儿童及青少年躯体症状障碍诊疗进展

doi:10.11852/zgetbjzz2024-0804

摘要/Abstract

摘要： 儿童及青少年躯体症状障碍(SSD)是一种常见的心理障碍,可表现为腹痛、头痛、恶心等症状,影响患者的生活、学习和日常功能。该病的早期诊断依赖于详细的病史采集、体格检查和排除其他潜在的疾病。究其病因,可能与生物心理社会影响因素有关。在干预及治疗中,学校与家庭参与的认知行为疗法是重要的治疗手段。

关键词: 躯体症状障碍, 认知行为疗法, 儿童, 青少年

Abstract: Somatic symptom disorder (SSD) in children and adolescents is a common psychological disorder that manifests as symptoms such as abdominal pain, headaches, nausea, and others, affecting patients′ life, learning and daily functioning. Early diagnosis of this disorder relies on detailed history-taking, physical examination, and the exclusion of other potential medical conditions. Its etiology may be related to biopsychosocial factors. In terms of intervention and treatment, cognitive-behavioral therapy involving both schools and families is an important therapeutic approach.

Key words: somatic symptom disorder, cognitive-behavioral therapy, children, adolescents

中图分类号:

R749.94

赖乾坤, 王艳霞, 欧萍, 余秋娟, 李银枝, 郭敬民, 黄欣欣. 儿童及青少年躯体症状障碍诊疗进展[J]. 中国儿童保健杂志, 2025, 33(2): 208-213.

LAI Qiankun, WANG Yanxia, OU Ping, YU Qiujuan, LI Yinzhi, GUO Jingmin, HUANG Xinxin. Diagnosis and treatment of somatic symptom disorder in children and adolescents[J]. Chinese Journal of Child Health Care, 2025, 33(2): 208-213.

参考文献

[1] Malas N, Ortiz-Aguayo R, Giles L, et al. Pediatric somatic symptom disorders[J]. Curr Psychiatr Rep,2017,19(2):11.
[2] 中华医学会心身医学分会躯体症状及相关障碍学组,上海市医学会心身医学专科分会. 躯体症状障碍多学科诊疗专家共识[J].中华精神科杂志,2024,57(2):65-77.
Somatic Symptoms and Related Disorders Group of Psychosomatic Medicine Branch of Chinese Medical Association, Psychosomatic Medicine Branch of Shanghai Medical Association.Chinese expert consensus on multi-disciplinary diagnosis and treatment of somatic symptom disorder[J]. Chin J Psychiatry,2024, 57(2):65-77.(in Chinese)
[3] American Psychiatric Association. Somatic symptoms and related disorders. Diagnostic and statistical manual of mental disorders: DSM-5[M]. 5th ed.Washington DC: American Psychiatric Association, 2013.
[4] Karkhanis DG, Winsler A. Somatization in children and adolescents: Practical implications[J]. Journal of Indian Association for Child and Adolescent Mental Health,2016,1(12):79-115.
[5] Stone AL, Walker LS, Heathcote LC, et al. Somatic symptoms in pediatric patients with chronic pain: Proposed clinical reference points for the children′s somatic symptoms inventory (formerly the children′s somatization inventory)[J]. J Pain,2019,20(8):932-940.
[6] Koenig J, Oelkers-Ax R, Parzer P, et al. The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: Evidence from a population-based study[J]. Child Adolesc Psychiatry Ment Health,2015,9:32.
[7] Li A, Guessoum SB, Ibrahim N, et al. A systematic review of somatic symptoms in school refusal[J]. Psychosom Med,2021,83(7):715-723.
[8] Sardesai A, Muneshwar KN, Bhardwaj M, et al. The importance of early diagnosis of somatic symptom disorder: A case report[J]. Cureus,2023,15(9):e44554.
[9] Amendola S, Hengartner MP, Spensieri V, et al. Patterns of internalizing symptoms and disability functioning in children and adolescents[J]. Eur Child Adolesc Psychiatry,2022,31(9):1455-1464.
[10] Jensen ET, Chaiboonma K, Ayala O, et al. Sleep, anxiety, somatization, quality of life, and resilience in pediatric patients with eosinophilic esophagitis[J]. Clinical and Translational Gastroenterology, 2024,15(3):e672.
[11] Ionescu CG, Popa-Velea O, Mihailescu AI, et al. Somatic symptoms and sleep disorders:A literature review of their relationship, comorbidities and treatment[J]. Healthcare (Basel),2021,9(9).
[12] Van den Bergh O, Witthoft M, Petersen S, et al. Symptoms and the body:Taking the inferential leap[J]. Neurosci Biobehav Rev,2017,74(Pt A):185-203.
[13] Palma-Gudiel H, Peralta V, Deuschle M, et al. Epigenetics-by-sex interaction for somatization conferred by methylation at the promoter region of SLC6A4 gene[J]. Prog Neuropsychopharmacol Biol Psychiatry,2019,89:125-131.
[14] Vesterling C, Schütz-Wilke J, Bäker N, et al. Epidemiology of somatoform symptoms and disorders in childhood and adolescence: A systematic review and meta-analysis[J]. Health Soc Care Comm,2023,16(1):1-16.
[15] Geremek A, Lindner C, Jung M, et al. Prevalence of somatic symptoms and somatoform disorders among a german adolescent psychiatric inpatient sample[J]. Children (Basel),2024,11(3):280.
[16] Lallukka T, Mekuria GB, Nummi T, et al. Co-occurrence of depressive, anxiety, and somatic symptoms: Trajectories from adolescence to midlife using group-based joint trajectory analysis[J]. BMC Psychiatry,2019,19(1):236.
[17] Bohman H, Laftman SB, Cleland N, et al. Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: A long-term community-based follow-up study[J]. Child Adolesc Psychiatry Ment Health,2018,12:42.
[18] Zhang J, Jiang M, Yao D, et al. Alterations in white matter integrity in first-episode, treatment-naive patients with somatization disorder[J]. Neurosci Lett,2015,599:102-108.
[19] Kakisaka Y, Jin K, Fujikawa M, et al. Levetiracetam improves symptoms of multiple chemical sensitivity: Case report[J]. J Med Invest,2017,64(3.4):296-298.
[20] Hamamura T, Mearns J. Depression and somatic symptoms in Japanese and American college students:Negative mood regulation expectancies as a personality correlate[J].Int J Psychol,2019, 54(3):351-359.
[21] Park B, Lee S, Jang Y, et al. Affective dysfunction mediates the link between neuroimmune markers and the default mode network functional connectivity, and the somatic symptoms in somatic symptom disorder[J]. Brain Behav Immun,2024,118:90-100.
[22] Lee S, Tomlinson R, Lumley MN, et al. Positive schemas, coping, and quality of life in pediatric recurrent abdominal pain[J]. J Clin Psychol Med Settings,2024,31(1):37-47.
[23] Xie X, He J, Xu S, et al. Psychological factors may affect the quality of life in irritable bowel syndrome patients more than the gut itself? A multicenter cross-sectional study[J]. JGH Open, 2024,8(3):e13045.
[24] Farhoumandi N, Zarean M, Nasiri M, et al. Somatization mediates the structural relationship of alexithymia with anxiety and depression[J]. Iran J Psychiatry,2022,17(2):144-153.
