1
|
Blasco-Fontecilla H, Li C, Vizcaino M, Fernández-Fernández R, Royuela A, Bella-Fernández M. A Nomogram for Predicting ADHD and ASD in Child and Adolescent Mental Health Services (CAMHS). J Clin Med 2024; 13:2397. [PMID: 38673670 PMCID: PMC11051553 DOI: 10.3390/jcm13082397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Objectives: To enhance the early detection of Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) by leveraging clinical variables collected at child and adolescent mental health services (CAMHS). Methods: This study included children diagnosed with ADHD and/or ASD (n = 857). Three logistic regression models were developed to predict the presence of ADHD, its subtypes, and ASD. The analysis began with univariate logistic regression, followed by a multicollinearity diagnostic. A backward logistic regression selection strategy was then employed to retain variables with p < 0.05. Ethical approval was obtained from the local ethics committee. The models' internal validity was evaluated based on their calibration and discriminative abilities. Results: The study produced models that are well-calibrated and validated for predicting ADHD (incorporating variables such as physical activity, history of bone fractures, and admissions to pediatric/psychiatric services) and ASD (including disability, gender, special education needs, and Axis V diagnoses, among others). Conclusions: Clinical variables can play a significant role in enhancing the early identification of ADHD and ASD.
Collapse
Affiliation(s)
- Hilario Blasco-Fontecilla
- Instituto de Investigación, Transferencia e Innovación, Ciencias de la Saludy Escuela de Doctorado, Universidad Internacional de La Rioja, 26006 Logroño, Spain
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, 28029 Madrid, Spain
| | - Chao Li
- Faculty of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | | | | | - Ana Royuela
- Biostatistics Unit, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain;
| | - Marcos Bella-Fernández
- Puerta de Hierro University Hospital, 28222 Majadahonda, Spain;
- Faculty of Psychology, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| |
Collapse
|
2
|
MacNeily AE, Afshar K, Hogues V, Kim S, Noparast M, Westwell-Roper C, Stewart SE. Prevalence of previously undiagnosed psychiatric symptom groupings in pediatric patients with bladder and bowel dysfunction. J Pediatr Urol 2024; 20:17.e1-17.e6. [PMID: 37858512 DOI: 10.1016/j.jpurol.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/23/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION AND OBJECTIVE The incidence of concomitant psychiatric disorders in conjunction with bladder and bowel dysfunction (BBD) is thought to be higher than the general population. The identification of these disorders with validated tools followed by management may improve urological outcomes. The objective of this study was to determine the prevalence of undiagnosed psychiatric symptom groupings in children presenting with BBD. METHODS Consecutive patients 6-18 yrs with a clinical diagnosis of BBD, a score ≥11 on the Vancouver Symptom Score (VSS) and no prior psychiatric diagnoses were recruited. Two validated questionnaires (Child Behavior Checklist for Ages 6-18 (CBCL) and Autism Spectrum Quotient 10 (AQ-10)) were used to screen for psychiatric comorbidities. Descriptive statistics for demographic variables were presented. Distribution of VSS for normal & abnormal categories (borderline/clinical) of CBCL scores were compared by Mann-Whitney U test. Spearman correlation coefficient was used to examine the relationship between VSS domain scores and CBCL. RESULTS From Sept 2017-May 2022, 50 (17 male) of 110 eligible patients completed the study. Median VSS was 18 (11-33), indicating significant BBD. In 36 patients (72 %), at least one of the CBCL subscales scored as borderline/clinical. Thirty-two patients (64 %) scored in the abnormal range for Internalizing symptoms, 21 (42 %) for Externalizing symptoms, and 31 (62 %) for Total problem scores. Four patients of 48(8 %) scored ≥6 on the AQ-10. The only significant correlation found between CBCL and VSS sub scores was with the Bowel Habit Domain of VSS and Internalizing CBCL T-scores (P = 0.02). CONCLUSION This study identified a high prevalence of previously undiagnosed psychiatric symptom groupings in patients presenting with BBD, with a higher prevalence of internalizing and externalizing symptoms and autism traits than reported in the general population. These findings should encourage urologists to use validated tools to screen for psychiatric comorbidities with referral for further assessment as appropriate. This may prevent unnecessary urological testing, save valuable health resources and potentially improve treatment outcomes of BBD in this population.
Collapse
Affiliation(s)
- Andrew E MacNeily
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Kourosh Afshar
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Valerie Hogues
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Soojin Kim
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Maryam Noparast
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Clara Westwell-Roper
- Division of Pediatric Psychiatry, BC Children's Hospital. UBC Department of Psychiatry. 4480 Oak St, Vancouver, British Columbia, Canada, V6H 3V4.
| | - S Evelyn Stewart
- Division of Pediatric Psychiatry, BC Children's Hospital. UBC Department of Psychiatry. 4480 Oak St, Vancouver, British Columbia, Canada, V6H 3V4.
| |
Collapse
|
3
|
Eliezer DD, Lam C, Smith A, Coomarasamy JM, Samnakay N, Starkey MR, Deshpande AV. Optimising the management of children with concomitant bladder dysfunction and behavioural disorders. Eur Child Adolesc Psychiatry 2023; 32:1989-1999. [PMID: 35767104 PMCID: PMC10533605 DOI: 10.1007/s00787-022-02016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
Abstract
Bladder dysfunction and behavioural disorders in children are commonly concomitant; hence, it is difficult to treat each in isolation. Pharmacotherapy is common treatment for behavioural disorders, and these medications may have intended or unintended positive or negative bladder sequelae. This review identifies the literature regarding the effects of behavioural pharmacotherapy on bladder functioning and possible bladder management strategies in children with concomitant behaviour and bladder disorders to enable clinicians to better manage both conditions. A PROSPERO registered PRISMA-guided review of three major databases was performed. After an initial scoping study revealed significant heterogeneity, a narrative approach was undertaken to discuss the results of all relevant cases relating to children being treated with pharmacotherapy for behaviour disorders and outcomes related to bladder function. Studies were screened to identify those that described effects of commonly prescribed medications in children with behavioural disorders such as stimulants, alpha 2 agonists, tricyclic antidepressants (TCA), serotonin and noradrenergic reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI) and antipsychotics, and the findings and implications were summarised. The review identified 46 studies relevant to behavioural pharmacotherapy and bladder function (stimulants (n = 9), alpha 2 agonists (n = 2), TCAs (n = 7), SNRIs (n = 8), SSRIs (n = 8) and antipsychotics (n = 6). Six studies focused specifically on bladder management in children with behavioural disorders with concurrent behavioural pharmacotherapy. This review identifies useful factors that may assist clinicians with predicting unintended bladder effects following initiation of behavioural pharmacotherapy to facilitate the best approach to the treatment of bladder dysfunction in children with behavioural disorders. With this evidence, we have provided a useful decision-making algorithm to aide clinicians in the management of these dual pathologies.
Collapse
Affiliation(s)
- Dilharan D Eliezer
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
- Urology Unit, Department of Surgery, Department of Paediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - Christopher Lam
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Angela Smith
- Hunter New England Library, New Lambton Heights, NSW, Australia
| | | | - Naeem Samnakay
- Department of Surgery, Perth Children's Hospital, Nedlands, WA, Australia
- Division of Surgery, Medical School, University of Western Australia, Crawley, WA, Australia
| | - Malcolm R Starkey
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia
| | - Aniruddh V Deshpande
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Urology Unit, Department of Surgery, Department of Paediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| |
Collapse
|
4
|
Ghogare A, Pole R, Vankar G. A clinical review of enuresis and its associated psychiatric comorbidities. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
de Sena Oliveira AC, Athanasio BDS, Mrad FCDC, Vasconcelos MMDA, Albuquerque MR, Miranda DM, Simões E Silva AC. Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis. Pediatr Nephrol 2021; 36:3547-3559. [PMID: 34009466 DOI: 10.1007/s00467-021-05083-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Attention deficit and hyperactivity/impulsivity disorder (ADHD) and enuresis are common behavioral disorders in childhood, impacting adolescence and adult life. Enuresis (NE) is an incontinence disorder frequently observed in children with ADHD. The relationship between ADHD and NE has been a matter of debate. OBJECTIVES We aimed to verify the relationship between ADHD and enuresis and how these conditions can modify each other during development. Using PRISMA guidelines, under the PROSPERO registration number CRD42020208299, we systematically searched the literature and conducted a meta-analysis to answer the following question: how frequent is ADHD and enuresis comorbidity? Twenty-five studies were fully read, and data from seven less heterogeneous case-control studies were pooled to estimate enuresis prevalence comparing ADHD and control samples, whereas six studies were combined to evaluate ADHD frequencies in children with and without enuresis. RESULTS We found the ADHD rates in children with enuresis are similar to the enuresis rates in the group of children with ADHD. The presence of ADHD and enuresis comorbidity does not seem to play a role in gender distribution and the presence of other comorbidities in comparison to controls. However, enuresis seems to persist for more time in children with ADHD. LIMITATIONS The selected papers differed in study type, research question, samples, and controls utilized. CONCLUSIONS Our systematic review with meta-analysis supports the reciprocal association between enuresis and ADHD. Further studies are necessary to build more robust evidence.
