Psychosomatic diseases in children

Abstract

The onset of psychosomatic diseases in children has a close relationship to the developmental level of the central nervous system (Abb. CNS). For example, sleep terror disorders are seen in early childhood, tic disorders from early childhood to childhood, recurrent abdominal pain and headache in childhood and puberty and enuresis are needed for evaluation and treatment in childhood. The level of socialization also depends on the developmental levels of CNS. The relationship to family is very important, especially to mothers in infancy and in early childhood, conflicts with siblings from early childhood to childhood and the relationships with friends and teachers from childhood to puberty. Recurrent abdominal pain and headache are common as psychosomatic symptoms in the outpatient clinic of paediatrics. There were 231 patients with reccurent abdominal pain and/or headache in our clinic during the past 3 years. In 51 patients out of 231, these symptoms were recognized as psychosomatic ones. In addition to that, 25 patients out of the 51 showed school refusal on their course. These symptoms sometimes are accompanied by school refusal. We think that one spectrum is consisted between these symptoms and school refusal. Sleep terror disorder (STD) is rather common in patients with parasomnia, especially between the ages of 3 and 6 years. Main triggering factors at the onset and aggravating factors on course were fear, tension and excitement. Usually patients could not tell any hallucinating contents during the episodes. However, some patients were able to tell the contents to mothers on partial awakening during the episodes and some other patients remember a part of the contents after awakening the next morning. We confirmed the contents in 5 patients out of 102 with STD. All the contents of the episodes were accompanied by fear, for example, of ghosts, being killed, monsters and so on. Enuresis is also common in children. A decrease of secretion of antidiuretic hormon during sleep, small contents of bladder and arousal disorders are recognized as main ontogenesis of enuresis. In addition to those, physical and mental stress may play a role in enuresis. In some cases, treatment of enuresis was quite effective by the use of drugs. The enuresis continued to disappear or decrease markedly during and even after the treatment for 2-4 weeks in those cases. This condition may show the role of secondary psychological stress from enuresis itself or some unknown mechanisms of enuresis. Main ontogenesis of tic is thought as diviation of the brain function and abnormality of neurotransmitters. The age of onset was mainly between 3 and 8 years. Main symptoms at the onset were eye blinking, head shaking, twitch of shoulder etc. However, in addition to those symptoms, movement of trunks, arms and legs were seen during the course. The symptoms disappear or decrease in a reverse order in a similar manner when haloperidol or psychological treatment was given. Both treatments were effective for transient tic, but not so effective for Tourette syndrome. We need to clarify those unknown mechanisms.