Diagnostic delays and dilemmas - Management of affected patients in the psychiatric inpatient unit of a general children's hospital

We present the role of the medical-psychiatric unit in the management of ch ildren and adolescents with somatic symptoms in whom diagnosis remains unce rtain or delayed, which can lend to severe impairment in the child's normal development and functioning and cause anger and hostility in the families. We describe two patients, one with cyclic vomiting syndrome, considered a medical disorder, and the other with conversion disorder, considered a psyc hiatric disorder. Both patients had had multiple EX admissions and outpatie nt visits with elaborate and expensive diagnostic workups. On admission to our unit, a coherent and integrated treatment plan was finally formulated a nd successfully implemented We discuss the advantage of the medical-psychia tric unit for simultaneous medical and psychosocial intervention early in t he development of symptoms and signs. The units need to be ready and able t o cope with a wide range of medical and psychiatric disorders with differen t levels of gravity. (C) 1999 Elsevier Science Inc.