“Other Medical” Presentations and Considerations in Pediatric Consultation-Liaison Psychiatry

  • Taryn ParkEmail author
  • Ian Kodish
  • Anthony P. S. Guerrero


This chapter covers some of the more common consultation-liaison psychiatry scenarios, including the patient with “somatic” symptoms of uncertain etiology requiring a thorough evaluation for “other medical” etiologies and the patient with behavioral symptoms more clearly attributable to “other medical” or “biological” (in the biopsychosocial formulation) etiologies. The consultant can play a key role in adequately investigating differential possibilities, in addressing all relevant aspects of the biopsychosocial formulation, in establishing an expected course of recovery, and in insuring that the child and family feel supported. The case vignettes will review the traditional somatic symptom and related disorders as well as other situations where the psychiatrist can help guide the team in considering other medical etiologies for behavioral symptoms.


Brain Injuries Traumatic Serotonin syndrome Neuroleptic malignant syndrome Pediatric Child psychiatry Sleep Conversion disorder Somatization 


  1. Abu-Kishk, I., Toledano, M., Reis, A., Daniel, D., & Berkovitch, M. (2004). Neuroleptic malignant syndrome in a child treated with an atypical antipsychotic. Journal of Toxicology. Clinical Toxicology, 42, 921–925.CrossRefGoogle Scholar
  2. Badin, E., Haddad, C., & Shatkin, J. P. (2016). Insomnia: The sleeping Giant of pediatric public health. Current Psychiatry Reports, 18, 47.CrossRefGoogle Scholar
  3. Bag, O., Erdogan, I., Onder, Z. S., Altinoz, S., & Ozturk, A. (2012). Steroid-induced psychosis in a child: Treatment with risperidone. General Hospital Psychiatry, 34, 103.e5–103.e6.CrossRefGoogle Scholar
  4. Bruni, O., Ottaviano, S., Guidetti, V., Romoli, M., Innocenzi, M., Cortesi, F., & Giannotti, F. (1996). The sleep disturbance scale for children (SDSC) construct ion and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. Journal of Sleep Research, 5(4), 251–261.CrossRefGoogle Scholar
  5. Cespedes, E. M., Gillman, M. W., Kleinman, K., Rifas-Shiman, S. L., Redline, S., & Taveras, E. M. (2014). Television viewing, bedroom television, and sleep duration from infancy to mid-childhood. Pediatrics, 133, e1163–e1171.CrossRefGoogle Scholar
  6. Chapman, L. A., Wade, S. L., Walz, N. C., Taylor, H. G., Stancin, T., & Yeates, K. O. (2010). Clinically significant behavior problems during the initial 18 months following early childhood traumatic brain injury. Rehabilitation Psychology, 55, 48–57.CrossRefGoogle Scholar
  7. Cole, C. M., Falcone, T., Caplan, R., Timmons-Mitchell, J., Jares, K., & Ford, P. J. (2014). Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures. Epilepsy & Behavior, 37, 145–150.CrossRefGoogle Scholar
  8. Cornaggia, C. M., di Rosa, G., Polita, M., Magaudda, A., Perin, C., & Beghi, M. (2016). Conversation analysis in the differentiation of psychogenic nonepileptic and epileptic seizures in pediatric and adolescent settings. Epilepsy & Behavior, 62, 231–238.CrossRefGoogle Scholar
  9. Croarkin, P. E., Emslie, G. J., & Mayes, T. L. (2008). Neuroleptic malignant syndrome associated with atypical antipsychotics in pediatric patients: A review of published cases. The Journal of Clinical Psychiatry, 69, 1157–1165.CrossRefGoogle Scholar
  10. Edwards, M. S. (1991). Neuroleptic malignant syndrome. Pediatrics, 88, 1074.PubMedGoogle Scholar
  11. Gringras, P. (2008). When to use drugs to help sleep. Archives of Disease in Childhood, 93, 976–981.CrossRefGoogle Scholar
  12. Guerrero, A. P. S., & Matsu, C. R. (2007). Chapter 24: Children and Adolescents. In H. Leigh & J. Streltzer (Eds.), Handbook of Consultation-Liaison Psychiatry (pp. 316–340). New York: Springer.CrossRefGoogle Scholar
  13. Honaker, S. M., & Meltzer, L. J. (2016). Sleep in pediatric primary care: A review of the literature. Sleep Medicine Reviews, 25, 31–39.CrossRefGoogle Scholar
  14. Hooper, S. R., Alexander, J., Moore, D., Sasser, H. C., Laurent, S., King, J., Bartel, S., & Callahan, B. (2004). Caregiver reports of common symptoms in children following a traumatic brain injury. NeuroRehabilitation, 19, 175–189.PubMedGoogle Scholar
  15. Hosenbocus, S., & Chahal, R. (2011). SSRIs and SNRIs: A review of the discontinuation syndrome in children and adolescents. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20, 60–67.PubMedPubMedCentralGoogle Scholar
  16. Ibeziako, P., & Bujoreanu, S. (2011). Approach to psychosomatic illness in adolescents. Current Opinion in Pediatrics, 23, 384–389.CrossRefGoogle Scholar
  17. Janssens, K. A., Oldehinkel, A. J., & Rosmalen, J. G. (2009). Parental overprotection predicts the development of functional somatic symptoms in young adolescents. The Journal of Pediatrics, 154, 918–923.e1.CrossRefGoogle Scholar
