Diagnostik och behandling av uppgivenhetssyndrom hos barn

I Sverige beskrevs symtom på uppgivenhet bland barn redan på 1950-talet och under 2000-talets början ökade rapporterna om allvarliga uppgivenhetssymtom hos asylsökande barn. Socialstyrelsen har publicerat en vägledning om uppgivenhetssyndrom för personal inom socialtjänst och hälso- och sjukvård, men det finns en osäkerhet kring hur tillståndet bäst diagnostiseras och behandlas.

Lästid: ca 13 min Publicerad: Publikationstyp:

SBU:s upplysningstjänst

Strukturerad litteratur­sökning som besvarar fråga från vården eller social­tjänsten om vilka relevanta översikter och studier som finns. Vi bedömer risken för bias i systematiska översikter och vid behov även kvalitet och över­förbarhet av resultaten i hälso­ekonomiska studier. Svaret utformas av medarbetare på SBU, vid behov med stöd av ämnessakkunnig.

Kontakta SBU
Publicerad: Rapportnr: ut202003 Diarienr: SBU 2019/664 https://www.sbu.se/ut202003

Sökord

Apatiska barn Apatiska flyktingbarn

Fråga till SBU:s upplysningstjänst

Vilka vetenskapliga studier finns om diagnostik och behandling av uppgivenhetssyndrom hos barn?

Frågeställare: Enhetschef, Socialstyrelsen

Sammanfattning SBU:s upplysningstjänst

På SBU:s upplysningstjänst identifierar och redovisar vi sammanställd forskning (systematiska översikter) eller identifierar vetenskapliga studier som svar på en avgränsad fråga. Vi bedömer risken för bias (överskattning eller underskattning av resultat) i systematiska översikter och presenterar författarnas slutsatser från systematiska översikter med låg eller måttlig risk för bias. I vetenskapliga primärstudier bedömer vi inte risken för bias och därför presenteras de bara som referenser. Vid behov bedömer vi kvalitet avseende ekonomiska aspekter och överförbarhet av resultat i hälsoekonomiska studier och presenterar författarnas slutsatser från de studier som bedöms ha tillräcklig kvalitet. I svaren väger vi inte samman resultaten eller bedömer graden av vetenskaplig tillförlitlighet.

SBU:s upplysningstjänst har efter litteratursökning varken identifierat någon relevant systematisk översikt eller någon relevant primärstudie om tillförlitligheten vid diagnostik eller effekter av behandling vid uppgivenhetssyndrom. Klinisk forskning om diagnostik och effekter av behandling är därför önskvärd.

Projektgrupp och externa granskare

Detta svar är sammanställt av Elizabeth Åhsberg (projektledare), Laura Lintamo (utredare), Sara Fundell (projektadministratör) samt Miriam Entesarian Matsson (produktsamordnare) vid SBU.

Svaret är granskat av Anne-Liis von Knorring, professor emerita vid Uppsala universitet och Hugo Lagercrantz, professor emeritus vid Karolinska institutet.

Litteratursökning

PubMed via NLM 2019-11-15
Diagnostics and treatment of pervasive refusal syndrome among refugee children and adolescents
The search result, usually found at the end of the documentation, forms the list of abstracts.; [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation
Search terms Items found
Population:
1. resignation[Title/Abstract] OR “traumatic withdrawal”[Title/Abstract] OR withdrawal[Title/Abstract] OR refusal[Title/Abstract] OR “refusal withdrawal regression”[Title/Abstract] OR “pervasive refusal”[Title/Abstract] OR “pervasive arousal withdrawal”[Title/Abstract] 98 921
2. syndrome*[Title/Abstract] 954 580
3. 1 AND 2 9 856
4. “refusal withdrawal regression spectrum”[Title/Abstract] OR “pervasive refusal”[Title/Abstract] OR “stuporous condition”[Title/Abstract] OR “stuporous conditions”[Title/Abstract] OR "Stupor"[Mesh] OR “pervasive loss of function”[Title/Abstract] OR “pervasive loss of functions”[Title/Abstract] OR catatoni*[Title/Abstract] OR "Catatonia"[Mesh] OR apath*[Title/Abstract] OR "Apathy"[Mesh] OR “loss of ADL”[Title/Abstract] OR “loss of activities of daily living”[Title/Abstract] OR “flaccid paralysis”[Title/Abstract] OR “flaccid paralysation”[Title/Abstract] OR “flaccid paralyzation”[Title/Abstract] OR malinger*[Title/Abstract] OR "Malingering"[Mesh] OR ”culture-bound”[Title/Abstract] OR somatisation[Title/Abstract] OR somatization[Title/Abstract] OR somatic[Title/Abstract] OR "Somatoform Disorders"[Mesh] OR Jaspers*[Title/Abstract] OR Bodegård*[Title/Abstract] OR Münchhausen*[Title/Abstract] OR Munchhausen*[Title/Abstract] OR Münchausen*[Title/Abstract] OR Munchausen*[Title/Abstract] OR "Munchausen Syndrome"[Mesh] 143 696
5. 3 OR 4 153 136
6. child*[Title/Abstract] OR “Child"[Mesh] OR adolescent*[Title/Abstract] OR “Adolescent"[Mesh] 3 384 826
7. refugee*[Title/Abstract] OR “Refugees"[Mesh] OR asylum*[Title/Abstract] OR migration[Title/Abstract] OR immigra*[Title/Abstract] 283 794
8. 6 AND 7 26 874
Final 5 AND 8 362