Collapse
Affiliation(s)
- Ana Cecília de Sena Oliveira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Bruno da Silva Athanasio
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Flávia Cristina de Carvalho Mrad
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil
| | - Monica Maria de Almeida Vasconcelos
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil
| | - Maicon Rodrigues Albuquerque
- Neurosciences of Physical Activity and Sports Research Group, Department of Sports, UFMG, Belo Horizonte, MG, Brazil
| | - Débora Marques Miranda
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil.
| |
Collapse
|
6
|
Morais J, Soares S, Correia-Costa L, Santos AC, Barreira JL. Determinants of bedwetting trajectories between 4 and 7 years - A birth cohort analysis. J Pediatr Urol 2021; 17:647.e1-647.e10. [PMID: 34736725 DOI: 10.1016/j.jpurol.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Enuresis is frequent in school-aged children and results from a complex interaction between genetics, biological and psychosocial factors. This study aims to analyze bedwetting trajectories between 4 and 7 years of age and to evaluate the impact of biological and developmental characteristics of the child and sociodemographic factors in those bedwetting trajectories. METHODS Data from 5433 children from the Generation XXI population-based birth cohort was analyzed. Four bedwetting trajectories were defined: normative (acquired nighttime bladder control at 4 years and no enuresis at 7 years); delayed (no nighttime bladder control at 4 years and no enuresis at 7 years); enuresis (no nighttime bladder control at 4 years and enuresis at 7 years); and secondary enuresis (acquired nighttime bladder control at 4 years and enuresis at 7 years). Multinomial logistic regression models were fitted to test the association between biological and developmental characteristics of the child and sociodemographic factors with bedwetting trajectories. RESULTS At the age of 4 years, 36.5% of children had bedwetting (8.1% infrequently and 28.4% frequently) and at the age of 7 years, 11.0% had enuresis (5.8% infrequently and 5.2% frequently). Of the 4-year-old children who were infrequent bedwetters, 14.0% had enuresis at 7 years, while among frequent bedwetters, 30.2% had enuresis at 7 years. Regarding bedwetting trajectories, 26.8% of children were classified in the delayed trajectory, 9.7% in the enuresis trajectory and 1.3% were in the secondary enuresis trajectory. Children with developmental disorders presented an increased risk of being in enuresis trajectory (OR = 1.47, 95% CI 1.15-1.88) than children without developmental disorders. Living in overcrowded houses (OR = 1.60, 95% CI 1.12-2.30), growing up in families with low household income (OR = 1.27, 95% CI 1.03-1.57) and an orphan of one parent (OR = 3.19, 95% CI 1.18-8.64) presented higher odds of being in the enuresis trajectory than in the normative trajectory. Having a sibling both before the age of 4 years and between the ages of 4 and 7 years was associated with delayed trajectory (OR = 1.55, 95% CI 1.16-2.07) and with enuresis (OR = 1.53, 95% CI 1.01-2.33), when compared with children without siblings born at that time. CONCLUSION Both developmental disorders and sociodemographic factors seem to be important determinants of bedwetting trajectories. Further studies are needed to better characterize the impact of biological and environmental determinants, on the nighttime bladder control acquisition, to enable timely medical interventions that improve the quality of life of enuretic children.
Collapse
Affiliation(s)
- Joana Morais
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sara Soares
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional (ITR), Porto, Portugal
| | - Liane Correia-Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional (ITR), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Divisão de Nefrologia Pediátrica, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Luís Barreira
- Divisão de Pediatria, Centro Hospitalar de São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| |
Collapse
|
7
|
Vasconcelos MMDA, Bastos JM, Arana IE, Teixeira IB, Lima EM, Carvalho TA, de Bessa J, Mrad FCDC. Association between Attention Deficit Hyperactivity Disorder and lower urinary tract symptoms in children and adolescents in a community setting. Int Braz J Urol 2021; 47:969-978. [PMID: 34260173 PMCID: PMC8321464 DOI: 10.1590/s1677-5538.ibju.2020.0978] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The present study aims to investigate the prevalence of lower tract urinary symptoms (LUTS) and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and their association in a community setting using validated scoring instruments. MATERIALS AND METHODS A cross-sectional study was carried out from February 2015 to December 2019, during which the parents or guardians of 431 children and adolescents from 5 to 13 years of age, attending a general pediatric outpatient clinic were interviewed. RESULTS The prevalence of ADHD symptoms and LUTS were 19.9% and 17.9%, respectively. Of the 82 children and adolescents with ADHD, 28% (23) had LUTS (OR 2.31, 95% CI 1.28 to 3.75, p=0.008). Mean total DVSS score in children in the group of children presenting ADHD symptom was significantly higher than those without ADHD symptom (10.2±4.85 vs. 4.9±2.95, p=0.002). Urgency prevailed among LUTS as the most frequent symptom reported by patients with ADHD symptoms (p=0.004). Analyzing all subscales of the DVSS, the items "When your child wants to pee, can't he wait? "Your child holds the pee by crossing his legs, crouching or dancing?" were higher in those with ADHD symptoms (p=0.01 and 0.02, respectively). Functional constipation was present in 36.4% of children with LUTS and 20.7% without LUTS (OR 4.3 95% CI 1-5.3 p=0.001). CONCLUSION Children and adolescents with ADHD symptoms are 2.3 times more likely to have LUTS. The combined type of ADHD was the most prevalent among them.