  18. Joshi, P. T., Capozzoli, J. A., & Coyle, J. T. (1991). Neuroleptic malignant syndrome: Life-threatening complication of neuroleptic treatment in adolescents with affective disorder. Pediatrics, 87, 235–239.PubMedGoogle Scholar
  19. Kant, S., & Liebelt, E. (2012). Recognizing serotonin toxicity in the pediatric emergency department. Pediatric Emergency Care, 28, 817–821. quiz 822-4.CrossRefGoogle Scholar
  20. Kodish, I. (2016). Functional neurological symptom disorder in youth. Pediatric Annals, 45, e356–e361.CrossRefGoogle Scholar
  21. Kotagal, P., Costa, M., Wyllie, E., & Wolgamuth, B. (2002). Paroxysmal nonepileptic events in children and adolescents. Pediatrics, 110, e46.CrossRefGoogle Scholar
  22. Levin, H. S., & Hanten, G. (2005). Executive functions after traumatic brain injury in children. Pediatric Neurology, 33, 79–93.CrossRefGoogle Scholar
  23. Luis, C. A., & Mittenberg, W. (2002). Mood and anxiety disorders following pediatric traumatic brain injury: A prospective study. Journal of Clinical and Experimental Neuropsychology, 24, 270–279.CrossRefGoogle Scholar
  24. Max, J. E., Lindgren, S. D., Knutson, C., Pearson, C. S., Ihrig, D., & Welborn, A. (1997). Child and adolescent traumatic brain injury: Psychiatric findings from a paediatric outpatient specialty clinic. Brain Injury, 11, 699–711.CrossRefGoogle Scholar
  25. Max, J. E., Lansing, A. E., Koele, S. L., Castillo, C. S., Bokura, H., Schachar, R., Collings, N., & Williams, K. E. (2004). Attention deficit hyperactivity disorder in children and adolescents following traumatic brain injury. Developmental Neuropsychology, 25, 159–177.CrossRefGoogle Scholar
  26. Nunes, M. L., & Bruni, O. (2015). Insomnia in childhood and adolescence: Clinical aspects, diagnosis, and therapeutic approach. Jornal de Pediatria, 91, S26–S35.CrossRefGoogle Scholar
  27. Owens, J. A., & Dalzell, V. (2005). Use of the ‘BEARS’sleep screening tool in a pediatric residents’ continuity clinic: A pilot study. Sleep Medicine, 6(1), 63–69.CrossRefGoogle Scholar
  28. Park, E. G., Lee, J., Lee, B. L., Lee, M., & Lee, J. (2015). Paroxysmal nonepileptic events in pediatric patients. Epilepsy & Behavior, 48, 83–87.CrossRefGoogle Scholar
  29. Pelayo, R., & Dubik, M. (2008). Pediatric sleep pharmacology. Seminars in Pediatric Neurology, 15, 79–90.CrossRefGoogle Scholar
  30. Phan, H., Casavant, M. J., Crockett, S., Lee, A., Hall, M. W., & Nahata, M. C. (2008). Serotonin syndrome following a single 50 mg dose of sertraline in a child. Clinical Toxicology (Philadelphia, Pa.), 46, 845–849.CrossRefGoogle Scholar
  31. Plioplys, S., Asato, M. R., Bursch, B., Salpekar, J. A., Shaw, R., & Caplan, R. (2007). Multidisciplinary management of pediatric nonepileptic seizures. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1491–1495.CrossRefGoogle Scholar
  32. Plioplys, S., Doss, J., Siddarth, P., Bursch, B., Falcone, T., Forgey, M., Hinman, K., Lafrance, W. C., Jr., Laptook, R., Shaw, R. J., Weisbrot, D. M., Willis, M. D., & Caplan, R. (2016). Risk factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures. Seizure, 38, 32–37.CrossRefGoogle Scholar
  33. Rasimas, J. J., & Liebelt, E. L. (2012). Adverse effects and toxicity of the atypical antipsychotics: What is important for the pediatric emergency medicine practitioner. Clinical Pediatric Emergency Medicine, 13, 300–310.CrossRefGoogle Scholar
  34. Sadeh, A. (2004). A brief screening questionnaire for infant sleep problems: Validation and findings for an internet sample. Pediatrics, 113(6), e570–e577.CrossRefGoogle Scholar
  35. Sawchuk, T., & Buchhalter, J. (2015). Psychogenic nonepileptic seizures in children – psychological presentation, treatment, and short-term outcomes. Epilepsy & Behavior, 52, 49–56.CrossRefGoogle Scholar
  36. Stuart, F. A., Segal, T. Y., & Keady, S. (2005). Adverse psychological effects of corticosteroids in children and adolescents. Archives of Disease in Childhood, 90, 500–506.CrossRefGoogle Scholar
  37. Takasaki, K., Diaz Stransky, A., & Miller, G. (2016). Psychogenic nonepileptic seizures: Diagnosis, management, and bioethics. Pediatric Neurology, 62, 3–8.CrossRefGoogle Scholar
  38. Ty, E. B., & Rothner, A. D. (2001). Neuroleptic malignant syndrome in children and adolescents. Journal of Child Neurology, 16, 157–163.PubMedGoogle Scholar
  39. Ularntinon, S., Tzuang, D., Dahl, G., & Shaw, R. J. (2010). Concurrent treatment of steroid-related mood and psychotic symptoms with risperidone. Pediatrics, 125, e1241–e1245.CrossRefGoogle Scholar
  40. Warrington, T. P., & Bostwick, J. M. (2006). Psychiatric adverse effects of corticosteroids. Mayo Clinic Proceedings, 81, 1361–1367.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Taryn Park
    • 1
    Email author
  • Ian Kodish
    • 2
  • Anthony P. S. Guerrero
    • 1
  1. 1.Department of PsychiatryUniversity of Hawai‘i John A. Burns School of MedicineHonoluluUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleUSA

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