Statens beredning för medicinsk och social utvärdering
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.
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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
| 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 |
| 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 |
| /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 |
| 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 |
| 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 |
| 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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