Collapse
Affiliation(s)
- Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - José Murillo Bastos
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
- Hospital e Maternidade Terezinha de JesusJuiz de ForaMGBrasilHospital e Maternidade Terezinha de Jesus, Juiz de Fora, MG, Brasil
| | - Isaac Eduardo Arana
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Isabela Benevenuto Teixeira
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Eleonora Moreira Lima
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - Tânia Antunes Carvalho
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de UrologiaSantanaBABrasilDepartamento de Urologia, Universidade Estadual de Feira de Santana, BA, Brasil
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| |
Collapse
|
8
|
Arasteh A, Mostafavi S, Zununi Vahed S, Mostafavi Montazeri SS. An association between incontinence and antipsychotic drugs: A systematic review. Biomed Pharmacother 2021; 142:112027. [PMID: 34392083 DOI: 10.1016/j.biopha.2021.112027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022] Open
Abstract
To date, due to the increasing prevalence of psychiatric diseases, the use of antipsychotic drugs has expanded. One of the proven side effects of these drugs is incontinence. Treatment of this complication improves the quality of life in these patients, increases self-confidence, and betters cope with their psychiatric illness. The exact mechanism of this side effect is not fully understood, but various methods have been used experimentally to deal with it. Strategies such as behavior therapy, discontinuation or change of drugs, reducing the dose of drugs, and adding drugs with less incontinence have been used. Each of these methods and studies has different results that need to be summarized to make optimal use of them. Since most of these reports are case reports with a low statistical population, our study has systematically reviewed these studies to find a comprehensive model to deal with this complication.
Collapse
Affiliation(s)
- Amin Arasteh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soroush Mostafavi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | |
Collapse
|
9
|
Wang R, Van den Heuvel M, Rickard M, El-Bardisi Y, Mistry N, Koyle M, Farhat W, Santos JD. Neurodevelopmental and psychiatric disorders in pediatric bladder and bowel dysfunction. J Pediatr Urol 2021; 17:450.e1-450.e6. [PMID: 33947637 DOI: 10.1016/j.jpurol.2021.03.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bladder and bowel dysfunction (BBD) is a common pediatric problem that describes a constellation of lower urinary tract symptoms associated with constipation and/or encopresis. Its association with neurodevelopmental and psychiatric (NDP) problems is not well understood. OBJECTIVES Our primary aim was to identify pre-existing NDP disorders in children with BBD. Secondarily, we aimed to screen for new behavioral problems and evaluate the association between bladder or bowel symptoms and behaviors symptoms. METHODS A cross sectional study was conducted in urology clinics. New patients referred for BBD between 4 and 17 years old were recruited and completed: a demographics survey, Dysfunctional Voiding Score System questionnaire, assessment of bowel movements with the Bristol Stool Scale, and Strength and Difficulties questionnaire (SDQ). Those with known spinal dysraphism were excluded. SDQ scores were evaluated for abnormal screens in different subscales and total difficulties scores. Pearson correlation analyses were conducted for association. RESULTS We included 61 participants (age 9.5 ± 4.1 years), including 33 females and 28 males. One or more pre-existing NDP disorder(s) was reported in 14 (23%) children; most commonly being learning disability (43%) and attention deficit hyperactivity disorder (29%). This cohort had more severe BBD symptoms as reflected in DVSS scores. SDQ scores demonstrated that 12 patients without pre-existing NDP diagnoses scored in the clinical range, with hyperactivity as the most common difficulty (6/12; 50%). CONCLUSIONS A significant proportion of children with BBD have a comorbid NDP disorder and present with more severe symptomatology. The SDQ can be used as a behavioral screening tool this population for the identification of children who may benefit from formal developmental pediatrics assessment.
