Symptom Management

Recent strides have been made in the area of pediat-ric symptom management, yet children's symptoms at the end of life remain notoriously undertreated. Systematic evaluations demonstrate that children and adolescents with cancer continue to suffer from pain and other distressing symptoms often and substantially (Hechler et al. 2008; Pritchard et al. 2008; Theunissen et al. 2007; Wolfe et al. 2000). Symptoms most commonly reported during the last days of life included fatigue, pain, dyspnea, poor appetite, nausea, vomiting, and constipation. Of note, previous research (Hechler et al. 2008; Pritchard et al. 2008; Theunissen et al. 2007; Wolfe et al. 2000) has relied on retrospective parental reports, ranging from 6 months to 7 years after their child's time of death. In future research, attempts should be made to obtain self-reports from children diagnosed with a broader range of medical illnesses.

Psychological symptoms in seriously ill children are often multiply determined and in flux (Sourkes 2006). Physical pain, metabolic imbalance, neurological dysfunction, infection, and the impact of medications are closely linked with and at times inseparable from psychological distress. Most common are diagnoses in the broad categories of anxiety and depression. Anxiety represents a widely diverse group of developmentally appropriate and pathological coping responses, ranging from preexistent anxieties exacerbated under the stress of illness, to cumulative generalized anxiety, to posttraumatic stress disorder. Also, sleep deprivation and delirium may present as anxiety and agitation.

The psychological and somatic symptoms of depression can be hard to differentiate from effects of the illness and treatment. Furthermore, sadness and anticipatory grief are sometimes confused with clinical depression. Psychotic and organic brain syndromes often present with cognitive and perceptual disturbances. Delirium may also present as anxiety or oppositional or aggressive behavior; parents frequently report sensing that something is "different" about their child but are unable to describe specifically the change. For reasons such as these, definitive psychiatric diagnosis can at times be elusive. As a result of these diagnostic ambiguities, one often proceeds with psychological or psychotropic intervention on the basis of managing specific symptoms rather than treatment of a presumed underlying psychiatric disorder.

Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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