Current Current

Total Page:16

File Type:pdf, Size:1020Kb

Current Current CP_0406_Cases.final 3/17/06 2:57 PM Page 67 Current p SYCHIATRY CASES THAT TEST YOUR SKILLS Chronic enuresis has destroyed 12-year-old Jimmy’s emotional and social functioning. The challenge: restore his self-esteem by finding out why can’t he stop wetting his bed. The boy who longed for a ‘dry spell’ Tanvir Singh, MD Kristi Williams, MD Fellow, child® Dowdenpsychiatry ResidencyHealth training Media director, psychiatry Medical University of Ohio, Toledo CopyrightFor personal use only HISTORY ‘I CAN’T FACE MYSELF’ during regular checkups and refer to a psychia- immy, age 12, is referred to us by his pediatri- trist only if the child has an emotional problem J cian, who is concerned about his “frequent secondary to enuresis or a comorbid psychiatric nighttime accidents.” His parents report that he wets disorder. his bed 5 to 6 times weekly and has never stayed con- Once identified, enuresis requires a thorough sistently dry for more than a few days. assessment—including its emotional conse- The accidents occur only at night, his parents quences, which for Jimmy are significant. In its say. Numerous interventions have failed, including practice parameter for treating enuresis, the restricting fluids after dinner and awakening the boy American Academy of Child and Adolescent overnight to make him go to the bathroom. Psychiatry (AACAP)1 suggests that you: Jimmy, a sixth-grader, wonders if he will ever Take an extensive developmental and family stop wetting his bed. He refuses to go to summer history. Find out if the child was toilet trained and camp or stay overnight at a friend’s house, fearful started walking, talking, or running at an appro- that other kids will make fun of him after an acci- priate age. Delays in reaching developmental dent. Asked how “wet nights” are affecting his life, milestones can predict enuresis.1 he says, “I can’t face myself in the mirror.” Also find out if either parent had enuresis during childhood. Enuresis is heritable,2 and The authors’ observations children often outgrow the problem at the same Primary nocturnal enuresis is diagnosed in chil- age as did the parent(s). dren age ≥ 5 who have never gone 6 consecutive Focus on the bedwetting and the child’s reaction months without an overnight accident. Ped- to it. Treat enuresis aggressively if it is hurting the iatricians generally discover enuresis incidentally child’s performance at school, social or emotion- VOL. 5, NO. 4 / APRIL 2006 67 For mass reproduction, content licensing and permissions contact Dowden Health Media. CP_0406_Cases.final 3/17/06 2:57 PM Page 68 CASES THAT TEST YOUR SKILLS The boy who longed for a ‘dry spell’ tion to rule out subtle dysfunction associated How would you with enuresis.1 handle this case? Perform a urinalysis and urine culture to rule out urinary tract infection (UTI). Order urodynamic studies or renal ultrasound if Visit www.currentpsychiatry.com to input your answers and compare them with enuresis persists after two unsuccessful treatment those of other readers trials, the physical examination uncovers positive findings, or the child has had a UTI. al development, or self-esteem, or if the youth Psychotherapy has a limited role in treating appears emotionally withdrawn or distressed. primary enuresis unless you suspect a psycholog- 1 Interview the child and parents separately, as ical cause. We offered Jimmy supportive coun- each often reacts differently to the problem. In seling to help alleviate emotional problems some cases, for example, the child’s bedwetting caused by bedwetting. He and his parents upsets the parents but the child hardly seems to declined but agreed to reconsider later. care. Also, children often feel more at ease talking to a doctor alone, and parents can vent frustration FURTHER HISTORY TOILET TRAINED AT 2 without upsetting their child. immy was toilet trained at age 2 and reached all While interviewing the child, listen for psy- J other age-appropriate developmental mile- chosocial stressors that can lead to enuresis, such stones, his mother says. Results of urine culture, as parents’ marital problems, problems at school, repeated urinalyses, and recent hospitalization, physical or neurologic and physical exami- sexual abuse, or the recent birth of a nations are normal. Neither