A case of pervasive refusal syndrome: A diagnostic conundrum

Abstract

A case is presented of an 11-year-old girl with pervasive refusal syndrome (PRS) who ultimately recovered acutely and completely after an 18-month paediatric hospitalisation. There was an apparent absence of previously proposed important aetiological factors in PRS, such as family pathology and markedly traumatic or abusive experiences, and her recovery was sudden and complete. The authors consider the differential diagnoses of PRS paying particular attention to the possibility of a conversion disorder or catatonia, given the absence of PRS in the North American literature. Consideration of catatonia is important as it has a diagnostic test and responds rapidly to appropriate treatment, in contrast to conventional treatment for PRS and conversion disorder.

Rediscovering catatonia: the biography of a treatable syndrome

“…Video images of her behavior clearly met the criteria for catatonia, but her parents refused a benzodiazepine treatment trial. She recovered after 18 months of nursing care in hospital (181). Dirk Dhossche, a child psychiatrist in Jackson, Mississippi, has looked further into similar cases, applying the present criteria for catatonia.…”

“…She recovered after 18 months of nursing care in hospital (181). Video images of her behavior clearly met the criteria for catatonia, but her parents refused a benzodiazepine treatment trial.…”

Pervasive refusal syndrome: systematic review of case reports

“…There was a mixed picture of both active refusal and passive resistance in the asylum-seeking group and those not seeking asylum. Some of the case reports [3,28,32,38,42] described a variable pattern of refusal; ranging from active and angry refusal to passive resistance, thus, suggesting that refusal in PRS is a continuum. The most commonly reported feature in all cases was food refusal.…”

Pervasive refusal syndrome – A clinical challenge

“…Ten to twelve differential diagnoses have been proposed for PRS like depression, anxiety, somatization, catatonia and selective mutism (Lask, 2004;Jaspers et al, 2009;McNicholas et al, 2012McNicholas et al, , 2013. Multidisciplinary approach with the main focus on child's survival is important.…”