Voiding Disorders Research Articles

MP77-09 CHRONIC PSYCHOLOGICAL STRESS LEADS TO BLADDER HYRALGESIA VIA STRESS INDUCED SENSITIZATION OF C FIBERS AND MECHANORECPTORS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2016MP77-09 CHRONIC PSYCHOLOGICAL STRESS LEADS TO BLADDER HYRALGESIA VIA STRESS INDUCED SENSITIZATION OF C FIBERS AND MECHANORECPTORS Yunliang Gao, Rong Zhang, Huiyi Chang, and Larissa Rodriguez Yunliang GaoYunliang Gao More articles by this author , Rong ZhangRong Zhang More articles by this author , Huiyi ChangHuiyi Chang More articles by this author , and Larissa RodriguezLarissa Rodriguez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients affected by overactive bladder and painful bladder syndrome/interstitial cystitis report symptoms exacerbation when stressed. We have shown that anxiety prone animals exposed to chronic psychological water avoidance stress (WAS) develop sustained bladder hyperalgesia. The bladder cooling reflex (BCR) is a segmental reflex believed to be triggered by cold receptors in bladder wall with C fibers signaling. We aimed to evaluate the chronic stress induces changes in BCR and if C fiber sensitization contributes to stress-induced bladder hypersensitivity. METHODS 22 adult female Wistar-Kyoto rats equally divided to 10-day WAS or handled controls. On day 11, animals were evaluated by cystometrogram (CMG) as well as visceromotor reflex (VMR) for bladder sensitivity and pain to saline infusion. CMG and VMR were obtained during bladder infusion at room temperature (RT) and cold (4 degree C) with an open urethral outlet thus allowing the animal to void. CMG and VMR were also obtained during RT isotonic bladder distention (RT-IBD, 10-40 cmH2O) with urethral occlusion. RESULTS During RT infusion, WAS rats had a significant decreases in pressure threshold (PT) and the ratio of VMR threshold/maximum intravesical pressure (IVPmax). VMR duration significantly increased in WAS. BCR induced a more dramatic significant decline in PT and the ratio of VMR threshold/IVPmax in WAS (Fig.1A). No significant differences were found in contraction duration, inter-contraction interval or the VMR area under the curve (AUC) and duration. At RT-IBD (Fig.1B-C), VMR latency in WAS significantly decreased compared to controls. At 20 cmH2O, VMR AUC in WAS significantly increased compared to controls. CONCLUSIONS Chronic psychological stress induces bladder hypersensitivity, which manifests as earlier voiding and VMR. Prolonged VMR duration in WAS correlates with increased bladder sensitivity during voiding. BCR evokes C fibers activation and suggests that stress induced bladder hypersensitivity in functional voiding disorders mediated in part by afferent sensitization. Earlier VMR appearance at RT-IBD suggests a role for mechanoreceptor sensitivity in stress-induced bladder hypersensitivity. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1018-e1019 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yunliang Gao More articles by this author Rong Zhang More articles by this author Huiyi Chang More articles by this author Larissa Rodriguez More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Association between elimination disorders and abusive maternal attitudes

ObjectiveEnuresis and encopresis, both conditions are very distressful to children and their family members and it is responsible for significant social and psychological consequences in children and adolescents. The present study aims to determine the rate of abusive maternal attitudes towards children and adolescents with elimination disorders (EDs) and to investigate the maternal psychological and socio-cultural factors associated with abusive parenting attitudes. MethodN = 180 children with ED were included in the study. Family Assessment Device (FAD), and Symptom Check List (SCL-90-R) were administered to mothers. ResultsOur results indicated that prevalence of abusive maternal attitudes in our sample was 73.8%. Children and adolescents with ED who live with low-educated parents (p = 0.008), low socio economic status (p = 0.014), and in cases with living in a large or divorced family (p = 0.014), disorganized or chaotic families can be considered a population at risk (p < 0.05), since it is more likely that they suffer more severe abusive maternal attitudes. ConclusionPresent study showed high rates of abusive parenting attitudes in cases of EDs in a sample of Turkish children and adolescents. Further research on the etiological and therapeutic importance of the family in the case of ED referred to a psychiatry clinic should be carried out.

Quality of life, cognitive level and school performance in children with functional lower urinary tract dysfunction.

Lower urinary tract dysfunction (LUTD) are voiding dysfunctions without anatomical or neurological defects. The diagnosis is primarily clinical, with symptoms standardized by the International Children's Continence Society. Few studies relate quality of life of patients with cognitive and school performance. To evaluate milestones of bladder control, daily problems, quality of life (QoL), cognitive function and school performance of children with LUTD. Case series of patients followed in the Pediatric Nephrology tertiary hospital with assessment of QoL (Pediatric Quality of Life Inventory - PedsQoL version 4), School Performance Test (TDE) and Raven Progressive Matrices test. Girls of lower social class were (90.9%) of eligible children. The mean age was 9.1 ± 4.8 years old. The most common symptoms were urge incontinence (81%), holding maneuvers (77.3%) and enuresis (59.1%) associated with the elimination disorder syndrome (63.6%). Caregivers considered volunteers urinary losses and/ or symptoms, and fought and/or beat the child. Children had been subjected to embarrassing situations such as warnings of teachers, they hid symptoms and/or the dirty clothes. Mean score of QoL was 71.0 ± 12.6 with the lowest mean score on the school dimension. In TDE 55% had lower performance and in Raven Matrices 60% were intellectually in the medium level. It was observed lower QoL scores in the medium and lower level of TDE and average intellectual capacity/below average in Raven matrices. LUTD may negatively affect family and social relationships, school performance and QoL of children with the dysfunction.

Dikkat eksikliği/ hiperaktivite bozukluğu olan çocuklarda metilfenidat yanıtı ile ilişkili faktörler: Retrospektif bir çalışma

Objective: We aimed to explore the predictive value of clinical features and self-concept on methylphenidate (MPH) response in children with attention deficit/hyperactivity disorder (ADHD). Methods: The study had a naturalistic design where the results were analyzed retrospectively. ADHD and comorbidity were diagnosed by Schedule for Affective Disorders and Schizophrenia for School-Age Children Present Lifetime Version (K-SADS-PL). At the baseline assessment, parents completed Turgay DSM-IV Disruptive Disorders Rating Scale (T-DSM-IV-S) and Child Behavior Check List (CBCL); teachers were given T-DSM-IV-S, CBCL. The children completed Piers-Harris Children’s Self-Concept Scale (PHSCS), Children’s Depression Inventory (CDI), and Screen for Child Anxiety Related Emotional Disorders (SCARED). Following 4-8 weeks of MPH treatment, the parents completed T-DSM-IV-S and the clinician completed Clinical Global Impression-Improvement scale (CGI-I). This study included 54 children (18 girls, 36 boys; mean age 9.32±0.21 years old). The sample was divided in “good responders” (GR) and “poor responders” (PR) regarding the response criteria defined by authors. Results: The PR group had significantly higher rates of anxiety disorders, higher internalizing scores and lower PHSCS scores compared to GR. Comorbid anxiety disorders, elimination disorders and negative self-concept were found to predict poor MPH response by multiple regression analysis. Conclusions: The results point to the need for additional interventions in the presence of comorbid anxiety, incontinence or poor self-concept in children with ADHD.

Urodynamic profile of patients with neurobehçet: About 5 cases

Behçet's disease is a systemic disease whose most frequent symptoms include the appearance of oral genital ulcers. More rarely, other genital and bladder voiding disorder manifestations of origin can also be observed. To describe the urodynamic profile of these patients to take better care of their urinary manifestations. This is a prospective study collated in physical medicine and rehabilitation Casablanca, including patients with neurobehçet and have urinary symptoms. The mean age of patients was 35 years (26 years–47 years) with a male 4 H/1 F, duration of onset of symptoms was on average two and a half years. Three patients reported urinary frequency, urge incontinence and urinary leakage, and 2 patients report dysuria associated with nocturnal leakage. At the flow measurement, 4 patients dysuria with detrusor sphincter dysynergie and significant RPM at cystometry, all patients have détrosuriennes hyperactivity associated with concomitant leaks, presenting a significant risk to the top unit. At the profilometry, 2 patients had sphincter incompetence, while the other 3 patients have normal profilometry. While only 0.07% of patients followed for Behcet's disease consult for disorders mictionnels. In fact, 18–77% of patients with these symptoms in case of systematic questioning. Irritative signs are the most frequent, sometimes leading to incontinence. Dysuria may also be observed, corresponding to either a detrusor sphincter dyssynergia is a deficit in contractility vésicale.les patients followed for Behcet's disease require urological evaluation, especially in cases of associated neurological disease. In case of bladder and sphincter disorders marked, urodynamic and ultrasound monitoring to verify the absence of impact on the upper urinary tract.

A. Tamilselvi, Ajay Rane (eds.): Principles and Practice of Urogynaecology

This is a must-read textbook for all practitioners of Urogynecology. This concise book addresses all urogynecologic disorders, including pelvic organ prolapse, defecation disorders, painful and irritative voiding disorders, and urinary incontinence. The volume presents vital information on the current treatment options and examines the use of mesh in reconstructive pelvic surgery. Despite the wide prevalence of urogynecological problems, in clinical practice, there is a paucity of specialists who are skilled in the management of these conditions. The

Uroflowmetry with pelvic floor electromyography: inter-rater agreement on diagnosis of pediatric non-neurogenic voiding disorders

Uroflowmetry with electromyography (uroflow-EMG) is commonly used for evaluation of lower urinary tract (LUT) function in children. Diagnostic criteria based largely on uroflow-EMG findings have previously been proposed for several conditions collectively termed non-neurogenic voiding disorders (NNVDs). These include dysfunctional voiding (DV), idiopathic detrusor overactivity disorder (IDOD), detrusor underutilization disorder (DUD), and primary bladder neck dysfunction (PBND). It is unknown whether practitioners with varying levels of training and experience can apply the diagnostic criteria for these conditions with a high level of consistency. To assess inter-rater agreement on diagnosis of NNVDs using uroflow-EMG studies. Six raters performed post hoc evaluation of 84 uroflow-EMG studies and associated clinical data from children with symptoms of LUT dysfunction and no evidence of neurologic or anatomic abnormalities. Each rater was asked to categorize the uroflow-EMG studies as being consistent with DV, IDOD, DUD, PBND, or normal/unclassifiable. A consensus diagnosis was noted for studies on which at least four raters agreed. Inter-rater agreement was assessed via calculation of unweighted Fleiss' kappa statistics. Overall inter-rater agreement on NNVD diagnoses was moderate (kappa 0.46, 95% CI 0.38-0.54). Agreement between individual raters ranged from 0.33 (fair) to 0.74 (substantial) (Figure). There was no consensus on diagnosis for 20 patients (24%). Several factors may contribute to inter-rater disagreement on diagnosis of NNVDs. These include instances where patients satisfy one criterion for a particular diagnosis while missing others - or have findings consistent with more than one diagnosis. Strategies to address this may involve simplifying the diagnostic criteria, developing a clear algorithm that prioritizes certain criteria, and/or allowing assignment of multiple diagnoses. Practitioners could also benefit from standardized education regarding the diagnostic criteria for NNVDs. Potential limitations of this analysis included the use of just one uroflow-EMG study per patient in almost all cases. Also, the raters had variable levels of previous experience using the diagnostic criteria for NNVDs, and it is possible that they were not always applied as originally intended. If this were the case, it would support development of a standardized education tool to facilitate practitioner understanding and application of the criteria. Uroflow-EMG has shown promise for improving clinical management of NNVDs associated with pediatric LUT dysfunction. However, inter-rater agreement on NNVD diagnoses using current criteria is suboptimal. Various mechanisms should be explored to improve consistency in practitioners' diagnosis of NNVDs.

MP21-09 CYSTOMETRIC EFFECTS OF ANDROGEN DEPRIVATION AND DAILY TADALAFIL ADMINISTRATION IN MICE WITH DETRUSOR OVERACTIVITY INDUCED BY NITRIC OXIDE CHRONIC DEFICIENCY

