Stomachaches

Abstract: Objective To evaluate the prevalence of somatic symptoms (SSs) in children and adolescents with anxiety disorders; the relationship between SSs and anxiety severity, impairment, and child global functioning; and the impact of fluvoxamine (FLV) versus pill placebo (PBO) on reducing SSs. Method As part of a double-blind, placebo-controlled trial, 128 children (mean age, 10.8 years; range, 6-17) with DSM-IV anxiety disorders (i.e., social, separation, and generalized anxiety) were assessed by expert clinicians on 16 SSs using the Pediatric Anxiety Rating Scale. Results The most common SSs at baseline were restlessness (74%), stomachaches (70%), blushing (51%), palpitations (48%), muscle tension (45%), sweating (45%), and trembling/shaking (43%). Older children (age 12 and older) reported more SSs than younger children, boys and girls reported similar numbers of SSs, and SSs were higher among children with than without generalized anxiety disorder. SSs were significantly and positively correlated with anxiety severity, impairment, and global functioning. Pre-/postreductions in SSs were statistically significant in both PBO and FLV conditions; however, FLV was superior to PBO in reducing SSs. Conclusions SSs are highly prevalent among children and adolescents with anxiety disorders and are associated with greater anxiety severity and impairment. Treatment with FLV was effective in reducing rather than increasing SSs. The high rates of SSs in youths with each of the three anxiety disorders suggest a re-evaluation of SSs in the DSM-IV diagnostic criteria for the most common anxiety disorders among children and adolescents.

Abstract: The intolerance of children with autistic disorder to changes in their routine or environment is well known, typically presenting with acute symptoms of anxiety, panic, irritability, or agitation. In a clinical sample of children (6-12 years old) with autistic disorder and transition-induced behavioral deterioration, 8 of 9 patients showed a clinically significant improvement in response to sertraline treatment. Only one child was taking concurrent psychotropic medication. Therapeutic doses were surprisingly low in all cases (25-50 mg daily), with a clinical response appearing generally in 2-8 weeks. Adverse effects were minimal (one child developed stomachaches), except for apparent sertraline-induced behavioral worsening in 2 children when their doses were raised to 75 mg daily. In 3 children, an initial satisfactory clinical response appeared to diminish after 3-7 months of treatment, despite steady or increased doses. In 6 patients, the beneficial effects persisted throughout the several-month follow-up period. Only four of the children's families were identified as having mood and/or anxiety disorders. This open-label study suggests that short-term sertraline treatment may reduce the behavioral reactions seen in association with situational transitions or environmental changes in children with autistic disorder, though the beneficial effect may be only temporary in some children. Our experience suggests that small doses of sertraline may be effective and that some children may require divided doses of sertraline during the day. Controlled studies are needed to determine the efficacy, safety, and pharmacokinetics of sertraline in treating this "need for sameness," both in short-term and long-term studies of children with autistic disorder.

