Clinical Manual of Pediatric Psychosomatic Medicine: Mental Health Consultation With Physically Ill Children And Adolescents

426 Pages·2006·3.16 MB·English

by  Richard J. Shaw

Clinical Manual of
Pediatric Psychosomatic
Medicine
Mental Health Consultation With
Physically Ill Children and
Adolescents
This page intentionally left blank
Clinical Manual of
Pediatric Psychosomatic
Medicine
Mental Health Consultation With
Physically Ill Children and
Adolescents
Richard J. Shaw, M.B., B.S.
David R. DeMaso, M.D.
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is accurate
at the time of publication and consistent with general psychiatric and medical standards,
and that information concerning drug dosages, schedules, and routes of administration
is accurate at the time of publication and consistent with standards set by the U.S.
Food and Drug Administration and the general medical community. As medical
research and practice continue to advance, however, therapeutic standards may change.
Moreover, specific situations may require a specific therapeutic response not included
in this book. For these reasons and because human and mechanical errors sometimes
occur, we recommend that readers follow the advice of physicians directly involved in
their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views and
opinions of the individual authors and do not necessarily represent the policies and
opinions of APPI or the American Psychiatric Association.
Copyright © 2006 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
10 09 08 07 06 5 4 3 2 1
First Edition
Typeset in Adobe’s Formata and AGaramond.
American Psychiatric Publishing, Inc., 1000 Wilson Boulevard, Arlington, VA 22209–
3901; www.appi.org
Library of Congress Cataloging-in-Publication Data
Shaw, Richard J., 1958–
Clinical manual of pediatric psychosomatic medicine : mental health consultation
with physically ill children and adolescents / by Richard J. Shaw, David R. DeMaso.
—1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58562-187-0 (pbk. : alk. paper)
1. Medicine, Psychosomatic. 2. Pediatrics. I. DeMaso, David R. (David Ray),
1949– . II. Title.
[DNLM: 1. Mental Disorders—complications. 2. Adolescent. 3. Child. 4. Mental
Disorders—diagnosis. 5. Mental Disorders—therapy. 6. Psychophysiologic Disor-
ders. 7. Referral and Consultation. WS 350 S535c 2006]
RC49.S53 2006
618.92—dc22 2006012000
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiv
1
Pediatric Psychosomatic Medicine . . . . . . . . . . .1
Roles of the Psychiatry Consultant . . . . . . . . . . . . . . . . . .3
Staffing of Pediatric Psychosomatic
Medicine Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Funding of Pediatric Psychosomatic
Medicine Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Referral Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Referral Patterns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Practice Patterns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
2
Coping and Adaptation in
Physically Ill Children . . . . . . . . . . . . . . . . . . . . .15
Models of Adaptation and Coping . . . . . . . . . . . . . . . . .16
Coping During Hospitalization and Procedures. . . . . . .19
Long-Term Adaptation to Childhood Illness . . . . . . . . .23
Guidelines for Assessing Medical Distress . . . . . . . . . . .26
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
3
Pediatric Consultation Psychiatry
Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
The Consultation Process. . . . . . . . . . . . . . . . . . . . . . . . .32
Psychiatric Assessment Protocol. . . . . . . . . . . . . . . . . . .41
Observation of Behavior and Play. . . . . . . . . . . . . . . . . .49
Developing a Biopsychosocial Formulation. . . . . . . . . .50
Communicating Findings
to the Medical Team and Family. . . . . . . . . . . . . . . . . .52
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
4
Legal and Forensic Issues. . . . . . . . . . . . . . . . . .59
Consent for Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . .60
Confidentiality and Privilege . . . . . . . . . . . . . . . . . . . . . .64
Assessment for Parenting Capacity
and Medical Neglect. . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
5
Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Clinical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Differential Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
6
Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . .95
Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Diagnosis of Depression in the Physically Ill . . . . . . . . .98
Clinical Considerations in the Physically Ill Child. . . . . .98
Primary Mood Disorder . . . . . . . . . . . . . . . . . . . . . . . . .103
Mood Disorder as Reaction to Medical Illness. . . . . . .103
Mood Disorder Due to
a General Medical Condition. . . . . . . . . . . . . . . . . . . .105
Substance-Induced Mood Disorder . . . . . . . . . . . . . . .111
Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
7
Anxiety Symptoms and Disorders . . . . . . . . . .121
