Somatic symptom and related disorders in a tertiary paediatric hospital: prevalence, reach and complexity, 2020, Wiggins et al

[Andy]

Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children’s hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings was recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3–18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis.

Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway.

What is Known
• Functional somatic symptoms are commonly seen in children and adolescents.
• Few studies have explored the reach of functional somatic symptoms across a tertiary paediatric hospital; the majority of inpatient studies have focused on a limited set of disorder or cases referred to psychiatry departments.
What is New
• Symptoms that spanned multiple body systems were the most common presentation of SSRDs in admitted children and adolescents.
• Somatic symptom disorders are less likely to be recorded as a discharge diagnosis compared with functional neurological symptom disorder.

Paywall, https://link.springer.com/article/10.1007/s00431-020-03867-2
Sci hub, https://sci-hub.se/10.1007/s00431-020-03867-2

 

[NelliePledge]

The Aussies are up to this rubbish as well then

 

[Arnie Pye]

Specialist paediatric services manage a variety of presentations of functional somatic symptoms.

Can anyone tell me what the difference is between "functional somatic symptoms" and "psychosomatic symptoms" ?

somatic symptom and related disorders (SSRDs)

SSRD was diagnosed as an inpatient in 79.9% patients

So, what does the word "somatic" mean in this context when the word "functional" isn't included?

Real?

I find it impossible to believe that 79.9% of children go into hospital with "unreal" symptoms, but any use of the word "somatic" makes me think that the doctors are hoping for a way to dismiss the patients as mentally ill.

 

[Amw66]

Can anyone tell me what the difference is between "functional somatic symptoms" and "psychosomatic symptoms" ?





So, what does the word "somatic" mean in this context when the word "functional" isn't included?

Real?

I find it impossible to believe that 79.9% of children go into hospital with "unreal" symptoms, but any use of the word "somatic" makes me think that the doctors are hoping for a way to dismiss the patients as mentally ill.

What % are female ?
Sounds like classic label attaching when cause is not known and medics don't know what else to do.

 

[Peter T]

Can anyone tell me what the difference is between "functional somatic symptoms" and "psychosomatic symptoms" ?

So, what does the word "somatic" mean in this context when the word "functional" isn't included?

Real?

I find it impossible to believe that 79.9% of children go into hospital with "unreal" symptoms, but any use of the word "somatic" makes me think that the doctors are hoping for a way to dismiss the patients as mentally ill.

My understanding is:

Literally ‘somatic’ means relating to the body. So literally ‘somatic symptoms’ are simply bodily symptoms. In origin the word is neutral as to cause, however in these contexts it is generally used in the sense of ‘psychosomatic’ that is symptoms of the body arising from the mental or psychological causes.

Again literally ‘functional’ relates to how a bodily system functions, rather than any impairment to its ‘structures’. This then became analogous to the distinction between ‘software’ and ‘hardware’ in computing, so problems in the mind body system that arise from the functioning of the mind rather than the body. Different people use ‘functional’ in different ways and part of its early use was an attempt to develop a language neutral as to causes, but it too has come to be used by some as synonymous with ‘psychosomatic’ with the implication of underlying psychiatric issues and a suggestion of choice or even blame.

Literally ‘functional somatic symptoms’ are bodily symptoms that do not arise from a physical or organic causes, but from mental or psychiatric causes.

In general research such as this does not give a concrete definition for any of these terms, and fails to set out any testable basis for how these physical symptoms arise from mental or psychological causes. There are probably as many beliefs as to what this hypothetical process is, from simple programming errors via postulated traumatic experiences through conversion disorders to personality defects or spiritual reasons [added - I had a friend who was a relatively experienced hypnotherapist who believed that many conditions arose from possession by spirits, and who seriously suggested treating my ME by a combination of hypnosis and exorcism], as there are people working in this field.

But without testable theories as to how these unspecified psychological causes manifest as physical symptoms, and with no way of distinguishing them from symptoms arising from yet unidentified biomedical conditions, this whole field is based on supposition and belief.

I wonder if a reason for this proliferation of terms, beyond the lack of any serious development of testable theoretical expositions, is that over time each new term, initially intended to be neutral as to cause, acquires pejorative associations and is replaced by another causally neutral term which in turn becomes pejorative.

[edited for clarity and indicated addition]

 

[alex3619]

Can anyone tell me what the difference is between "functional somatic symptoms" and "psychosomatic symptoms" ?

So far as I can see just the label ... they hope the new label is more tolerated than the old label.

The Aussies are up to this rubbish as well then

We got colonized by this nonsense long ago, but its taken off a bit slower here.