Advertisement

Interdisciplinary Treatment of Maladaptive Behaviors Associated with Postural Orthostatic Tachycardia Syndrome (POTS): A Case Report

  • Barbara K. Bruce
  • Karen E. Weiss
  • Tracy E. Harrison
  • Daniel A. Allman
  • Matthew A. Petersen
  • Connie A. Luedkte
  • Philip R. Fischer
Article

Abstract

The prevalence of postural orthostatic tachycardia syndrome (POTS) in adolescents and young adults has been increasing during the past decade. Despite this increase, documentation regarding treatment of these patients is just beginning to emerge. In addition, despite a call for a multidisciplinary or interdisciplinary approach, no studies have examined the efficacy of such an approach to treatment. This paper describes a case study of a 19-year-old male with debilitating POTS seen at a tertiary clinic for evaluation and subsequent intensive interdisciplinary treatment. The treatment approach is described and outcomes are presented.

Keywords

Adolescent Young adult Postural orthostatic tachycardia syndrome Biopsychosocial Interdisciplinary rehabilitation 

Notes

Acknowledgments

The authors would like to thank Jessica Gehin, RN, for her assistance in data management.

Compliance with Ethical Standards

Conflict of Interest

Barbara K. Bruce, Karen E. Weiss, Tracy E. Harrison, Daniel A. Allman, Matthew A. Petersen, Connie A. Luedkte, and Philip R. Fischer declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This was a case study, and so was not required to go through the IRB at our institution. However, all procedures followed were in accordance with established institutional and national ethical standards. Brian and his parents gave informed consent with respect to having their case published, as well as their consent to having their medical records reviewed for research purposes.

References

  1. Allen, L. B., Lu, Q., Tsao, J. C. I., Hayes, L. P., & Zeltzer, L. K. (2011). Depression partially mediates the relationship between alexithymia and somatization in a sample of healthy children. Journal of Health Psychology, 16, 1177–1186.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Benarroch, E. E. (2012). Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clinic Proceedings, 87, 1214–1225.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Benrud-Larson, L. M., Dewar, M. S., Sandroni, P., Rummans, T. A., Haythornthwaite, J. A., & Low, P. A. (2002). Quality of life in patients with postural tachycardia syndrome. Mayo Clinic Proceedings, 77, 531–537.CrossRefPubMedGoogle Scholar
  4. Bouvette, C. M., McPhee, B. R., Opfer-Gehrking, T. L., & Low, P. A. (1996). Role of physical countermaneuvers in the management of orthostatic hypotension: Efficacy and biofeedback augmentation. Mayo Clinic Proceedings, 71, 847–853.CrossRefPubMedGoogle Scholar
  5. Burba, B., Oswald, R., Grigaliunien, V., Neverauskiene, S., Jankuviene, O., & Chue, P. (2006). A controlled study of alexithymia in adolescent patients with persistent somatoform pain disorder. Canadian Journal of Psychiatry, 51, 468–471.PubMedGoogle Scholar
  6. Burkhardt, B. E., Fischer, P. R., Brands, C. K., Porter, C. B., Weaver, A. L., Yim, P. J., & Pianosi, P. T. (2011). Exercise performance in adolescents with autonomic dysfunction. Journal of Pediatrics, 158, 15–19.CrossRefPubMedGoogle Scholar
  7. Claar, R. L., & Walker, L. S. (2006). Functional assessment of pediatric pain patients: Psychometric properties of the functional disability inventory. Pain, 121, 77–84.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Crombez, G., Bijttebier, P., Eccleston, C., Mascagni, T., Mertens, G., Goubert, L., & Verstraeten, K. (2003). The child version of the pain catastrophizing scale (PCS-C): A preliminary validation. Pain, 104(3), 639–646.CrossRefPubMedGoogle Scholar
  9. Dobe, M., & Zernikow, B. (2014). How to stop chronic pain in children: A practical guide. Retrieved from http://www2.ciando.com/ebook/bid-1553733/intrefid/420528.
  10. Fales, J. L., Essner, B. S., Harris, M. A., & Palermo, T. M. (2014). When helping hurts: Miscarried helping in families of youth with chronic pain. Journal of Pediatric Psychology, 39, 427–437.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Faulstich, M. (1986). Assessment of depression in childhood and adolescence: An evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). The American Journal of Psychiatry, 143(8), 1024–1027.CrossRefPubMedGoogle Scholar
  12. Fischer, A. J., Luiselli, J. K., & Dove, M. B. (2015). Effects of clinic and in-home treatment on consumption and feeding-associated anxiety in an adolescent with avoidant/restrictive food intake disorder. Clinical Practice in Pediatric Psychology, 3, 154–166.CrossRefGoogle Scholar
  13. Gatta, M., Canetta, E., Zordan, M., Spoto, A., Ferruzza, E., Manco, I., … Battistella, P. A. (2011). Alexithymia in juvenile primary headache sufferers: a pilot study. Journal of Headache Pain, 12, 71–80.Google Scholar
  14. Gaughan, V., Logan, D., Sethna, N., & Mott, S. (2012). Parents’ perspective of their journey caring for a child with chronic neuropathic pain. Pain Management Nursing, 15, 246–257.CrossRefPubMedGoogle Scholar
  15. Gauntlett-Gilbert, J., & Eccleston, C. (2007). Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning. Pain, 131(1–2), 132–141.CrossRefPubMedGoogle Scholar
  16. Gordon, V. M., Opfer-Gehrking, T. L., Novak, V., & Low, P. A. (2000). Hemodynamic and symptomatic effects of acute interventions on tilt in patients with postural tachycardia syndrome. Clinical Autonomic Research, 10, 29–33.CrossRefPubMedGoogle Scholar
  17. Johnson, J. N., Mack, K. J., Kuntz, N. L., Brands, C. K., Porter, C. J., & Fischer, P. R. (2010). Postural orthostatic tachycardia syndrome: A clinical review. Pediatric Neurology , 42, 77–85.CrossRefPubMedGoogle Scholar
  18. Kashikar-Zuck, S., Flowers, S. R., Claar, R. L., Guite, J. W., Logan, D. E., Lynch-Jordan, A. M., … Wilson, A. C. (2011). Clinical utility and validity of the Functional Disability Inventory among a multicenter sample of youth with chronic pain. Pain, 152, 1600–1607.Google Scholar
  19. Kizilbash, S, J., Ahrens, S. P., Bruce, B. K., Chelimsky, G., Driscoll, S. W., Harbeck-Weber, C., … Fischer, P. R. (2014). Adolescent fatigue POTS, and recovery: A guide for clinicians. Current Problems in Pediatric and Adolescent Health Care, 44, 107–134.Google Scholar
  20. Kritzberger, C. J., Antiel, R. M., Wallace, D. P., Zacharias, J. D., Brands, C. K., Fischer, P. R., & Harbeck-Weber, C. (2011). Functional disability in adolescents with orthostatic intolerance and chronic pain. Journal of Clinical Neurology, 26, 593–598.Google Scholar
  21. Lai, C. C., Fischer, P. R., Brands, C. K., Fisher, J. L., Porter, C. B., Driscoll, S. W., & Graner, K. K. (2009). Outcomes in adolescents with postural orthostatic tachycardia syndrome treated with midodrine and beta-blockers. Pacing Clinical Electrophysiology, 32, 234–238.CrossRefPubMedGoogle Scholar
  22. Mack, K. J., Johnson, J. N., & Rowe, P. C. (2010). Orthostatic intolerance and the headache patient. Seminars in Pediatric Neurology, 17, 109–116.CrossRefPubMedGoogle Scholar
