Skip to main content
SpringerLink
Log in

Functional Symptoms in Intensive Care: The Vicious Circle of Anxiety and Symptoms

  • Chapter
  • First Online:
Functional Symptoms in Pediatric Disease

  • 1539 Accesses

Abstract

This chapter reviews the functional symptoms likely to be encountered in the pediatric critical care setting. Considering symptoms to be “functional” implies that a psychological or emotional state contributes to the symptom. Thus functional symptoms overlap with related terms such as “psychogenic,” “psychosomatic,” and “nonorganic” symptoms. Functional symptoms occur on a daily basis in the intensive care unit (ICU) when a child’s anxiety intensifies unpleasant symptoms. At the same time, unpleasant symptoms amplify anxiety. And if there is a vicious circle of anxiety and symptoms for the child, this is also exacerbated by a vicious circle of anxiety among the child, family, and staff. Symptoms during routine care, procedures, or crises in the ICU can be controlled by a combination of pharmacological and nonpharmacological strategies. Functional symptoms may mimic a life threatening condition, on rare occasions, requiring a timely diagnostic evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Thompson RH. The handbook of child life: a guide for pediatric psychosocial care. Springfield, IL: Charles C Thomas; 2009.

    Google Scholar 

  2. Garrouste-Orgeas M, Coquet I, Périer A, Timsit JF, Pochard F, Lancrin F, Philippart F, Vesin A, Bruel C, Blel Y, Angeli S, Cousin N, Carlet J, Misset B. Impact of an intensive care unit diary on psychological distress in patients and relatives. Crit Care Med. 2012;40(7):2033–40.

    Article  PubMed  Google Scholar 

  3. Berde CB, Walco GA, Krane EJ, Anand KJ, Aranda JV, Craig KD, Dampier CD, Finkel JC, Grabois M, Johnston C, Lantos J, Lebel A, Maxwell LG, McGrath P, Oberlander TF, Schanberg LE, Stevens B, Taddio A, von Baeyer CL, Yaster M, Zempsky WT. Pediatric analgesic clinical trial designs, measures, and extrapolation: report of an FDA scientific workshop. Pediatrics. 2012;129(2):354–64.

    Article  PubMed  Google Scholar 

  4. Sanders RD, Tononi G, Laureys S, Sleigh JW. Unresponsiveness ≠ unconsciousness. Anesthesiology. 2012;116(4):946–59.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics. 2008;122 Suppl 3:S130–3.

    Article  PubMed  Google Scholar 

  6. Keltner JR, Furst A, Fan C, Redfern R, Inglis B, Fields HL. Isolating the modulatory effect of expectation on pain transmission: a functional magnetic resonance imaging study. J Neurosci. 2006;26(16):4437–43.

    Article  CAS  PubMed  Google Scholar 

  7. Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111(3):657–77.

    Article  PubMed  Google Scholar 

  8. Ossipov MH, Dussor GO, Porreca F. Central modulation of pain. J Clin Invest. 2010;120(11):3779–87.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Khan RS, Ahmed K, Blakeway E, Skapinakis P, Nihoyannopoulos L, Macleod K, Sevdalis N, Ashrafian H, Platt M, Darzi A, Athanasiou T. Catastrophizing: a predictive factor for postoperative pain. Am J Surg. 2011;201(1):122–31.

    Article  PubMed  Google Scholar 

  10. Ridling DA, Lewis-Newby M, Lindsey D. Family-centered care in the PICU. In: Fuhrman BP, Zimmerman JJ, Carcillo JA, Clark RS, Rotta AT, Tobias JD, Relvas MS, Thompson AE, editors. Pediatric critical care. Philadelphia, PA: Elsevier; 2011. p. 92–101.

    Chapter  Google Scholar 

  11. Heard CMB, Fletcher JE. Sedation and analgesia. In: Fuhrman BP, Zimmerman JJ, Carcillo JA, Clark RS, Rotta AT, Tobias JD, Relvas MS, Thompson AE, editors. Pediatric critical care. Philadelphia, PA: Elsevier; 2011. p. 1654–81.

    Chapter  Google Scholar 

  12. Pokela ML. Pain relief can reduce hypoxemia in distressed neonates during routine treatment procedures. Pediatrics. 1994;93(3):379–83.

    CAS  PubMed  Google Scholar 

  13. Bauchner H. Procedures, pain, and parents. Pediatrics. 1991;87(4):563–5.

    CAS  PubMed  Google Scholar 

  14. Blount RL, Zempsky WT, Jaaniste T, Evans S, Cohen LL, Devine KA, et al. Handbook of pediatric psychology. New York: Guilford Press; 2009.

    Google Scholar 

  15. Carlson KL, Broome M, Vessey JA. Using distraction to reduce reported pain, fear, and behavioral distress in children and adolescents: a multisite study. J Soc Pediatr Nurs. 2000;5(2):75–85.

    Article  CAS  PubMed  Google Scholar 

  16. Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics. 2008;122 Suppl 3:S134–9.

    Article  PubMed  Google Scholar 

  17. Gaynard L, Wolfer J, Goldberger J, Thompson R, Redburn L, Laidley L. Psychosocial care of children in hospitals: a clinical practice manual from the ACCH Child Life Research Project. Rockville, MD: Child Life Council, Inc.; 1998.

    Google Scholar 

  18. Gold JI, Kim SH, Kant AJ, Joseph MH, Rizzo AS. Effectiveness of virtual reality for pediatric pain distraction during i.v. placement. Cyberpsychol Behav. 2006;9(2):207–12.

    Article  PubMed  Google Scholar 

  19. Kuttner L. A child in pain. Portland, OR: Hartley & Marks; 1996.

    Google Scholar 

  20. Pederson C, Harbaugh BL. Nurses’ use of nonpharmacologic techniques with hospitalized children. Issues Compr Pediatr Nurs. 1995;18(2):91–109.

