Factitious Disorder and CFSin Adolescents.ppt

Factitious Disorder and CFSin Adolescents David S. Bell MD, FAAP Associate Clinical Professor of Pediatrics State University of New York at Buffalo January 12, 2007 Case Presentation 16 year old girl, acute mononucleosis 2 weeks out of school with physician’s note Did not recover; Persistent fatigue, headaches, sore throat, myalgia, joint pains, nausea Bedridden 6 Months No Specific Diagnosis Referral to Social Services because of school truancy Case Presentation - 2 Failure to attend school considered educational neglect. Educational neglect considered child abuse Court action begun to remove child from family as a treatment for neglect (“parent-ectomy”) School refused any educational support at home because no medical diagnosis Case Presentation - 3 Psychosocial evaluation revealed healthy, “intact” family, both parents were PhD’s. No substance abuse, adolescent was A student, no history of neglect or abuse. Case continued 1 year, $20,000 spent in legal fees No education offered during this time. ME/CFS in Children and Adolescents Jason L, Porter N, Shelleby E, et al. A case definition for children with myalgic encephalomyelitis/chronic fatigue syndrome. Clinical Medicine: Pediatrics 2008;1:1-5. Adolescent CFS 1. Unexplained, persistent or relapsing chronic fatigue over the past 3 months that was not the result of ongoing exertion and was not substantially alleviated by rest. 2. Substantial reduction in previous levels of social, educational, and personal activities. 3. Specific symptoms within the five classic symptom categories, which have persisted or recurred during the past 3 months of illness, but may predate the reported onset of fatigue Five Symptom Categories 1. Post-exertional malaise with loss of physical or mental stamina, rapid muscle or cognitive fatigability. 2. Unrefreshing sleep; disturbance of quantity and/or rhythm 3. Myofascial pain, joint pain, abdominal and/or head pain 4. Two or more neurocognitive manifestations 5. At least one