Resignation syndrome

The diagnosis resignation syndrome (in Swedish: uppgivenhetssyndrom), since 1991 called e.g. pervasive refusal syndrome in the scientific literature, has been used to describe children suffering from symptoms such as an inability to eat, drink, walk, talk or care for themselves. In 2014 the diagnosis was included in the Swedish version of the International Classification of Diseases and related health problems (ICD-10 F32.3.A).

Question

What scientific studies have been published on resignation syndrome, regarding diagnosis and treatment?

Identified literature

Eight descriptive primary studies were identified [1-8] as well as a proposal for diagnostic critera [9]. However, no relevant systematic reviews, or primary studies regarding the diagnostic reliability or efficacity of treatment, met our inclusion criteria.

References

  1. Aronsson B, Wiberg C, Sandstedt P, Hjern A. Asylum-seeking children with severe loss of activities of daily living: clinical signs and course during rehabilitation. Acta Paediatrica 2009;98:1977-1981.
  2. Bodegard G. Pervasive loss of function in asylum-seeking children in Sweden. Acta Paediatr 2005;94:1706-7.
  3. Bodegård G. Life-threatening loss of function in refugee children: another expression of pervasive refusal syndrome? Clinical Child Psychology & Psychiatry 2005;10:337-350.
  4. Forslund CM, Johansson BA. Pervasive refusal syndrome among inpatient asylum-seeking children and adolescents: a follow-up study. Eur Child Adolesc Psychiatry 2013;22:251-8.
  5. Lask B, Britten C, Kroll L, Magagna J, Tranter M. Children with pervasive refusal. Archives of Disease in Childhood 1991;66:866–869.
  6. Sondergaard HP, Kushnir MM, Aronsson B, Sandstedt P, Bergquist J. Patterns of endogenous steroids in apathetic refugee children are compatible with long-term stress. BMC Res Notes 2012;5:186.
  7. Thompson SL, Nunn KP. The pervasive refusal syndrome: the RAHC experience. Clinical Child Psychology & Psychiatry 1997;2:145-65.
  8. von Knorring AL, Hultcrantz E. Asylum-seeking children with resignation syndrome: catatonia or traumatic withdrawal syndrome? Eur Child Adolesc Psychiatry 2019.
  9. Jaspers T, Hanssen GMJ, Van der Valk JA, Hanekom JH, Van Well GT, Schievald JNM. Pervasive refusal syndrome as part of the refusal-withdrawal regression spectrum: critical review ofd the literature illustrated by a case report. Eur Child Adolesc Psychiatry 2009;18:645-651.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 1/31/2020
Contact SBU: registrator@sbu.se
Report no: ut202003
Registration no: SBU 2019/664

Literature search

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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