You have accessJournal of UrologyBladder and Urethra: Anatomy, Physiology and Pharmacology II1 Apr 2015MP21-09 CYSTOMETRIC EFFECTS OF ANDROGEN DEPRIVATION AND DAILY TADALAFIL ADMINISTRATION IN MICE WITH DETRUSOR OVERACTIVITY INDUCED BY NITRIC OXIDE CHRONIC DEFICIENCY Raphael Farias Carvalho, Ricardo Reges, Patrícia Gaspar, Lucas Marinho, João Batista Cerqueira, and Lúcio Flávio Gonzaga-Silva Raphael Farias CarvalhoRaphael Farias Carvalho More articles by this author , Ricardo RegesRicardo Reges More articles by this author , Patrícia GasparPatrícia Gaspar More articles by this author , Lucas MarinhoLucas Marinho More articles by this author , João Batista CerqueiraJoão Batista Cerqueira More articles by this author , and Lúcio Flávio Gonzaga-SilvaLúcio Flávio Gonzaga-Silva More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.961AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower Urinary Tract Symptoms (LUTS) represents one of the most commonly complaints in male. Several voiding disorders can be involved in the pathogenesis of LUTS. Hipogonadism is a common and underdiagnosed disease in the aging male. This study aims to evaluate the cystometric effects of chronic tadalafil administration in castrated mice and the effects of testosterone replacement. METHODS A total of 42 mice were randomized to six groups. Group 1 (L-NAME): L-name (60mg/kg), which is an oxide-nitric sintethase inhibitor, was administrated in drinking water. Group 2 (DTAD): L-name + diluent of tadalafil (mannitol and xantane gum). Group 3 (TAD): L-name + daily tadalafil (4mg/kg). Group 4 (ORQ): L-name + orchiectomy. Group 5(ORQ+TAD): L-name + orchiectomy + tadalafil. Group 6 (TEST): L-name + ORQ + tadalafil + testosterone undecanoate SC single dose (100mg/kg). During cystometry, five parameters were measured: number of non-voiding contractions before first micturition (NVC) and micturition frequency (FM). Threshold pressure (TP), basal pressure (BP), and volume threshold (VT) were expressed as mmHg. Statistical analysis were held with GraphPad Prism®, using analysis of variance (ANOVA) and Tukey's tests. Level of significance was 5% (P<0.05). Mean and standard desviation (SD) were analysed. RESULTS TAD (1.28±1.89), ORQ(0.16±0.40), and TEST (1.14±1.21) Groups had lower number of NVC compared to L-name (5.42±4.11) Group. ORQ + TAD(1,5±1,64) and ORQ had similar similar NVC (p=0,0042). TAD (1.06±0.29) and ORQ (0.59±0.20) groups had lower FM compared L-name Group (2.16±0.50). ORQ + TAD (0.71±0.24) and ORQ had similar FM. TEST (2,97±0,45) had higher FM between groups (p<0,0001). TAD (27.57±7.41) and ORQ (27±5.51) Groups had lower TP compared to L-name (41.43±10.86). ORQ + TAD (32.17±7.27) and ORQ had similar TP. TEST (42.14±6.09) had higher TP compared to ORQ (27±5.51) and TAD Groups (p=0,0006). TAD (18.71±3.94) and ORQ (13±10.94) Groups had lower BP compared to L-name (31.14±4.56). ORQ(13±10.94) and ORQ+TAD (19.83±3.25) had similar BP. TEST(28±5.83) had higher BP compared to ORQ (p=0,0006). There were no statistical diferences in volume threshold between groups. There were no diferences between DTAD and L-name in any parameter. CONCLUSIONS Tadalafil and castration were equally effective reducing detrusor overactivity in mice with nitric oxide chronic deficiency. Co-treatment of testosterone with tadalafil to hipogonadic rats improves frequency of micturition, basal and threshold pressure. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e235-e236 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raphael Farias Carvalho More articles by this author Ricardo Reges More articles by this author Patrícia Gaspar More articles by this author Lucas Marinho More articles by this author João Batista Cerqueira More articles by this author Lúcio Flávio Gonzaga-Silva More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Develooment of the lower urinary tract and its functional disorders

A normal development of lower urinary tract function control evolves from involuntary bladder empting (incontinence) during infancy to daytime urinary continence, and finally a successful day and night continence that is generally achieved by the 5th to 7th year of age.This gradual process primarily depends on the progressive maturation of the neural control of the lower urinary tract, but it is also influenced by behavioral training that evolves through social support. Functional voiding disorders (bladder dysfunction) are common problems during childhood. They are present in 5-15 % of general pediatric population, and in one-fifth of school-age children or in over one-third of patients of the pediatric urologist or nephrologist. More than half of children with bladder dysfunction have vesicoureteral reflux, and more than two-thirds have recurrent urinary tract infections. There is also a frequent association of bladder dysfunction with constipation and encopresis (dysfunctional elimination syndrome). Bladder dysfunction may cause a permanent damage to the upper urinary tract and kidneys. In addition, urinary incontinence, as the most common manifestation of bladder dysfunction can be the cause of major stress in school- age children and have a negative effect on the child's feeling of self-esteem. Thus, a timely detection and treatment of this group of disorders in children is highly significant.

Evaluación urodinámica y comparativa de la calidad de vida en pacientes con trastorno de vaciamiento vesical sometidos a terapia InterStim, Medtronic®

BackgroundSince 1980, sacral neuromodulation therapy has been shown to be a valid alternative therapy in the management of urinary disorders due to lower urinary tract pathology, and its primary indications are: idiopathic urinary retention, urge incontinence, and fecal incontinence. It is still considered a novel therapy in Mexico and there are no studies using quantitative parameters that evaluate its efficacy in terms of quality of life. AimsTo establish the efficacy of the Medtronic InterStim® sacral neuromodulation therapy in the management of patients with bladder voiding disorders through urodynamic and quality of life analyses before and after treatment. Urine volume, periods of incontinence, patient satisfaction, and quality of life were determined. MethodsA comparative urodynamic and quality of life evaluation was carried out using the SF-36 v2 (Mexican version) and the ICIQSF instruments on patients presenting with nonobstructive bladder voiding disorders that were refractory to medical treatment. ResultsTen patients with the following diagnoses were included in the study: detrusor sphincter dyssynergia, overactive bladder, and nonobstructive urinary retention. Two of the patients were men and 8 were women. There was a 50% or greater improvement in all 10 patients during the test phase of the neuromodulation therapy and the definitive placement phase produced the following results: a 50-65% improvement in the qualitative parameters of physical function, social function, and emotional role, as well as in the quantitative variables of voiding volume, voiding efficacy, and reduced periods of incontinence. DiscussionOur results were similar to those established in the international literature in relation to the beneficial effect on quality of life and efficacy in urinary incontinence management; the literature reports success percentages in the complete cessation of incontinence episodes at above 50%. ConclusionsNeuromodulation through sacral nerve stimulation is a successful form of treatment of nonobstructive and medical treatment-refractory bladder voiding disorders. It is safe, minimally invasive, and easy to apply and it improves patient quality of life. Nevertheless, further randomized studies on this type of therapy need to be conducted that take into account objective parameters (urodynamics) and possible medium and long-term complications.

Biofeedback for Nonneuropathic Daytime Voiding Disorders in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Biofeedback has been used to treat children with symptoms of bladder dysfunction not responding to standard therapy alone. However, evidence of the effectiveness of biofeedback is scarce and is based on small studies. We conducted a systematic review of the literature to assess the effects of biofeedback as adjunctive therapy for symptoms of nonneuropathic voiding disorders in children up to age 18 years. We searched MEDLINE(®), Embase(®) and CENTRAL on the OvidSP(®) platform as well as conference proceedings for randomized trials presented at scientific conventions, symposia and workshops through August 13, 2013. Hand searches and review of reference lists of retrieved articles were also performed. Five eligible studies were included in the systematic review, of which 4 (382 participants) were pooled in the meta-analysis based on available outcomes data. The overall proportion of cases with resolved incontinence at month 6 was similar in the biofeedback and control groups (OR 1.37 [95% CI 0.64 to 2.93], RD 0.07 [-0.09, 0.23]). There was also no significant difference in mean maximum urinary flow rate (mean difference 0.50 ml, range -0.56 to 1.55) or likelihood of urinary tract infection (OR 1.30 [95% CI 0.65 to 2.58]). Current evidence does not support the effectiveness of biofeedback in the management of children with nonneuropathic voiding disorders. More high quality, randomized controlled trials are needed to better evaluate the effect of biofeedback.

