Children With Psychiatric Disorders in Primary Care

Abstract

A substantial minority (23%) of children between 7 and 12 years of age attending general practice were found to have psychiatric disorders. Disturbance was slightly more frequent in girls than in boys, and emotional disorder was the most common diagnosis. Psychiatric disorder was associated with psychological disadvantage (broken homes, the child had lived away from the family, family history of psychiatric disorder) and with current high levels of parental stress in relation to their children. Disturbed children tended to present with symptoms of anxiety, bed-wetting, hayfever, nosebleeds or scabies. Amongst a subsample of children consulting in general practice, psychiatric disorder may be a relevant factor contributing to somatic consultation.

Medically unexplained physical symptoms in children in a non-specialist paediatric setting

“…This finding is consistent with the high health service utilization seen among children with MUS 3,8,19 . This observation is explained on the basis of several child and parent related factors associated with MUS, such as the affected children having more emotional and behavioural difficulties and being perceived as "sickly", anxious, sensitive to pain and having adjustment difficulties 3,18,20,21 .…”

“…It is known that experience of stress may act as a precipitating, predisposing or perpetuating factor in the aetiology of MUS 3,13,26 . Our investigation was limited to eliciting the presence or absence of stressful experiences but 33% to 50% of children with MUS are thought to have psychiatric comorbidity, especially anxiety and depression 7,13,19,27 . A further observation that deserves comment is that nearly 25% of parents did not suggest a possible cause for the child's symptoms or the anticipated prognosis.…”

Common mental health disorders in children and adolescents in primary care: A survey of knowledge, skills and attitudes among general practitioners in a newly developed European country

“…This is particularly important given the high prevalence rates of youngsters presenting to primary care with mental health problems 26,27 . Amongst seven-to twelveyear old children presenting to primary care, 23% may be suffering from a mental disorder, many of whom are likely to initially present with a somatic complaint 26 .…”

“…This is particularly important given the high prevalence rates of youngsters presenting to primary care with mental health problems 26,27 . Amongst seven-to twelveyear old children presenting to primary care, 23% may be suffering from a mental disorder, many of whom are likely to initially present with a somatic complaint 26 . Amongst adolescents attending general practice, the prevalence of mental disorders increases to 38%, with the tendency for presentation with somatic complaints becoming even more pronounced 27 .…”

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

“…Children and adolescents often report such symptoms 10,11 and often have multiple visits for these symptoms in primary care and other settings. 3,5,12,13 Vague, poorly described complaints, recent or current stressful events, symptoms that fluctuate with activity or stress, and lack of physical findings and laboratory abnormalities are common. 3 Symptoms of pediatric somatic symptom and related disorders often do not meet strict Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria and defy categorization.…”