Tag Archives: depression

High Rates of Anxiety Develop in Kids with RAP

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From NY Times review of a recent Pediatrics study:

Children with chronic stomach pains are at high risk for anxiety disorders in adolescence and young adulthood, a new study has found (goo.gl/I2UvHP ), suggesting that parents may wish to have their children evaluated at some point for anxiety.

Researchers at Vanderbilt University tracked 332 children with recurring stomachaches that could not be traced to a physical cause — so-called functional abdominal pain — comparing them as they reached young adulthood with 147 children who had never had such stomachaches.

About half the teenagers and young adults who had had functional abdominal pain as children developed an anxiety disorder at some point, compared with 20 percent of the control group, the researchers found. The vulnerability to anxiety persisted into adulthood even if the pain had disappeared, although the risk was highest if the pain continued.

Forty percent of the children with functional abdominal pain went on to experience depression, compared with 16 percent of those who had never had these stomachaches.

The study was published on Monday in the journal Pediatrics.

“What this study shows is a strong connection between functional abdominal pain and anxiety persists into adulthood, and it drives home the point that this isn’t by chance,” said Dr. John V. Campo, chairman of the department of psychiatry at Ohio State University, who was not involved in the new study….

Chronic abdominal pain affects 8 percent to 25 percent of school-age children. The problem can lead to school absences and take a toll on families.

“Somebody might say, ‘Of course they have mental issues or they are emotionally distressed — it’s because of the pain,’ ” said Lynn S. Walker, senior author of the study and director of the division of adolescent health at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“But we found even if the pain went away, these adolescents and young adults still have anxiety,” Dr. Walker said. “So maybe we need to treat their anxiety.”

The state-of-the-art treatment for functional abdominal pain is rehabilitative, focused on getting patients to participate in daily activities despite their stomachaches. “There’s no question that there are triggers for the pain, but the problem is in the perception of the pain and adaptation to the pain,” said Dr. Samuel Nurko, director of a functional abdominal pain center at Children’s Hospital Boston.

Dr. Nurko compared the pain to a light on a dimmer switch, which psychological techniques can help children control. “You don’t take away the pain,” he said. “You ‘dim’ it to be able to cope better.”

The new study underscores the importance of screening children with the condition for anxiety or depression, the authors said. Anxious children tend to be good children who are concerned about doing their best, Dr. Walker said, and parents may be flummoxed by the suggestion that such a child could be grappling with a mental health issue.

Related blog link:

Anxiety and Functional Abdominal Pain | gutsandgrowth  This link has additional links on related material.

Fewer Intern Hours & No Change in Patient Safety

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Excerpt from Gastroenterology & Endoscopy News (Shorter Workweeks for Interns Do Not Promote Patient Safety) :

A policy to shorten the workweek for interns in the United States has failed to improve their quality of life and has possibly put patients at greater risk for medical errors, a new study has found (Sen S et al. JAMA Intern Med 2013;173:657-662).

The 2011 policy change, recommended by the Accreditation Council for Graduate Medical Education, capped at 16 continuous hours the longest shift a first-year resident could work in the hope that doing so would ease the strain on physician trainees.

But although the new rules have shortened the typical intern’s workweek from 67 to 64.3 hours, they haven’t encouraged residents to sleep more, helped them to avoid depression or increased their overall sense of well-being, the study found…The study was based on email surveys of 2,323 residents …entered training in 2009, 2010 and 2011, after the rule change.

“Given that increased sleep was a key [mechanism] through which the new duty-hour restrictions were intended to improve the health of residents, the lack of such an effect in the postimplementation cohort in our study is a cause for concern,” wrote the authors, led by Srijan Sen, MD, PhD, a psychiatrist at the University of Michigan in Ann Arbor. “Designing work schedules that account for circadian phase and explicitly training residents on practices to increase sleep time and improve sleep quality may be necessary.”