Toilet Refusal Syndrome in Preschool Children

Toilet refusal syndrome (TRS) is a common, benign disorder in toddlers defined by the use of diapers and refusal of toilet for defaecation, but has not been described systematically in preschool children yet. The aim of the study was to analyse and identify possible subgroups of TRS. Retrospective analysis of all of the consecutive children with TRS presented as outpatients in a clinic for elimination disorders. Patients had received a detailed paediatric and child psychiatric assessment, including the Child Behavior Checklist questionnaire. Three typical case vignettes are presented of TRS with constipation, oppositional defiant disorder, and sibling rivalry. Twenty-five children (10 boys) with a mean age of 5.2 (3.4-7.3) years were included-representing 2.5% of all of the children (n = 1001) presented. They had high rates of constipation (60%) and elimination disorders (24%-44%). Child psychiatric International Classification of Diseases-10th Edition disorders were common (40%) and heterogeneous, with significantly more boys affected, but no differences between children with and without constipation. This study shows that TRS occurs also in older preschool (and even school) children. At this later age, it is associated with constipation and behavioural disorders. The case vignettes show differences in therapy and may represent different subgroups of TRS. TRS is associated with constipation, elimination disorders, and psychiatric disorders. Owing to this variety of comorbid disorders, different therapeutic approaches are needed. A general screening for behavioural symptoms is recommended.

Atomoxetine-Induced Hypomania-Like Symptoms in a Preadolescent Patient

[Author Affiliation]Esra Guney. Ankara Pediatric & Pediatric Hematology Oncology Training and Research Hospital, Child and Adolescent Psychiatry Department, Ankara, Turkey.Ozden Sukran Uneri. Ankara Pediatric & Pediatric Hematology Oncology Training and Research Hospital, Child and Adolescent Psychiatry Department, Ankara, Turkey.Address correspondence to: Esra Guney, MD, Ankara cocuk sagligi ve hastaliklari egitim arastirma hastanesi, Ziraat Mah, Irfan Bastug Cad. Kurtdereli Sk. No: 10, Diskapi-Ankara, Turkey, E-mail, : dresraguney@gmail.comTo The Editor:Atomoxetine, a selective noradrenaline reuptake inhibitor, is the first nonstimulant drug approved by the Food and Drug Administration for the treatment of attention- deficit/hyperactivity disorder (ADHD) (Kaplan and Newcorn 2011). It has been reported that atomoxetine can be safely used in comorbid anxiety disorder and tic disorders (Christman et al. 2004). In this article, we aimed to report hypomania-like symptoms triggered by atomoxetine in a patient with ADHD and social anxiety disorder.Case ReportA 10-year-old male patient presenting with attention deficit, forgetfulness, difficulty in memorizing, and low school success underwent a Wechsler Intelligence Scale For Children-Revised (WISC-R) test to assess his mental capacity. The test revealed that his verbal subtest score was 64, performance subtest score was 68, and total subtest score was 63. According to observations of the psychologist applying the test, attention deficit and performance anxiety affected the test result unfavorably. In addition, it was determined that the patient could not express himself properly in social settings, avoided activities requiring performance, such as not attending classes out of fear of making mistakes, and was usually quiet and shy; therefore, his daily functions were unfavorably affected by his condition.Assessment with respect to ADHD revealed that his time spent studying was limited. In addition, he made careless mistakes in homework, was easily distracted, forgot daily activities easily, and, hence, was frequently warned by his family and teacher. The assessment indicated no activity or impulsivity that had an impact on functionality. He had been advised to take methylphenidate for similar symptoms at the age of 7, but the treatment had been stopped by the family because of side effects such as marked sedation, appetite loss, and irritability. The teacher notification form that was sent via the family also supported these findings.For diagnosis, semistructured interviews based on the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnostic criteria were conducted with the child and his parents (American Psychiatric Association 1994). Moreover, Conners' Parent and Teacher Rating Scales (Goyette et al. 1978; Conners 1997) were applied. According to the evaluation of the patient, it was determined that he fulfilled the diagnostic criteria for ADHD--attention-deficit subtype and social anxiety disorder--common type. The patient was also evaluated through a semistructured interview based on the DSM-IV diagnostic criteria for any symptoms of other anxiety disorders, mood disorder, and oppositional defiant disorder/conduct disorder, as well as tics and elimination disorders; no signs of these psychiatric disorders were observed. He was begun on atomoxetine 10 mg/day (body weight 36 kg) with gradual dose increases. Special educational support was postponed until a repeat WISC-R test could be administered at 6 months after the treatment.The patient was brought to our polyclinic with nervousness, defiance to parents, and overactivity on 7th day of atomoxetine treatment. A repeat evaluation revealed that his self-esteem increased; he also developed behavioral and emotional changes in the form of occasional anxiety and irritability, and sometimes excessive joy, restlessness, impatience, pugnaciousness, pressured speech, speech interruption behavior, tendency to commit violence against friends, one attempt to kiss one of his friends on her cheeks, and very frequent and irritating kissing behavior toward his mother. …