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
Primary Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . .124
Medical Posttraumatic Stress Disorder. . . . . . . . . . . . .125
Anxiety Disorder Due to a General
Medical Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
Substance-Induced Anxiety Disorder . . . . . . . . . . . . . .129
Anxiety Symptoms in Specific
Physical Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . .134
Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
8
Somatoform Disorders . . . . . . . . . . . . . . . . . . .143
Risk Factors for Pediatric Somatization. . . . . . . . . . . . .144
The Somatoform Disorders . . . . . . . . . . . . . . . . . . . . . .147
Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
9
Pediatric Pain. . . . . . . . . . . . . . . . . . . . . . . . . . .169
Classification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Developmental Factors. . . . . . . . . . . . . . . . . . . . . . . . . .173
Measurement of Pain. . . . . . . . . . . . . . . . . . . . . . . . . . .175
Psychiatric Assessment. . . . . . . . . . . . . . . . . . . . . . . . . .177
Principles of Pain Management. . . . . . . . . . . . . . . . . . .182
Nonpharmacological Management. . . . . . . . . . . . . . . .185
Pharmacological Management . . . . . . . . . . . . . . . . . . .188
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
10
Solid Organ Transplantation. . . . . . . . . . . . . . .205
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .206
Pretransplant Psychiatric Assessment. . . . . . . . . . . . . .207
Living Donor Assessment. . . . . . . . . . . . . . . . . . . . . . . .214
Transplant Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223
11
Treatment Adherence . . . . . . . . . . . . . . . . . . . .227
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
Consequences of Nonadherence . . . . . . . . . . . . . . . . .228
Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
Developmental Influences. . . . . . . . . . . . . . . . . . . . . . .231
Psychiatric Factors Affecting Adherence. . . . . . . . . . . .233
Assessment of Treatment Adherence. . . . . . . . . . . . . .234
Treatment Interventions. . . . . . . . . . . . . . . . . . . . . . . . .234
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239
12
Pediatric Cancer, Bone Marrow
Transplantation, and Palliative Care . . . . . . . .243
Sequelae of Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . .245
Family Adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248
Bone Marrow Transplantation. . . . . . . . . . . . . . . . . . . .251
Palliative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260
13
Individual Psychotherapy
in the Pediatric Setting . . . . . . . . . . . . . . . . . . .263
Models of Psychotherapy. . . . . . . . . . . . . . . . . . . . . . . .263
Selected Psychotherapy Issues
in Pediatric Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . .269
Countertransference Issues
for the Consultant. . . . . . . . . . . . . . . . . . . . . . . . . . . . .274
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .277
14
Family Therapy. . . . . . . . . . . . . . . . . . . . . . . . . .279
Illness Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280
Family Life Cycle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .282
Factors Affecting Family Adjustment. . . . . . . . . . . . . . .285
Impact of Illness on Family Functioning. . . . . . . . . . . .287
Reactions of Siblings. . . . . . . . . . . . . . . . . . . . . . . . . . . .293
Relationship With the Pediatric Team. . . . . . . . . . . . . .294
Family Intervention Guidelines . . . . . . . . . . . . . . . . . . .296
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
15
Psychopharmacological Approaches and
Considerations. . . . . . . . . . . . . . . . . . . . . . . . . .305
Pharmacokinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
Drug–Drug Interactions . . . . . . . . . . . . . . . . . . . . . . . . .309
Antidepressants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .311
Mood Stabilizers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .324
Antipsychotic Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . .330
Anxiolytic Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .336
Hypnotic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .340
Psychostimulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .341
Psychotropic Medication Use
in Specific Physical Illnesses . . . . . . . . . . . . . . . . . . . .345
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .354
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355
16
Preparation for Procedures. . . . . . . . . . . . . . . .357
Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .358
Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .358
Coping Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361
Medical Hypnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .366
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .374
Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .377
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .385