Importance of neuropsychiatric evaluation in children with primary monosymptomatic enuresis

Disgust sensitivity and psychopathic behavior: A narrative review

Humans live under constant threat from pathogenic microorganisms and minimizing such threat has been a major evolutionary selective force in shaping human behavior and health. A particular adaptive mechanism against the harm caused by parasites and their infectiousness is disgust sensitivity, which has evolved to detect and avoid poisonous foods as well as bodily secretions harboring virulent microorganisms. This ubiquitous and reflexive behavior requires the integration of several internal and external sensory signals between the brain, the autonomic nervous system (ANS), and the gastrointestinal tract. Although the emotional expression of disgust is experienced by almost all individuals, the neural mechanisms of sensory signals underlying disgust sensitivity may differ in certain psychiatric conditions. Psychopathy, for instance, is a personality disorder in which disgust sensitivity to contagious bodily secretions is apparently absent or downregulated from its atypical personality temperament. In this review, we provide convergent behavioral, anatomical, and cellular evidence to suggest that a fractured experience of disgust sensitivity might be an additional feature of psychopathic behavior. First, we discuss the neural networks of certain brain regions mediating the emotional states of disgust and then discuss the intersection of the ANS and gastrointestinal tract in the processing of disgust and its relevance to aberrant antisocial behavior. Together, this work highlights the interconnections between the brain and the bilateral body plan as an integrated cell network that is relevant for understanding common principles underlying function and dysfunction of disgust levels in psychiatric domains.

Relationship between elimination disorders and internalizing-externalizing problems in children: A systematic review and meta-analysis

Background

Elimination disorders are highly prevalent in childhood and often associated with clinically relevant comorbid psychological disorders. The aim of this study is to determine if, and to what extent, children with elimination disorders show higher internalizing and externalizing problems than their healthy peers.

Methods

A multistep literature search was performed from database inception until May 1st, 2022. PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022303555) were used to identify studies reporting on internalizing and/or externalizing symptoms in children with an elimination disorder and a healthy control (HC) group. First, a systematic review was provided. Second, where data allowed for it, a quantitative meta-analysis with random effects model was conducted to analyze the differences between the elimination disorder and the HC groups for internalizing and externalizing symptoms. Effect size was standardized mean difference. Meta-regression analyses were conducted to examine the effect of sex, age, and study quality. Funnel plots were used to detect a publication bias. Where found, the trim and fill method was used to correct it.

Results

36 articles were included, 32 of them reporting on enuresis (n = 3244; mean age = 9.4; SD = 3.4; 43.84% female) and 7 of them on encopresis (n = 214; mean age = 8.6; SD = 2.3; 36.24% female). Children with an elimination disorder presented significantly lower self-concept (ES:0.42; 95%CI [0.08; 9.76]; p = 0.017) and higher symptom scores for thought problems (ES:-0.26; 95%CI: -0.43;-0.09]; p = 0.003), externalizing symptoms (ES: -0.20; 95%CI [-0.37;-0.03]; p = 0.020), attention problems (ES:-0.37; 95%CI [-0.51;-0.22]; p = 0.0001), aggressive behavior (ES:-0.33; 95%CI [-0.62;-0.04]; p = 0.025) and social problems (ES:-0.39; 95%CI [-0.58;-0.21]; p = 0.0001). Significant publication biases were found across several of the studied domains. No significant effect of sex, age or quality of the study score was found.

Conclusions

Children with an elimination disorder may have significant internalizing and externalizing problems, as well as impaired self-concept. It is recommendable to screen for them in children with enuresis or encopresis and provide appropriate interventions.

An evaluation of parental attitudes and attachment in children with primary monosymptomatic nocturnal enuresis: A case-control study

INTRODUCTION

Enuresis is a common childhood disorder associated with the lack of bladder control that would be expected based on the child's age or developmental stage. Enuresis affects the lives of both children and their parents due to the burden it entails in daily life.

OBJECTIVE

In this study, we aimed to evaluate the dimensions of attachment between children with enuresis and their mothers, as well as the relationship with parental attitudes.

METHODS

This study included 70 children were diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) based on the guidelines of the International Children's Continence Society (ICCS) along with 70 children with not enuresis and any psychiatric disorders. We asked the mothers of all participants to complete the Parental Attitude Research Instrument, and the children to complete The Experiences in Close Relationships Scale Revised - Middle Childhood.

RESULTS

Both groups in our study were well balanced in terms of gender, age, and sociodemographic data. Children with enuresis were found to score higher on the anxiety and avoidance dimensions of the attachment scale with statistical significance (p < 0.01). Also, on the scale completed by the mothers of children with enuresis, the subtests indicating overprotective parenting and strict discipline presented significant differences (p < 0.01).

DISCUSSION

Data obtained in our study demonstrate that enuresis can have a negative effect on the mother-child attachment and parental attitudes. The use of harsh language or punishment by the mother in response to the failure of the child to achieve nocturnal dryness may affect the attachment between the mother and the child, and cause the child to experience negative emotions such as shame, anxiety, embarrassment, frustration, and loneliness.

CONCLUSION

We think that it would be useful to evaluate the mother-child attachment and the crisis experienced by the family after each wetting incidence in combination with parental attitudes and behaviors in the treatment of enuresis cases.

Evaluation of health-related quality of life and affecting factors in child with enuresis

BACKGROUND

Enuresis is a common problem in children and distressing condition that can have an impact on the child's behavior and on their emotional and social life. Health-related quality of life (HRQoL) is defined as an individual's perception of the impact of the disease and treatment.

OBJECTIVE

The aim of this study was to evaluate the HRQoL in Turkish children with enuresis and to investigate the effect of independent sociodemographic and clinical variables on HRQoL in children with enuresis.

