent psychiatric disorders at follow-up in four groups of children based on the presence of any physical and/or any psychiatric conditions at baseline. Psychiatric disorders were assessed using standardised multi-informant diagnostic assessment. Separate multivariable binary logistic regressions were conducted for each group. In CYP with pLTCs, rented housing (aOR = 1.42, 95% CI 1.01 to 1.99), non-traditional family structure (aOR = 2.08, 95% CI 1.42 to 3.05), increased parental distress (aOR = 1.09, 95% CI 1.04 to 1.14), and greater peer relationship difficulties (aOR = 1.29, 95% CI 1.19 to 1.39) predicted future psychiatric disorder. Only peer relationship difficulties predicted persistent disorder (aOR = 1.27, 95% CI 1.17 to 1.38) in this group. A greater number of factors predicted the onset of psychiatric disorder in CYP with pLTCs compared to physically healthier peers and similarly, a higher number of factors predicted persistent disorder in CYP without pLTCs. CYP with pLTCs might comprise a group with different vulnerabilities, some of which are potentially tractable and may be useful indicators of patients who require preventable or management interventions.
Collapse
Affiliation(s)
- Laura Panagi
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
| | - Simon R White
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
| | - Xiaolu Dai
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
- Department of Social Work and Social Administration, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Pokfulam, Hong Kong
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK.
| |
Collapse
|
2
|
Baker J, Barnett C, Cavalli L, Dietrich M, Dixon L, Duffy JR, Elias A, Fraser DE, Freeburn JL, Gregory C, McKenzie K, Miller N, Patterson J, Roth C, Roy N, Short J, Utianski R, van Mersbergen M, Vertigan A, Carson A, Stone J, McWhirter L. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry 2021; 92:1112-1125. [PMID: 34210802 DOI: 10.1136/jnnp-2021-326767] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022]
Abstract
Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.
Collapse
Affiliation(s)
- Janet Baker
- Speech Pathology, Flinders University, Adelaide, South Australia, Australia
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caroline Barnett
- South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK
| | - Lesley Cavalli
- Department of Speech & Language Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, London, UK
- Division of Psychology and Language Sciences, University College London, London, London, UK
| | - Maria Dietrich
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Lorna Dixon
- National Hospital for Neurology and Neurosurgery, London, London, UK
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Annie Elias
- Speech and Language Therapy, Kent Community Health NHS Foundation Trust, Ashford, Kent, UK
| | - Diane E Fraser
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
| | | | | | | | - Nick Miller
- Speech Language Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Jo Patterson
- University of Liverpool, Liverpool, Merseyside, UK
| | - Carole Roth
- Speech Pathology Division, Naval Medical Center San Diego, San Diego, California, USA
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
- Division of Otolaryngology - Head and Neck Surgery (Adjunct), The University of Utah, Salt Lake City, Utah, USA
| | | | - Rene Utianski
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Speech Pathology and Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Miriam van Mersbergen
- School of Communication Sciences and Disorders, Institute for Intelligent Systems, The University of Memphis, Memphis, Tennessee, USA
| | - Anne Vertigan
- Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
- Centre for Healthy Lungs, Hunter Medical Research Institute; School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Alan Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
| |
Collapse
|
3
|
Hansen AS, Rask CU, Christensen AE, Rodrigo-Domingo M, Christensen J, Nielsen RE. Psychiatric Disorders in Children and Adolescents With Psychogenic Nonepileptic Seizures. Neurology 2021; 97:e464-e475. [PMID: 34031196 DOI: 10.1212/wnl.0000000000012270] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Knowledge regarding psychiatric disorders in children and adolescents with psychogenic nonepileptic seizures (PNES) is limited. This study outlines the spectrum and risk of psychiatric disorders in childhood-onset PNES. METHODS We performed a nationwide matched cohort study of children and adolescents with PNES 5 to 17 years of age at the time of diagnosis between January 1, 1996, and December 31, 2014. Two matched comparison groups were included: children and adolescents with epilepsy (ES) and children and adolescents without PNES or epilepsy, called healthy controls (HC). Outcomes were prevalent psychiatric disorders before index (i.e., date of diagnosis or corresponding date for HC) and incident psychiatric disorders 2 years after index. Relative risks (RRs) were calculated and adjusted for potential confounders. RESULTS We included 384 children and adolescents with validated PNES, 1,152 with ES, and 1,920 HC. Among the cases of PNES, 153 (39.8%) had prevalent psychiatric disorders and 150 (39.1%) had incident psychiatric disorders. Compared to the ES and HC groups, children and adolescents with PNES had elevated risks of both prevalent psychiatric disorders (adjusted RRPNES/ES 1.87, 95% confidence interval [CI] 1.59-2.21, adjusted RRPNES/HC 5.54, 95% CI 4.50-6.81) and incident psychiatric disorders (adjusted RRPNES/ES 2.33, 95% CI 1.92-2.83, adjusted RRPNES/HC 8.37, 95% CI 6.31-11.11). A wide spectrum of specific psychiatric disorders displayed elevated RRs. CONCLUSIONS Children and adolescents with PNES are at higher risk of a wide range of psychiatric disorders compared to children and adolescents with ES and HC. A careful psychiatric evaluation is warranted to optimize and individualize treatment.