Jimmy sibling. Consider physical nor his family have a history of UTI, We spend about one half-hour causes, emotional dysuria, urgency, or increased urination with the child and another half- stressors, and frequency. hour with the parents to thoroughly developmental When Jimmy was age 9, his pedia- gauge enuresis’ emotional impact. delays when trician prescribed imipramine, 25 mg/d, to To engage the child and hold his assessing enuresis try to stop his bedwetting. He did not attention during that half-hour, we respond after 6 months, so his parents offer toys or play a game. stopped giving the drug to him. Check for physical causes. According to the A few months later, Jimmy’s par- AACAP practice parameter for enuresis treat- ents heard about a “bedwetting alarm” designed to ment, you should: condition children not to urinate while asleep, but • assess nare patency and voice quality to the boy and his parents viewed this treatment as rule out enlarged adenoids “humiliating” and refused to try it. They have not • check the nasal pharynx for enlarged tonsils attempted another intervention for 2 years. • palpate the abdomen to check for bladder How would you help Jimmy? distention or fecal impaction a) urge the family to try the bedwetting alarm • examine genitalia for abnormalities b) prescribe imipramine at a higher dosage • view the back for a sacral dimple or other c) try another medication sign of a vertebral or spinal cord anomaly. d) try a different behavioral treatment Also order a thorough neurologic examina- 68 Current VOL. 5, NO. 4 / APRIL 2006 p SYCHIATRY CP_0406_Cases.final 3/17/06 2:57 PM Page 69 Current p SYCHIATRY The authors’ observations Box Having found no medical or psychological basis Enuresis: Possible causes for Jimmy’s enuresis (Box), we pondered our next clinical move. Genetics. In more than one-half of children Behavioral interventions. Parents commonly try to with enuresis, one or both parents had the stop their child’s bedwetting by restricting his or disorder during childhood. her fluid or caffeine intake, enforcing a reward sys- Developmental delay. Delayed functional tem, bladder control training, and/or awakening CNS maturation can decrease arousal. the child overnight to go to the bathroom. Enuresis is common in children with developmental disorders, including autism, Among behavioral treatments, only the bed- Rett’s syndrome, or pervasive developmental wetting alarm has shown effectiveness in clinical disorder NOS. 1,3 trials, and it carries the lowest risk of post-treat- Irregular sleep pattern associated with 3 ment relapse. Urine moistens a sensor in the bed specific sleep disorders, such as narcolepsy pad or inside cloth, triggering an alarm that awak- and sleep apnea. Also, children with enuresis ens the child when wetting starts. The child grad- sleep more soundly than do youths without ually awakens earlier in an enuretic episode until the disorder. the sensation of bladder fullness awakens him. Psychological problem. Considered a reaction Many parents/guardians and their children— to primary enuresis rather than its cause. particularly older youths—consider alarm systems Medical condition. Enlarged adenoids, tonsils, demeaning. We again suggested this treatment to constipation with fecal impaction, vertebral Jimmy and his parents, but they refused. and spinal cord anomaly, and diabetes mellitus may cause enuresis. Medication. Six months of low-dose imipramine, a tricyclic antidepressant often prescribed for enure- Source: Reference 1 sis, produced no response. We did not restart imipramine at a higher dosage because of its asso- TREATMENT MEANINGLESS RESPONSE ciation with increased arrhythmia risk. e start Jimmy on oral desmopressin, 0.2 mg at We instead considered desmopressin acetate, a W bedtime, after discussing its benefits and risks synthetic analog of ADH vasopressin that regu- with his parents. We increase the dosage to 0.4 mg lates diurnal variation, which is usually abnormal after 3 days and to 0.6 mg the following week, as in children with enuresis. Desmopressin, often the lower dosages have not worked. Serum elec- used to treat clozapine-induced enuresis in adults, trolytes, gauged before starting desmopressin and has been associated with successful outcomes in as again 2 weeks later, are normal. We see Jimmy many as 65% of children in