Dysfunctional Disorder Research Articles

Nonneurogenic Neurogenic Bladder Dysfunction Diagnosed Prenatally Or In Early Infancy

PURPOSE Nonneurogenic neurogenic bladder (NNNB) is a potentially severe dysfunctional voiding disorder including detrusor-sphincter functional dyssynergia and upper-tract dilatation without anatomic outlet obstruction or neurological defect. Although NNNB is thought to be an acquired condition it seems that it can sometimes be a congenital dysfunction, revealed before toilet training. We report our experience with NNNB diagnosed during early infancy, focusing on those revealing on prenatal US. MATERIAL AND METHODS We retrospectively reviewed the cases of NNNB in children diagnosed before toilet training. We included either cases of NNNB dysfunction without prenatal symptoms (group 1) and children with urinary tract abnormalities on prenatal ultrasound (group 2). RESULTS In group 1, six children (two females) presented at a median age of 20 months (range 2- 30) with indirect signs of bladder dysfunction including either vesico-ureteral reflux (n = 4) and/or hydro-ureteronephrosis (n = 4). After a median follow-up of 11 years (range 5–20), 3/6 children were on clean intermittent catheterization (two Mitrofanoff), and 3/6 underwent bladder augmentation . Three children had chronic renal failure of whom one underwent renal transplant. In group 2, five children (one girl, T21) had prenatally diagnosed bilateral hydro-ureteronephrosis. Follow-up showed decompensation toward severe bladder dysfunction, diagnosed either after toilet training, or after ureteral reimplantation (n = 3). Currently, with a median follow-up of 14 years (range 0,5-20), 4/5 were on CIC with bladder augmentation, and the remaining required sphincterial reeducation with good result. Two of them had chronic renal failure. CONCLUSIONS All of these cases NNNB were initially misdiagnosed. In both groups, follow-up revealed upper tract severe impairment and secondary renal dysfunction. Antenatal diagnosis of bilateral pyeloureteral dilatation may be the first sign of early bladder dysfunction.

Dysfunctional belief-based obsessive-compulsive disorder subgroups

An attempt was made to identify obsessive-compulsive disorder (OCD) subgroups based on differences in OCD related beliefs. OCD patients ( N = 3 6 7 ) were assessed with the Obsessional-Beliefs Questionnaire prior to treatment. Individuals’ scores on measures of inflated personal responsibility and the tendency to overestimate threat, perfectionism and intolerance of uncertainty, and over-importance and over-control of thoughts were subjected to cluster analysis. Support for both a simple and complex subgroup model was found (2-subgroup and 5-subgroup taxonomies). A low-beliefs subgroup was identified in both taxonomies. The low-beliefs subgroups reported scores on belief measures equivalent to scores reported for non-OCD comparison groups in earlier studies. Additional analyses were conducted to determine relations between belief-based and symptom subgroups. Significant relationships were found (e.g., Symmetry symptom subgroup membership was associated with membership in the Perfectionism/Certainty beliefs subgroup), although the shared variance was modest. Implications for understanding OCD heterogeneity and for cognitive theory are discussed.

Widespread pain as a risk factor for dysfunctional temporomandibular disorder pain

Widespread pain has been found to be a risk factor for onset and persistence of temporomandibular disorder (TMD) pain. The aim of this cohort study was to determine if widespread pain is associated with interference and disability related to TMD pain. Three hundred and ninety-seven TMD patients were interviewed at 1 and 2 years following enrollment. Dysfunctional TMD pain was defined as grades IV, III and II with any disability points on the graded chronic pain scale (GCPS). Widespread pain was defined by the number of pain sites (0–4: head, back, stomach, chest) outside the masticatory system. Multivariable logistic regression analysis, controlling for the effects of age, education, depression, baseline GCPS, and time since study enrollment, was used to examine the relationship between widespread pain and risk of onset or maintenance of dysfunctional TMD pain during follow-up. Among women without dysfunctional TMD pain at baseline, widespread pain was a risk factor for development of dysfunctional TMD pain (odds ratio (OR): 1.9, 95% confidence interval (CI): 1.2–2.8, P=0.003). However, there was no association between widespread pain and onset of dysfunctional TMD pain among men (OR: 1.0, 95% CI: 0.4–2.8, P=0.95) or maintenance of dysfunctional TMD among either women (OR: 1.0, 95% CI: 0.8–1.4, P=0.85) or men (OR: 0.4, 95% CI: 0.1–3.2, P=0.40). Widespread pain was independently and highly associated with risk of developing pain-related disability among women who did not have pain dysfunction at baseline, but was not predictive of risk of onset of dysfunctional TMD pain among men or maintenance of dysfunctional pain among either women or men.

