Ricerca
“Più matti che malati”: chi, quanti, cosa succede di loro
Admissions related to children's emotional distress or mental health disorder in the paediatric ward of a tertiary referral children's hospital
Giuliana Morabito1, Giorgio Cozzi1, Chiara Bertolini2, Sergio Ghirardo2, Egidio Barbi1,2, Alessandro Ventura1,2
1IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
2Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università di Trieste
Gennaio 2018 - pagg. 27 -34
Abstract
Functional and somatic disorders are common in childhood and can become long-lasting
and disabling. This study showed a 6.9% prevalence of children with emotional distress
and/or mental disorders among children admitted to a third level paediatric ward
for physical symptoms. Most cases were characterised by long-lasting symptoms, “doctor
shopping”, school absenteeism and functional disability. A psychiatric disorder, mostly
an anxious-depressive status, was observed in 21% of cases. At a two-year followup,
the symptoms and the disability were still present in 34% of cases in spite of a declared
exclusion of any organic disease and the activation of a multidisciplinary therapeutic
approach aimed to reduce symptoms and disability. Functional and somatic disorders
are frequent in children admitted to hospital for physical complaints. The prognosis
of these cases is still unacceptably poor. Paediatricians should improve their skills in facing
this emerging problem.
Classificazione MeSH
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Bibliografia
1. Schechter NL. Functional pain: time for a
new name. JAMA Pediatr 2014;168(8):693-4.
2. Eminson DM. Medically unexplained symptoms
in children and adolescents. Clin
Psychol Rev 2007;27(7):855-71.
3. Malas N, Donohue L, Cook RJ, Leber SM,
Kullgren KA. Pediatric somatic symptom and
Related disorders: primary care provider perspectives.
Clin Pediatr (Phila) 2017:992281-
7727467 [Epub ahead of print].
4. Kaczynski K, Gambhir R, Caruso A, Lebel
A. Depression as a mediator of the relation
between family functioning and functional disability
in youth with chronic headaches. Headache
2016;56(3):491-500.
5. Varni JW, Bendo CB, Nurko S, et al.; Pediatric
Quality of Life Inventory (PedsQL) Gastrointestinal
Symptoms Module Testing
Study Consortium. Health-related quality of life
in pediatric patients with functional and organic
gastrointestinal diseases. J Pediatr 2015;
166(1):85-90.
6. Jackson JL, Kroenke K. Prevalence, impact,
and prognosis of multisomatoform disorder in
primary care: a 5-year follow-up study. Psychosom
Med 2008;70(4):430-4.
7. Roth-Isigkeit A, Thyen U, Stöven H, Schwarzenberger
J, Schmucker P. Pain among children
and adolescents: restrictions in daily living
and triggering factors. Pediatrics 2005;
115(2):e152-62.
8. Chun TH, Mace SE, Katz ER; American
Academy of Pediatrics; Committee on Pediatrics
Emergency Medicine; American College
of Emergency Physicians; Pediatric Emergency
Medicine Committee. Executive summary:
evaluation and management of children
with acute mental health or behavioral problems.
Part II. Recognition of clinically challenging
mental health related conditions presenting
with medical or uncertain symptoms.
Pediatrics 2016;138(3) [Epub 2016 Aug 22].
9. Cozzi G, Minute M, Skabar A, et al. Somatic
symptom disorder was common in children
and adolescents attending an emergency department
complaining of pain. Acta Paediatr
2017;106(4):586-93.
10. Cozzi G, Barbi E. Il bambino che non funziona.
Medico e Bambino 2018;37(1):21-6.
11. The Lancet. Making the most out of crisis:
child and adolescent mental health in the emergency
department. Lancet 2016;388(10048):
935.
12. Minute M, Cozzi G, Barbi E. An adolescent
with disabling abdominal pain. BMJ 2016;355:
i6101.
13. Roberts JH, Crosland A, Fulton J. “I think
this is maybe our Achilles heel..” Exploring
GPs’ responses to young people presenting
with emotional distress in general practice: a
qualitative study. BMJ Open 2013;3(9):e002927.
14. Martinez R, Reynolds S, Howe A. Factors
that influence the detection of psychological
problems in adolescents attending general
practices. Br J Gen Pract 2006;56(529):594-9.
15. Vila M, Kramer T, Hickey N, et al. Assessment
of somatic symptoms in British secondary
school children using the Children’s Somatization
Inventory (CSI). J Pediatr Psychol
2009;34(9):989-98.
16. Bonvanie IJ, Kallesøe KH, Janssens KAM,
Schröder A, Rosmalen JGM, Rask CU. Psychological
interventions for children with
functional somatic symptoms: a systematic review
and meta-analysis. J Pediatr 2017;187:
272-281.e17.
17. Kramer T, Garralda ME. Child and adolescent
mental health problems in primary care.
Adv Psychiatr Treat 2000;6:287-94.
18. Wessely S, Nimnuan C, Sharpe M. Functional
somatic syndromes: one or many? Lancet
1999;354(9182):963-9.
19. Hawkrigg S, Payne DN. Prolonged school
non-attendance in adolescence: a practical approach.
Arch Dis Child 2014;99(10):954-7.
20. Haraldstad K, Sørum R, Eide H, Natvig
GK, Helseth S. Pain in children and adolescents:
prevalence, impact on daily life, and
parents’ perception, a school survey. Scand J
Caring Sci 2011;25(1):27-36.
21. Kerzner B, Milano K, MacLean WC Jr, Berall
G, Stuart S, Chatoor I. A practical approach
to classifying and managing feeding difficulties.
Pediatrics 2015;135(2):344-53.
22. Taddio A, Cannioto Z, Barbi E, et al. IGARIS
(Iatrogenic Ghost Allergy and Reflux Infant
Syndrome): una nuova forma iatrogenica
di rifiuto del cibo. Medico e Bambino 2017;36
(9):571-6.
23. Janssens KA, Klis S, Kingma EM, Oldehinkel
AJ, Rosmalen JG. Predictors for persistence
of functional somatic symptoms in
adolescents. J Pediatr 2014;164(4):900-905.e2.
24. Panontin E, Cozzi G, Skabar A, et al. La sindrome
di Münchausen by proxy. Medico e
Bambino 2014;33(8):497-510.
25. Vervoort T, Goubert L, Eccleston C, Bijttebier
P, Crombez G. Catastrophic thinking
about pain is independently associated with
pain severity, disability, and somatic complaints
in school children and children with
chronic pain. J Pediatr Psychol 2006;31(7):
674-83.
26. Tierney CD, Walker-Harding LR. Early intervention
for functional somatic symptoms
using psychological interventions highlights
the need for a medical home care model for
pediatric patients. J Pediatr 2017;187:15-7.
27. Aliverti R. I disturbi somatoformi. Un protocollo
di azione comune tra pediatra e neuropsichiatra
infantile. Medico e Bambino 2004;
23(6):273-76.
28. Zwaigenbaum L, Szatmari P, Boyle MH,
Offord DR. Higly somatizing young adolescents
and the risk of depression. Pediatrics
1999;103(6 Pt 1):1203-9.
Corrispondenza: giuliana5morabito@gmail.com