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Published in: Journal of Clinical Psychology in Medical Settings 2/2016

01-06-2016

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

Authors: Barbara K. Bruce, Karen E. Weiss, Tracy E. Harrison, Daniel A. Allman, Matthew A. Petersen, Connie A. Luedkte, Philip R. Fischer

Published in: Journal of Clinical Psychology in Medical Settings | Issue 2/2016

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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.
Literature
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.PubMed 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.PubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference Claar, R. L., & Walker, L. S. (2006). Functional assessment of pediatric pain patients: Psychometric properties of the functional disability inventory. Pain, 121, 77–84.CrossRefPubMedPubMedCentral Claar, R. L., & Walker, L. S. (2006). Functional assessment of pediatric pain patients: Psychometric properties of the functional disability inventory. Pain, 121, 77–84.CrossRefPubMedPubMedCentral
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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. 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.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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. 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.
go back to reference 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. 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.
go back to reference 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. 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.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference Mack, K. J., Johnson, J. N., & Rowe, P. C. (2010). Orthostatic intolerance and the headache patient. Seminars in Pediatric Neurology, 17, 109–116.CrossRefPubMed Mack, K. J., Johnson, J. N., & Rowe, P. C. (2010). Orthostatic intolerance and the headache patient. Seminars in Pediatric Neurology, 17, 109–116.CrossRefPubMed
go back to reference March, J. S. (1997). Manual for the multidimensional anxiety scale for children. North Tonawanda, NY: Multi-Health Systems. March, J. S. (1997). Manual for the multidimensional anxiety scale for children. North Tonawanda, NY: Multi-Health Systems.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference McNally, R. J. (1994). Choking phobia: A review of the literature. Comprehensive Psychiatry, 35(1), 83–89.CrossRefPubMed McNally, R. J. (1994). Choking phobia: A review of the literature. Comprehensive Psychiatry, 35(1), 83–89.CrossRefPubMed
go back to reference Ojha, A., Chelimsky, T. C., & Chelimsky, G. (2011). Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. Journal of Pediatrics, 158, 20–23.CrossRefPubMed Ojha, A., Chelimsky, T. C., & Chelimsky, G. (2011). Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. Journal of Pediatrics, 158, 20–23.CrossRefPubMed
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
go back to reference 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. 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.
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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. 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.
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference Walker, L., & Greene, J. (1991). The Functional Disability Inventory: Measuring a neglected dimension of child health status. Journal of Pediatric Psychology, 16, 39–58.CrossRefPubMed Walker, L., & Greene, J. (1991). The Functional Disability Inventory: Measuring a neglected dimension of child health status. Journal of Pediatric Psychology, 16, 39–58.CrossRefPubMed
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
Interdisciplinary Treatment of Maladaptive Behaviors Associated with Postural Orthostatic Tachycardia Syndrome (POTS): A Case Report
Authors
Barbara K. Bruce
Karen E. Weiss
Tracy E. Harrison
Daniel A. Allman
Matthew A. Petersen
Connie A. Luedkte
Philip R. Fischer
Publication date
01-06-2016
Publisher
Springer US
Published in
Journal of Clinical Psychology in Medical Settings / Issue 2/2016
Print ISSN: 1068-9583
Electronic ISSN: 1573-3572
DOI
https://doi.org/10.1007/s10880-015-9438-3

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