A Conceptual Model of Psychosomatic Illness in Children

Minuchin, Salvador

doi:10.1001/archpsyc.1975.01760260095008

Cited by 799 publications

(445 citation statements)

References 20 publications

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“…For instance, an additional child requires a changed family structure in which every member has to adapt and yet still retain his or her own individuality. In the authors' studies the solutionbased-brief therapy (40)(41)(42)(43) has been used in combination with proposals for the treatment of psychosomatic families (44)(45)(46) . This method, termed structural family therapy, simply attempts to re-establish a workable family structure by 'getting the family back on track'.…”

Section: The Impact Of the Familymentioning

confidence: 99%

“…The therapist uses the structural model (44)(45)(46) as a frame perspective within which the solution-based model (40)(41)(42)(43) exerts its influence. Usually, the situations that the families want to discuss are those in which the child or parents experience difficulty in following the prescribed diet or recommended exercise, not the recommendations per se.…”

Section: The Strategy In Therapymentioning

confidence: 99%

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Childhood obesity: from nutrition to behaviour

Flodmark

Ohlsson

2008

Proc. Nutr. Soc.

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Obesity in children is difficult to treat, but it seems to be easier to treat than adult obesity. The first step in treatment is to identify effective advice relating to nutrition and physical activity. In most treatment studies the macronutrient composition of the diet is not of major importance for treatment outcome. In relation to physical activity fat-utilisation strategies have been described. The second step includes appropriate approaches to lifestyle change. In Europe there are no drugs approved for children, and surgery for children is still limited to research projects. Thus, the major challenge is to develop effective ways of changing lifestyle. Family therapy may be an effective approach in preventing severe obesity from developing during puberty, and a therapeutic strategy based on treatment studies is described. The family-therapy techniques used here are intended to facilitate the family's own attempts to modify their lifestyle, and to increase their own sense of responsibility and readiness to change, i.e. these variables are the prime targets during therapy. Thus, the family, not the therapist, assumes responsibility for the changes achieved. This approach may be helpful in making the therapeutic process less cumbersome for the therapist. Instead of the therapist attempting to persuade the obese subjects to lose weight, it might be more effective to teach them to control their eating patterns through their own efforts. The treatment model includes structural family therapy and solutionfocused-brief therapy. The use of such a model makes it possible to train therapists and health professionals to use an evidence-based intervention model. Family therapy: Childhood obesity: Systemic family medicineTreating obesity in children, although difficult, seems to be easier than treating adult obesity (1)(2)(3) . The first step is to identify effective advice on nutrition and physical activity.In relation to nutrition, several studies have investigated an epidemiological association between BMI and food habits, but the results have been inconclusive, as pointed out in a recent review (4) . From the epidemiological perspective, the cross-sectional Bogalusa Study, which has investigated 1562 children aged 10 years over a 21-year period, has found that the consumption of sweetened beverages, sweets and meat and the total consumption of low-quality foods are positively associated with overweight status (5) . Furthermore, the total amount of food consumed, specifically from snacks, is positively associated with overweight status. However, the percentage variance explained from the eating pattern-overweight models is very small. In relation to treatment, a meta-analysis has shown that low-carbohydrate non-energy-restricted diets in adults appear to be at least as effective as low-fat energyrestricted diets in inducing weight loss for £ 1 year (6) . However, in a recent study of forty-one 8-12-year-old obese children who were randomly assigned to a 24-month family-based behavioural treatment the macronutrient cont...

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Section: The Impact Of the Familymentioning

confidence: 99%

Section: The Strategy In Therapymentioning

confidence: 99%

Childhood obesity: from nutrition to behaviour

Flodmark

Ohlsson

2008

Proc. Nutr. Soc.