STUDY DESING

110 children with enuresis and their mothers and 120 healthy children and their mothers were included in the study. The German quality of life questionnaire (KINDL®) scales were used to assess the children's HRQoL. For comparing the data of children with enuresis and healthy children, a two-sided unpaired t-test and linear regression model were used.

RESULT

The total HRQoL score for the children with enuresis group was 63.14 ± 21.98 and for the children in the control group was 75.6 ± 10.1 (P < 0.001). After adjusting for sex and age using the unstandardized coefficient of regression model, HRQoL score for the children with enuresis still remained statistically significant lower than that for healthy peers (64.21 ± vs 75.11 ± P < 0.001). The HRQoL subscale scores showed that children with enuresis had lower emotional well-being scores (64.23 ± 14.2 vs 78.9 ± 11.4, P < 0.001), self-esteem score (62.23 ± 11 vs 68.6 ± 17.4, P = 0.001), family relationship score (76.23 ± 2 vs 83.4 ± 12.2, P = 0.042), and friendship score (62.4 ± 13.2 vs 68.8 ± 15.3, P = 0.023) compared to the control group. When the effects of independent sociodemographic factors and clinical variables on HRQoL were evaluated, it was seen that the presence of lower urinary tract symptoms (LUTS) negatively affected total HRQoL score (59.89 ± 11.2 vs 69.29 ± 10.9 P = 0.028). Also the total HRQoL score was higher in treated children with enuresis than in nontreated children (65.96 ± 12.1 vs 55.27 ± 10.1 P = 0.032). Among the treated children, complete treatment response group had higher total HRQoL score compared to partial treatment response group and nonresponse group (respectively, 70.98 ± 9.7, 65.25 ± 10.1, 60.45 ± 10.9, P = 0.034, P = 0.01) (Summary Figure). Family income level affected total HRQoL score, low-income group had lower total HRQoL score compared to high-income group (62.17 ± 11.9 vs 69.25 ± 10 P = 0.039).

DISCUSSION

This study demonstrated that enuresis negatively affects the HRQoL of children and most affected domains in HRQoL were self-esteem, emotional well-being, and their relationship for family and friends. Our presented study showed that HRQoL was lower in non-primary monosymptomatic nocturnal enuresis (non-PMNE) children, nontreated patients. Also there were higher HRQoL scores in patients who had a total or partial response to treatment.

CONCLUSION

Our study may indicate that, low-income children with enuresis, nontreated enuretic children, and presence of LUTS should be considered as a risk group for low HRQoL.

Practical recommendations of the EAU-ESPU guidelines committee for monosymptomatic enuresis-Bedwetting

BACKGROUND AND AIMS

The objective of this update of the EAU-ESPU guidelines recommendations for nocturnal enuresis was to review the recent published literature of studies, reviews, guidelines regarding the etiology, diagnosis and treatment options of nocturnal enuresis and transform the information into a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist and urologist.

MATERIAL AND METHODS

Since 2012 a monthly literature search using Scopus® was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (http://bedwetting.europeanurology.com/). In addition, guideline papers and statements of the European Society for Paediatric Urology (ESPU), the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the International Children Continence Society (ICCS) were used to update the knowledge and evidence resulting in this practical recommendation strategy. Recommendations have been discussed and agreed within the working group of the EAU-ESPU guidelines committee members.

RESULTS

The recommendations focus to place the child and his family in a control position. Pragmatic analysis is made of the bedwetting problem by collecting voiding and drinking habits during the day, measuring nighttime urine production and identification of possible risk factors such as high-volume evening drinking, nighttime overactive bladder, behavioral or psychological problems or sleep disordered breathing. A questionnaire will help to identify those risk factors.

CONCLUSION

Motivation of the child is important for success. Continuous involvement of the child and the family in the treatment will improve treatment compliance, success and patient satisfaction.

The impact of bowel and bladder problems on children's quality of life and their parents: A scoping review

BACKGROUND

Functional bladder and bowel problems are common in children and have a serious psychological as well as physical impact. The objective of this scoping review was to synthesise evidence on the impact of such conditions both on children's quality of life (QOL) and their parents.

METHODS

The scoping review followed Arksey and O'Malley's framework. Relevant studies were identified by a comprehensive search of scientific databases. Inclusion criteria focused on children with bladder and bowel dysfunction, their QOL, and impact on parents. Studies were analysed for aims, study populations, measures, and results.

RESULTS

A total of 783 records were retrieved with 30 meeting the criteria. Most studies found that QOL was reduced in children with nocturnal enuresis, day bladder dysfunction, bowel dysfunction, and combined bladder and bowel dysfunction. Parents' QOL and social-emotional functioning were also negatively affected.

CONCLUSIONS

Functional bladder and bowel problems should be identified and treated as early as possible to minimise negative impacts on QOL of children and their carers. Future research should focus on how to best provide early and effective intervention in the most accessible manner.

Urinary disorders and bladder-bowel dysfunction in children: approaches to diagnosis, treatment and prevention

Pediatric urinary disorders manifested as urinary incontinence, compelling urges to urinate, etc. remain an important problem of contemporary healthcare. In spite of being extensively covered in the literature, urinary disorders, including enuresis, still present a diagnostic challenge to the physicians of primary healthcare facilities. Based on the findings of our retrospective study that revealed discrepancies between referral and final diagnoses of pediatric urinary disorders, we give recommendations to both physicians of primary healthcare facilities and their inpatient care colleagues that will help them to arrive at the correct diagnosis of a urinary disorder or concomitant bladder-bowel dysfunction using the proposed diagnostic algorithm.