[25] Taycan O, Ozdemir A, Erdogan TS. Alexithymia and somatization in depressed patients: The role of the type of somatic symptom attribution[J]. Noro Psikiyatr Ars,2017,54(2):99-104.
[26] Masuda A, Mandavia A, Tully EC. The role of psychological inflexibility and mindfulness in somatization, depression, and anxiety among Asian Americans in the United States[J]. 2014,3(5):230-236.
[27] Salmon M, Sibeoni J, Harf A, et al. Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur[J]. Front Psychiatry,2022,13:897002.
[28] Cheng Q, Xu Y, Xie L, et al. Prevalence and environmental impact factors of somatization tendencies in eastern Chinese adolescents:A multicenter observational study[J]. Cad Saude Publica,2019,35(1):e8418.
[29] Michel G, Francois C, Harju E, et al. The long-term impact of cancer: Evaluating psychological distress in adolescent and young adult cancer survivors in Switzerland[J].Psychooncology,2019,28(3): 577-585.
[30] Kozlowska K, Palmer DM, Brown KJ, et al. Conversion disorder in children and adolescents:A disorder of cognitive control[J]. J Neuropsychol,2015,9(1):87-108.
[31] Vassilopoulos A, L Poulopoulos N, Ibeziako P. School absenteeism as a potential proxy of functionality in pediatric patients with somatic symptom and related disorders[J].Clin Child Psychol Psychiatry,2021, 26(2):342-354.
[32] Philip AC, Fahad M. School bullying and association with somatic complaints in victimized children: Correspondence[J]. Indian J Pediatr,2022,89(5):524.
[33] Levantini V, Camodeca M, Iannello NM. The contribution of bullying involvement and alexithymia to somatic complaints in preadolescents[J]. Children (Basel),2023,10(5):905.
[34] Hulgaard D, Dehlholm-Lambertsenb G, Ulrikka RC. Family-based interventions for children and adolescents with functional somatic symptoms:A systematic review[J]. Journal of Family Therapy,2019 (41):4-28.
[35] Wolff N, Darlington AS, Hunfeld J, et al. Determinants of somatic complaints in 18-month-old children: The generation R study[J]. J Pediatr Psychol,2010,35(3):306-316.
[36] Hagemann E, Silva DT, Davis JA, et al. Developmental origins of health and disease (DOHaD): The importance of life-course and transgenerational approaches[J]. Paediatr Respir Rev,2021,40:3-9.
[37] Ji NN, Jiang H, Xia M. The influence of the enriched environment in different periods on neonatal maternal separation-induced visceral pain, anxiousness,and depressive behaviors[J]. Transl Pediatr,2022, 11(9):1562-1569.
[38] Bizzi F, Riva A, Charpentier MS, et al. Attachment representation to caregivers and mentalizing ability in early adolescents with primary headache[J]. Clin Psychol Psychother,2021,28(4):862-871.
[39] Agarwal V, Srivastava C, Sitholey P. Clinical practice guidelines for the management of somatoform disorders in children and adolescents[J]. Indian J Psychiatry,2019,61(Suppl 2):241-246.
[40] Sartori R, Tessitore A, Della TA, et al. Efficacy of physiotherapy treatments in children and adolescents with somatic symptom disorder and other related disorders: Systematic review of the literature[J]. Ital J Pediatr,2022,48(1):127.
[41] Jungmann SM, Wagner L, Klein M, et al. Functional somatic symptoms and emotion regulation in children and adolescents[J]. Clin Psychol Eur,2022,4(2):e4299.
[42] Winding TN, Andersen JH. Do negative childhood conditions increase the risk of somatic symptoms in adolescence?-a prospective cohort study[J]. BMC Public Health,2019,19(1):828.
[43] Fisher E, Villanueva G, Henschke N, et al. Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: A WHO systematic review and meta-analysis[J]. Pain,2022,163(1):e1-e19.
[44] Mcfarlane FA, Allcott-Watson H, Hadji-Michael M, et al. Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series[J]. Eur J Paediatr Neurol,2019,23(2):317-328.
[45] Liu J, Gill NS, Teodorczuk A, et al. The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: A meta-analysis of randomized controlled trials[J]. J Affect Disord,2019,245:98-112.
[46] Siegle GJ, Thompson WK, Collier A, et al. Toward clinically useful neuroimaging in depression treatment:Prognostic utility of subgenual cingulate activity for determining depression outcome in cognitive therapy across studies, scanners, and patient characteristics[J].Arch Gen Psychiatry,2012,69(9): 913-924.
[47] Heyne D, Sauter FM, Ollendick TH, et al. Developmentally sensitive cognitive behavioral therapy for adolescent school refusal:Rationale and case illustration[J]. Clin Child Fam Psychol Rev,2014,17(2): 191-215.
[48] Sprenger L, Gerhards F, Goldbeck L. Effects of psychological treatment on recurrent abdominal pain in children - a meta-analysis[J]. Clin Psychol Rev,2011,31(7):1192-1197.
[49] Kleinstauber M, Witthoft M, Steffanowski A, et al. Pharmacological interventions for somatoform disorders in adults[J]. Cochrane Database Syst Rev,2014(11):CD10628.
[50] Hale AE, Ginsburg GS, Chan G, et al. Mediators of treatment outcomes for anxious children and adolescents: The role of somatic symptoms[J]. J Clin Child Adolesc Psychol,2018,47(1):94-104.