 

Cochrane Library via Wiley 2019-11-15
Diagnostics and treatment of pervasive refusal syndrome among refugee children and adolescents
The search result, usually found at the end of the documentation, forms the list of abstracts.; au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. resignation OR “traumatic withdrawal” OR withdrawal OR refusal OR “refusal withdrawal regression” OR “pervasive refusal” OR “pervasive arousal withdrawal”:ti,ab,kw 37 668
2. syndrome:ti,ab,kw 80 498
3. 1 AND 2 6 715
4. MeSH descriptor: [Stupor] explode all trees 1
5. “stuporous condition” OR “stuporous conditions”:ti,ab,kw 0
6. 4 OR 5 1
7. MeSH descriptor: [Catatonia] explode all trees 18
8. catatoni*:ti,ab,kw 143
9. 7 OR 8 143
10. MeSH descriptor: [Apathy] explode all trees 64
11. apath*:ti,ab,kw 826
12. 10 OR 11 826
13. MeSH descriptor: [Malingering] explode all trees 80
14. malinger*:ti,ab,kw 136
15. 13 OR 14 136
16. MeSH descriptor: [Somatoform Disorders] explode all trees 637
17. somatisation OR somatization OR somatic:ti,ab,kw 4 303
18. 16 OR 17 4 750
19. MeSH descriptor: [Munchausen Syndrome] explode all trees 2
20. Münchhausen* OR Munchhausen*OR Münchausen* OR Munchausen*:ti,ab,kw 3
21. 19 OR 20 3
22. 3 OR 6 OR 9 OR 12 OR 15 OR 18 OR 21 12 422
23. “refusal withdrawal regression spectrum” OR “pervasive refusal” OR “pervasive loss of function” OR “pervasive loss of functions” OR “loss of ADL” OR “loss of activities of daily living” OR “flaccid paralysis” OR “flaccid paralysation” OR “flaccid paralyzation” OR culture-bound OR Jaspers* OR Bodegård*:ti,ab,kw 165
24. 22 OR 23 12 583
25. MeSH descriptor: [Child] explode all trees 1 203
26. child*:ti,ab,kw 146 667
27. MeSH descriptor: [Adolescent] explode all trees 101 404
28. adolescent*:ti,ab,kw 131 188
29. teen*:ti,ab,kw 672
30. 25 OR 26 OR 27 OR 28 OR 29 231 821
31. MeSH descriptor: [Refugees] explode all trees 101
32. refugee* OR asylum*:ti,ab,kw 4698
33. 31 OR 32 4698
34. 30 AND 33 876
Final 24 AND 34
Cochrane Reviews: 5
Cochrane Protocols: 0
Trials: 7
Editorials: 0
Special Collections: 0
Clinical Answers: 0		 12

 

