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Aymerich C, Pedruzo B, Pacho M, Herrero J, Laborda M, Bordenave M, Salazar de Pablo G, Sesma E, Fernández‐Rivas A, Catalan A, González‐Torres MÁ. Relationship between elimination disorders and internalizing-externalizing problems in children: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12185. [PMID: 37720580 PMCID: PMC10501701 DOI: 10.1002/jcv2.12185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 06/09/2023] [Indexed: 09/19/2023] Open
Abstract
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.
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Affiliation(s)
- Claudia Aymerich
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
- Psychiatry Department. Biocruces Bizkaia Health Research InstituteBilbaoSpain
- Centro de Investigación en Red de Salud Mental (CIBERSAM)MadridSpain
| | - Borja Pedruzo
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
| | - Malein Pacho
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
| | - Jon Herrero
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
| | - María Laborda
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
| | | | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Department of Psychosis StudiesEarly Psychosis: Interventions and Clinical‐detection (EPIC) LabInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Child and Adolescent Mental Health Services (CAMHS)South London and Maudsley NHS Foundation TrustLondonUK
| | - Eva Sesma
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
- Psychiatry Department. Biocruces Bizkaia Health Research InstituteBilbaoSpain
- Centro de Investigación en Red de Salud Mental (CIBERSAM)MadridSpain
- Neuroscience DepartmentUniversity of the Basque Country (UPV/EHU)LeioaSpain
| | - Aranzazu Fernández‐Rivas
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
- Psychiatry Department. Biocruces Bizkaia Health Research InstituteBilbaoSpain
- Centro de Investigación en Red de Salud Mental (CIBERSAM)MadridSpain
- Neuroscience DepartmentUniversity of the Basque Country (UPV/EHU)LeioaSpain
| | - Ana Catalan
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
- Psychiatry Department. Biocruces Bizkaia Health Research InstituteBilbaoSpain
- Centro de Investigación en Red de Salud Mental (CIBERSAM)MadridSpain
- Neuroscience DepartmentUniversity of the Basque Country (UPV/EHU)LeioaSpain
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Miguel Ángel González‐Torres
- Psychiatry DepartmentBasurto University HospitalBilbaoSpain
- Psychiatry Department. Biocruces Bizkaia Health Research InstituteBilbaoSpain
- Centro de Investigación en Red de Salud Mental (CIBERSAM)MadridSpain
- Neuroscience DepartmentUniversity of the Basque Country (UPV/EHU)LeioaSpain
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Jie LP. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children. Open Med (Wars) 2023; 18:20230712. [PMID: 37398900 PMCID: PMC10314128 DOI: 10.1515/med-2023-0712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 07/04/2023] Open
Abstract
The objective was to explore the efficacy of Tongdu Tuina manipulation in the treatment of primary single-symptom enuresis in children. A total of 102 children aged 5-16 with primary single-symptom enuresis were included in this study and randomly assigned to the Tuina group, the medication group and the control group, with 34 children in each group. The Tongdu Tuina group included manipulation of the Guanyuan, Qihai, Zhongji, Mingmen, kidney, Baihui, Sishencong and bladder acupoints, five times a week, the medication group was treated with 0.1 mg desmopressin acetate every night, and in the control group, the patients were given foods with high water content and underwent water deprivation 2 h before bedtime every night. The intervention time of each group was 1 month. The participants were followed up on Day 1 following treatment, as well as half a month, 1 month and 3 months after the implementation of the intervention measures, and the effective rate, the incidence of enuresis per week and the recurrence rate were calculated. As a result baseline demographic characteristics were comparable among 102 patients. Overall, 32 patients in the Tongdu Tuina group, 30 patients in the medication group and 34 patients in the control group completed the intervention. After half a month of treatment, there was no significant difference in the therapeutic efficacy among the three groups (P = 0.158), but each treatment could effectively reduce the frequency of weekly enuresis. The frequency of weekly enuresis in the Tongdu Tuina group was 3.8 ± 1.1 times, while that in the medication group was 4.0 ± 2.0 times. The frequency of weekly enuresis in the control group was 4.7 ± 1.8 times, and the difference was statistically significant (P = 0.016). After 1 month of treatment, the effective rates of the Tongdu Tuina group and the medication group were significantly increased (87.5% vs 83.33%, P < 0.0001), which was not the case with the control group. The frequency of enuresis was 1.9 ± 2.1 times per week in the Tongdu Tuina group, 2.4 ± 1.8 times per week in the medication group and 4.0 ± 0.9 times per week in the control group after 1 month of treatment. The difference between the three groups was statistically significant (P = 0.021), and there was a difference between the Tongdu Tuina group and the medication group (P < 0.0001). There was no significant difference between recurrence rate and the incidence of adverse events (P = 0.837, P = 0.856). In conclusion, both Tuina manipulation and desmopressin treatment can effectively improve children's primary single-symptom enuresis with safety. However, Tongdu Tuina therapy may be superior to desmopressin treatment.
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Affiliation(s)
- Li-Pu Jie
- Department of Paediatrics, The First People’s Hospital of Lanzhou, No. 1, Wujia West Street, Qilihe District, Lanzhou City, Gansu, 730050, China
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Chen Q, Zhao J, Gu H, Li X. Inhibitory Control of Emotional Interference in Deaf Children: Evidence From Event-Related Potentials and Event-Related Spectral Perturbation Analysis. Front Psychiatry 2022; 13:897595. [PMID: 35815005 PMCID: PMC9263210 DOI: 10.3389/fpsyt.2022.897595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impairment of interference control ability may reflect a more general deficit in executive functioning, and lead to an increase in internal-externalized problems such as impulsivity, which has been reported in deaf children. However, few researches have examined the neural mechanism of this impairment. METHODS This study applied the electroencephalogram (EEG) technique to investigate the interference control ability in 31 deaf children and 28 hearing controls with emotional face-word stroop task. RESULTS Results from behavioral task showed that deaf children exhibited lower accuracy compared to hearing controls. As for EEG analysis, reduced activation of ERP components in N1 and enhanced activation of ERP components in N450 have been found in deaf children. Besides, incongruent condition elicited larger N450 than congruent condition. Furthermore, for brain oscillation, alpha band (600-800 ms) revealed a reduced desynchronization in deaf children, while theta band (200-400 ms) revealed an enhanced synchronization in deaf children and incongruent condition, which were in line with ERP components. CONCLUSION The present findings seem to indicate that the deficit during emotional interference control ability among deaf children might be due to the impaired attention allocation ability and emotional cognitive monitoring function during emotional conflict detection process. Consequently, reduced N1 and enhanced N450 might be due to early attention impairment causing more effort of deaf children later in emotional cognitive monitoring.
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Affiliation(s)
- Qiong Chen
- Shaanxi Provincial Key Research Center for Children Mental and Behavioral Health, School of Psychology, Shaanxi Normal University, Xi'an, China.,Institute of Behavior and Psychology, School of Psychology, Henan University, Kaifeng, China
| | - Junfeng Zhao
- Institute of Behavior and Psychology, School of Psychology, Henan University, Kaifeng, China
| | - Huang Gu
- Institute of Behavior and Psychology, School of Psychology, Henan University, Kaifeng, China
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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Sun H, Xue B, Peng M, Ma H, Yu B, Hou Y, Guo Q. Abnormal neurite orientation dispersion and density imaging of white matter in children with primary nocturnal enuresis. NEUROIMAGE-CLINICAL 2020; 28:102389. [PMID: 32911428 PMCID: PMC7490590 DOI: 10.1016/j.nicl.2020.102389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
NODDI probes white matter (WM) microstructure in PNE children. Different patterns of WM microstructural abnormalities were found in PNE children. NDI of anterior thalamic radiation was correlated with abnormal arousal in PNE children.