Collapse
Affiliation(s)
- Anne Sofie Hansen
- From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark.
| | - Charlotte Ulrikka Rask
- From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark
| | - Ann-Eva Christensen
- From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark
| | - Maria Rodrigo-Domingo
- From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark
| | - Jakob Christensen
- From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark
| | - René Ernst Nielsen
- From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark
| |
Collapse
|
4
|
Wiggins A, Court A, Sawyer SM. Somatic symptom and related disorders in a tertiary paediatric hospital: prevalence, reach and complexity. Eur J Pediatr 2021; 180:1267-1275. [PMID: 33185780 DOI: 10.1007/s00431-020-03867-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children's hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings were recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3-18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis.Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway. What is Known • Functional somatic symptoms are commonly seen in children and adolescents. • Few studies have explored the reach of functional somatic symptoms across a tertiary paediatric hospital; the majority of inpatient studies have focused on a limited set of disorders or cases referred to psychiatry departments. What is New • Symptoms that spanned multiple body systems were the most common presentation of SSRDs in admitted children and adolescents. • Somatic symptom disorders are less likely to be recorded as a discharge diagnosis compared with functional neurological symptom disorder.
Collapse
Affiliation(s)
- Aaron Wiggins
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia.
| | - Andrew Court
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- Department of Adolescent Medicine, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
5
|
Heyman I, Liang H, Hedderly T. COVID-19 related increase in childhood tics and tic-like attacks. Arch Dis Child 2021; 106:archdischild-2021-321748. [PMID: 33677431 DOI: 10.1136/archdischild-2021-321748] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Isobel Heyman
- Psychologcial Medicine Team, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Holan Liang
- Psychologcial Medicine Team, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM), Guy's King's and Saint Thomas' School of Medicine, London, UK
| |
Collapse
|
6
|
Winarizal AS, Horvath A, Sawyer SM. Measuring functional recovery in somatic symptom and related disorders: a scoping review. Arch Dis Child 2020; 105:1086-1092. [PMID: 32398323 DOI: 10.1136/archdischild-2020-318955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/21/2020] [Accepted: 04/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Somatic symptom and related disorders (SSRDs) are prevalent, heterogenous conditions that have the potential to profoundly affect normative function in children and adolescents. Yet there is little understanding of pathways to recovery. This study aimed to systematically scope how functional recovery has been measured in children and adolescents with SSRD . DESIGN Scoping review of primary studies. METHOD Medline (Ovid) and PsychInfo were systematically searched for publications from January 1998 to April 2019. Primary studies in English that reported functional outcomes of children and adolescents with SSRD were included. Case reports and population studies were excluded. Within the tools and clinician notes, the core domains of functional outcome were identified. RESULTS Sixteen studies were identified that used 11 different functional outcome tools. The domains assessed within these functional outcome tools, together with the domains noted by clinicians, included physical and mental health symptoms, as well as school attendance and academic outcomes, recreational participation, impact on family and service utilisation. There was no evidence of a preferred outcome measure as only two of the tools were used in more than one study. CONCLUSIONS The variability of tools and domains used to measure functional recovery in children and adolescents with SSRD suggests lack of conceptual agreement about what constitutes functional recovery. Continued focus on symptom measurement or mental health comorbidities risks limiting research to single types of disorder (eg, functional neurological disability) or interventions, which threatens a much needed wider research agenda around appropriate treatment, including of complex and persistent disorders.
Collapse
Affiliation(s)
- Afiah Salsabila Winarizal
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Fakultas Kedokteran Universitas Indonesia, Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia
| | - Anita Horvath
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia .,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
|