    Article  CAS  PubMed  Google Scholar 

  21. Rollins JH, Bolig R, Mahan CC. Meeting children’s psychosocial needs across the health-care continuum. Austin, TX: Pro ed; 2005.

    Google Scholar 

  22. Seers K, Carroll D. Relaxation techniques for acute pain management: a systematic review. J Adv Nurs. 1998;27(3):466–75.

    Article  CAS  PubMed  Google Scholar 

  23. Vessey JA, Carlson KL. Nonpharmacological interventions to use with children in pain. Issues Compr Pediatr Nurs. 1996;19(3):169–82.

    Article  CAS  PubMed  Google Scholar 

  24. Morris MJ, Christopher KL. Diagnostic criteria for the classification of vocal cord dysfunction. Chest. 2010;138(5):1213–23.

    Article  PubMed  Google Scholar 

  25. Maturo S, Hill C, Bunting G, Baliff C, Ramakrishna J, Scirica C, Fracchia S, Donovan A, Hartnick C. Pediatric paradoxical vocal-fold motion: presentation and natural history. Pediatrics. 2011;128(6):e1443–9.

    Article  PubMed  Google Scholar 

  26. Kanter RK. Control of breathing and acute respiratory failure. In: Fuhrman BP, Zimmerman JJ, Carcillo JA, Clark RS, Rotta AT, Tobias JD, Relvas MS, Thompson AE, editors. Pediatric critical care. Philadelphia, PA: Elsevier; 2011. p. 509–14.

    Chapter  Google Scholar 

  27. Murphy G, Bartle S. Hypocalcemic laryngospasm and tetany in a child with renal dysplasia. Pediatr Emerg Care. 2006;22(7):507–9.

    Article  PubMed  Google Scholar 

  28. Sen A, Scott C, Sisodiya SM. Stertorous breathing is a reliably identified sign that helps in the differentiation of epileptic from psychogenic non-epileptic convulsions: an audit. Epilepsy Res. 2007;77(1):62–4.

    Article  PubMed  Google Scholar 

  29. Coykendall DS, Gauderer MW, Blouin RR, Morales A. Vagus nerve stimulation for the management of seizures in children: an 8-year experience. J Pediatr Surg. 2010;45(7):1479–83.

    Article  PubMed  Google Scholar 

  30. Weinberger M, Abu-Hasan M. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. Pediatrics. 2007;120(4):855–64.

    Article  PubMed  Google Scholar 

  31. Ayers JG, Mansur AH. Vocal cord dysfunction and severe asthma. Am J Respir Crit Care Med. 2011;184(1):2–3.

    Article  Google Scholar 

  32. Jardine D, Bhutta OJ, Inglis A. Specific diseases of the respiratory system: upper airway. In: Fuhrman BP, Zimmerman JJ, Carcillo JA, Clark RS, Rotta AT, Tobias JD, Relvas MS, Thompson AE, editors. Pediatric critical care. Philadelphia, PA: Elsevier; 2011. p. 561–74.

    Chapter  Google Scholar 

  33. Watts KD, Goodman DM. Wheezing in infants. In: Kliegman RM, Stanton BF, St Geme III JW, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. Philadelphia, PA: Elsevier; 2011. p. 1456–9.

    Google Scholar 

  34. Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics. 2011;128(5):e1062–8.

    Article  PubMed  Google Scholar 

  35. Miller AC, Gladwin MT. Pulmonary complications of sickle cell disease. Am J Respir Crit Care Med. 2012;185(11):1154–65.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Lee EY, Tse SK, Zurakowski D, Johnson VM, Lee NJ, Tracy DA, Boiselle PM. Children suspected of having pulmonary embolism: multidetector CT pulmonary angiography–thromboembolic risk factors and implications for appropriate use. Radiology. 2012;262(1):242–51.

    Article  PubMed  Google Scholar 

  37. Selbst SM. Approach to the child with chest pain. Pediatr Clin North Am. 2010;57(6):1221–34.

    Article  PubMed  Google Scholar 

  38. Bhatia MS, Sapra S. Psuedoseizures in children: a profile of 50 cases. Clin Pediatr (Phila). 2005;44(7):617–21.

    Article  Google Scholar 

  39. Shellhaas RA, Smith SE, O’Tool E, Licht DJ, Ichord RN. Mimics of childhood stroke: characteristics of a prospective cohort. Pediatrics. 2006;118(2):704–9.

    Article  PubMed  Google Scholar 

  40. Wainwright MS. Pediatric neurological assessment and monitoring. In: Fuhrman BP, Zimmerman JJ, Carcillo JA, Clark RS, Rotta AT, Tobias JD, Relvas MS, Thompson AE, editors. Pediatric critical care. Philadelphia, PA: Elsevier; 2011. p. 746–58.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, SUNY Upstate Medical University, Upstate Golisano Children’s Hospital, 750 E. Adams Street, Syracuse, NY, 13210, USA

    Robert K. Kanter MD & Regina J. Lozito-Yorton BS, MSEd, CCLS

Authors
  1. Robert K. Kanter MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Regina J. Lozito-Yorton BS, MSEd, CCLS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert K. Kanter MD .

Editor information

Editors and Affiliations

  1. Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA

    Ran D. Anbar

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

13-year-old requiring mechanical ventilation and chest physiotherapy (WMV 81127 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kanter, R.K., Lozito-Yorton, R.J. (2014). Functional Symptoms in Intensive Care: The Vicious Circle of Anxiety and Symptoms. In: Anbar, R. (eds) Functional Symptoms in Pediatric Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4899-8074-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-8074-8_16

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4899-8073-1

  • Online ISBN: 978-1-4899-8074-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation