Pervasive refusal syndrome revisited: a conative disorder
- PDF / 449,421 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 15 Downloads / 168 Views
EDITORIAL
Pervasive refusal syndrome revisited: a conative disorder Jan N. M. Schieveld1,2 · Karl Sallin3
© Springer-Verlag GmbH Germany, part of Springer Nature 2020
Keywords Pervasive refusal syndrome · Apathy · Catatonia · Conative · DSM-5 · ICD-11 · MESH term Pervasive Refusal Syndrome (PRS) is a rare but serious child psychiatric disorder; its prevalence is unknown. A PubMed search on February 23, 2020 with the search terms: “Pervasive AND Refusal AND Syndrome” resulted in only 34 hits during the period 1988–2019, with finally only 31 hits valid dating from the period 1991–2019. PRS is characterized by a pervasive refusal of activities such as social engaging, speaking, eating and drinking and selfcare, and it is often accompanied by an active—and often angry—resistance to help. These are considered the core criteria (Table 1). This frequently leads to an endangered state of the child, and to exhaustion of parents as well as professionals involved (1). The seriousness of PRS also is reflected by the severe suffering of both the child and its family, and often requires intensive multidisciplinary (inpatient) hospital treatment periods > 6 months. It frequently results in splitting mechanisms and a dividing of the treatment team, and last but not least: it is hard to diagnose, or not recognized at all. Neither DSM-5 nor ICD-11 recognize PRS rendering it important to bring the syndrome to the attention of all disciplines constituting the pediatric mental health community. And that is why this month’s paper by John Otasowie et al. [2] entitled. Pervasive refusal syndrome: systematic review of case reports” is very welcome (2). Its strengths are its thorough critical screening and discussing of the existent literature by using the PRISMA guidelines, its clear systematic structure and its honest approach regarding all the aspects which we do not know or which we do not understand (yet).
* Jan N. M. Schieveld [email protected] 1
Department of Psycxhiatry and NeuroPsychology, Maastricht University Medical Center, Maastricht, The Netherlands
2
Mutsaers Academy, Venlo, The Netherlands
3
Karolinska Institute, Stockholm, Sweden
However, we also want to make some additional observations regarding six aspects: (1) the essence of the core feature of PRS and its overarching diagnostic category; (2) the clinical diagnostic problem of atypicality; (3) comorbidity; (4) primary versus secondary disorders; (5) differential diagnoses, and; (6) treatment. Ad (1) The essence of PRS. The first six categories of the neuropsychiatric mental status examination are: appearance, consciousness and cognition, thinking, perception, mood and affect, will and (motor) behavior. Disorders of this last group are called “conative” disorders—from the Latin noun “conatus” which means effort/impulse/tendency. The classical—but nearly forgotten by neuropsychiatry, but not by psychology—conative symptoms are psychomotor retardation, psychomotor overactivity, motor stereotypy, catatonia, posturing, negativism, and all other distur
Data Loading...