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The prevalence of voiding disorders in women varies between 1.8% and 18% and appears to increase with age 1, 2; 3 . Urodynamic tests define voiding disorders with repeated peak flow rates of around 14ml/s and or 200ml or more of residual urine. Voiding disorders are common in women. The prevalence of voiding disorder (VD) in women varies between 1.8% and 18% and appears to increase with age. Urodynamic evidence of voiding difficulty was defined as repeated peak flow rates of 14ml/s and/or 200 ml or more of residual urine. The causes include: Acute inflammation such as genital or urinary tract infection, Drugs such as epidural anaesthesia, oxybutynin, detrusitol and antidepressants, Nerve damage such as spinal cord injury and diabetic neuropathy, Psychological influences such as anxiety, hysteria, Schizophrenia and depression, Pelvic surgery and vaginal delivery, Obstruction due to pelvic organ prolapse, faecal impaction and urethral narrowing, detrusor underactivity or detrusor areflexia, Overdistension of the bladder, Inability to relax the urethral sphincter during voiding, Symptoms include: Delay in initiating urination, Slow urinary flow, Sensation of incomplete emptying of bladder, The need to immediately re-void, The need to strain to void, Dribbling of urine after completing bladder emptying. Investigations include Urinalysis, Uroflowmetry, Urodynamics, Electromyography, Radiology, Cystoscopy, Urethral pressure profile; treatment includes medical and surgical management. CONCLUSION: Voiding disorder (VD) in women varies between 1.8% and 18% and appears to increase with age. Early diagnosis and treatment is mandatory to prevent irreversible damage to the

Elimination disorders and anxious-depressed symptoms in preschool children: a population-based study

The prevalence rates of elimination disorders and anxious/depressed symptoms of a representative sample of young children and their associations were assessed. 2,079 children in a defined geographical area were examined at school-entry. A parental questionnaire with 4 questions referring to symptoms of incontinence and 14 items of the anxious/depressed scale of the Child Behavior Checklist (CBCL) was administered. 9.5 % of 6-year-old children wet at night, 2.7 % wet during day and 1.2 % had faecal incontinence. Significantly more boys wet at night (11.7 %) than girls (7.2 %; OR 0.58, 95 % CI 0.43-0.78). 12.7 % had clinically relevant anxious/depressed symptoms. Children with at least one elimination disorder had significantly higher T values of the 'anxious/depressed' CBCL than continent controls. Children with faecal incontinence had highest T values of the 'anxious/depressed' CBCL syndrome scale, significantly higher than those of children with other elimination disorders and controls. Elimination disorders, as well as anxious/depressed symptoms are common at a young age. Boys are more affected by elimination disorders than girls, but not by anxious/depressed symptoms. Children with faecal incontinence have the highest rate of anxious/depressed symptoms.

Interrater-Reliabilität des Diagnostischen Interviews bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS)

This study investigates the interrater reliability of the «Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter» (Kinder-DIPS; Schneider, Unnewehr & Margraf, 2009) based on child and parent interviews. It further investigates differences in the interrater reliability depending on age or sex of the children. 48 certified interviewers conducted 264 parent and 213 child interviews in various inpatient, outpatient, and research settings. There is a good interrater reliability for the parent and child interviews for the major diagnostic categories of conduct disorders, tic disorders, elimination disorders, mood disorders, eating disorders, sleeping disorders, the majority of the specific psychiatric disorders, and the exclusion of psychiatric disorders. Neither the sex nor the age of the children influenced interrater reliability. The second and expanded Kinder-DIPS proves to be a reliable parent and child interview for the assessment of mental disorders in both outpatient and inpatient settings.

