Pervasive refusal syndrome revisited: a conative disorder

Pervasive Refusal Syndrome (PRS) is a rare child psychiatric condition. We describe a case of PRS in a 9-year-old boy with a diagnosis of Autism Spectrum Disorder (ASD) presenting with severe weight loss due to extreme restriction of food and fluids. Other prominent symptoms included total mutism, school refusal, and self-neglect. He was admitted to a specialist Child and Adolescent Mental Health Unit. We discuss the symptoms present in this case and the differential diagnosis of ASD in PRS. Although this differential has briefly been considered one in previous case, there have been no reported cases of PRS with a prior diagnosis of ASD. We explore comorbidity and interaction of the two diagnoses. We discuss the possible impact of ASD as a predisposing factor upon the progression and prognosis of PRS.

Download Full-text

Pervasive refusal syndrome in asylum-seeking children: Review of the current evidence

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104519846580 ◽

2019 ◽

Vol 25 (1) ◽

pp. 227-241 ◽

Cited By ~ 2

Author(s):

Thinh Ngo ◽

Matthew Hodes

Keyword(s):

Asylum Seekers ◽

Mental Health Disorder ◽

Current Evidence ◽

Post Traumatic Stress ◽

Moderating Factors ◽

Pervasive Refusal Syndrome ◽

Third Stage ◽

Foreign Policies ◽

Threatening Condition ◽

Life Threatening

This study reviews the current evidence in pervasive refusal syndrome (PRS) in asylum-seeking children. Refugees can experience a variety of traumas throughout the process of migration. Children can be exposed to multiple traumas such as experienced or witnessed physical or sexual violence, loss and bereavement, parental separation and the threat of persecution and/or kidnapping. The third stage of the migration journey can add further stress; children and families may experience multiple rejections of asylum application effectively living in limbo with the constant threat of deportation. High rates of mental health disorder are well documented in young asylum seekers, particularly depression, anxiety and post-traumatic stress disorder (PTSD). PRS is less frequently described but nonetheless a severe and life-threatening condition affecting young asylum seekers. Traumatisation, cultural factors and hostile asylum processes are specific moderating factors seen in asylum-seeking children. Asylum-seeking children normally make a full recovery from PRS. This study suggests a link between prolonged asylum processes and hostile foreign policy in developing and maintaining illness; similar cases are now being reported in other countries with hostile foreign policies. These findings are therefore relevant to clinicians and politicians working with this vulnerable group.

Download Full-text

Pervasive refusal syndrome

Advances in Psychiatric Treatment ◽

10.1192/apt.10.2.153 ◽

2004 ◽

Vol 10 (2) ◽

pp. 153-159 ◽

Cited By ~ 35

Author(s):

Bryan Lask

Keyword(s):

Age Groups ◽

Self Care ◽

Well Being ◽

Treatment Needs ◽

Resistance To Treatment ◽

Younger Age ◽

Pervasive Refusal Syndrome ◽

Life Threatening

Pervasive refusal syndrome is a severe, pervasive and life-threatening disorder. Most commonly seen in girls between the ages of 8 and 15, although also affecting boys and younger age groups, it is characterised by a profound and pervasive refusal to eat, drink, talk, walk and engage in any form of self-care. A determined resistance to treatment is a striking component of the condition. The causes are unclear, but likely to be complex, multiple and associated with a sense of hopelessness. Treatment needs to be comprehensive and is based on supporting the child in recovering at her own pace, while ensuring physical safety and well-being. The prognosis is good, provided treatment is appropriate, but recovery tends to take a year or more.

Download Full-text

Giving up on everything: a case and review of pervasive refusal syndrome

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v88i1.6238 ◽

2020 ◽

pp. 57-59

Author(s):

Jordan Ho ◽

Brynn Charron

Keyword(s):

Female Patient ◽

Self Care ◽

Therapeutic Options ◽

Clinical Knowledge ◽

Current State ◽

Pervasive Refusal Syndrome

We present a case of pervasive refusal syndrome (PRS), in which a 11-year-old female patient refused to eat, drink, interact, or self-care in any way. The patient was kept on IV nutrition and multiple therapeutic options were tried to no effect. After 18 months, the patient spontaneously recovered with no lasting harm, and her symptoms did not recur. We further discuss the current state of clinical knowledge on PRS, as well as the form that has appeared amongst children in asylum-seeking families in Sweden.

Download Full-text

Pervasive refusal syndrome in child asylum seekers on Nauru

Australasian Psychiatry ◽

10.1177/1039856220956251 ◽

2020 ◽

Vol 28 (5) ◽

pp. 585-588

Author(s):

Louise Newman ◽

Beth O’Connor ◽

Vernon Reynolds ◽

George Newhouse

Keyword(s):

Asylum Seekers ◽

Patient Advocacy ◽

Social Needs ◽

Legal Obligations ◽

Pervasive Refusal Syndrome ◽

Life Threatening

Objectives: Between 2013 and 2019, an estimated 200 children seeking asylum in Australia were detained on the island of Nauru. In 2018, 15 of these children developed the rare and life-threatening pervasive refusal syndrome (PRS). This paper describes the PRS case cluster, the complexities faced by clinicians managing these cases, and the lessons that can be learned from this outbreak. Conclusions: The emergence of PRS on Nauru highlighted the risks of long-term detention of children in settings that are unable to meet their physical and psycho-social needs. The case cluster also underscored (a) the difficulties faced by doctors working in conditions where their medical and legal obligations may be in direct conflict, and (b) the role of clinicians in patient advocacy.

Download Full-text

Pervasive Refusal Syndrome

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000128 ◽

2011 ◽

Vol 39 (5) ◽

pp. 351-359 ◽

Cited By ~ 6

Author(s):

Thomas Jans ◽

Juliane Ball ◽

Maike Preiss ◽

Michael Haberhausen ◽

Andreas Warnke ◽

...

Keyword(s):

Food Intake ◽

Dissociative Disorders ◽

Dissociative Disorder ◽

Passive Resistance ◽

Diagnostic Categories ◽

Clinical Presentations ◽

Pervasive Refusal Syndrome ◽

Case Vignettes ◽

Life Threatening ◽

Core Features

Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of food intake, decreased or complete lack of mobilization, and lack of communication as well as a retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however, been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of “depressive devitalization” – a refusal syndrome mainly characterized by passive resistance – into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients’ symptomatology can be allocated on this continuum of active refusal to passive resistance supporting the usefulness of such a continuum in comparing various clinical presentations of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.

Download Full-text