Parental Adjustment to Type 1 Diabetes

Although the majority of parents of children with type 1 diabetes adapt well, a subset of parents reports clinically significant psychological distress following initial diagnosis and throughout the course of their child's illness (e.g., Kovacs et al. 1990 Parker et al. 1994). Increased maternal psychological distress (e.g., symptoms of anxiety, somatiza-tion, anger, suspiciousness, depression, dysphoria) has been observed immediately following diagnosis. Parents of children with chronic...

Neuropsychiatric Manifestations

Neuropsychiatric sequelae of pediatric SLE occur due to disease involvement in the central and periph eral nervous systems. Prevalence rates of neuropsy-chiatric manifestations vary widely and range from 20 to 95 these variable rates may be due to lack of standard definitions in the literature and to the frequency of lupus-associated headaches (Benseler and Silverman 2007). Common neuropsychiatric sequelae include headaches, psychiatric manifestations (e.g., anxiety disorders, mood disorders,...

Child Adjustment to Type 1 Diabetes

A considerable amount of research has been conducted over the past three decades that examines youth adjustment to type 1 diabetes. Collectively, the extant research suggests that many of these children are well adjusted across multiple domains of emotional and behavioral functioning (e.g., Dela-mater 2007 Jacobson et al. 1997 Johnson 1980). At the same time, a consistent subset of youth with type 1 diabetes appears to be at risk for developing significant adjustment difficulties, particularly...

Mood Disorders in Specific Physical Illnesses

Depression co-occurring with physical illness worsens the prognosis of many general medical conditions. The presence of depression is associated with higher morbidity and mortality rates in many adult physical illnesses (Evans et al. 2005a). In this section, we briefly review specific illness conditions for Table 6-10. Confounding overlaps between DSM-IV-TR symptoms of depression and symptoms of physical illness and or its treatment Table 6-10. Confounding overlaps between DSM-IV-TR symptoms of...

Renal Disease

Renal insufficiency results from a functional loss of nephrons. Although generally transient and reversible as in acute renal failure, the loss may be permanent and lead to dialysis in chronic renal failure. Table 30-1. Medication use in hepatic disease Impact of hepatic disease on drug dosing Potential drug effect on liver function Antidepressants that are metabolized by phase I hepatic oxidative metabolism require an approximately 50 dosage reduction. Doses of bupropion should not exceed 75...

Refeeding and Nutrition

Managing meals and eating behaviors during an inpatient medical admission presents many challenges. Unlike specialized units, general medical or psychiatric units often do not have an established treatment program for patients with eating disorders. To complicate matters further, patients admitted for medical complications of their malnutrition may be at significant risk for refeeding syndrome (Katzman 2005). To effectively minimize such risks, staff need to closely monitor the patient's fluids...

Precocious Puberty

Normal pubertal development requires activation of the hypothalamic-pituitary-gonadal axis (see Figure 19-3). In girls, the first sign of puberty is typically breast development, occurring between ages 8 and 13 years, followed by the appearance of pubic hair and menarche. In boys, the first sign of puberty is usually testicular enlargement, occurring between ages 9 and 14 years, followed by the appearance of pubic hair and penile growth. Generally speaking, pediatricians and pediatric...

Substance Induced Mood Disorder

Manic or depressive episodes may result from medications, alcohol or drugs of abuse, or toxic agents. DSM-IV-TR specifies that the mood disturbance, either manic or depressive, must have developed within 1 month of substance intoxication or withdrawal that the substance (or medication) must be etiologically related to the disturbance and that these clinical conclusions must be based on the medical history, physical examination, or laboratory findings (see Table 6-11). Alcohol, cannabis,...

Anxiety Disorder Due to a General Medical condition

Many medical conditions may result in symptoms of anxiety, and the consultant should consider this possibility if the history is not typical for a primary anxiety disorder or if anxiety symptoms are resistant to treatment (see Table 7-5). Medical etiologies are also more likely when physical symptoms of anxiety, such as shortness of breath, tachycardia, or tremor, are more marked. Anxiety that is secondary to a medical condition should be differentiated from co-morbid anxiety or anxiety that is...

Hormone Secreting Tumors

Pheochromocytoma is a rare disorder that can occur in both children and adults and is associated with catecholamine secretion from a tumor in the renal medulla. This secretion results in acute, episodic, or chronic symptoms of anxiety that are often associated with hypertension. Clinical symptoms include increased heart rate, increased blood pressure, myo-cardial contractility, and vasoconstriction. Patients may present with headache, sweating, palpitations, apprehension, and a sense of...

Medical Overview

Lyme disease is a tick-borne infection transmitted to humans via deer ticks and is caused by the spiro-chete Borrelia burgdorferi (Healy 2000). Lyme disease initially enters the bloodstream and can disseminate into the musculoskeletal, neurological, and cardiovascular systems (Eppes et al. 1999 Gus-taw et al. 2001). Prompt diagnosis and treatment of Lyme disease commonly result in full recovery (Sood 2006). However, in cases in which treatment and or diagnosis is delayed, chronic Lyme disease,...

Acute Agitation

Acute agitation is a heightened state of anxiety, emotional arousal, and increased motor activity that occurs not uncommonly in the pediatric setting, for example, in states of acute intoxication, sedative withdrawal, and delirium, as well as in the context of emergency department evaluations or in patients with primary mood and psychotic disorders (Jibson 2007). Patients with organic brain syndromes or with cognitive impairments may also be at higher risk of such behaviors. In these...

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a problem-oriented treatment that seeks to identify and modify maladaptive behavior and cognitions. It is based on the premise that patients and their families develop cognitive distortions (e.g., passive locus of control, learned helplessness) and or maladaptive behaviors (e.g., inactivity, poor self-soothing) that adversely affect their functioning (see Table 28-3). For example, the belief that important medical information is being withheld may lead a...

Congenital Heart Disease

Congenital heart disease (CHD) refers to a diverse grouping of heart defects, including acyanotic (left- to-right shunt) lesions, cyanotic (right-to-left shunt) lesions, and obstructive lesions (see Table 21-1). The clinical effects of these disorders can differ significantly between and within the diagnostic groupings. Whereas some children affected by CHD display only subtle symptomatology with few consequences, others can face reduced physical functioning, extended hospital stays, repeated...

Epidemiology

Asthma is the most common chronic illness facing children in the United States. The prevalence rates for pediatric asthma are at historically high levels (Moorman et al. 2007). Morbidity and mortality remain inexplicably elevated, despite the considerable advances in the pharmacological management of asthma this phenomenon is commonly referred to as a modern health paradox. Prevalence of childhood asthma ranges from 5 to 15 , depending on the country (International Study of Asthma and Allergies...

Health Related Quality of Life

Patients' health-related quality of life (HRQOL) varies depending on the stage of CKD, the need for dialysis, and whether or not patients are transplant recipients. In many studies, these groups are compared with each other, leading to variable findings. Much of the early HRQOL research was done using generic questionnaires. Goldstein et al. (2008), however, developed the Pediatric Quality of Life Inventory 3.0 ESRD Module to assess changes in HRQOL that are specific to CKD. Ruth et al. (2004)...

Pediatric Illness Falsification in the Child

Children are victimized by a variety of means, limited only by the perpetrator's imagination. They are subjected to unnecessary hospitalizations, tests, procedures, and treatments for disabilities that are physical, psychological, or educational (attention-deficit hyperactivity disorder ADHD and learning problems). Disease falsification includes symptom exaggeration and distortion false reports manipu Figure 12-1. The diagnoses that jointly constitute Munchausen by proxy. lation of medication,...