Medically Ill Complications
Although most children with a chronic medical illness do not experience a major psychiatric disturbance, the overall risk of psychiatric disorder is somewhat greater than that in the general population of children with no chronic physical illness. When medically-ill children do develop problems, evidence suggests that these present primarily as internalizing syndromes, such as anxiety and depression, and persist over time (DeMaso, Martini, & Cahen, 2009).
Symptoms:
Is It Medical or Is It Psychological?
There
is a tendency to dichotomize the psychiatric problems of medically ill children
into ‘‘medical’’ versus ‘‘psychiatric” or “functional.” The distinction however
is often not that simple. “Functional symptoms” is a phrase doctors often use
(or misuse) that seems to make intuitive sense to people without really having
a clear definition. Functional generally describes physical symptoms for which
no physical causes can be found, and the unspoken implication is that the
physical symptoms are secondary to psychiatric problems. Another similar term is “medically
unexplained physical symptoms” (MUPS).
How
doctors educate patients about functional or MUPS problems is important. The physical symptoms may be due to physical
causes that can’t be found by modern tests.
The physical and psychiatric symptoms may be caused by the body and/or
brain not working properly; therefore, functional symptoms may be caused by
mental factors, physical factors, or a combination of both. A treatment approach that is usually most
effective with patients is to try to figure out the causes together rather than
implying that it is “all in their heads.”
Treatment:
There
has been little research to develop psychotherapeutic or psychopharmacologic
interventions specifically for medically ill children and adolescents. The most promising evidence exists for
cognitive behavior therapy (CBT) although most of the studies have been conducted
with adult samples (Allen et al., 2006; Escobar et al., 2007; Perez-Benitez et
al., 2013)
A
bereavement model has also been used to help conceptualize the process of
adaptation to a physical illness and to guide treatment intervention. The
emotional responses to physical illness or disability can be viewed as a
process that begins with shock and denial and proceeds through feelings of
anguish and frustration toward an assimilation of illness information and
adjustment (DeMaso, Martini, & Cahen, 2009).
It
is also important to remember that psychiatric problems may result from symptom
attacks or medical procedures that were perceived as life-threatening. Up to 80% of pediatric patients and their
families report experiencing some traumatic stress following illness, injury,
hospitalization, or painful medical procedures. Left untreated, traumatic
stress reactions can negatively impact medical adherence, treatment, and
recovery.
Resources
Medical doctors (M.D.’s or D.O.’s) have the most
extensive training on the physical body relative to other clinical
professions. However, any type of licensed
clinician (e.g., PhD, LCSW, or LPC) may be excellent if he or she has made a
commitment to understand and work with this population.
If you are a local provider in the New Orleans region and an expert in any of these areas, please let us know so we can highlight your expertise for consumers. Contact us as [email protected].
One local resource is Tulane University School of Medicine’s Triple Board training program. Triple Board residents train in Pediatrics, General Psychiatry, and Child and Adolescent Psychiatry in order to integrate the clinical knowledge of pediatrics and psychiatry. The Triple Board Clinic is a resident-run clinic with supervision for medical and psychiatric issues by Pediatric and Child Psychiatry attending physicians. They provide initial child and adolescent psychiatric evaluations, medication management, and psychotherapy on a sliding scale basis. (504)-988-4794
Mental Health
The National Child Traumatic Stress Network (NCTSN) - Pediatric Medical Traumatic Stress Toolkit for Health Care Providers – offers of compendium of tools to guide medical professionals in effectively assessing and treating medical traumatic stress in children and families, resources in English and Spanish
General Support Groups and Information for Chronic Conditions
Medical Home Portal – For Parents and Families. Contains much information to help care for a child with chronic and complex conditions – Including navigating transitions with your child: http://www.medicalhomeportal.org/living-with-child
Disorder-Specific Resources
Brain Injury
Brain Injury Association of Louisiana – Support Groups:
http://www.biala.org/support-groups-1
Blindness
Lighthouse for the Blind Louisiana – Youth Services:
http://www.lighthouselouisiana.org/Services/Youth-Services
Cancer
Children’s Oncology Group (COG) – Family Handbook for Children with Cancer –Provides information regarding hospitalization, types of pediatric cancer, etc., and also provides a section about caring for your child and family:
http://www.childrensoncologygroup.org/index.php/cog-family-handbook
Children’s Oncology Group (COG) – Coping with Cancer – Multiple websites providing information on community support, school support, brief information on feelings and behaviors, and grieving and palliative care:
http://www.childrensoncologygroup.org/index.php/coping-with-cancer
Look Good Feel Better Program for Teens –2bMe – interactive teen website that teens can access information on dealing with their appearance, and social and psychosocial issues of a cancer diagnosis and treatment:
http://lookgoodfeelbetter.org/programs/programs-for-teens
Cystic Fibrosis
Cystic Fibrosis Foundation – Louisiana Chapter – contact information and link to yearly event calendar (walks, golf, bowling, plus more):
http://www.cff.org/Chapters/louisiana/
Epilepsy
Epilepsy Foundation Louisiana – Support Programs:
http://www.epilepsylouisiana.org
Fibromyalgia
National Fibromyalgia Association
Sickle Cell
Sickle Cell Center of Southern Louisiana – Transitional Clinic – Designed to help adolescents and young adults (ages 16-25) learn more about their sickle cell disease, provide special education, and psychosocial support as they transition from pediatric to adult care:
https://medicine.tulane.edu/tulane-doctors/sickle-cell-center
Baton Rouge Sickle Cell Anemia Foundation:
Sickle Cell Disease Association of America (S.C.D.A.A.) – Provides links and contact information to sickle cell disease centers in Louisiana:
http://www.sicklecelldisease.org/index.cfm?page=chapters
References:
Allen, L.A., Woolfolk, R.L., Escobar, J.I., Gara, M.A., Hamer, R.M. (2006). Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial. Archives of Internal Medicine 166, 1512-1518.
DeMaso, D. R., Martini, D., &Cahen, L. A. (2009). Practice parameter for the psychiatric assessment and management of physically ill children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 48(2), 213-233.doi:10.1097/CHI.0b013e3181908bf4
Escobar, J.I., Gara, M.A., Diaz-Martinez, A.M., Interian, A., Warman, M., Allen, L.A., Woolfolk, R.L., Jahn, E., Rodgers, D. (2007). Effectiveness of a Time-Limited Cognitive Behavior Therapy–Type Intervention among Primary Care Patients with Medically Unexplained Symptoms. Annals of Family Medicine 328-335. DOI: 10.1370/afm.702.
Perez-Benitez, C.I., Zlotnick, C., Gomez, J., Rendon, M.J., Swanson, A. (2013). Cognitive behavioral therapy for PTSD and somatization: an open trial. Behaviour Research & Therapy. 51(6):284-9.
- Updated March 27, 2019