Prescribing for Mentally Ill Children Generally in Line With Best Practices

Patients receiving two or more medications were more likely to have a bipolar or pervasive developmental disorder, to have been placed in special education, or to have been psychiatrically hospitalized.

Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction

To investigate prevalence and patterns of psychiatric disorders in young subjects with Internet addiction (IA). Subjects were taken from a sample of patients, aged 10-18 years old, referred to Istanbul Medical Faculty, Child and Adolescent Psychiatry Department due to a variety of behavioral and emotional problems alongside problematic Internet use. Inclusion criteria included IQ ≥70 and score ≥80 on Young's Internet Addiction Scale (YIAS). Psychiatric comorbidity was assessed using the Turkish version of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version. Subjects were 45 boys (75%) and 15 girls (25%) with an age range of 10-18 years old (mean age, 13.38 ± 1.79 years). A total of 60% (n = 36) had been using Internet for ≥5 years. Mean hours/week spent on the Internet was 53.7 (range, 30-105 h) and the average YIAS score was 85. All subjects (100%) had at least one and 88.3% (n = 53) had at least two comorbid psychiatric disorders. The frequency of diagnostic groups were as follows: behavioral disorder, n = 52 (86.7%); anxiety disorder, n = 43 (71.7%); mood disorder, n = 23 (38.3%); elimination disorder, n = 16 (26.7%); tic disorder, n = 10 (16.7%); and substance use disorder, n = 4 (6.7%). The most common psychiatric disorders were attention-deficit hyperactivity disorder (n = 53; 83.3%), social phobia (n = 21; 35.0%) and major depressive disorder (n = 18; 30.0%). High rates of psychiatric comorbidity, particularly behavioral, anxiety and mood disorders were found in young subjects with IA. Because the presence of psychiatric disorders may affect the management /prognosis of IA, assessment should include that for other psychiatric disorders.

Multiple system atrophy with prolonged survival: is late onset of dysautonomia the clue?

Multiple system atrophy (MSA) is a neurodegenerative disease characterised by cardiovascular autonomic failure and/or urinary dysfunctions, associated with parkinsonism, cerebellar and/or corticospinal signs, usually leading to death after an average of 7 years. We describe the disease course of five patients diagnosed with probable MSA (4 with predominant parkinsonism and 1 with predominant cerebellar ataxia) who survived for more than 15 years and were followed throughout the disease course at our department. Cardiovascular autonomic dysfunction of any severity occurred late (mean latency from disease onset 9.4 ± 5 years) in this subgroup of MSA patients. The time of involvement of the urogenital system was more variable (from 0 to 14 years after disease onset) and manifested with symptoms of storage disorders (urinary urgency, frequency and incontinence) and erectile dysfunction in men. Conversely complains suggestive of urinary voiding dysfunction (incomplete bladder emptying and urinary retention) were not recorded and patients required catheterization only late in the disease course. In conclusion, our study showed that late onset of both cardiovascular autonomic failure and urinary voiding disorders may be positive prognostic factors in MSA irrespective of the MSA subtype.

Pathogenic mechanisms linking benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction

Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are clinical entities very prevalent in men aged over 50 years. There is evidence that both may have a common pathophysiology. The objective of this study was to conduct a literature review aiming to show theories and hypotheses that justify a single pathophysiology for ED and LUTS/BPH. A search in Medline using the keywords of the Medical Subject Headings (MESH) 'erectile dysfunction' and 'lower urinary tract symptoms' in all fields of the database up to 15 December 2012. This search found 198 relevant articles that were analyzed. The data and articles were divided according to the type of evidence found. There are strong epidemiological data showing that LUTS/BPH is a risk factor for developing ED. Several experimental models demonstrated partial obstruction of the bladder in animals causes voiding disorders as well as a negative impact on erectile function of the operated animals. The increased adrenergic tonus in animals leads to prostate growth and urodynamic conditions similar to those found in men with LUTS and ED. Arteriosclerosis may lead to loss of vesical complacency, urinary tract obstruction and fibrosis of the cavernous bodies. The use of phosphodiesterase type 5 inhibitors (PDE-5i) and/or alpha-adrenergic blockers to treat ED and LUTS/BPH reinforces the hypothesis that, at least in some patients, both clinical pictures may have the same pathophysiology.