Treatment of somatic symptom disorder in childhood: evidence-based psychotherapy interventions / Szomatizációs zavarok kezelése gyermekkorban: bizonyítottan hatékony pszichoterápiás módszerek

INTRODUCTION: About 25-30% of patients present themselves in general practice and specialized healthcare with medically unexplained somatic symptoms. The prevalence of these symptoms is the highest among the elderly, children and adolescents. Approximately 20% of patients in primary care and 47% of them in specialized clinics are children between the age of 7-12 who seem to have somatic symptom disorder (SSD). Somatization disorder most frequently occur with symptoms of headache, stomach ache or various kinds of pain in the limbs that show high comorbidity with other mental disorders, predominantly with anxiety. SSDs are always multicausal issues where biological, social-environmental and psychological factors are interconnected in a complex manner. According to our experience, somaziting patients are often drifting in the healthcare system for years, and instead of getting adequate treatment, they only receive medication, thus their symptoms may easily become chronic. Aim, method: Our aim was to review the current literature and guidelines concerning evidence-based treatments for SSD in childhood. Furthermore, to underline the importance of psychotherapy in SSD, we present the cognitive behavior therapy of a 16-year-old adolescent with vertigo, gastrointestinal symptoms and insomnia over a 8-month period. DISCUSSION: The results of effectiveness studies unequivocally recommend cognitive behavioral therapy in the treatment of SSD patients, accompained by family therapy or family consultation. The therapy should focus on reducing psychosocial stressors, health anxiety and catastrophizing thinking style in the family, while developing adequate coping and communication skills as well as maintaining the patient's age-appropriate activity level. CONCLUSION: Cognitive behavior therapy is the treatment of choice in SSD for children and young people. Applying the biopsychosocial approach is a key issue in the assessment of predisposing and maintaining factors, ensuring that only methods based on scientific evidence will be applied to help these children. Orv Hetil. 2020; 161(25): 1050-1058.

Abundance of large old trees in wood-pastures of Transylvania (Romania).

Wood-pastures are special types of agroforestry systems that integrate trees with livestock grazing. Wood pastures can be hotspots for large old tree abundance and have exceptional natural values; but they are declining all over Europe. While presence of large old trees in wood-pastures can provide arguments for their maintenance, actual data on their distribution and abundance are sparse. Our study is the first to survey large old trees in Eastern Europe over such a large area. We surveyed 97 wood-pastures in Transylvania (Romania) in order to (i) provide a descriptive overview of the large old tree abundance; and (ii) to explore the environmental determinants of the abundance and persistence of large old trees in wood-pastures. We identified 2520 large old trees belonging to 16 taxonomic groups. Oak was present in 66% of the wood-pastures, followed by beech (33%), hornbeam (24%) and pear (22%). For each of these four species we constructed a generalized linear model with quasi-Poisson error distribution to explain individual tree abundance. Oak trees were most abundant in large wood-pastures and in wood-pastures from the Saxon cultural region of Transylvania. Beech abundance related positively to elevation and to proximity of human settlements. Abundance of hornbeam was highest in large wood-pastures, in wood-pastures from the Saxon cultural region, and in places with high cover of adjacent forest and a low human population density. Large old pear trees were most abundant in large wood-pastures that were close to paved roads. The maintenance of large old trees in production landscapes is a challenge for science, policy and local people, but it also can serve as an impetus for integrating economic, ecological and social goals within a landscape.