Current Opinion in Pediatrics:
August 2011 - Volume 23 - Issue 4 - p 384–389
Approach to psychosomatic illness in adolescents
Ibeziako, Patricia; Bujoreanu, Simona
Abstract
Purpose of review: Due to the increased prevalence of psychosomatic presentations and the difficulty of managing such patients, this article summarizes the latest findings for identifying individual and family risk factors, and new trends in the evaluation and management of pediatric patients with psychosomatic illness.
Recent findings: Up to 50% of patients in pediatric care will complain of medically unexplained symptoms with significant functional and emotional impairment. Such patients place heavy burdens on the healthcare system (frequent utilization of health resources and hospitalizations, specialist consultations, unnecessary investigations, and treatments). Somatoform disorders in pediatric care are associated with risks for psychiatric co-morbidity (anxiety and depressive disorders), family conflict, parent-perceived ill health, and school problems/absenteeism.
Summary: Gaining expertise in addressing pediatric psychosomatic illness can make a great difference in patients’ life and in physicians’ professional satisfaction. Effective treatment approaches involve a multidisciplinary approach to consolidate care and facilitate communication, target the patient/family’s understanding of the mind–body relationship and their acceptance of the bio-psycho-social formulation and treatment, and utilize functional rehabilitation and cognitive behavioral therapy for the individual and family and management guidance for schools.
[ Bujoreanu (an author to that above) is the psychologist that diagnosed Somatiform disorder in Justina. To the extent all that above sounds like Obamacare death panel type business, well now you know why there is no coverage of this story by the MSM. If children were systematically denied care the liability will be in the hundreds of millions of dollars. The judge, presumably the temporary custodian, just gave retroactive custody to DCFS -he’s a coward and he knows now they are going to burn if Justina seared out an affidavit or worse lives long enough to testify against the lot of them. => This is what death panels look like. ]
My advice as a nurse:
When you are an adult, and the doctor in the hospital recommends a treatment plan that you disagree with, the doctor will most likely document in his notes the treatment he recommended, the patient’s refusal, and discharge the patient. No mess, no fuss.
If you are a pediatric patient, and the parents refuse a recommended treatment,the medical staff is required as a “mandated reporter” to file a child neglect case with CPS. If you discharge a pediatric patient knowing the parents are not going to provide the treatment, you can get your medical license yanked and even face criminal charges .
Therefore, if you do not agree with the doctor, act reasonable, agree with treatment plan, get your kid out of the hospital, and seek a second opinion later. This Pelletier family fought tooth and nail, which forced the hospital to make the report. A lot of times, the hospital does not even track if the patient has followed up on the recommendations. This family could have made fast tracks back to Tufts after the discharge. Boston Childrens would have just washed their hands off of this issue. Sometimes, it is just best to keep your cool, and act later.
I have also seen parents complain to the media, but because of HIPAA, the medical staff could not defend themselves. I think there is more to this story, because in my dealings with CPS, they are pretty useless . For them to go to this much trouble sends up warning flags to me.
“out-of-state lawyer “
Don’t they elect out-of-state Senators?
I really have to hold my tongue about this because the things I want to say would probably be illegal to say. What I will say is this:
“The court document also said Lou and Linda Pelletier were “verbally abusive to Justina’s hospital providers.” It cited other parents complaining that the Pelletiers were saying their children were being kidnapped and noted threats made to medical employees to have licenses revoked.”
Clearly their child HAS been kidnapped by the government, and the government in return is complaining that the parents have not shown what it deems to be the proper respect. No respect is due. ***k these b******s. Threatening to have their licenses revoked? That’s the least I would have done. I say the parents have shown more than considerable restraint here! Oh no, how dare they threaten the professional licenses of those who have mistreated their child! I will say one more thing, in response to this:
“Pelletier family spokesman Rev. Patrick Mahoney told TheBlaze Tuesday evening that he thinks the case ‘clearly appears to be the strong-arming of the Pelletiers who refuse to go along with Boston Children’s and what DCF has ordered. They are being punished and they are the canary in the coal mine.’”
Indeed, and if no one stands up and does what is right, even if in violation of the law, then God help us all. Glenn was right when he said we’d wake up and not recognize our country. That day has come.
Oh, one more thing for the geniuses in Massachusetts, I may just be a neuroscientist, I may not know what Justina’s exact symptoms are, her exact diagnosis from Tufts, or what her medical information all shows, but I do know this. Mitochondrial diseases are very real (despite what you liars at BCH say to CYA) and some forms include dementia, so psychiatric diagnoses do not in and of themselves disprove the existence of very real mitochondrial dysfunction.