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“…The goal was to ascertain how the transplantee perceived his family to function and what might be his relationship to it. 12 Of dimensions that describe family function, two span the extremes of enmeshment to disengagement and rigidity to chaos; [13][14][15][16][17] an 'ideal' balance would be where consistency and respect for individual autonomy include sufficient flexibility to allow timely adjustment of roles, interactions and boundaries. In sum, the interview aimed to assess these life-long attributes to answer the question, 'To whom does the transplant belong?…”

Section: Psychiatric Assessmentmentioning

confidence: 99%

Psychological risk factors and early complications after bone marrow transplantation in adults

Szkrumelak

1999

Bone Marrow Transplant

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Summary:Complications of bone marrow transplantation can compromise its effectiveness, and often it is not possible to predict who is at greatest risk. In a previous study we reported that certain psychological factors correlated with a high incidence of post-transplant mortality, and here we analyze the associated complications and causes of death. Prior to receiving high-dose chemotherapy and bone marrow transplantation, 112 patients underwent a psychodynamically oriented psychiatric assessment (the 'FIT' assessment). Mortality and associated complications were ascertained by a retrospective chart review. The results of the 'FIT' assessment correlated with the incidence of complications and death, whether or not the transplant was performed for hematologic or solid organ cancers, or was from an allogeneic or autologous source. Most individuals with a high risk profile died of progressive major organ dysfunction or recurrent/refractory neoplastic disease in the first year after transplant. We propose that such a psychiatric assessment might identify a subgroup of individuals in whom pre-emptive therapeutic interventions could be most effective. Keywords: bone marrow transplantation; multiorgan failure; personality assessment; risk assessment; leukemia/lymphoma; cancer of breast and ovary Bone marrow transplantation can reverse the myelotoxicity of high-dose radiation and chemotherapy used in many current strategies to treat cancer. However, sepsis and hemorrhage before engraftment, acute and chronic graftversus-host disease, graft rejection, and late organ dysfunction still limit its effectiveness. 1 Thus, an understanding of predisposing factors that place an individual at risk for such difficulties might enable better control and prevention, and ultimately improve survival.Early in the development of clinical bone marrow transplantation, psychiatrists had recognized that family interactions, coping style, and meaning of the transplant had a profound impact on the individual, 2-5 but not until 1988

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“…Herzog (58) and Minuchin and associates (59,60) review studies of families in which food issues can contribute to such psychosomatic problems as obesity, anorexia nervosa, and bulimia. Newbrough et al (61) present a similar schema for understanding factors in the management and control of childhood diabetes.…”

Section: Dietary Protein Recent Studies Document Renal Failurementioning

confidence: 99%

Pediatric, Adolescent, and Young-Adult Nutrition Issues in IDDM

Brink

1988

Diabetes Care

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Although insulin is life sustaining for patients with insulin-dependent diabetes mellitus (IDDM), the meal plan is of critical importance for avoiding hyperglycemia, preventing hypoglycemia, and maintaining metabolic balance. Consistency, timing, composition, and caloric content of food intake and physical activity, age, sex, growth, and pubertal status alter meal-plan needs. Self-monitoring of blood glucose should be used to individualize the meal plan. The general American Diabetes Association recommendations suggest that 50-65% of total calories be from carbohydrates from foods with a lower glycemic index and/or high fiber content. Protein should contribute 12-20% of total calories and fat <30%, with <10% saturated fat and <300 mg/day cholesterol. More severe fat restriction should be considered in individuals with persistent lipid abnormalities when compared with sex-and ageadjusted values. Calories should be sufficient for growth and development, with growth data obtained several times a year and plotted on standardized weight, height, and velocity charts. Blood pressure should be similarly plotted on age-and sex-standardized curves. All meal plans should be individualized, but certain circumstances require special attention in IDDM patients: 1) lack of minerals or vitamins in a youngster who is a picky eater; 2) eating disorders (i.e., obesity, bulimia, anorexia nervosa); 3) specific gastrointestinal diseases (i.e., Crohn's disease, celiac disease, giardiasis, or IgA deficiency); 4) low iron stores because of associated achlorhydria and positive gastroparietal antibodies; 5) alternative sweeteners, especially in pregnant women and very young children; 6) mineral balance changes that may occur with increased soluble fiber intake and episodes of hyperglycemia with or without ketosis/ketoacidosis; 7) changes in physical

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A Conceptual Model of Psychosomatic Illness in Children

Cited by 799 publications

References 20 publications

Childhood obesity: from nutrition to behaviour

Childhood obesity: from nutrition to behaviour

Psychological risk factors and early complications after bone marrow transplantation in adults

Pediatric, Adolescent, and Young-Adult Nutrition Issues in IDDM

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