clinical trials.1,4 every 2 weeks to check progress and monitor for Desmopressin, however, can reduce urine pro- side effects. duction. Water intoxication or hyponatremia is Soon after the second dosage increase, Jimmy’s rare but can lead to seizures or coma, and the risk accidents gradually decrease to 2 to 3 per week, but increases with the dosage. Obtain informed con- no improvement is seen after that. sent from the parents before starting this drug. Two months later, Jimmy is still avoiding sleep- Check electrolytes 2 or 3 days after the first dose, 1 overs and has trouble making friends. His parents month later, then again every 2 to 3 months. worry about his increasing frustration, hopelessness, Discontinue at once if serum sodium decreases and low self-esteem. We again offer supportive coun- significantly from baseline or is <135 mmol/L. seling, but the boy refuses. continued VOL. 5, NO. 4 / APRIL 2006 69 CP_0406_Cases.final
Recommended publications
  • Point-Of-Care Ultrasound to Assess Anuria in Children
    CME REVIEW ARTICLE Point-of-Care Ultrasound to Assess Anuria in Children Matthew D. Steimle, DO, Jennifer Plumb, MD, MPH, and Howard M. Corneli, MD patients to stay abreast of the most current advances in medicine Abstract: Anuria in children may arise from a host of causes and is a fre- and provide the safest, most efficient, state-of-the-art care. Point- quent concern in the emergency department. This review focuses on differ- of-care US can help us meet this goal.” entiating common causes of obstructive and nonobstructive anuria and the role of point-of-care ultrasound in this evaluation. We discuss some indications and basic techniques for bedside ultrasound imaging of the CLINICAL CONSIDERATIONS urinary system. In some cases, as for example with obvious dehydration or known renal failure, anuria is not mysterious, and evaluation can Key Words: point-of-care ultrasound, anuria, imaging, evaluation, be directed without imaging. In many other cases, however, diagnosis point-of-care US can be a simple and helpful way to assess urine (Pediatr Emer Care 2016;32: 544–548) volume, differentiate urinary retention in the bladder from other causes, evaluate other pathology, and, detect obstructive causes. TARGET AUDIENCE When should point-of-care US be performed? Because this imag- ing is low-risk, and rapid, early use is encouraged in any case This article is intended for health care providers who see chil- where it might be helpful. Scanning the bladder first answers the dren and adolescents in acute care settings. Pediatric emergency key question of whether urine is present.
    [Show full text]
  • Supporting Children with Autism with Bedwetting Difficulties
    Supporting Children with Autism with Bedwetting Difficulties (Primary Nocturnal Enuresis) Bedwetting is described as involuntary wetting during sleep, and is a common occurrence in childhood. Ten per cent of 7 year olds are affected by bedwetting. Boys are affected more than girls, and there is often a family history. Bedwetting often improves with age. There is a higher incidence of bedwetting in children with Autism Spectrum Disorders (ASD). Bedwetting can occur as a result of one or more of the following reasons: 1. Bladder control has not yet matured 2. Sleeping deeply and not waking in response to a full bladder 3. Producing a lot of urine at night due to hormonal reasons 4. Overactive bladder (by day and by night) Recommendations Avoid any punishment for bedwetting. Anxiety or significant socialisation difficulties can affect bedwetting. Focus on these first before addressing bedwetting. Children with ASD often have sleep difficulties. Any approaches to help bedwetting should not affect sleep. Strategies Use social stories and visual schedules to support your child. Examples include; a schedule of their bedtime routine that may include two trips to the toilet (see below), and social stories about what to do if their bed is wet when they wake during the night or in the morning. Set realistic and appropriate targets, and reward your child for achieving them. Rewarding a dry night may be unachievable initially and may result in disappointment for your child. An example of an achievable target may be; putting a used pull up in the bin, or helping to change the sheets. Empty bladder at night-time as part of bedtime routine.
