lørdag den 31. august 2013

Pervasive Arousal Withdrawal Syndrome (PAWS)

I have previously written about Pervasive Refusal Syndrome: Afvisningssyndrom eller ME?  (In Danish, but quotes and references in English)

A new name for Pervasive Refusal Syndrome is suggested in this arcticle: Pervasive refusal syndrome (PRS) 21 years on: a re-conceptualisation and a renaming. The new name is Pervasive Arousal Withdrawal Syndrome (PAWS).

A neurobiological model is proposed to explain PAWS. The autonomic nervous system is divided into the parasympathetic nervous system and the sympathetic nervous system. The model in PAWS is a breakdown in the normal relationship between the sympathetic and parasympathetic nervous systems. Normally there is a balance between the to systems, but in PAWS there is both sympathetic hyper-arousal and parasympathetic hyper-arousal. The two systems, sympathetic and parasympathetic are in a deadlock.

Then the authors of the article write: "Testing of this model could include: (1) exploring biological markers of arousal of both arms of the autonomic nervous system...."

PAWS is not a WHO diagnosis. And this paper on the new name PAWS is the only one I could find. So perhaps a little further testing of the model is good idea. I look forward to an article with test of the autonomic nervous system - including auto antibodies involved in dysautonomia.

The limited amount of literature on PRS is confirmed in this paper by Carl-Magnus Forslund and Björn Axel Johansson:

Pervasive refusal syndrome among inpatient asylum-seeking children and adolescents: a follow-up study:

15 articles (24 cases) identified in this review by Jaspers et al.


a search at PubMed.com (August 2012), using the term ‘‘Pervasive Refusal Syndrome’’, revealed 7 additional articles (10 cases) published after 2009.

So Forslund and Johansson have counted 34 cases. And they state:

"No evidence-based treatment for PRS is known."

But they mention that "Mean period of inpatient treatment was 5 months." 

PRS has not been identified among adults.

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