Collapse
Affiliation(s)
- Rebecca Wang
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada; Faculty of Art & Science, University of Toronto, Ontario, Canada
| | - Meta Van den Heuvel
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | - Yara El-Bardisi
- Faculty of Art & Science, University of Toronto, Ontario, Canada
| | - Niraj Mistry
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Martin Koyle
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | - Walid Farhat
- Division of Pediatric Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Gizli Çoban Ö, Önder A, Sürer Adanır A. Psychiatric comorbidities of children with elimination disorders. Arch Pediatr 2020; 28:59-63. [PMID: 33223199 DOI: 10.1016/j.arcped.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/27/2020] [Accepted: 10/11/2020] [Indexed: 02/08/2023]
Abstract
Enuresis and encopresis can be stressful for children and parents. We investigated the comorbid psychiatric disorders and the emotional and behavioral symptoms associated with elimination disorders. A total of 97 children and adolescents (aged 4-17 years) with an elimination disorder participated in this study. The elimination disorder group consisted of three subgroups: 50 subjects with enuresis nocturna, 26 with encopresis, and 21 subjects with enuresis+encopresis. The control group with no elimination disorder comprised 50 healthy subjects. All children were interviewed by a child and adolescent psychiatrist. Comorbid psychiatric disorders were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Strengths and Difficulties Questionnaire. The most common diagnosis was attention-deficit/hyperactivity disorder, followed by oppositional defiant disorder. The highest rate of psychiatric comorbidity was observed in the enuresis+encopresis subgroup, followed by the enuresis nocturna and encopresis subgroups. All the subgroups had higher total difficulties scores than the control group. Screening for psychiatric disorders should be performed for all children with incontinence.
Collapse
Affiliation(s)
- Ö Gizli Çoban
- Akdeniz University Tip Faculty, Child and adolescent psychiatry Antalya, Antalya, Turkey.
| | - A Önder
- Akdeniz University Tip Faculty, Child and adolescent psychiatry Antalya, Antalya, Turkey
| | - A Sürer Adanır
- Akdeniz University Tip Faculty, Child and adolescent psychiatry Antalya, Antalya, Turkey
| |
Collapse
|
11
|
Abstract
The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively. Prospective trials were few and the level of evidence was low. Most of the recommendations have been done by committee consensus after extensive discussion of literature reports. History taking is an integral part of evaluation assessing day- and nighttime urine and bowel control, urgency, and frequency symptoms. Exclusion of any neurogenic and organic cause is essential. Uroflowmetry and residual urine determination are recommended in all patients to evaluate bladder emptying. Urodynamic studies are reserved for refractory or complicated cases. Urotherapy that aims to educate the child and family about bladder and bowel function and guides them to achieve normal voiding and bowel habits should initially be employed in all cases except those who have urinary tract infections (UTI) and constipation. Specific medical treatment is added in the case of refractory overactive bladder symptoms and recurrent UTIs.Conclusion: Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.What is Known:• Symptoms of the lower urinary tract may have significant social consequences and sometimes clinical morbidities like urinary tract infections and vesicoureteral reflux. In many children, however, there is no such obvious cause for the incontinence, and they are referred to as having functional bladder problems.What is New:• This review aims to construct a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist, and urologist for LUTS in children. Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.
Collapse
|
12
|
Mattheus HK, Wagner C, Becker K, Bühren K, Correll CU, Egberts KM, Ehrlich S, Fleischhaker C, Föcker M, Hahn F, Hebebrand J, Herpertz-Dahlmann B, Jaite C, Jenetzky E, Kaess M, Legenbauer PhD T, Pfeiffer PhD JP, Renner Md TJ, Roessner V, Schulze U, Sinzig J, Wessing I, von Gontard A. Incontinence and constipation in adolescent patients with anorexia nervosa-Results of a multicenter study from a German web-based registry for children and adolescents with anorexia nervosa. Int J Eat Disord 2020; 53:219-228. [PMID: 31617610 DOI: 10.1002/eat.23182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are common disorders in childhood and are frequently accompanied by comorbid psychiatric disorders. Despite a high association between urinary and fecal incontinence with psychiatric and neurodevelopmental disorders, research on comorbidity between incontinence and anorexia nervosa (AN) remains scarce. Yet, it is well known that somatic consequences of AN include metabolic and gastrointestinal disorders. The study sought to assess the prevalence of incontinence and constipation in children and adolescents with AN and to examine associations of these two symptoms with body weight at admission and with BMI changes during inpatient treatment. METHODS Data collected between 2015 and 2017 by a multicenter German web-based registry for AN were analyzed. Three hundred and forty-eight patients with AN (96.3% female, mean age = 15.1 ± 1.8 years) were assessed regarding AN subtype, psychiatric comorbidity, body weight, incontinence, and constipation. RESULTS Overall, 27.6% of patients had constipation, 1.8% had NE and 1.8% DUI. Prevalence of constipation did not significantly differ between AN subtypes. Constipation did not lead to any significant differences in weight/BMI changes during inpatient treatment. DISCUSSION This is the largest study of incontinence and constipation in patients with AN, so far. Our results indicate that constipation is highly prevalent in adolescent patients with AN and reflects a clinically relevant condition. Despite, patients with AN do not have an increased prevalence of incontinence compared with the general population. Future studies should include medical examinations like ultrasound and physical examination of the lower abdomen to evaluate the severity of constipation.
