RESUMO
Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of hood intake, decreased or complete lack of mobilization, and lack of communication as well as retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however; been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of "depressive devitalization" -- a refusal syndrome mainly characterized by passive resistance -- into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients' symptomatology can be allocated on this continuum of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.
Assuntos
Transtornos de Alimentação na Infância/diagnóstico , Mutismo/diagnóstico , Isolamento Social , Estupor/diagnóstico , Adolescente , Anorexia Nervosa/classificação , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Índice de Massa Corporal , Criança , Terapia Combinada , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Dissociativos/classificação , Transtornos Dissociativos/diagnóstico , Transtornos Dissociativos/psicologia , Transtornos Dissociativos/terapia , Transtornos de Alimentação na Infância/classificação , Transtornos de Alimentação na Infância/psicologia , Transtornos de Alimentação na Infância/terapia , Feminino , Seguimentos , Humanos , Classificação Internacional de Doenças , Masculino , Mutismo/classificação , Mutismo/psicologia , Mutismo/terapia , Admissão do Paciente , Estupor/classificação , Estupor/psicologia , Estupor/terapiaRESUMO
Childhood depressive disorders are a health risk that need to be taken seriously due to their potential associated complications. A literature search of previously published studies about this subject utilizing PubMed, Psycontent and Psyndex has been performed. The data has been analyzed and the results discussed critically. It becomes apparent that few studies focus on depressive disorders in children and not much consideration is given to possible gender-related differences. Further investigation is needed in regard to epidemiology, symptoms, comorbid factors and duration of these disorders including studying the children's developmental psychopathology. It is especially essential to establish adequate pharmaco- and psychotherapeutic treatments to ameliorate prognosis, progression and persistence of depressive disorders in children.
