Psychiatric disorders in general paediatric referrals.

Abstract

SUMMARY Detailed interviews with parents of 128 children aged 7 to 12 years consecutively referred to general paediatric clinics identified psychiatric disturbance in 36 (28%) of the children. Emotional disorders were the commonest psychiatric diagnoses (present in two thirds); less frequent diagnoses were conduct disorders (5/36, 14%), mixed conduct/emotional disorders (six, 17%), and hyperkinetic-syndrome (three, 8%). Disturbance was related to level of energy, with disturbed children being described significantly more frequently as 'bounding with energy' or conversely 'tired and apathetic'. Psychosocial problems (broken homes, mentally distressed mothers, family stress including financial stress and marital difficulty) were also increased in the disturbed group, but most of all these mothers reported feeling stressed in relation to the children.Psychiatric disorders, particularly emotional disorders, are common associated problems in paediatric referrals. Family stress, specially that focused on parenting, is likely to be an important factor contributing to disturbed children's consultations in general paediatric clinics.Child mental health problems are a common reason for consultation in general paediatric clinics. They have been reported as the main reason for attending in between 5 to 10% of children in several surveys. '-There are indications that childhood psychiatric morbidity may also be present as an associated or background factor in children with somatic presentations,6 but recognition of these behavioural problems by physicians is probably limited.7 In contrast with the work done in adult medical patients, which has documented psychiatric morbidity in between a quarter and 40% of medical patients and physician recognition rates of between 40-50%,8 these issues have received little direct research attention in the paediatric literature.More information on the frequency, nature, and associations of childhood psychiatric morbidity among paediatric patients is clearly necessary if these problems are to be recognised and attended to, if appropriate, in paediatric clinics.Two studies have used child behavioural questionnaires completed by parents in children attending general paediatric clinics and reported high rates of psychological deviance in over 35% of children.9 10

Fortnightly review: Aggressive behaviour in childhood

“…Psychiatric disorders are present in 28% of paediatric outpatient referrals 10. Social services departments expend a lot of effort trying to protect disruptive children whose parents can no longer cope without hitting or abusing them.…”

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