Embase via embase.com 2019-11-15
Diagnostics and treatment of pervasive refusal syndrome among refugee children and adolescents
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ti,ab,kw = Title or abstract or keyword; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. resignation OR 'traumatic withdrawal' OR withdrawal OR refusal OR 'refusal withdrawal regression' OR 'pervasive refusal' OR 'pervasive arousal withdrawal':ti,ab,kw 346 933
2. syndrome:ti,ab,kw 1 220 536
3. #1 AND #2 32 184
4. 'stupor'/exp 2 555
5. 'stuporous condition' OR 'stuporous conditions':ti,ab,kw 9
6. #3 OR #4 2 561
7. 'catatonia'/exp 4 993
8. catatoni*:ti,ab,kw 4 464
9. #7 OR #8 6 024
10. 'apathy'/exp 8 852
11. apath*:ti,ab,kw 9 709
12. #10 OR #11 12 569
13. 'malingering'/exp 3 352
14. malinger*:ti,ab,kw 2 642
15. #13 OR #14 4 085
16. 'somatoform disorder'/exp 25 933
17. somatisation OR somatization OR somatic:ti,ab,kw 150 902
18. #16 OR #17 166 811
19. 'munchausen syndrome'/exp OR 'munchausen syndrome by proxy'/exp 2 271
20. münchhausen* OR munchhausen* OR münchausen* OR munchausen*:ti,ab,kw 2 743
21. #19 OR #20 2 743
22. #6 OR #9 OR #12 OR #15 OR #18 OR #21 193 045
23. 'refusal withdrawal regression spectrum' OR 'pervasive refusal' OR 'pervasive loss of function' OR 'pervasive loss of functions' OR 'loss of adl' OR 'loss of activities of daily living' OR 'flaccid paralysis' OR 'flaccid paralysation' OR 'flaccid paralyzation' OR 'culture bound' OR jaspers* OR bodegård*:ti,ab,kw 7 520
24. #3 OR #22 OR #23 231 443
25. 'child'/exp OR 'adolescent'/exp 3 592 889
26. child* OR adolescent* OR teen*:ti,ab,kw 4 117 705
27. #25 OR #26 4 579 194
28. 'refugee'/exp OR 'asylum'/exp OR 'asylum seeker'/exp OR 'immigration'/exp OR 'immigrants'/exp 19 302
29. refugee* OR asylum* OR migration OR immigra*:ti,ab,kw 444 130
30. #28 OR #29 445 643
31. #27 AND #30 50 019
Combined sets:
32. #24 AND #31 567
Limits:
  [embase]/lim  
Final #32 AND [embase]/lim 449

 

CINAHL with Full Text via ebsco.com 2019-11-15
Diagnostics and treatment of pervasive refusal syndrome among refugee children and adolescents
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TI ( resignation OR 'traumatic withdrawal' OR withdrawal OR refusal OR 'refusal withdrawal regression' OR 'pervasive refusal' OR 'pervasive arousal withdrawal' ) OR AB ( resignation OR 'traumatic withdrawal' OR withdrawal OR refusal OR 'refusal withdrawal regression' OR 'pervasive refusal' OR 'pervasive arousal withdrawal' ) 20 041
2. TI syndrome OR AB syndrome 159 906
3. 1 AND 2 1 756
4. (MH "Catatonia") OR (MH "Apathy") OR (MH "Malingering") OR (MH "Somatoform Disorders+") OR (MH "Munchausen Syndrome+") OR (MH "Munchausen Syndrome By Proxy") 5 805
5. TI ( stupor OR 'stuporous condition' OR 'stuporous conditions' OR catatoni* OR apath* OR malinger* OR somatisation OR somatization OR somatic OR münchhausen* OR munchhausen* OR münchausen* OR munchausen* ) OR AB ( stupor OR 'stuporous condition' OR 'stuporous conditions' OR catatoni* OR apath* OR malinger* OR somatisation OR somatization OR somatic OR münchhausen* OR munchhausen* OR münchausen* OR munchausen* ) 14 460
6. TI ( 'refusal withdrawal regression spectrum' OR 'pervasive refusal' OR 'pervasive loss of function' OR 'pervasive loss of functions' OR 'loss of adl' OR 'loss of activities of daily living' OR 'flaccid paralysis' OR 'flaccid paralysation' OR 'flaccid paralyzation' OR 'culture bound' OR jaspers* OR bodegård* ) OR AB ( 'refusal withdrawal regression spectrum' OR 'pervasive refusal' OR 'pervasive loss of function' OR 'pervasive loss of functions' OR 'loss of adl' OR 'loss of activities of daily living' OR 'flaccid paralysis' OR 'flaccid paralysation' OR 'flaccid paralyzation' OR 'culture bound' OR jaspers* OR bodegård* ) 1 008
7. 3 OR 4 OR 5 OR 6 20 440
8. (MH "Child") OR (MH "Adolescence") 692 532
9. TI ( child* OR adolescen* OR teen* ) OR AB ( child* OR adolescent* OR teen* ) 499 102
10. 8 OR 9 880 807
11. (MH "Immigrants+") OR (MH "Refugees") 19 464
12. TI ( refugee* OR asylum* OR migration OR immigra* ) OR AB ( refugee* OR asylum* OR migration OR immigra* ) 35 898
13. 11 OR 12 42 516
14. 10 AND 13 10 235
Final 7 AND 14 93

