title: Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy?
abstract: The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children's hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8-17 years, using the Diagnostic Interview Schedule for Children-parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children's Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07-8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02-8.74, p = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache.
authors.affiliation: Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, A 01.468, PO Box 85500, 3508 GA, Utrecht, The Netherlands. L.M.E.Knook@umcutrecht.nl
authors.forename: Lidewij M E
authors.initials: LM
authors.lastname: Knook
authors.forename: Antoinette Y
authors.initials: AY
authors.lastname: Konijnenberg
authors.forename: Joost
authors.initials: J
authors.lastname: van der Hoeven
authors.forename: Jan L L
authors.initials: JL
authors.lastname: Kimpen
authors.forename: Jan K
authors.initials: JK
authors.lastname: Buitelaar
authors.forename: Herman
authors.initials: H
authors.lastname: van Engeland
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: de Graeff-Meeder
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D018710:Pain Clinics; D010147:Pain Measurement; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index