    [Show full text]
  • Hemorrhagic Anuria with Acute Kidney Injury After a Single Dose of Acetazolamide: a Case Study of a Rare Side Effect
    Open Access Case Report DOI: 10.7759/cureus.10107 Hemorrhagic Anuria With Acute Kidney Injury After a Single Dose of Acetazolamide: A Case Study of a Rare Side Effect Christy Lawson 1 , Leisa Morris 2 , Vera Wilson 3 , Bracken Burns Jr 4 1. Surgery, Quillen College of Medicine, East Tennesse State University, Johnson City, USA 2. Trauma, Ballad Health Trauma Services, Johnson City, USA 3. Pharmacy, Ballad Health Trauma Services, Johnson City, USA 4. Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA Corresponding author: Bracken Burns Jr, [email protected] Abstract Acetazolamide (ACZ) is a relatively commonly used medication in critical illness, glaucoma and altitude sickness. ACZ is sometimes used in the intensive care unit to assist with the treatment of metabolic alkalosis in ventilated patients. This is a case report of a patient who received two doses of ACZ, one week apart, for metabolic alkalosis and subsequently developed renal colic and dysuria that progressed to hemorrhagic anuria and acute kidney injury. This is an incredibly rare side effect of ACZ therapy, and has been reported in a few case reports in the literature, but usually is associated with a longer duration of therapy. This case resolved entirely within 24 hours with aggressive fluid therapy. Clinicians using ACZ therapy for any reason should be aware of this rare but significant side effect. Categories: Trauma Keywords: acetazolamide, hemorrhagic anuria, acute kidney injury Introduction Acetazolamide (ACZ) is a carbonic anhydrase inhibitor. It works to cause an accumulation of carbonic acid in the proximal kidney, preventing its breakdown, and causes lowering of blood pH and resorption of sodium, bicarbonate, and chloride with their subsequent excretion into the urine [1].
    [Show full text]
  • Guidelines for Management of Acute Renal Failure (Acute Kidney Injury)
    Guidelines for management of Acute Renal Failure (Acute Kidney Injury) Children’s Kidney Centre University Hospital of Wales Cardiff CF14 4XW DISCLAIMER: These guidelines were produced in good faith by the author(s) reviewing available evidence/opinion. They were designed for use by paediatric nephrologists at the University Hospital of Wales, Cardiff for children under their care. They are neither policies nor protocols but are intended to serve only as guidelines. They are not intended to replace clinical judgment or dictate care of individual patients. Responsibility and decision-making (including checking drug doses) for a specific patient lie with the physician and staff caring for that particular patient. Version 1, S. Hegde/Feb 2009 Guidelines on management of Acute Renal Failure (Acute Kidney Injury) Definition of ARF (now referred to as AKI) • Acute renal failure is a sudden decline in glomerular filtration rate (usually marked by rise in serum creatinine & urea) which is potentially reversible with or without oliguria. • Oliguria defined as urine output <300ml/m²/day or < 0.5 ml/kg/h (<1 ml/kg/h in neonates). • Acute on chronic renal failure suggested by poor growth, history of polyuria and polydipsia, and evidence of renal osteodystrophy However, immediately after a kidney injury, serum creatinine & urea levels may be normal, and the only sign of a kidney injury may be decreased urine production. A rise in the creatinine level can result from medications (e.g., cimetidine, trimethoprim) that inhibit the kidney’s tubular secretion. A rise in the serum urea level can occur without renal injury, such as in GI or mucosal bleeding, steroid use, or protein loading.
    [Show full text]
  • Hair Pulling Disorder)
    THE IMPACT OF PULLING STYLES ON FAMILY FUNCTIONING AMONG ADOLESCENTS WITH TRICHOTILLOMANIA (HAIR PULLING DISORDER) A thesis submitted To Kent State University in partial Fulfillment of the requirements for the Degree of Master of Arts by Yolanda E. Murphy May, 2016 © Copyright All rights reserved Except for previously published materials Thesis written by Yolanda E. Murphy B.S., Howard University, 2013 M.A., Kent State University, 2016 Approved by Christopher Flessner, Ph.D. , Advisor Manfred van Dulmen, Ph.D., Acting Chair, Department of Psychological Sciences James L. Blank, Ph.D. , Interim Dean, College of Arts and Sciences TABLE OF CONTENTS LIST OF TABLES……………………………………………………………………………..iv INTRODUCTION……………………………………………………………………………..1 METHOD………………………………………………………………………………………6 RESULTS……………………………………………………………………………………...15 DISCUSSION…………………………………………………………………………….……20 REFERENCES…………………………………………………………………………….…..26 iii LIST OF TABLES Table 1. Demographic Characteristics of Adolescent HPD and Control Samples……………....7 Table 2. Demographic Characteristics of Parents (Mothers, Fathers) Present at Initial Intake Assessment………………………………………………….………………………….8 Table 3. Regression Summary for CRPBI Controls vs. Cases Analyses.…...………………......16 Table 4. Regression Summary for FES Controls vs. Cases Analyses.…...……………………...17 Table 5. Regression Summary for ATMCRC Pulling Style Analyses.….…………....…….…...18 Table 6. Characteristics of HPD Sample.…………………………………....…………………..18 iv Introduction Trichotillomania (hair pulling disorder, HPD) is characterized by the recurrent pulling out of one’s hair, resulting in hair loss. Although largely understudied in the pediatric population, HPD research suggests a substantial presence of this disorder amongst youths. The precise number of youth affected is unknown, however past research in adult populations indicates approximately 3.4% of adults to be affected by HPD, with a large portion of individuals exhibiting an adolescent onset (i.e. mean age of 13; Bruce, Barwick, & Wright, 2005; Christenson, Pyle, & Mitchell, 1991).
    [Show full text]
  • Secondary Enuresis & Body Dysmorphic Disorder in A
    Psychiatria Danubina, 2010; Vol. 22, Suppl. 1, pp 53–55 Conference paper © Medicinska naklada - Zagreb, Croatia SECONDARY ENURESIS & BODY DYSMORPHIC DISORDER IN A CAUCASIAN MALE WITH CATATONIC SCHIZOPHRENIA: A case report Nuruz Zaman, Milind Karale & Mark Agius South Essex Partnership University Foundation NHS Trust, UK SUMMARY We describe a patient with Schizophrenia and secondary enuresis. The enuresis settled with resolution of his psychotic symptoms but later remerged after starting Clozapine. We explore the mechanisms of incontinence in Schizophrenia and those due to Clozapine. This case highlights the need to inquire about incontinence in patients with schizophrenia prior to prescribing clozapine. Key words: schizophrenia – enuresis – clozapine – incontinence - body dysmorphic disorder * * * * * Introduction Clozapine. This case highlights the need to inquire about incontinence in patients with schizophrenia prior Urinary incontinence in patients with schizophrenia to prescribing clozapine. can present with daytime urinary leakage, urge incontinence and bed wetting. The association between Case Report bedwetting and schizophrenia has been noted since the pre neuroleptic era when Kraeplin reported a group of Mr AP is a 21 year old man who was referred to an schizophrenic patients with resistant incontinence. child and adolescent outpatient clinic at the age of 17 Various mechanisms have been postulated for this with a six month history of not coping with training and association. The ventricular enlargement (hydrocepha- educational tasks. He had low mood, poor self esteem, lus), selective neuronal loss with gliosis, and dopamine occasional aggressive outbursts and certain compulsion dysregulation in schizophrenia may indicate a like repeatedly checking doors, windows and mirrors. neurological basis to the incontinence. These anatomical He walked with his hand over his nose and perceived lesions might interrupt the pathways of bladder control people to be laughing at his nose.
    [Show full text]
  • Aripiprazole-Induced Diurnal and Nocturnal Enuresis in Down's Syndrome
    ARIPIPRAZOLE-INDUCED DIURNAL AND NOCTURNAL ENURESIS IN DOWN’S SYNDROME STEFANO MARINI (1) 1 Il Cireneo Foundation for Autism Spectrum Disorder, Vasto, Italy. INTRODUCTION Aripiprazole is an atypical antipsychotic with unique pharmacological profile: partial agonist for dopamine D2 and serotonin 5-HT1A and antagonist for 5-HT2A receptors. Moreover, it also exhibits affinity for dopamine D4, serotonin 5-HT2C, and 5-HT7, alpha 1 adrenergic and histamine H1 receptors [1]. Compared with other atypical antipsychotics, aripiprazole is known to have fewer adverse effects, particularly QTc prolongation, weight gain, and dysregulation of glucose and lipid metabolism, sedation, and prolactin elevation. However, common side effects are represented by headache, tremor, akathisia, nausea, vomiting, constipation, somnolence, dyspepsia, and insomnia. In the clinical practice, aripiprazole is prescribed for psychosis, bipolar disorder, adjunctive treatment of major depressive disorder, Tourette’s syndrome, irritability, and behavioral problems associated with autism spectrum disorder. Past literature highlighted clozapine, risperidone, olanzapine, and quetiapine-induced enuresis. Aripiprazole-induced enuresis has been reported as a very rare adverse effect, but contrasting data has been found in different types of patients. In children, two studies reported an aripiprazole-induced enuresis [2,3], and two studies in adults used aripiprazole to treat enuresis caused by other treatments [4,5]. CASE PRESENTATION 20-years old female drug-naive outpatient affected by Down’s syndrome and mental retardation presented auditory hallucinations, irritability, anger bursts, self-harm and aggression towards others and an increase of stereotyped behaviors. In author’s knowledge, no psychopharmacology guidelines have been published yet for the treatment of psychiatric symptoms in patients affected by Down’s Syndrome.
    [Show full text]
  • Topic Objectives Physical Examination
    LECTURE MODULE 3; PHYSICAL EXAMINATION OF URINE Topic Objectives 1. Identify the colors which commonly associated with abnormal urine. 2. State two possible causes for urine turbidity in a sample that is not fresh. 3. Identify possible causes for abnormal urinary foam. 4. Identify the odors commonly associated with abnormal urine. 5. Differentiate between the following abnormalities of urine volume: Polyuria Oliguria Anuria Nocturia 6. Define specific gravity of urine. 7. Define refractive index of a solution. 8. Identify possible causes of abnormal specific gravities of urine. 9. Compare and contrast Diabetes Mellitus with Diabetes Insipidus. Physical Examination Appearance Color Transparency Foam Odor Specific Gravity Volume 1 Color • When an examiner first receives a urine specimen, color is observed and recorded. • Normal urine usually ranges from a light yellow to a dark amber color. • The normal metabolic products which are excreted from the body contribute to this color. • Urochrome is the chief urinary pigment. • Urinary color may vary, depending on concentration, dietary pigments, drugs, metabolites, and the presence or absence of blood. • A pale color generally indicates dilute urine with low specific gravity. • Occasionally, a pale urine with high specific gravity is seen in a diabetic patient. Color In many diseases, urinary color may drastically change. In liver disease, bile pigments may produce a yellow-brown or greenish tinge in the urine. Pink, red, or brown urine usually indicates the presence of blood, but porphyrins may also cause a pink or red urine. Since drugs, dyes and certain foods may alter urine color, the patient’s drug list and diet intake should be checked.
    [Show full text]
  • An Fmri Study Xiangyu Zheng1,7, Jiawei Sun2,7, Yating Lv3,4, Mengxing Wang5, Xiaoxia Du6, Xize Jia3,4* & Jun Ma1*
    www.nature.com/scientificreports OPEN Frequency‑specifc alterations of the resting‑state BOLD signals in nocturnal enuresis: an fMRI Study Xiangyu Zheng1,7, Jiawei Sun2,7, Yating Lv3,4, Mengxing Wang5, Xiaoxia Du6, Xize Jia3,4* & Jun Ma1* Resting state functional magnetic resonance imaging studies of nocturnal enuresis have focused primarily on regional metrics in the blood oxygen level dependent (BOLD) signal ranging from 0.01 to 0.08 Hz. However, it remains unclear how local metrics show in sub‑frequency band. 129 children with nocturnal enuresis (NE) and 37 healthy controls were included in this study. The patients were diagnosed by the pediatricians in Shanghai Children’s Medical Center afliated to Shanghai Jiao Tong University School of Medicine, according to the criteria from International Children’s Continence Society (ICCS). Questionnaires were used to evaluate the symptoms of enuresis and completed by the participants. In this study, fALFF, ReHo and PerAF were calculated within fve diferent frequency bands: typical band (0.01–0.08 Hz), slow‑5 (0.01–0.027 Hz), slow‑4 (0.027–0.073 Hz), slow‑3 (0.073– 0.198 Hz), and slow‑2 (0.198–0.25 Hz). In the typical band, ReHo increased in the left insula and the right thalamus, while fALFF decreased in the right insula in children with NE. Besides, PerAF was increased in the right middle temporal gyrus in these children. The results regarding ReHo, fALFF and PerAF in the typical band was similar to those in slow‑5 band, respectively. A correlation was found between the PerAF value of the right middle temporal gyrus and scores of the urinary intention‑ related wakefulness.
