A 13-year-old was seen in child and adolescent mental health services (CAMHS) for school refusal, extreme separation anxiety, temper tantrums, headache, nausea, vomiting, lethargy, and aches and pains. She was overweight, bullied in school and had a past history of reflux heartburn and psychosomatic complaints for 2-3 years, for which she had been seeing paediatricians.
During her contact with CAMHS therapeutic group, she was isolated and difficult to engage. She was regressed in behaviour and relied a lot on her mother. Her family all along suspected an unidentified organic condition.
With the emergence of vision problems, her general practitioner referred her again to the paediatric team. Idiopathic intracranial hypertension was diagnosed and subsided after treatment with acetazolamide and lumbar punctures. She still has headaches and other non-specific symptoms.
It is known that idiopathic intracranial hypertension is a rare self-limiting condition generally lasting less than 12 months, and in children can present with psychological and non-specific symptoms (Reference KLEINSCHMIDT, DIGRE and HANOVERKleinschmidt et al, 2000; Reference YOURONKOS, PSYCHON and FRYSSIRASYouronkos et al, 2000). There is 13-27% possibility of visual loss if untreated (Reference SOLER, COX and BULLOCKSoler et al, 1998).
In this patient, given the long history of psychosomatic symptoms pre-dating the onset and persisting after treatment of the idiopathic intracranial hypertension, it is likely to have been a coincidental finding.
This patient illustrates that physical illnesses may arise in children with psychological problems and our dilemma in deciding how far to investigate non-specific symptoms, balancing against the risk of reinforcing somatisation. Regular joint working and consultation between CAMHS, educational services and paediatricians in such complex cases may be a way of sharing knowledge, identifying things early and improving patient care.
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