Page 58 - JCBP-1-1

Journal of Clinical and
Basic Psychosomatics Crouzon comorbidity with psychiatric disorders

2.8. Final diagnosis of CS patients in China likely surpasses the reported

After obtaining additional psychiatric history narrated cases, emphasizing the need for increased attention from
from the patient herself, the final diagnosis of acute clinicians. After all, the suspicion of CS can be reasonably
transient psychiatric disorder and CS was confirmed. raised based on prenatal ultrasound findings and
distinctive facial features observed after birth , and the
[12]
3. Discussion clinical course of deterioration of craniofacial anomalies in
the first 1 – 2 years after birth was helpful to the diagnosis
Few CS patients were reported with comorbid mental of CS .
[13]
disorders worldwide. Present studies stated the relationship
between mental disorders and CS, the lack of a formal There is no definitive cure for CS. Surgical treatment
psychiatric diagnosis, and the treatment process in CS is the primary choice for improving craniofacial
patients. We aimed to present the CS case for clinicians, malformations. Early intervention (before 1 year of
referring to psychiatric comorbidities or symptoms. To the age) minimizes complications (cognitive impairment,
best of our knowledge, this is the first documented case airway obstruction, and vision loss) and leads to a better
report in China of a CS patient presenting psychiatric prognosis [13,14] . Good family and social supports contribute
symptoms, and she was first admitted to the psychiatry to the improvement of daily life quality and mediate the
department. Typically, patients with CS were priorly relationship between discrimination and mental health
[15]
identified in otorhinolaryngology, ophthalmology, outcomes . Consistent with our case, another CS patient
stomatology, and plastic surgery rather than psychiatry. had comorbid emotional disturbance, social avoidance,
This report highlights the importance of early identification and adjustment problems, whose psychological state
and treatment of mental disorders in patients with CS. improved after psychotherapy and emotional support from
[16]
family . Psychological counseling and family support
It was reported that premature closure of the sutures give CS patients confidence and enhance their feeling of
had caused the deformed skull. The raised intracranial belongingness to reduce stress .
[17]
pressure permanently damages the brain, resulting
in intellectual and cognitive impairment . Besides, Multi-disciplinary team approach for the management
[4]
congenital craniofacial anomalies can significantly impact of CS has been proposed, but mental cares are often needed
mood. Patients with craniofacial anomalies often report during the process. Pertschuk and Whitaker noted that
higher appearance-related negative emotions than those children with congenital craniofacial anomalies tended to
without . Stress, personality, and emotional development be more introverted, anxious, and exhibiting poorer self-
[9]
[14]
issues are often observed among them. The research has esteem before undergoing surgical treatment . However,
shown that the stress and social discrimination experienced extensive research focused on the mental health of patients
by patients with CS could persist into adulthood. with CS after surgical treatment [17,18] . A follow-up study
of patients with syndromic craniosynostosis, including
In our case, the parents said that the girl’s complaints Crouzon, Apert, and Pfeiffer, after surgical intervention,
about appearance dissatisfaction, interpersonal showed that patients with CS after surgical intervention
relationships, and adjustment problems increased had lower participation, self-care, and self-evaluation
gradually during adolescence. Long-term ignorance in society compared to those with Apert . The possible
[19]
from parents regarding the unique appearance of the girl, reason was that patients with CS have no significant
coupled with the psychological burden and emotional intellectual or physical disabilities and must participate in
changes, may exacerbate the patient’s stress. The parents normal life as a member of society, and previous traumatic
tend to believe the immature mentality of the children experiences and limited social opportunities hurt their
over their abnormal mood. It is important to note that emotions, resulting in poor mental health, even though
pre-adolescence and adolescence are the most important they had undergone craniofacial surgical intervention at a
stages in life. During the critical period, mental health later stage .
[19]
vulnerability and emotional developmental sensitivity are
prominent for the children [10,11] . 4. Conclusion

Therefore, the long-term neglect of the disease could The mental health of patients with craniosynostosis requires
influence the girl’s personality development. Our patient more attention at some critical periods: the first medical
was reported in the late stage of the syndrome (15 years visit, perioperative periods, and transitional periods in child
old) and had never received treatment. Due to the vast development, such as school age and puberty. Besides, the
territory and ethnic diversity in China, the clinicians could management of CS is multidisciplinary, and mental health
easily neglect the girl’s unique facial features. The number problems in patients with CS need continuous attention.

Volume 1 Issue 1 (2023) 4 https://doi.org/10.36922/jcbp.0405