LONDON – Close links exist between physical and mental health, yet the two are often treated separately, according to an expert in child and adolescent mental health.
"We know that physical and mental health are inextricably linked," said Dr. Elena Garralda, professor of child and adolescent psychiatry at Imperial College London. However, speaking Dec. 3 at the Excellence in Paediatrics annual meeting, she noted that pediatric services had become very disjointed over the years, with children seen by different specialists depending on their physical and mental health problems.
Psychiatric disorders can have an adverse effect on physical health, and they can also be a manifestation of physical disorders, Dr. Garralda explained, so it is important that the two be considered together rather than in isolation.
"Until very recently, the links between physical and mental health tended to focus on disorders such as epilepsy and the brain, because as we all know the brain is the basis of emotions and behavior," Dr. Garralda said. Over the past 10 years, however, there has been increasing realization that psychiatric morbidity may be a manifestation of physical illness, and in turn, that psychiatric disorders can have an adverse impact on physical health.
Children with attention-deficit/hyperactivity disorder (ADHD), for example, tend to be more prone than those without the disorder to have accidents, including road traffic incidents. Depression is linked to deliberate self-harm, and anorexia with increased mortality. All of these conditions and their consequences can affect adherence with prescribed treatment.
It can be difficult to tease out the relative contribution of physical and psychiatric factors and to decide which needs to be treated first, but it is clear that physical and psychological problems need to be addressed jointly. Indeed, clinical psychiatrists and pediatricians need to work together – ideally within the same clinical unit.
"There is very high psychiatric comorbidity among children attending pediatric clinics," Dr. Garralda observed. Psychiatric disorders are particularly increased in children with unexplained medical symptoms, chronic physical illnesses, and acute, life-threatening illnesses.
Unexplained medical symptoms may include recurrent abdominal pains, which have been linked to anxiety and depression in primary care (Pediatrics 2004;113:817-24). Treatment of these underlying psychological problems may therefore resolve the physical symptoms to a greater extent that addressing the physical signs directly.
Risk factors for unexplained medical symptoms and emotional disorders might be shared, and include intrinsic or environmental influences. Intrinsic influences are personality features and sensitivity to stress, whereas environmental influences include parental responses to illness, and life’s stresses in general.
More dialogue is needed between psychiatric and pediatric care, Dr. Garralda said.
Dr. Garralda had no conflicts of interest.