Abstract

UNDERLYING PSYCHIATRIC DISORDER AMONG CHILDREN WITH SOMATIC COMPLAINTS PRESENTED AT PEDIATRIC UNIT OF A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN

Author(s): Arshalooz J Rahman

Objective: Children with functional somatic symptoms (FSS) often present with chronic symptoms severe enough to result in decreased quality of life, healthcare seeking behavior and skepticism in general pediatricians due to timely non-diagnosis is a major issue. Neurobiological alterations and adverse psychosocial factors contribute to FSS. This research aims to study the presence of undiagnosed psychiatric disorder and adverse psychosocial factors contributing to somatization. Methods: Retrospective approach was adapted and pre-recorded patient-centered data of five years (2008-2012) of the pediatric ward of Aga Khan University Hospital in Karachi, Pakistan was utilized.  Medical records of patients admitted with complaints of bodily symptoms and diagnosed with a psychiatric disorder were identified and retrieved, manually. Data was entered and analyzed using SPSS v.23. Results: Of 20,608 admissions, 67 (0.63%) of all ward admissions had somatic complaints and after an evaluation, they were diagnosed with a psychiatric or conversion disorder (CD). Most frequent clinical presentations were pseudoseizure (n=15, 22.3%) and headache (n=11, 16.4%). The most common psychiatric diagnoses were Conversion Disorder (CD) (n=38, 56.7%) and Major Depressive Disorder (MDD) (n=10, 14.9%). History of physical/verbal abuse and parental marital discord were significant stressors for CD. 17.9% (n=12) children had suicidal ideation which included 50% (n=5) children with MDD. Conclusion: This retrospective analysis concludes that somatization with underlying undiagnosed psychiatric disorders such as Conversion and Major Depressive disorder are commonly seen in the pediatric general practice. Somatization and comorbid psychiatric disorder roots back to emotional trauma or distress such as physical abuse and parental marital discord.