Pervasive refusal syndrome – A clinical challenge

Kaku, Sowmyashree Mayur; Kommu, John Vijay Sagar; Seshadri, Shekhar; Girimaji, Satish Chandra; Srinath, Shoba

doi:10.1016/j.ajp.2015.07.001

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…Although our literature search was worldwide, we observed that most of the cases were from Europe. The case reports originated from the UK (12 articles: [1, 2, 7, 24, 30, 32, 34, 36-38, 43, 46]), Australia (four articles: [3,11,27,39]), Sweden (three articles: [22,42,48]), Denmark (two articles: [40,47]), The Netherlands (two articles: [4,29]), Germany (two articles: [26,35]), Ireland (two articles: [28,48]), Belgium (one article: [49]), and India (one article: [25]).…”

Section: Risk Factorsmentioning

confidence: 99%

“…Most patients with PRS did not respond to the usual treatment for the identified differential diagnoses. For instance, in the cases described by [1,[24][25][26][27], the patients did not respond to therapeutic doses of antidepressants. McNicholas et al [28] considered a diagnosis of catatonia and modified their treatment accordingly when rehabilitative treatment approach for PRS was seemingly ineffective.…”

Section: Risk Factorsmentioning

confidence: 99%

“…All cases were extensively investigated using appropriate and relevant blood tests, lumbar puncture when clinically indicated and radiological tests such as CT and MRI scans where appropriate. There may be a risk of over investigation, but given the multitude of diagnoses to be excluded and the potential risk for a fatal outcome in missed diagnoses [54] as the case from India [25] perhaps illustrates, one may argue that extensive diagnostic investigations may be justifiable. However, it is important to note that in the vast majority of cases in this review, all investigations were normal.…”

Section: Clinical Investigationmentioning

confidence: 99%

“…The treatment methods used in most of the cases were individualised and tailored to the specific needs of the affected patients. When catatonia was considered as a possible differential diagnosis or comorbid condition, the patients were treated with benzodiazepine and/or ECT accordingly [25,28,30].…”

Section: Treatmentmentioning

confidence: 99%

“…However, it is noteworthy that when catatonia was considered a provisional diagnosis, it did not appear to have received optimum treatment. Patients received an inadequate dosage of benzodiazepine [25,28] and those who were treated with ECT [25,30] received insufficient sessions necessary for effective treatment of catatonia. Authorities on the treatment of catatonia recommend incremental doses of lorazepam starting at 1-2 mg/day and gradually increasing up to (10-20 mg/day), and if there is no response, to administer between 10 and 20 sessions of bilateral ECT [9,15].…”

Section: Treatmentmentioning

confidence: 99%

See 4 more Smart Citations

Pervasive refusal syndrome: systematic review of case reports

Otasowie

Paraiso

Bates

2020

Eur Child Adolesc Psychiatry

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Pervasive refusal syndrome (PRS) is a complex condition that affects young people leading to social withdrawal, inability or refusal to eat, drink, mobilise or speak. The affected individual regresses and is unable to self-care and quite characteristically will resist rehabilitation, worsen with praise or remain entirely passive. This systematic review was aimed at describing clinical features of PRS, current interventions and to summarise some of the nosological aspects of the condition. Without language restriction, an electronic search was conducted in Embase, PsychInfo, Medline, Cochrane library, and PubMed databases yielding 29 articles with a total of 79 cases. We performed a risk of assessment bias using an adapted Newcastle-Ottawa Scale and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 124 articles were identified, of which 29 were included and these yielded 79 cases. Seventy-six percent of the studies had a low rate of risk of assessment bias (good quality). Our results show that PRS overlaps with several conditions, mainly affects young females aged 7-15 years and has a recovery rate of 78% if diagnosed and treated early but the duration of inpatient treatment may last up to 9.44 months (8.82 SD). The patients had multiple inter-dependent risks. The major predisposing factors included vulnerable premorbid personality and pre-existing mental disorder. Precipitating factors were stressors such as infection and traumatic experiences. Enmeshed parent-child relationship served as a maintaining factor. The themes of treatment approach are essentially rehabilitative: (1) working collaboratively with patient and family, (2) having access to multidisciplinary team, and (3) peer/group supervision. This study has systematically evaluated a large sample of patients with PRS to ascertain its clinical features and the core elements of its treatment. Its key treatment approach is a multi-modal rehabilitative strategy that is compassionate, transparent and inclusive.

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