Collapse
Affiliation(s)
- Hannah K Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Catharina Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg and University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Karin M Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Freia Hahn
- Department of Child an Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR - Hospital Viersen, Viersen, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ekkehart Jenetzky
- Department of Child and Adolescent Psychiatry, University Medicine of the Johannes Gutenberg-University, Mainz, Germany.,Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tanja Legenbauer PhD
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr University Bochum, Bochum, Germany
| | - Jens P Pfeiffer PhD
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg and University Hospital Marburg, Marburg, Germany
| | - Tobias J Renner Md
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital, University of Ulm, Ulm, Germany
| | - Judith Sinzig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Ida Wessing
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| |
Collapse
|
13
|
Nieuwhof-Leppink AJ, Schroeder RPJ, van de Putte EM, de Jong TPVM, Schappin R. Daytime urinary incontinence in children and adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:492-501. [DOI: 10.1016/s2352-4642(19)30113-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 01/21/2023]
|
14
|
Alabaf S, Gillberg C, Lundström S, Lichtenstein P, Kerekes N, Råstam M, Anckarsäter H. Physical health in children with neurodevelopmental disorders. J Autism Dev Disord 2019; 49:83-95. [PMID: 30043349 PMCID: PMC6331488 DOI: 10.1007/s10803-018-3697-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With increasing numbers of children being diagnosed with neurodevelopmental disorders (NDDs) attention has been drawn to these children's physical health. We aimed to identify the prevalence of defined physical problems (epilepsy, migraine, asthma, cancer, diabetes, psoriasis, lactose intolerance, celiac disease, diarrhea, constipation, daytime enuresis, encopresis) in a nationwide population of 9- and 12-year-old twins subdivided into those with and without indications of NDDs. Parents of 28,058 twins participated in a well-validated telephone interview regarding their children's mental health and answered questions about their physical problems. The results indicate a high rate of physical problems in children with NDDs, particularly in those with indications of the presence of combinations of several NDDs.
Collapse
Affiliation(s)
- Setareh Alabaf
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Center for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Henrik Anckarsäter
- Center for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
15
|
Mahdi S, Ronzano N, Knüppel A, Dias JC, Albdah A, Chien-Ho L, Almodayfer O, Bluschke A, Karande S, Huang HL, Christiansen H, Granlund M, de Vries PJ, Coghill D, Tannock R, Rohde L, Bölte S. An international clinical study of ability and disability in ADHD using the WHO-ICF framework. Eur Child Adolesc Psychiatry 2018; 27:1305-1319. [PMID: 29455340 DOI: 10.1007/s00787-018-1124-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 02/09/2018] [Indexed: 01/27/2023]
Abstract
This is the fourth and final study designed to develop International Classification of Functioning, Disability and Health (ICF, and children and youth version, ICF-CY) core sets for attention-deficit hyperactivity disorder (ADHD). To investigate aspects of functioning and environment of individuals with ADHD as documented by the ICF-CY in clinical practice settings. An international cross-sectional multi-centre study was applied, involving nine units from eight countries: Denmark, Germany, India, Italy, Portugal, Saudi Arabia, Sweden and Taiwan. Clinicians and clinical researchers rated the functioning level of 112 children, adolescents and adults with ADHD using the extended ICF-CY checklist version 2.1a. The ratings were based on a variety of information sources, such as medical records, medical history, clinical observations, clinical questionnaires, psychometric tests and structured interviews with participants and family members. In total, 113 ICF-CY categories were identified, of which 50 were related to the activities and participation, 33 to environmental factors and 30 to body functions. The clinical study also yielded strengths related to ADHD, which included temperament and personality functions and recreation and leisure. The study findings endorse the complex nature of ADHD, as evidenced by the many functional and contextual domains impacted in ADHD. ICF-CY based tools can serve as foundation for capturing various functional profiles and environmental facilitators and barriers. The international nature of the ICF-CY makes it possible to develop user-friendly tools that can be applied globally and in multiple settings, ranging from clinical services and policy-making to education and research.