    [Show full text]
  • Treatment Options for Clozapine-Induced Enuresis: a Review of Clinical Effectiveness
    TITLE: Treatment Options for Clozapine-Induced Enuresis: A Review of Clinical Effectiveness DATE: 27 September 2010 CONTEXT AND POLICY ISSUES: Clozapine is an atypical antipsychotic indicated in the management of treatment-resistant schizophrenia.1 Clozapine binds dopamine receptors as well as exerting potent anticholinergic, adrenolytic, antihistaminic, and antiserotoninergic activity.1 It has been shown to be efficacious in treating both the positive (e.g., hallucinations) and negative symptoms (e.g., social withdrawal) associated with schizophrenia. Patients treated with clozapine may experience adverse effects ranging in severity from relatively benign to serious and potentially life-threatening conditions such as seizures and agranulocytosis.1,2 One potential adverse effect is enuresis, or an inability to control urination, which can cause emotional stress and poor compliance among the affected patients.3 The true prevalence of clozapine-induced enuresis has yet to be determined as published estimates range from 0.23% to 44%.4,5 The reasons for this lack of consistency is are unclear and may be related to differences in dosage,6 ethnicity,7 and treatment setting.3 The mechanism for clozapine-induced enuresis has not been fully elucidated; however, a leading hypothesis involves blockade of the α-adrenergic receptors resulting in a decrease in internal bladder sphincter tone.7 A number of treatments are available for the management of enuresis including desmopressin,8 tricyclic antidepressants,9 anticholinergics,10 and alarms.11 However, there is currently no universally accepted approach to addressing clozapine-induced enuresis.2,6 This report reviews the safety and effectiveness of the various treatment strategies for clozapine- induced enuresis.
    [Show full text]
  • 1 Serious Emotional Disturbance (SED) Expert Panel
    Serious Emotional Disturbance (SED) Expert Panel Meetings Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Behavioral Health Statistics and Quality (CBHSQ) September 8 and November 12, 2014 Summary of Panel Discussions and Recommendations In September and November of 2014, SAMHSA/CBHSQ convened two expert panels to discuss several issues that are relevant to generating national and State estimates of childhood serious emotional disturbance (SED). Childhood SED is defined as the presence of a diagnosable mental, behavioral, or emotional disorder that resulted in functional impairment which substantially interferes with or limits the child's role or functioning in family, school, or community activities (SAMHSA, 1993). The September and November 2014 panels brought together experts with critical knowledge around the history of this federal SED definition as well as clinical and measurement expertise in childhood mental disorders and their associated functional impairments. The goals for the two expert panel meetings were to operationalize the definition of SED for the production of national and state prevalence estimates (Expert Panel 1, September 8, 2014) and discuss instrumentation and measurement issues for estimating national and state prevalence of SED (Expert Panel 2, November 12, 2014). This document provides an overarching summary of these two expert panel discussions and conclusions. More comprehensive summaries of both individual meetings’ discussions and recommendations are found in the appendices to this summary. Appendix A includes a summary of the September meeting and Appendix B includes a summary of the November meeting). The appendices of this document also contain additional information about child, adolescent, and young adult psychiatric diagnostic interviews, functional impairment measures, and shorter mental health measurement tools that may be necessary to predict SED in statistical models.
    [Show full text]
  • Nocturnal Enuresis C
    PRACTICAL THERAPEUTICS Nocturnal Enuresis C. CAROLYN THIEDKE, M.D., Medical University of South Carolina, Charleston, South Carolina Nocturnal enuresis is a common problem that can be troubling for children and their families. Recent studies indicate that nocturnal enuresis is best regarded as a O A patient informa- group of conditions with different etiologies. A genetic component is likely in many tion handout on bed- wetting, written by affected children. Research also indicates the possibility of two subtypes of patients the author of this with nocturnal enuresis: those with a functional bladder disorder and those with a article, is provided on maturational delay in nocturnal arginine vasopressin secretion. The evaluation of page 1509. nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Treatment options include nonpharmacologic and pharmacologic measures. Continence training should be incorporated into the treatment regimen. Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmo- pressin and imipramine are the primary medications used to treat nocturnal enure- sis, but both are associated with relatively high relapse rates. (Am Fam Physician 2003; 67:1499-506,1509-10. Copyright© 2003 American Academy of Family Physicians.) Members of various octurnal enuresis is a com- wetting episodes per month, and a child older family practice depart- mon problem, affecting an than six years of
    [Show full text]