Several lines of evidence indicate that multiple abnormalities of gray matter are related to the pathogenesis of primary nocturnal enuresis (PNE); however, few studies have been conducted with respect to abnormalities in white matter (WM) of children with PNE. The present work investigated the microstructure of WM in children with PNE using a neurite orientation dispersion and density imaging (NODDI) method. NODDI data were obtained from 29 children with PNE (age = 9.8 ± 1.2 years, 59% males) and 34 healthy controls (age = 10.3 ± 1.6 years, 56% males) in this study. Multi-b-value diffusion-weighted imaging data were acquired with a 3 T MR system, and the orientation dispersion index (ODI) and neurite density index (NDI) maps were calculated. Tract-Based Spatial Statistics analyses of WM tracts were performed with ODI and NDI maps in children with PNE and controls. Children with PNE had lower ODIs in WM fiber tracts of the bilateral superior longitudinal fasciculus (SLF) and higher ODIs in the bilateral internal capsule (IC) and right anterior thalamic radiation (ATR) than controls. PNE children also had lower NDIs in the bilateral IC and the cingulum and higher NDIs in the bilateral SLF. These changes in NODDI indices, which indicated abnormal neural maturation of the WM microstructures, may be related to abnormal sleep and enuresis in children with PNE.
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Affiliation(s)
- Hongbin Sun
- Department of Radiology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China.
| | - Bing Xue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Miao Peng
- Department of Psychology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Hongwei Ma
- Department of Developmental Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Bing Yu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Abnormal neural responses to emotional stimuli in children with primary monosymptomatic nocturnal enuresis. Eur Child Adolesc Psychiatry 2019; 28:949-956. [PMID: 30474751 DOI: 10.1007/s00787-018-1255-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022]
Abstract
Nocturnal enuresis (NE) is a common disorder in school-aged children that has been reported to affect nearly 10% of 7-year-old children and affects both the children and their families. Previous studies have shown that the risk of psychosocial difficulties in children with enuresis is elevated. Thus, children with NE may experience negative effects on psychosocial health or emotion processing. Therefore, the aim of this study was to investigate the potential disturbance in emotional processing in children with NE using functional magnetic resonance imaging (fMRI). In this work, we used fMRI and an affective picture task to evaluate brain response changes in children with NE. Two groups, one consisting of 22 children with primary monosymptomatic NE and one with 23 healthy controls, were scanned using fMRI. Compared to the healthy subjects, children with NE mainly showed increased activation when viewing negative vs. neutral pictures in the bilateral medial superior frontal gyrus that extended to the anterior cingulate cortex. Our results demonstrated that children with primary monosymptomatic NE showed abnormal neural responses to emotional stimuli and overactivation in the medial prefrontal and anterior cingulate cortices suggested that children with primary monosymptomatic NE may be hypersensitive in their sensory perception of negative pictures.
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Sousa E Silva GJ, Sammour SNF, Ferraro AA, Koch VHK. Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis. J Pediatr (Rio J) 2019; 95:188-193. [PMID: 29428322 DOI: 10.1016/j.jped.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/30/2017] [Accepted: 11/20/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate and correlate, before and after the therapeutic intervention, the behavioral problem scores evaluated by the CBCL/6-18 questionnaire and the quality of life indexes evaluated by the PedsQL™ 4.0 in patients with monosymptomatic nocturnal enuresis. METHOD After the initial evaluation and completion of the CBCL/6-18 questionnaire, a multidisciplinary evaluation and completion of the PedsQL™ 4.0 questionnaire was performed. Of the initially evaluated 140 children and adolescents aged 6-16 years, 58 were excluded due to non-monosymptomatic enuresis or associated comorbidities. Of the initially included 82 patients, who were randomized to three treatment groups, 59 completed the CBCL/6-18 and PedsQL™ 4.0 questionnaires at the end of the treatment and were included in this study. The α error was set at 5% for ruling out the null hypothesis. RESULTS Of the total of 59 participants, 45.8% responded with total success, 23.7% were partially successful, 23.7% did not reach the improvement criteria, and 6.8% gave up the treatment. There was a significant increase in quality of life indexes and a reduction of post-intervention behavioral problem scores, in the three proposed modalities, in patients who had a total or partial response to treatment. There was no correlation between higher scores of pre-treatment behavior problems and therapeutic failure. CONCLUSIONS Only the participants who successfully responded to interventions showed improvement in quality of life and behavioral problems, which indicates that enuresis is a primary problem that has a negative impact on these parameters. The authors suggest that it is possible to achieve success in the treatment of monosymptomatic enuresis, even in patients with high pre-intervention behavioral problem scores.
