TY - JOUR
T1 - Psychiatric morbidity in children with medically unexplained chronic pain
T2 - Diagnosis from the pediatrician's perspective
AU - Konijnenberg, Antoinette Y.
AU - De Graeff-Meeder, Elisabeth R.
AU - Van Der Hoeven, Joost
AU - Kimpen, Jan L.L.
AU - Buitelaar, Jan K.
AU - Uiterwaal, Cuno S.P.M.
AU - Van Dijken, Pieter J.
AU - Dijkman-Neerincx, Regina H.M.
AU - Essink, Alphons H.P.M.
AU - Flapper, Boudien C.T.
AU - Fliers, Ellen A.
AU - Ten Haaf, Jeanette K.
AU - Hofkamp, Marchinus
AU - Van Der Meer, Syb B.
AU - Moens, Marijn
AU - Pelleboer, Rolf A.A.
AU - Van Rhijn, Aart
AU - Russel, Ingrid M.B.
AU - Thunnissen, Bernadien T.M.J.
AU - Vlieger, Arine M.
AU - Wennink, Johanna M.B.
AU - Van Wieringen, Hester
AU - Zwart, Pieter
PY - 2006/3/1
Y1 - 2006/3/1
N2 - CONTEXT. There is very little general evidence to support the clinical management, particularly diagnosis, of medically unexplained chronic pain (UCP) in children. OBJECTIVE. We sought to assess in children with UCP if clinical characteristics held important by general pediatricians help to accurately diagnose psychiatric morbidity and, alternatively, if the same can be achieved using dedicated questionnaires. METHODS. We used a cross-sectional diagnostic study in a pediatric outpatient clinic of a university hospital. Our participants were 134 patients, aged 8 to 18 years, who were referred for UCP. Performed were (1) diagnostic test reflecting the pediatricians' choice of clinical characteristics and (2) selected questionnaires. Classification was performed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, by a child psychiatrist using the Diagnostic Interview Schedule for Children-Parent Version IV and the Semi-structured Clinical Interview for Children and Adolescents. Results were analyzed by logistic regression. RESULTS. Psychiatric morbidity was present in 80 of the children. A minority had a medical explanation for the pain (15% definite, 17% probable). The clinical diagnostic model included age, social-problem indicators, family structure, parental somatization, and school problems. In the quintile of children in whom this model predicted the highest risk, 93% indeed had psychiatric morbidity at reference testing. In the quintile with the lowest predicted risk, indeed only 27% had psychiatric morbidity. The Dutch Personality Inventory for Youth and the Child Behavior Checklist matched the pediatricians' choice of clinical characteristics. In the quintile of children with the highest predicted risk based on these questionnaires, 89% had psychiatric morbidity. In the quintile with the lowest predicted risk, only 15% had psychiatric morbidity. CONCLUSIONS. A pediatrician-chosen set of clinical characteristics of children with UCP proves useful in diagnosing psychiatric morbidity. Using selected questionnaire screening yields similar results.
AB - CONTEXT. There is very little general evidence to support the clinical management, particularly diagnosis, of medically unexplained chronic pain (UCP) in children. OBJECTIVE. We sought to assess in children with UCP if clinical characteristics held important by general pediatricians help to accurately diagnose psychiatric morbidity and, alternatively, if the same can be achieved using dedicated questionnaires. METHODS. We used a cross-sectional diagnostic study in a pediatric outpatient clinic of a university hospital. Our participants were 134 patients, aged 8 to 18 years, who were referred for UCP. Performed were (1) diagnostic test reflecting the pediatricians' choice of clinical characteristics and (2) selected questionnaires. Classification was performed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, by a child psychiatrist using the Diagnostic Interview Schedule for Children-Parent Version IV and the Semi-structured Clinical Interview for Children and Adolescents. Results were analyzed by logistic regression. RESULTS. Psychiatric morbidity was present in 80 of the children. A minority had a medical explanation for the pain (15% definite, 17% probable). The clinical diagnostic model included age, social-problem indicators, family structure, parental somatization, and school problems. In the quintile of children in whom this model predicted the highest risk, 93% indeed had psychiatric morbidity at reference testing. In the quintile with the lowest predicted risk, indeed only 27% had psychiatric morbidity. The Dutch Personality Inventory for Youth and the Child Behavior Checklist matched the pediatricians' choice of clinical characteristics. In the quintile of children with the highest predicted risk based on these questionnaires, 89% had psychiatric morbidity. In the quintile with the lowest predicted risk, only 15% had psychiatric morbidity. CONCLUSIONS. A pediatrician-chosen set of clinical characteristics of children with UCP proves useful in diagnosing psychiatric morbidity. Using selected questionnaire screening yields similar results.
KW - Adolescents
KW - Children
KW - Chronic pain
KW - Diagnostic procedures
KW - Predictive testing
KW - Psychiatry
UR - https://www.scopus.com/pages/publications/33645022326
U2 - 10.1542/peds.2005-0109
DO - 10.1542/peds.2005-0109
M3 - Article
C2 - 16510672
SN - 0031-4005
VL - 117
SP - 889
EP - 897
JO - Pediatrics
JF - Pediatrics
IS - 3
ER -