Collapse
Affiliation(s)
- Soheil Mahdi
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), CAP Research Center, Karolinska Institutet, Gävlegatan 22, 11330, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Nadia Ronzano
- Child and Adolescent Neuropsychiatric Unit, Department of Biomedical Science, University of Cagliari and "A. Cao" Microcitemico Paediatric Hospital, Cagliari, Italy
| | - Ane Knüppel
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - José Carlos Dias
- Childhood and Adolescence Psychiatry Department, Oporto Hospital Centre, Porto, Portugal
| | - Ayman Albdah
- Child Psychiatry Division, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
| | - Lin Chien-Ho
- Department of Psychiatry, Chimei Medical Center, Tainan, Taiwan
| | - Omar Almodayfer
- Mental Health Department, KAMC-R, MNGHA, Riyadh, Saudi Arabia
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technical University, Dresden, Germany
| | - Sunil Karande
- Learning Disability Clinic, Department of Paediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Huei-Lin Huang
- Institute of Behavioral Medicine, Institute of Clinical Medicine, Department of Psychiatry, National Chen Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Mats Granlund
- CHILD, SIDR, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - David Coghill
- Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, Australia
| | - Rosemary Tannock
- Research Institute of the Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Luis Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Development Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Sven Bölte
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), CAP Research Center, Karolinska Institutet, Gävlegatan 22, 11330, Stockholm, Sweden.
- Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden.
- Child and Adolescent Psychiatry, Stockholm County Council, 11330, Stockholm, Sweden.
| |
Collapse
|
16
|
Bladder-Bowel Dysfunction in Children: Consequences, Risk Factors and Recommendations for Primary Care Interventions. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
17
|
Franco I, Arlen AM, Collett-Gardere T, Zelkovic PF. Imipramine for refractory daytime incontinence in the pediatric population. J Pediatr Urol 2018; 14:58.e1-58.e5. [PMID: 29100969 DOI: 10.1016/j.jpurol.2017.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND OBJECTIVE Lower urinary tract (LUT) and voiding dysfunction constitute a large percentage of pediatric urology referrals. Children with urinary incontinence unresponsive to behavioral modifications and traditional pharmacotherapy including anticholinergics and alpha blockers remain a challenge. We evaluated the impact of imipramine on treatment outcomes in children with refractory incontinence. STUDY DESIGN Children ≤18 years of age with refractory non-neurogenic daytime incontinence prescribed imipramine were identified. Patient demographics and baseline testing were assessed, as well as medication dosing and side effects of all patients. The Vancouver Symptom Score (VSS) was completed at the initial consultation and each subsequent clinic visit. The questionnaire was self-administered and completed by patients and/or parents. Treatment success was defined as per the International Children's Continence Society (ICCS). RESULTS One hundred and three patients (55 males and 48 females) met the inclusion criteria. The intention-to-treat response rate was 65% (complete 44, partial response 23). Sixteen (15.6%) patients were non-responders and 20 (19.4%) were lost to follow-up. There was no statistical difference between all groups with regards to age, baseline VSS, and dose. Of those children with complete follow-up (n = 83), 44 (53%) experienced complete treatment response. Pre- and post-VSS were statistically different in both complete and partial response groups (complete 19.5-9.5; p < 0.0001; partial 19.7-13; p = 0.0002) (Table). Side effects were reported by 11 out of 83 (13.3%) patients; partial responders experienced a higher likelihood of side effects (26.1%; p = 0.03). DISCUSSION The mainstay of LUT dysfunction management in children is implementation of a bowel program and timed voiding regimen, with additional treatment modalities and pharmacotherapy added depending upon prevailing symptomatology. Daytime incontinence refractory urotherapy, anticholinergics, and/or non-selective alpha blockers can be difficult to treat, and can be unresponsive to parasacral transcutaneous electrical nerve stimulation (TENS) and percutaneous tibial nerve stimulation (PTNS). We observed that over half of children with refractory daytime incontinence reported complete resolution of daytime accidents with imipramine. Limitations of the study include the retrospective nature, relatively small sample size and lack of control group. CONCLUSIONS Two-thirds of children with refractory daytime incontinence experienced treatment response to imipramine, adding a valuable tool to the pediatric urologist's armamentarium in managing select, challenging patients.
Collapse
Affiliation(s)
- Israel Franco
- Department of Urology, Yale University, New Haven, CT, USA.
| | - Angela M Arlen
- Department of Urology, Yale University, New Haven, CT, USA
| | | | - Paul F Zelkovic
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
| |
Collapse
|
18
|
Abstract
OBJECTIVES The aim of the study was to assess the prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with functional defecation disorders (FDDs) and to assess the prevalence of FDDs in children with ADHD. METHODS A cross-sectional cohort study was carried out between September 2014 and May 2016. Group 1: Parents of children with FDDs according to the Rome III criteria completed the Child Behavior Checklist and the VvGK (Dutch questionnaire based on the American Disruptive Behavior Disorder rating scale). Patients with ADHD subarea scores ≥70 on the Child Behavior Checklist and/or ≥16 on the VvGK were referred for further psychiatric evaluation. Group 2: Parents of children treated for ADHD at a specialized ADHD outpatient clinic completed a standardized questionnaire regarding their child's defecation pattern. RESULTS In group 1 (282 children with FDDs), 10.3% (7.1%-13.5% bias-corrected and accelerate confidence interval) were diagnosed with ADHD. Group 2 consisted of 198 children with ADHD, 22.7% (17.6-28.8 bias-corrected and accelerate confidence interval) fulfilled the Rome III criteria for an FDD. Children with both an FDD and ADHD reported urinary incontinence significantly more often compared to children with an FDD or ADHD alone: 57.1% in FDD + ADHD versus 22.8% in FDD alone (P < 0.001) and 31.1% in ADHD + FDD versus 7.8% in ADHD alone (P < 0.001). CONCLUSIONS Approximately 10.3% of children with FDDs had ADHD and 22.7% of children with a known diagnosis of ADHD fulfilled the Rome III criteria for an FDD. This observation suggests that screening for behavioral disorders and FDDs should be incorporated into the diagnostic workup of these groups of children.