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Affiliation(s)
| | - Simone Nascimento Fagundes Sammour
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Pediatria, Hospital das Clínicas, Instituto da Criança (ICr), São Paulo, SP, Brazil
| | | | - Vera Hermina Kalika Koch
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Pediatria, São Paulo, SP, Brazil
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Sousa e Silva GJ, Sammour SNF, Ferraro AA, Koch VHK. Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yu B, Huang M, Zhang X, Ma H, Peng M, Guo Q. Noninvasive imaging of brain oxygen metabolism in children with primary nocturnal enuresis during natural sleep. Hum Brain Mapp 2017; 38:2532-2539. [PMID: 28195439 DOI: 10.1002/hbm.23538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/23/2016] [Accepted: 02/02/2017] [Indexed: 12/21/2022] Open
Abstract
A series of studies have revealed that nocturnal enuresis is closely related to hypoxia in children with primary nocturnal enuresis (PNE). However, brain oxygen metabolism of PNE children has not been investigated before. The purpose of this study was to investigate changes in whole-brain cerebral metabolic rate of oxygen (CMRO2 ), cerebral blood flow (CBF), and oxygen extraction fraction (OEF) in children suffering from PNE. We used the newly developed T2-relaxation-under-spin-tagging (TRUST) magnetic resonance imaging technique. Neurological evaluation, structural imaging, phase-contrast, and the TRUST imaging method were applied in children with PNE (n = 37) and healthy age- and sex-matched control volunteers (n = 39) during natural sleep to assess whole-brain CMRO2 , CBF, OEF, and arousal from sleep scores. Results showed that whole-brain CMRO2 and OEF values of PNE children were higher in controls, while there was no significant difference in CBF. Consequently, OEF levels of PNE children were increased to maintain oxygen supply. The elevation of OEF was positively correlated with the difficulty of arousal. Our results provide the first evidence that high oxygen consumption and high OEF values could make PNE children more susceptible to hypoxia, which may induce cumulative arousal deficits and make them more prone to nocturnal enuresis. Hum Brain Mapp 38:2532-2539, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Bing Yu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Mingzhu Huang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xu Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Hongwei Ma
- Department of Developmental Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Miao Peng
- Department of psychology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
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Visual cortex and cerebellum hyperactivation during negative emotion picture stimuli in migraine patients. Sci Rep 2017; 7:41919. [PMID: 28181500 PMCID: PMC5299401 DOI: 10.1038/srep41919] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023] Open
Abstract
Migraines are a common and undertreated disease and often have psychiatric comorbidities; however, the abnormal mechanism of emotional processing in migraine patients has not been well clarified. This study sought to investigate the different brain functional activation to neutral, positive and negative emotional stimuli between migraine and healthy subjects. Twenty-six adults with migraines and 26 healthy adults, group-matched for sex and age, participated in this experiment. Although there were no significant differences between two groups during the viewing of positive affective pictures vs. neutral affective pictures, there were different activation patterns during the viewing of negative to neutral affective pictures in the two groups; the control group showed both increased and decreased activation patterns, while the migraine subjects showed only increased activation. Negative affective pictures elicited stronger activation than neutral affective pictures in migraineurs, which included the bilateral cerebellum anterior lobe/culmen, the bilateral lingual gyri, the bilateral precuneus and the left cuneus. Our data indicated that migraine patients were hypersensitive to negative stimuli, which might provide clues to aid in the understanding of the pathophysiology and psychiatric comorbidities of migraines.
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