Abstract: Recurrent abdominal pain (RAP) is the most common recurrent pain complaint of childhood (McGrath, 1990). The pain must occur at least once a month for at least 3 months, in order to meet traditional criteria (Apley, 1975); however, many researchers note that Apley's (1975) criteria are too general and include too many subtypes of abdominal pain, including those with an organic cause, to be a useful classification (Rasquin-Weber et al., 1999). For the purposes of this article, we will continue to use the term “RAP” to denote abdominal pain that is without organic cause (i.e., functional), is usually periumbilical and does not relate to any specific physical activity. Epidemiological studies suggest that RAP affects 8–25% of school-age children ages 9- to 12-years old (Apley, 1975; Devanarayana, de Silva, & de Silva, 2008; Huguet & Miro, 2007; Konijnenberg, de Graeff-Meeder, van der Hoeven, Klimpen, Buitelaar, & Uiterwaal, 2006), and is more prevalent among girls (Apley, 1975; Colletti, 1998). RAP accounts for 2–4% of pediatric office visits (Starfield, Katz, & Gabriel, 1984), and many children with RAP go through potentially risky and possibly unnecessary hospitalizations, tests and procedures, thus placing a heavy burden on the medical community (Walker, Garber, Van Slyke, & Greene, 1995). Medical evaluations reveal organic disease in fewer than 5% of children evaluated in primary care settings (Stickler & Murphy, 1979). Nonetheless, nearly one-third to one-half of children with RAP continue to complain of abdominal pain and related symptoms after they reach adulthood (Walker et al., 1995). RAP is defined as “functional” because, in most cases, no organic cause can be found to explain the child's pain. RAP is therefore best conceptualized using a biopsychosocial approach that examines factors other than disease as potential mechanisms through which the condition emerged or is exacerbated (Gatchel, Peng, Peters, Fuchs, & Turk, 2007). One psychological variable that may contribute significantly to RAP in children is anxiety. A recent meta-analysis shows that internalizing symptoms, as measured by parent- and self-report, are approximately six times more likely to occur in children with RAP than matched healthy controls (Dufton & Compas, 2007). Campo et al. (2004) conducted an empirical study that showed parent reports of psychological symptoms as measured by the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2002) were significantly higher for children with RAP than for a matched healthy control. In addition, four studies completed structured diagnostic interviews with this population and found the prevalence of anxiety disorders in children with RAP to be between 42% and 85% (Campo et al., 2004; Dorn et al., 2003; Garber, Zeman & Walker, 1993; Liakopoulou-Kairis et al., 2002). The association between recurrent pain and anxiety in children is important for several reasons. First, there is evidence of an association between physical and psychological problems in children and adolescents. Egger, Costello, Erkanli, and Angold (1999) found that stomachaches, headaches, and musculoskeletal pains were strongly associated with anxiety, depression, and behavioral disorders in children age 9- to 16-years old. Second, physical symptoms are often part of the criteria for a psychological disorder. For example, “repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated” is part of the definition of separation anxiety disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, American Psychiatric Association, 1994). Third, pain symptoms may exacerbate or contribute to psychological symptoms, and vice versa. For example, a child with recurrent nausea induced by her stomachaches may become anxious in situations in which she may be far from a restroom, and as a result she may refuse to leave home to attend school or other social functions. Her avoidance of social situations may, in turn, increase her anxiety when she anticipates or is forced to engage in activities outside the home, which may also then exacerbate her gastrointestinal symptoms. Temperament and responses to stress may also play an important role in the development and maintenance of the illness, as well as account for the possible link between RAP and anxiety. For example, a behaviorally inhibited temperament in infancy is predictive of anxiety disorders in childhood (Biederman et al., 1993; Hirshfeld et al., 1992), and children with RAP have been found to display many temperamental features found in behaviorally inhibited children (Campo et al., 2004). Further, differences in temperament have been associated with differences in biobehavioral reactivity to stress (Boyce, Barr, & Zeltzer, 1992). For example, behavioral inhibition has been associated with a number of psychophysiological correlates, such as a high and stable resting heart rate (Kagan, Reznick, & Snidman, 1988). Because of the strong association between behavioral inhibition and anxiety disorders, many of these psychophysiological responses to stress are also found in anxious children, adolescents, and adults (Grillon, Ameli, Merikangas, Woods, & Davis, 1993; Thayer, Friedman, & Borkovec, 1996). It is possible that children with RAP may also display these same psychophysiological correlates that may contribute to their abdominal pain. Finally, the association between RAP and anxiety disorders and symptoms needs to be examined while controlling for somatic symptoms and features of anxiety that may artificially inflate this association. If recurrent bouts of abdominal pain are one of the criteria for an anxiety disorder, the apparent association between RAP and anxiety may be a result of this overlap in symptoms. To date, only one study has specifically compared children with RAP and children with an anxiety disorder. Dorn et al. (2003) compared children meeting criteria for RAP (n = 14) with children meeting criteria for an anxiety disorder (n = 14) and matched healthy controls (n = 14) using a structured diagnostic interview as well as several questionnaires. Dorn et al. found that 64% of the children with RAP met criteria for an anxiety disorder and that the RAP and anxious participants had comparable scores on psychological measures. This study builds upon Dorn et al.'s results by assessing the level of anxiety symptoms and diagnoses in a population of children with RAP, children with anxiety and a healthy comparison group. This current builds upon Dorn et al.'s results by including a larger sample size (and increased statistical power), obtaining parents’ and adolescents’ reports of internalizing symptoms (e.g., somatic complaints, anxiety, and depression), and using different and more specific measures of anxiety symptoms. We hypothesize that children with RAP will present with significantly more symptoms of anxiety than well children, though less than the children with an anxiety disorder. In addition, we expect the overall levels of somatic complaints to be higher in the RAP group than in both the anxiety and well groups given that this is a population with recurrent functional pain. Finally, structured diagnostic interview data will be examined in order to determine the point-prevalence rate of anxiety disorders in children with RAP. We hypothesize that children with RAP will have significantly more anxiety disorder diagnoses than well children.

Abstract: Psidium guajava L, Myrtaceae, is used widely in traditional medicine for the treatment of diarrhoea, dysentery, gastroenteritis, stomachaches, and indigestion However, the effect of the leaf extract of P guajava on the pathogenesis of infectious diarrhoea has not been studied The present study evaluates the effect of a hot aqueous extract (decoction) of dried leaves of P guajava on parameters associated with pathogenicity of infectious diarrhoea The aim was to understand its possible mechanism(s) of action in controlling infectious diarrhoea and compare it with quercetin, one of the most reported active constituents of P guajava with antidiarrhoeal activity The crude decoction and quercetin were studied for their antibacterial activity and effect on virulence features of common diarrhoeal pathogens viz colonization of epithelial cells and production and action of enterotoxins Colonization as measured by adherence of enteropathogenic Escherichia coli (EPEC) and invasion of enteroinvasive E coli (EIEC) and Shigella flexneri was assessed using HEp-2 cell line The production of E coli heat labile toxin (LT) and cholera toxin (CT) and their binding to ganglioside monosialic acid (GM1) were studied by GM1-ELISA whereas the production and action of E coli heat stable toxin (ST) was assessed by suckling mouse assay The decoction of P guajava showed antibacterial activity towards S flexneri and Vibrio cholerae It decreased production of both LT and CT and their binding to GM1 However, it had no effect on production and action of ST The decoction also inhibited the adherence of EPEC and invasion by both EIEC and S flexneri to HEp-2 cells Quercetin, on the other hand, had no antibacterial activity at the concentrations used nor did it affect any of the enterotoxins Although it did not affect adherence of EPEC, it inhibited the invasion of both EIEC and S flexneri to HEp-2 cells Collectively, the results indicate that the decoction of P guajava leaves is an effective antidiarrhoeal agent and that the entire spectrum of its antidiarrhoeal activity is not due to quercetin alone