Collapse
|
19
|
Physical Therapy for Fecal Incontinence in Children with Pelvic Floor Dyssynergia. J Pediatr 2017; 190:74-78. [PMID: 28807359 DOI: 10.1016/j.jpeds.2017.06.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/26/2017] [Accepted: 06/30/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the efficacy of physical therapy (PT) for fecal incontinence in children with pelvic floor dyssynergia (PFD). STUDY DESIGN Retrospective chart review of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital. The frequency of fecal incontinence (primary outcome), constipation-related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured at baseline and at the final PT visit. Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence). Compliance with PT was determined by the percentage of attended PT appointments. RESULTS Children included met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor. Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance. Children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015). Use of constipation-related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005). Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline. CONCLUSIONS Pelvic floor PT is effective in the majority of children with fecal incontinence related to PFD. Factors associated with PT efficacy include improved PFM functioning, good compliance with PT, and history of tethered cord.
Collapse
|
20
|
Urinary Nerve Growth Factor Can Predict Therapeutic Efficacy in Children With Overactive Bladder. Urology 2017; 103:214-217. [PMID: 28161379 DOI: 10.1016/j.urology.2017.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/14/2017] [Accepted: 01/18/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess urinary nerve growth factor (NGF) in children with overactive bladder (OAB) and to investigate the relationship between urinary NGF/creatinine (Cr) levels and OAB. PATIENTS AND METHODS Thirty-five children (27 boys and 8 girls) with OAB and 11 children (6 boys and 5 girls) without OAB or any other urinary symptoms, who served as controls, were included in this study. Urinary NGF levels were measured using enzyme-linked immunosorbent assay. The total urinary NGF levels were adjusted with the concentration of urinary creatinine (NGF/Cr level). Refractory OAB was defined as little improvement in OAB symptoms despite at least 3 months of urotherapy and anticholinergic agent treatment. Urinary NGF/Cr was compared between the children with OAB and the controls. The relationship between urinary NGF/Cr and treatment outcomes was also evaluated. RESULTS Urinary NGF/Cr was significantly higher in the children with OAB when compared with those in the control group (0.65 ± 0.82 vs 0.11 ± 0.09, P = .0007). Improvement of OAB symptoms was observed in 26 out of 35 children (74%). The remaining 9 children showed refractory OAB symptoms (the refractory group). Urinary NGF/Cr was significantly higher in the refractory group than in the improved group (1.28 ± 1.34 vs 0.44 ± 0.39, P = .027). CONCLUSION Urinary NGF/Cr was significantly higher in the children with OAB than in the controls, and was significantly higher in the refractory group than in the improved group. Urinary NGF/Cr could not only be a potential biomarker for children with OAB, but also a predictor of therapeutic efficacy in children with OAB.
Collapse
|
21
|
Abstract
Overactive bladder (OAB) is a ubiquitous syndrome that is defined by urinary urgency with, or without urinary incontinence. OAB is observed in all parts of the world, with a prevalence of 5-12% in children (5-10 years of age) and a prevalence of 0.5% in older adolescents (16-18 years of age). Published data indicate that around a third of children with OAB are likely to become adults with similar complaints. Studies in children and in adults with OAB indicate that these individuals are more likely to also have anxiety, depression and attention deficit problems, and that appropriate treatment of these comorbidities can often improve the patient's OAB symptoms. Furthermore, data from twin studies and familial surveys seem to indicate a genetic component of OAB. Pharmacological treatments of OAB in children have improved in the past 5 years, moving beyond anticholinergic agents and including the off-label use of α-blockers, β3-agonists and intravesical botulinum toxin. Use of several different electrical stimulation techniques is also effective, both as first-line treatments, and for patients with treatment-refractory symptoms. Overall the outlook of children with OAB seems to be improving, with a greater understanding of the pathophysiology of this syndrome. Treatment modalities that target the source of the underlying problem, especially in children, are likely to provide the best patient outcomes.
Collapse
|