Morality in clinical space: treatment of youngsters with functional somatic symptoms in a Western clinical context.

This paper explores the moral implications of treatment of young people with functional somatic symptoms. Based on an ethnographic field study at a Danish pain clinic for youngsters (age 8 to 18), the paper seeks to unearth the cultural, moral values that clinical practice steers by and upholds, and the implications this has for the assessment and management of ill body-selves. Through an exposition of the general practice of the clinic and an investigation of two specific cases of youngsters, it is found that the assessment of symptoms and selves and the goals of treatment are informed by cultural ideals of 'the good self' and 'the good life' in which agency and work ethic - both pertaining to the notion of individual responsibility - figure as prevalent virtues. The study underpins the findings of other researchers who have found that ideals of individual autonomy and responsibility for own life and health permeate the Western health care system and the discourses of ill individuals. The contribution of this article is to portray in ethnographic detail how such a cultural ethics manifests in practice and what implications this have for the treatment of young people with functional symptoms at a specific location and in specific cases. The two cases illustrate that the underlying norms and values can give rise to very different moral assessments of symptoms and selves within the same diagnostic category.

[Rising incidence rates of schizophrenia among children and adolescents]. / Stigende incidensrate af skizofreni hos børn og unge.

INTRODUCTION: The purpose was to expand the understanding of schizophrenia development in children and adolescents. An age- and gender-specific analysis of children and adolescents diagnosed with schizophrenia (F20.xx) was performed. The analysis included calculation of incidence rates of schizophrenia, schizophrenia subtypes, and an account of occurrence of any registered psychiatric diagnoses prior to first schizophrenia diagnosis. MATERIAL AND METHODS: Patients aged 0-21 years diagnosed with schizophrenia (F20.xx) and registered in the Danish Psychiatric Central Research Register in 1994-2007 were included. RESULTS: The cohort consisted of 3,065 patients aged 6-21 years. Incidence rates vary with age and gender, and have been increasing in recent years. Boys have earlier onset and higher incidence rates than girls. The most common schizophrenia subtypes were paranoid (F20.0; 44.0%) and unspecified (F20.9; 28.7%). Three in every four patients had contact with the psychiatric hospital system prior to first schizophrenia diagnosis. CONCLUSION: Schizophreniform symptomatology tends to overlap with other psychiatric disorders, and diagnostic stability is low. The diagnosis schizophrenia should be systematically included in diagnostic deliberations. Qualitative studies describing and analysing early psychopathology in children and adolescents with schizophrenia will improve the present knowledge.

Attachment in the doctor-patient relationship in general practice: a qualitative study.

OBJECTIVE: To explore why interpersonal continuity with a regular doctor is valuable to patients. DESIGN, SETTING, AND SUBJECTS: A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected after an observed consultation and sampled purposively according to reason for encounter, age, and sex. The research question was answered by means of psychological theory. RESULTS: A need for attachment was a central issue for the understanding of the value of interpersonal continuity for patients. The patients explained that they preferred to create a personal relationship with their GP and the majority expressed a degree of vulnerability in the doctor-patient relationship. The more sick or worried they were the more vulnerable and the more in need of a regular GP. Furthermore, patients stated that it was difficult for them to change GP even if they had a poor relationship. CONCLUSION: Attachment theory may provide an explanation for patients' need to see a regular GP. The vulnerability of being a patient creates a need for attachment to a caregiver. This need is fundamental and is activated in adults when they are sick or scared.

[Early onset of schizophrenia symptoms in children. A literature review]. / Tidlige skizofreniforme symptomer hos børn. En litteraturgennemgang.

Diagnosing schizophrenia in children is difficult, especially in the early stages, and the diagnosis is rarely made. The explanation could be that our knowledge of schizophrenia symptoms in children is insufficient. Moreover, there are no classification systems designed specifically for diagnosing schizophrenia in children. Perhaps diagnosis is rarely made because the disease is a rarity. This article presents a literature review of the present knowledge of early onset of schizophrenia in children and indicates perspectives for future research in schizophrenia.

[Schizophrenia in a seven year-old boy]. / Skizofreni hos en syvårig dreng.

Diagnosing schizophrenia in children is difficult, especially in the early stages. A possible explanation is that our knowledge of symptoms is insufficient. Moreover, there are no specific classification systems for diagnosing childhood schizophrenia. A seven year-old boy presented with symptoms resulting in differential diagnostic considerations of attention deficit/hyperactivity disorder or a behavioural or emotional disorder. The boy had auditory hallucinations, was socially dysfunctional and had emotional contact disturbances, leading to the schizophrenia diagnosis.

[Illness perception in general practice--in relation to patients with somatization disorder]. / Sygdomsopfattelser i almen praksis--i relation til patienter med somatiserende lidelse.

In this paper different perceptions of disease and illness in general practice and possible implications of these perceptions for the GP's clinical work are described and discussed. The focus is on patients with medically unexplained symptoms and on the question whether the illness perception of the GP to some extent can explain the often inappropriate treatment of these patients.