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Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy?

Knook LM, Konijnenberg AY, van der Hoeven J, Kimpen JL, Buitelaar JK, van Engeland H, de Graeff-Meeder ER - Eur Child Adolesc Psychiatry (2010)

Bottom Line: Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07-8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02-8.74, p = 0.04).In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP.Children with an additional risk are those presenting with headache.

View Article: PubMed Central - PubMed

Affiliation: Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, A 01.468, PO Box 85500, 3508 GA, Utrecht, The Netherlands. L.M.E.Knook@umcutrecht.nl

ABSTRACT
The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children's hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8-17 years, using the Diagnostic Interview Schedule for Children-parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children's Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07-8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02-8.74, p = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache.

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Related in: MedlinePlus

Psychiatric cases identified by parental interview (DISC) and/or child psychiatrists’ assessment (SCICA)
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Fig1: Psychiatric cases identified by parental interview (DISC) and/or child psychiatrists’ assessment (SCICA)

Mentions: Figure 1 shows the proportion of children identified as psychiatric cases by DISC and/or SCICA assessment. Of the 131 children assessed by both interviews, 14.5% of the children had a psychiatric diagnosis according to both DISC-P and SCICA outcome. In addition to the DISC who identified 20.5% of the children as psychiatric case, the SCICA identified another 14.5%. As much as 35% of the children had clinically relevant psychiatric disorder assessed by one or both interviews. The various single and comorbid psychiatric cases, based on the DISC-P (28 patients) and SCICA (38 patients), are given in Table 4.Fig. 1


Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy?

Knook LM, Konijnenberg AY, van der Hoeven J, Kimpen JL, Buitelaar JK, van Engeland H, de Graeff-Meeder ER - Eur Child Adolesc Psychiatry (2010)

Psychiatric cases identified by parental interview (DISC) and/or child psychiatrists’ assessment (SCICA)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3012208&req=5

Fig1: Psychiatric cases identified by parental interview (DISC) and/or child psychiatrists’ assessment (SCICA)
Mentions: Figure 1 shows the proportion of children identified as psychiatric cases by DISC and/or SCICA assessment. Of the 131 children assessed by both interviews, 14.5% of the children had a psychiatric diagnosis according to both DISC-P and SCICA outcome. In addition to the DISC who identified 20.5% of the children as psychiatric case, the SCICA identified another 14.5%. As much as 35% of the children had clinically relevant psychiatric disorder assessed by one or both interviews. The various single and comorbid psychiatric cases, based on the DISC-P (28 patients) and SCICA (38 patients), are given in Table 4.Fig. 1

Bottom Line: Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07-8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02-8.74, p = 0.04).In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP.Children with an additional risk are those presenting with headache.

View Article: PubMed Central - PubMed

Affiliation: Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, A 01.468, PO Box 85500, 3508 GA, Utrecht, The Netherlands. L.M.E.Knook@umcutrecht.nl

ABSTRACT
The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children's hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8-17 years, using the Diagnostic Interview Schedule for Children-parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children's Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07-8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02-8.74, p = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache.

Show MeSH
Related in: MedlinePlus