Jarbin Håkan, Saldeen Ann-Sofie, Forslund Carl-Magnus
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden.
Child and Adolescent Psychiatry, Region Halland, Sweden.
Case Rep Psychiatry. 2022 Mar 23;2022:2258180. doi: 10.1155/2022/2258180. eCollection 2022.
Pervasive refusal syndrome (PRS) is a severe child psychiatric syndrome not yet included in the international classification and mostly affecting girls aged 7-15 years. Hospital admission and severe loss of function extend for many months and years but most recover. Autism has been suggested as a predisposing factor but largely lacks support for typical cases of PRS. Treatment is not evidence-based and described as requiring a lengthy inpatient stay with a very gradual and sensitive rehabilitation program. . Three cases of pervasive refusal syndrome (PRS) in girls aged 9-16 years are presented to report autism as a predisposing factor and to discuss gentle coercion as part of the management strategy to speed up the lengthy recovery. The cases, which met the proposed criteria and typical background characteristics, were noted with the addition of undiagnosed autism in two cases. The duration of inpatient admission was 8-14 months. Disease duration was 15-36 months. An adequate but negative lorazepam trial to rule out catatonia was carried out. Treatment was in one case successfully expedited with gentle coercion within a transparent management plan. Rehabilitation was slower in PRS with comorbid autism; additionally, accommodations to school and living support needed to be put in place.
PRS is a useful clinical entity and best perceived as a primitive reaction to overwhelming stress rather than as catatonia. Autism might be another predisposing factor and needs to be assessed. A psychoeducational approach and a clear management plan support rehabilitation. A gentle coercion might hasten recovery.
广泛性拒绝综合征（PRS）是一种严重的儿童精神综合征，尚未被纳入国际分类，主要影响7至15岁的女孩。住院和严重的功能丧失会持续数月甚至数年，但大多数患者会康复。有人提出自闭症是一个诱发因素，但在典型的PRS病例中这一观点大多缺乏依据。治疗并非基于证据，据描述需要长时间住院，并采用非常渐进且敏感的康复计划。本文介绍了3例9至16岁女孩的广泛性拒绝综合征（PRS）病例，以报告自闭症作为诱发因素，并讨论温和强制作为管理策略的一部分以加速漫长的康复过程。这些病例符合提出的标准和典型的背景特征，其中2例还伴有未确诊的自闭症。住院时间为8至14个月。病程为15至36个月。进行了充分但结果为阴性的劳拉西泮试验以排除紧张症。在一个透明的管理计划中，通过温和强制成功加速了一例患者的治疗。伴有共病自闭症的PRS患者康复较慢；此外，还需要提供学校适应措施和生活支持。
PRS是一个有用的临床实体，最好将其视为对压倒性压力的一种原始反应而非紧张症。自闭症可能是另一个诱发因素，需要进行评估。心理教育方法和明确的管理计划有助于康复。温和强制可能会加速康复。
