Physician perceptions of medically unexplained symptoms in adolescent patients presenting to the emergency department.

INTRODUCTION: Adolescents presenting with medically unexplained symptoms (MUS) in non-mental healthcare settings, particularly Emergency Departments (EDs), pose diagnostic challenges necessitating a comprehensive bio-psycho-social approach. Amid the youth mental health crisis, recognising psychological distress is imperative. This study delved into physicians' perceptions and diagnostic tendencies regarding such cases, exploring the potential overshadowing of psychosomatic presentations by medicalized diagnoses in EDs. METHODS: Our study involved 74 physicians, representing 82% of eligible respondents in the Paediatric Emergency Medicine Department, and was conducted using an online questionnaire examining perceptions of case scenarios with psychosomatic presentations. RESULTS: Results disclosed a prevalent inclination toward medical diagnoses, with less than 10% of physicians considering psychosomatic conditions in specific scenarios. Interestingly, psychosomatic diagnoses were more probable for symptoms like headaches, shortness of breath, and chest pain. The study uncovered a possible bias among physicians towards medical diagnoses in EDs for adolescents with MUS, possibly stemming from physicians' focus on physical care, diagnostic uncertainties, cognitive biases, and concerns about stigmatisation. CONCLUSION: Adolescents with MUS seeking assistance in non-mental health settings may encounter delayed mental health diagnoses and interventions. Psychosomatic symptoms could signify stressors or underlying mental health disorders. Recognising psychosocial distress early on is crucial for optimal mental health outcomes. Consequently, the study advocates for a paradigm shift towards a holistic bio-psychosocial approach in both medical education and practice.

Gastrointestinal presentation and outcome of perinatal cytomegalovirus infection.

A term infant presented at birth with bilious vomiting and abdominal distension. Multiple investigations were undertaken, including two laparotomies and a rectal biopsy, as no obvious cause for his symptoms could be found. This included testing for human cytomegalovirus (CMV) infection as part of a TORCH screen, which was negative at 10 days of age. However, a repeat screen at 3 weeks of age demonstrated positive findings of CMV in both urine and blood PCR. This subsequently led to the diagnosis of gastrointestinal pseudoobstruction associated with perinatal CMV infection. This case is of interest though there is limited information regarding the recognition of gastrointestinal symptoms in relation to CMV infection. This report aims to highlight our experience with an infant with perinatal CMV infection and severe gastrointestinal symptoms.