  23. March, J. S. (1997). Manual for the multidimensional anxiety scale for children. North Tonawanda, NY: Multi-Health Systems.Google Scholar
  24. McDowell, B. J., Burgio, K. L., Dombrowski, M., Locher, J. L., & Rodriguez, E. (1992). An interdisciplinary approach to the assesssment and behavioral treatment of urinary incontinence in geriatric outpatients. Journal of the American Geriatrics Society, 40, 370–374.CrossRefPubMedGoogle Scholar
  25. McNally, R. J. (1994). Choking phobia: A review of the literature. Comprehensive Psychiatry, 35(1), 83–89.CrossRefPubMedGoogle Scholar
  26. Ojha, A., Chelimsky, T. C., & Chelimsky, G. (2011). Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. Journal of Pediatrics, 158, 20–23.CrossRefPubMedGoogle Scholar
  27. Palermo, T. M., Eccleston, C., Lewandowski, A. S., Williams, A. C., & Morley, S. (2010). Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review. Pain, 148, 387–397.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Raj, V., Haman, K. L., Raj, S. R., Byrne, D., Blakely, R. D., Biaggioni, I., … Shelton, R. C. (2013). Psychiatric profile and attention deficits in postural tachycardia syndrome. Journal of Neurology, Neurosurgery, & Psychiatry, 80, 339–344.Google Scholar
  29. Roberts, R. E., Andrews, J. A., Lewinsohn, P. M., & Hops, H. (1990). Assessment of depression in adolescents using the Center for Epidemiologic Studies Depression Scale. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2, 122–128.CrossRefGoogle Scholar
  30. Roe, B., Ostaszkiewicz, J., Milne, J., & Wallace, S. (2007). Systematic reviews of bladder retraining and voiding programmes in adults: A synopsis of findings from data analysis and outcomes using metastudy techniques. Journal of Advanced Nursing, 57, 15–31.CrossRefPubMedGoogle Scholar
  31. Sandroni, P., Opfer-Gehrking, T. L., McPhee, B. R., & Low, P. A. (1999). Postural tachycardia syndrome: Clinical features and follow-up study. Mayo Clinic Proceedings, 74, 1106–1110.CrossRefPubMedGoogle Scholar
  32. Sieberg, C. B., Williams, S., & Simons, L. E. (2011). Do parent protective responses mediate the relation between parent distress and child functional disability among children with chronic pain? Journal of Pediatric Psychology, 36, 1043–1051.CrossRefPubMedGoogle Scholar
  33. Simons, L. E., Sieberg, C. B., Pielech, M., Conroy, C., & Logan, D. E. (2013). What does it take? Comparing intensive rehabilitation to outpatient treatment for children with significant pain-related disability. Journal of Pediatric Psychology, 38, 213–223.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Singer, W., Sletten, D. M., Opfer-Gehrking, T. L., Brands, C. K., Fischer, P. R., & Low, P. A. (2012). Postural tachycardia in children and adolescents: What is abnormal? Journal of Pediatrics, 160, 222–226.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Stewart, J. M. (2004). Chronic orthostatic intolerance and the postural tachycardia syndrome (POTS). Journal of Pediatrics, 145, 725–730.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Sullivan, M., Thorn, B., Haythornthwaite, J., Keefe, F., Martin, M., Bradley, L., & Lefebvre, J. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17(1), 52–64.CrossRefPubMedGoogle Scholar
  37. Thieben, M. J., Sandroni, P., Sletten, D. M., Benrud-Larson, L. M., Fealey, R. D., Vernino, S., … Low, P.A. (2007). Postural orthostatic tachycardia syndrome: The Mayo clinic experience. Mayo Clinic Proceedings, 82, 308–313.Google Scholar
  38. van der Veek, S. M. C., Nobel, R. A., & Derkx, H. H. F. (2012). The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression. Psychology & Health, 27, 1359–1374.CrossRefGoogle Scholar
  39. Vervoort, T. T., Eccleston, C. C., Goubert, L. L., Buysse, A. A., & Crombez, G. G. (2010). Children’s catastrophic thinking about their pain predicts pain and disability 6 months later. European Journal of Pain, 14(1), 90–96.CrossRefPubMedGoogle Scholar
  40. Walker, L., & Greene, J. (1991). The Functional Disability Inventory: Measuring a neglected dimension of child health status. Journal of Pediatric Psychology, 16, 39–58.CrossRefPubMedGoogle Scholar
  41. Weiss, K. E., Hahn, A., Wallace, D. P., Biggs, B., Bruce, B. K., & Harrison, T. E. (2013). Acceptance of pain: Associations with depression, catastrophizing, and functional disability among children and adolescents in an interdisciplinary chronic pain rehabilitation program. Journal of Pediatric Psychology, 38, 756–765.CrossRefPubMedGoogle Scholar
  42. Weissman, M. M., Orvaschel, H., & Padian, N. (1980). Children’s symptom and social functioning self-report scales: Comparison of mothers’ and children’s reports. Journal of Nervous Mental Disorders, 168, 736–740.CrossRefGoogle Scholar
  43. Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152, S2–S15.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Barbara K. Bruce
    • 1
    • 4
  • Karen E. Weiss
    • 1
  • Tracy E. Harrison
    • 2
  • Daniel A. Allman
    • 1
  • Matthew A. Petersen
    • 1
  • Connie A. Luedkte
    • 1
  • Philip R. Fischer
    • 3
  1. 1.Department of Psychiatry and PsychologyMayo ClinicRochesterUSA
  2. 2.Department of AnesthesiologyMayo ClinicRochesterUSA
  3. 3.Department of Pediatric and Adolescent MedicineMayo ClinicRochesterUSA
  4. 4.Department of Psychiatry and PsychologyMayo ClinicJacksonvilleUSA

Personalised recommendations