Deshpande Sharmishtha S, Vidya G, Bendre Neelima S, Ghate Madhav R
Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.
Indian J Psychol Med. 2011 Jul;33(2):163-6. doi: 10.4103/0253-7176.92065.
Medically unexplained pain symptoms are common in children, and their incidence is on the rise. There is often a lack of clearly articulated pathophysiology in these patients. There is need to improve understanding about varied causes and presentations of these patients which would generate further insight in management of these patients. Documentation and detailed assessment of such children in Indian setting is not seen in literature.
A series of 17 cases, 10 boys and 7 girls referred from pediatrics department is discussed, so as to categorize them in three different subgroups for management.
Although there were often no overt anxiety or depressive features, some psychosocial stress which was mostly unnoticed by the child, the parents and the doctor, preceded such a pain. It was often an academic stress, familial separation or parental psychiatric illness. They were at times not able to verbalize their distress, which was revealed with the help of Children's Apperception Test (C.A.T.). They mainly had anxieties about loss of love or disapproval by parents and also fear of harm or injury. They used defence mechanisms like denial, reaction formation and repression, which were ineffective in handling the overwhelming anxiety. Most of these children had either above average or borderline intelligence. Somatic expression of emotional needs and fears in these children was managed effectively by supportive therapy and antidepressant drugs.
医学上无法解释的疼痛症状在儿童中很常见，且发病率呈上升趋势。这些患者往往缺乏清晰阐述的病理生理学机制。有必要加深对这些患者不同病因和表现的理解，这将有助于进一步了解对他们的管理。在印度背景下，此类儿童的记录和详细评估在文献中未见报道。
讨论了从儿科转诊的17例病例，其中10名男孩和7名女孩，以便将他们分为三个不同亚组进行管理。
虽然通常没有明显的焦虑或抑郁特征，但在出现这种疼痛之前，存在一些儿童、父母和医生大多未注意到的心理社会压力。这往往是学业压力、家庭分离或父母精神疾病。他们有时无法表达自己的痛苦，借助儿童统觉测验（C.A.T.）才得以揭示。他们主要担心失去父母的爱或遭到父母反对，也害怕受到伤害。他们使用否认、反向形成和压抑等防御机制，但在应对压倒性焦虑方面无效。这些儿童大多智力高于平均水平或处于临界水平。通过支持性治疗和抗抑郁药物有效地处理了这些儿童情感需求和恐惧的躯体表现。
