Somatisation in a child (functional abdominal pain) Flashcards
Define somatisation.
Somatisation – psychological difficulty or distress that is manifested through somatic symptoms. Patients have a tendency to experience and communicate somatic distress and symptoms, unaccounted for by pathological findings. There is tendency to attribute these to physical things and to seek medical help.
What are the common somatic symptoms?
Define “functional” recurrent abdominal pain.
Severe, impairing, occurs at least once a week for 3 months. No organic cause.
How common is functional abdominal pain?
: present in about 10% of children in the general population
Which features would suggest that the abdominal pain is from an organis cause rather than functional?
Functional is usually on or around the umbilicus, they should not wake up at night, and have no other symptoms or findings. Improvement occurs on weekends and on school holidays.
What investigations would you do for functional abdominal pain? What are the risks of investigating?
Should be in keeping with the history and limit investigations if history strongly suggests somatisation.
Overinvestigation can be counterproductive as it can cause reinforcement of the pain and harm may result from more invasive investigations e.g. laparoscopies.
What are the differentials for functional abdominal pain?
Should screen for anxiety and depression
What are the psychological and biological symptoms of anxiety?
How common is anxiety in functional RAP?
75% of children have co-morbid anxiety
What are the two types of anxiety disorders?
Generalised - anxiety, panic disorder
Restricted - to specific environments or objects e.g. separation from parents, social phobia, specific phobias
What are the symptoms of depression?
Which frameworks is used when investigating a diagnosis of FRAP?
Biopsychosicial framework - biological, psychological and social/environmental domains. If there are risk factors in all three domains there can be risk of maladjustment.
Give examples of how biological and psychological factors can contribute to FRAP.
Give examples of how social factors can contribute to FRAP.
When diagnosing FRAP you can also use a systemic or systematic approach.
- Thinking systemically – thinking about factors occurring within the child and in its immediate and wider environment
- Thinking systematically – in a rational structural way; e.g. thinking about different factors one at a time
CASE**: 12yr old, second child, 6 month history of on and off abdominal pain. Attendance reduced from 98% to 50%.
SOCRATES – periumbilical, non-radiating pain which is worst on Mondays and least on Saturdays.
DEVELOPMENTAL – periods, pain not related to menstrual cycle
RED FLAGS – no blood in stools, no changes in bowel habit, no weight loss, no change in appetite
SOCIAL HISTORY – be curious and ask “Do you have a best friend at school?” etc.
- Home
- Education – grades and friends at school
- Activities
- Drugs/Drinking
- Sex
- Self-harm, depression & suicide
- Safety (including social media/online) – do you feel safe at home
Broader social – boyfriend, friends outside of school
Family – parents and at home
Individual – any hobbies which can be a protective factor, risk factors can be the personality type (anxious, sensitive, conscientious), if hypersensitivity to pain (e.g. if immunisations)
EXAMINATION:
Basic observations, listen to heart and chest and do an abdominal examination.
Some basic bloods: FBC, U&Es and CRP
Summarise the management of FRAP.
- Explain and educate
- Pain management
- Address contributory factors
- Treat comorbid anxiety/depressive disorder
- Consider CBT family treatment if persistent problems
