Functional Symptoms in Pediatric Disease: A Clinical Guide

451 Pages·2014·5.58 MB·English

by  Ran D. Anbar (eds.)

Ran D. Anbar
Functional Editor
Symptoms in
Pediatric Disease
A Clinical Guide
123
Functional Symptoms in Pediatric
Disease

Ran D. Anbar
Editor
Functional Symptoms
in Pediatric Disease
A Clinical Guide
Editor
Ran D. Anbar, MD
Department of Pediatrics
SUNY Upstate Medical University
Upstate Golisano Children’s Hospital
Syracuse , NY , USA
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ISBN 978-1-4899-8073-1 ISBN 978-1-4899-8074-8 (eBook)
DOI 10.1007/978-1-4899-8074-8
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This book is dedicated to my wife, Hannah, my beloved partner
and companion, who has inspired our undertaking of some of
life’s greatest adventures.

Pref ace
T he effect of emotions in the practice of medicine has long been acknowl-
edged, given their underpinning for the development of double-blinded
placebo- controlled trials. Blinding of patients for research is necessary
because sometimes the act of taking even an inert substance can lead to
improvement in a patient’s health condition (which is defi ned as a placebo
response). This improvement can be attributed to a patient’s psychological
response to a therapy, which can lead to benefi cial physiological changes.
Blinding of the clinician also is helpful because a clinician’s expectation of a
therapeutic outcome can also affect the patient’s response to a therapy or the
clinician’s interpretation of the therapeutic outcome. The importance of rec-
ognizing the signifi cant psychological impact within medicine has been fur-
ther underscored by the recent modifi cation of the Medical College Aptitude
Test (MCAT).1 Beginning in 2015, this test will include assessment of knowl-
edge regarding behavioral and social sciences among applicants to US medi-
cal schools. In order to broaden the knowledge of healthcare providers about
the impact of psychology in the practice of pediatric medicine, this book
introduces readers to the wide spectrum of functional symptoms that can
affect children.
A ll children with medical conditions are affected by psychological factors
that may have been a precursor to and/or the result of the development of their
illness. Further, a signifi cant number of these children fail to improve com-
pletely despite their physicians’ best medical interventions. Sometimes, we
ascribe this failure to lack of adherence to therapy or to the severity of the
condition. What we often fail to appreciate or address is that the patients’
psychological states may contribute to the lack of response to medical ther-
apy. For example, some patients with asthma may experience shortness of
breath as a result of anxiety rather than from physical exacerbation of their
asthma. Some patients with infl ammatory bowel disease may experience
increased abdominal discomfort related to depression. Patients with migraine
headaches may experience an increase in the frequency and severity of their
symptoms as a result of psychosocial stress. Treating such patients by inten-
sifying their medical therapy is often of little use and may even be harmful.
Another group of patients have complaints that many clinicians recognize to
1 Kaplan RM, Satterfi eld JM, Kington RS. Building a better physician – the case for the
new MCAT. NEJM. 2012;266(14):1265–8.
vii
viii Preface
have arisen as a result of functional issues such as functional abdominal pain,
pseudoseizures, stress-related chest pain, and vocal cord dysfunction.
Review of the fi rst section of this book will enable healthcare providers to
recognize functional symptoms that can complicate organic disease, as well
as symptoms that are believed to be mostly functional in origin. Children’s
healthcare providers need to keep in mind that the manifestation of functional
symptoms can vary depending on the patients’ developmental age. Material
will be introduced through literature reviews, case studies, and quizzes. Video
demonstrations are provided with some of the chapters and can be accessed
on SpringerImages. Links to these videos are provided on the chapter’s open-
ing page as well as on the copyright page of the book and are freely accessible
to anyone who purchases the print version.
E ven when clinicians are comfortable in identifying patients with func-
tional disorders, planning a treatment program can be a challenge. Some
patients may be reluctant to undergo evaluation by mental health providers,
even when such competent providers are available. For this reason, the sec-
ond section of the book will help clinicians differentiate the patients for
whom referral to a mental health provider is mandatory from those for whom
other approaches may be useful. For the latter group, the book will teach
clinicians to empower themselves by learning how to incorporate various
approaches for the management of functional disorders in their practice,
including acupressure, biofeedback, basic cognitive behavioral therapy tech-
niques, hypnosis, imagery, meditation, and yoga. Means of obtaining training
in these modalities are provided in the appendix.
Our target readers are practicing clinicians including pediatricians, family
practitioners, pediatric subspecialists, child psychiatrists, psychologists,
other mental healthcare providers, and practitioners of alternative and com-
plementary medicine. Other readers may include students of medicine, other
health and behavioral sciences, and residents and fellows undergoing
advanced training.
Syracuse , NY , USA Ran D. Anbar
Acknowledgements
I am delighted to acknowledge the pivotal contributions to this book that were
made by my wife, Hannah. This book could not have been completed without
her, as she provided invaluable content and editing suggestions throughout its
production. Special acknowledgment is due to Christy Hall who ensured the
accuracy of the references listed in each chapter. I am very thankful for the
excellent videos for Chaps. 4 , 16 , and 21 that were produced and edited by
Steven Garlock, and for Chap. 2 5 that were produced and edited by Jonathan
Kaley-Isley.
I am very appreciative of the many people who reviewed drafts of various
chapters in this book, which helped greatly enhance its content. These review-
ers include Clare Arezina, Lucy Barbera, Cheryl Beighle, David Benhayon,
F. Ralph Berberich, Steve Blatt, Kathy Bratt, Richard Cantor, Jamie Cary,
Irene Cherrick, Rebecca Cherry, Reinhild Drager-Muenke, Courtney
DuMond, Andrea Dvorak, David Gottsegen, Nancy Havernick, Manoochehr
Karjoo, Lewis Kass, David Keith, Gloria Kennedy, Colin King, Jerry Klein,
Luke Klein, Paul Lehrer, Julie Linden, Ruth McKay, Alison McCrone, Vicky
Meguid, Richard Moss, Jennifer Nead, Murray Passo, Joan Pellegrino, Lou
Pellegrino, Kevin Ragosta, Amir Raz, Marcus Rivera, Hank Roane, Melissa
Schafer, Scott Schurman, Neal Seidberg, Caitlin Sgarlet, Jana Shaw, Phil
Shenefelt, Larry Shoemaker, Irene Sills, Juan Sotomayor, Zafer Soultan,
Arvind Srinath, Sue Stred, Ann Sveen, Eva Szigethy, Paul Taylor, Zulma
Tovar-Spinoza, Karen Teelin, Greg Thoreklson, Stuart Trust, Prateek Wali,
David Wark, Howard Weinberger, Miles Weinberger, Thomas Welch,
Christopher Woll, and Joseph Zastrow.
Many thanks are due to Amanda Quinn and Michael D. Sova, my Editors
at Springer who helped shepherd this book project from start to fi nish.
F inally, I thank my children, Joshua, Rebecca, Elinor, and Jonathan, for
their patience as I spent time working on this book rather than with them. I
look forward to their involvement with some of my future projects!
ix