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Pervasive refusal syndrome and Nauru till sidans topp

Professor David Isaacs

Fatima was a happy child who loved school and was a top student. She was 11?years old when she took to her bed, stopped eating and drinking, covered her head with the sheet, stopped washing and started wetting the bed. For months, she would not or could not get out of bed and had to be carried to the toilet. She would not speak to her parents or friends. After over 5 years on Nauru, almost half her life, she had lost control of her destiny, had lost all hope and had lost the will to live. When she was transferred to Australia with her mother, she needed nasogastric tube feeding for a week to maintain hydration and needed a walking aid for 2 months to move around. She gradually began to eat, drink, wash and toilet herself and to socialise. She remained a hospital inpatient for 2 months and is expected to need several more months of intensive outpatient treatment.

Pervasive refusal syndrome is a rare psychiatric condition mainly affecting children aged 7-15 years old, girls three times as often as boys, although the youngest child described is 4 years old. The term pervasive refusal was first used by a British child psychiatrist Bryan Lask and his colleagues to describe four girls aged between 9 and 15 with profound and pervasive refusal to eat, drink, walk, talk or care for themselves over a period of several months. Sydney clinicians who also saw cases proposed now widely accepted diagnostic criteria (Table 1). The condition shares features with but differs from other psychiatric conditions, including depression, anxiety, catatonia, selective mutism and chronic fatigue (Fig. 1). Pervasive refusal syndrome is different from anorexia nervosa, where children are delusional about their weight, but both conditions are potentially life?threatening. Death can result from metabolic derangement due to chronic malnutrition and due to re?feeding syndrome. Re?feeding syndrome was first described in prisoners of war after World War I. Potentially fatal shifts in fluids and electrolytes can cause encephalopathy and cardiac arrest.


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