Questions & answers

Dysfunctional elimination disorder is common in children with a history of infrequent bowel movements and reports of urinating three or fewer times per day. Most children with fecal incontinence related to constipation do not have an underlying organic disorder ( 5 Guerrero R. Cavender C. Constipation: Physical and psychological sequelae. Pediatric Annals. 1999; 28: 312-316 PubMed Google Scholar ). Urinary incontinence and fecal incontinence often occur together ( 3 Floch M. Dowd J. Incontinence and constipation: Pelvic floor disorders of gastrointestinal motility and urodynamics. Journal of Clinical Gastroenterology. 1998; 27: 4-5 Crossref PubMed Scopus (2) Google Scholar ). Fecal retention or “hoarding” causes chronic rectal distension and a decrease in tone. When the child has a large amount of compacted stool, a liquid or solid overflow of stool may occur. Dysfunctional voiding disorders are characterized by inefficient urination in the absence of anatomic or neurologic disease. This disorder may be a result of failure to relax the urethral sphincter and pelvic floor muscles. At a 2-week follow-up visit, you review Tiffany's ultrasound and discover that she indeed has an enlarged bladder capacity. You have ruled out other underlying disorders that may cause some of these same symptoms: Hirschsprung's disease, neurogenic bladder and bowel disorders, and adverse effects from medications.

Chronic pain conditions in women.

There are inconsistent data on the age/sex prevalence pattern of back pain and on chest pain. However, it is possible that for chest pain, the rates are higher in younger women and older men. Neck pain, joint pain, and fibromyalgia all appear to increase with age in both genders, whereas abdominal pain and tension-type headaches decrease with age, and migraine headache and TMD appear to peak in the reproductive years. A concluding example illustrates how epidemiologic data can be used to enhance our understanding of the causes of pain. A higher prevalence in women and a peak prevalence during the reproductive years as seen in TMD suggest that either biologic or psychosocial factors unique to women in this period of life could increase the risk of developing or maintaining this pain. As female reproductive hormones can play a role in migraine, at least for some women, it would be interesting to examine whether hormones play a role in TMD. The situation that occurs when menopause is followed by hormone replacement therapy (HRT) provides a natural experiment similar to a laboratory experiment in which female animals are deprived of the natural sources of hormones and then hormones are replaced exogenously. In women, of course, the decision to receive HRT may be associated with a number of psychosocial variables that might also influence pain. Recognizing these limitations, data from records of a large health maintenance organization were examined to ascertain whether use of estrogen or progestin (or both) in postmenopausal women might be associated with the occurrence of TMD pain and, thus, whether the hormone hypothesis might be worthy of further investigation. More women with TMD than controls used estrogen replacement therapy, and slightly more patients than controls used progestin. The use of estrogen significantly increased the odds of having TMD. Progestin use showed a weaker association, which did not hold up after other factors were controlled. However, the risk of TMD appears to increase with increasing doses of estrogen. A review of the epidemiologic literature indicates that there are definite age and sex differences in the prevalence of many chronic pain conditions. There is little basic information about the source of these differences, such as different onset rates, different probabilities of recurrence, or different durations of pain, or combinations of these in women and men. Nevertheless, a systematic examination of the existing epidemiologic data may be an important step in helping pain researchers to generate hypotheses in the search for a better understanding of chronic pain in both sexes.

Concepts of illness in populations as applied to fibromyalgia syndromes: a biopsychosocial perspective.

Chronic widespread musculoskeletal pains have been recorded since antiquity. However, critical medical and experimental research on these conditions have been performed mainly within the past one or two decades. Controversy exists regarding many aspects of these common problems, including: classification and nosology; causation mechanisms; course and outcomes, as well as management strategies. Fibromyalgia syndrome (FMS) is not a disease. Neither a defined pathology nor specific etiological mechanisms have been documented. Instead, FMS may be considered a dysfunctional disorder. Constellations of typical, although diverse, manifestations have been identified as well as predisposing factors. Under such circumstances, a new biopsychosocial paradigm of person-centered dynamics, rather than an agent per se or the environment, is fundamental to understanding the complex multifactorial interactions in FMS. Conceptual models of etiology and research methodology to investigate such complex, multifactorial mechanisms are not yet well-developed. More effective research approaches and improved management of persons with FMS is expected to result from such new conceptual constructs.