 

PsycINFO via ebsco.com 2019-11-15
Diagnostics and treatment of pervasive refusal syndrome among refugee children and adolescents
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TX resignation OR 'traumatic withdrawal' OR withdrawal OR refusal OR 'refusal withdrawal regression' OR 'pervasive refusal' OR 'pervasive arousal withdrawal' 45 812
2. TX syndrome 145 771
3. 1 AND 2 11 097
4. ((((DE "Catatonia") OR (DE "Apathy")) OR (DE "Malingering")) OR (DE "Somatoform Disorders")) OR(DE "Munchausen Syndrome" OR DE "Munchausen Syndrome by Proxy") 17 658
5. TX stupor OR 'stuporous condition' OR 'stuporous conditions' OR catatoni* OR apath* OR malinger* OR somatisation OR somatization OR somatic OR münchhausen* OR munchhausen* OR münchausen* OR munchausen* 47 295
6. TX 'refusal withdrawal regression spectrum' OR 'pervasive refusal' OR 'pervasive loss of function' OR 'pervasive loss of functions' OR 'loss of adl' OR 'loss of activities of daily living' OR 'flaccid paralysis' OR 'flaccid paralysation' OR 'flaccid paralyzation' OR 'culture bound' OR jaspers* OR bodegård* 2 345
7. 3 OR 4 OR 5 OR 6 67 124
8. TX child* OR adolescen* OR teen* 1 274 237
9. (DE "Refugees") OR (DE "Asylum Seeking") OR (DE "Immigration") 26 643
10. TX refugee* OR asylum* OR migration OR immigra* 75 755
11. 9 OR 10 75 755
12. 8 AND 11 24 430
Final 7 AND 12 446

 

SocINDEX with Full Text via ebsco.com 2019-11-15
Diagnostics and treatment of pervasive refusal syndrome among refugee children and adolescents
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TI ( resignation OR 'traumatic withdrawal' OR withdrawal OR refusal OR 'refusal withdrawal regression' OR 'pervasive refusal' OR 'pervasive arousal withdrawal' ) OR AB ( resignation OR 'traumatic withdrawal' OR withdrawal OR refusal OR 'refusal withdrawal regression' OR 'pervasive refusal' OR 'pervasive arousal withdrawal' ) 13 801
2. TI syndrome OR AB syndrome 10 394
3. 1 AND 2 399
4. TI ( stupor OR 'stuporous condition' OR 'stuporous conditions' OR catatoni* OR apath* OR malinger* OR somatisation OR somatization OR somatic OR münchhausen* OR munchhausen* OR münchausen* OR munchausen* ) OR AB ( stupor OR 'stuporous condition' OR 'stuporous conditions' OR catatoni* OR apath* OR malinger* OR somatisation OR somatization OR somatic OR münchhausen* OR munchhausen* OR münchausen* OR munchausen* ) 3 875
5. TI ( 'refusal withdrawal regression spectrum' OR 'pervasive refusal' OR 'pervasive loss of function' OR 'pervasive loss of functions' OR 'loss of adl' OR 'loss of activities of daily living' OR 'flaccid paralysis' OR 'flaccid paralysation' OR 'flaccid paralyzation' OR 'culture bound' OR jaspers* OR bodegård* ) OR AB ( 'refusal withdrawal regression spectrum' OR 'pervasive refusal' OR 'pervasive loss of function' OR 'pervasive loss of functions' OR 'loss of adl' OR 'loss of activities of daily living' OR 'flaccid paralysis' OR 'flaccid paralysation' OR 'flaccid paralyzation' OR 'culture bound' OR jaspers* OR bodegård* ) 440
6. 3 OR 4 OR 5 4 697
7. TI ( child* OR adolescen* OR teen* ) OR AB ( child* OR adolescen* OR teen* ) 277 357
8. ((((((DE "REFUGEE children") OR (DE "HEALTH of refugees")) OR (DE "REFUGEES")) OR (DE "RIGHT of asylum")) OR (DE "POLITICAL refugees")) OR (DE “IMMIGRANTS")) OR (DE “IMMIGRANT children") 16 467
9. TI (refugee* OR asylum* OR migration OR immigra*) OR AB (refugee* OR asylum* OR migration OR immigra*) 74 461
10. 8 OR 9 78 129
11. 7 AND 10 9 234
Final 6 AND 11 36

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