Hypnotherapy in child psychiatry: the state of the art.

Children are more easily hypnotized than adults, and hypnotherapy as a method responds to the general developmental needs of children by addressing their ability for fantasy and imagination. Hypnotherapy and self-hypnosis are tools with which to assess and develop protective factors, and enhance positive adjustment. Meta-analyses and overviews have demonstrated the effect of hypnotherapy in paediatric disorders like asthma, chronic and acute pain, and in procedure-related distress in cancer patients. We wanted to examine the use and benefits of hypnotherapy when applied to child psychiatric disorders. A review of a literature search from PubMed, PsychINFO and the Cochrane databases revealed 60 publications, mostly case reports based on 2-60 cases, addressing the use of hypnotherapy in various child psychiatric conditions. Findings indicate that hypnotherapy may be useful for a wide range of disorders and problems, and may be particularly valuable in the treatment of anxiety disorders and trauma-related conditions. In conclusion, knowledge of hypnosis is useful in clinical practice and hypnotherapy may play an important role as an adjunctive therapy in cognitive-behavioural treatment and family therapy. Additional qualitative and quantitative studies are needed to assess the place for hypnosis/hypnotherapy in child psychiatry.

Clinical and psychosocial follow-up study of children treated with extracorporeal membrane oxygenation.

BACKGROUND: Serious heart and pulmonary failure may be treated with extracorporeal membrane oxygenation (ECMO). The aim of this follow-up study was a multimodal assessment of outcome in children surviving ECMO at our hospital from 1991 to 2004. METHODS: Twenty-two children were, on average, 1.18 years old (SD = 1.92; range, 0.1 to 7.8) when ECMO was initiated. Average age at follow-up was 7.2 years (range, 1.8 to 13.9). Thirteen children were treated for cardiac and nine for pulmonary failure. Venoarterial ECMO was performed in 21 patients and venovenous ECMO in one patient. The protocol included a review of patients records, clinical, neurologic and neuropsychologic, and radiological examinations, electroencephalogram, and interviews with the parents. RESULTS: Moderate or severe impairment in at least two clinical assessments were found in 16 (72.7%) children. Five (22.7%) children had cerebral palsy and 15 (68.2%) had moderate or severe cognitive impairment. Eight (36%) children had pathological radiologic findings. Pathological electroencephalograms were found in 11 (50%) patients including four (18.2%) with epileptic activity. Children with radiologic findings had a slightly worse cognitive outcome. There was no association between the neurophysiologic findings and the neuropsychologic performance or the radiologic findings. Based on parental assessment, only four children had pathological scores. CONCLUSIONS: All children, except for two, came walking to the follow-up visit. All parents were positive to the ECMO treatment, and reported a good or slightly reduced quality of life for their child. Cerebral sequelae were frequently found in children treated with ECMO. The need for treatment and support should be assessed in order to optimize their physical and psychosocial functioning.

[Micturating cystourethrography--are the practical routines in accordance with empirical knowledge?]. / Miksjonsuretrocystografi--er praksis i tråd med empirisk kunnskap?

BACKGROUND: Micturating cystourethrography (MCUG) is a radiological examination of the urethra, bladder and kidneys frequently performed in children. The examination is known to be distressing for the child as well as parents and staff. The literature shows that proper information to both children and parents and the use of distraction techniques during the MCUG can lessen the children's distress and increase their cooperation. The use of sedation makes MCUG less distressing for the child, with very few side effects and no negative effects on the outcome of the examination. The aim was to study how Norwegian university hospitals apply empirical knowledge in their MCUG routines. MATERIAL AND METHODS: The study is based on observations of MCUG examinations of six children, mean age 3 years (range 6 months to 8 years). A questionnaire on MCUG routines and use of written information was completed by six departments of radiology. RESULTS: All the hospitals sent written information, though of varying quality and only in Norwegian, to patients/parents before the MCUG. The hospitals reported the use of different types of distraction techniques. Sedation with midazolam was used in all the hospitals, but the frequency varied from 6% to 75% of the examined children. CONCLUSION: The MCUG routines in Norwegian university hospitals are to varying extent in accordance with empirical recommendations; there is still scope for improvements with regard to written and oral information, distraction techniques and sedation.

Global assessment of psychosocial functioning in child and adolescent psychiatry. A review of three unidimensional scales (CGAS, GAF, GAPD).

Global assessment of functioning represents an important aspect of assessment in clinical practice and research. It can help identify persons in need of psychiatric treatment, have predictive value and measure change over time, including treatment effects. This review examines publications concerning development, psychometric properties and usefulness of three scales for children: Axis-VI in ICD-10 Global Assessment of Psychosocial Disability (GAPD), Children's Global Assessment Scale (CGAS) and Axis-V in DSM-IV Global Assessment of Functioning Scale (GAF). It is based on literature searches in PubMed and PsycInfo (1977-2003), and screening of Scandinavian and English textbooks on child psychiatry. The three scales differ in theoretical guidelines, descriptions of codes/anchor points and psychometric aspects. CGAS has been evaluated in 69 papers and 33 have been published on GAF used for children. The one paper comparing GAPD and CGAS found both scales sufficiently reliable for clinical practice. Reliability of CGAS and GAF has been found to vary from fair to substantial, depending on raters, training and diagnostic groups. International consensus for the use of one scale for global assessment of functioning for children 4-18 years would improve reliability in clinical practice and ease comparisons of studies across countries. A training programme would assist in this.

[Hypnotherapy in the treatment of refractory nocturnal enuresis]. / Hypnoterapi ved behandlingsrefraktaer enuresis nocturna.

BACKGROUND: Nocturnal enuresis represents a practical, social and emotional problem. The present study illustrates the advantage of using hypnosis as a therapy in chronic cases. MATERIAL: Twelve boys, median age 12 years (range 8-16), eight with primary nocturnal enuresis and four with primary nocturnal and diurnal enuresis, reported at referral a median of 0 (range 0-3) dry nights per week. All patients had a family history of enuresis and had used enuresis alarm and Desmopressin; 50% used Imipramin. Eight had been referred to psychological or psychiatric services for treatment. METHODS: All patients had undergone a somatic assessment by a paediatrician, a paediatric surgeon, or an urologist. After a preliminary assessment of motivation, they underwent hypnotherapy with a median of six sessions (range 2-8), followed by median one month with self-hypnosis exercises. RESULTS: At follow-up after three months and one year, nine out of 12 patients had respectively 6-7/7, and 7/7 dry nights per week. Three patients had nocturnal enuresis at follow-up; two of them were referred to a paediatric surgeon for their overactive urine bladder and one was referred to his local psychiatric clinic because of ongoing family conflicts. INTERPRETATION: Hypnotherapy had lasting effects for boys with chronic and complex forms of nocturnal enuresis. We suggest that hypnotherapy should be included in the therapeutic guidelines.