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Urinary Incontinence in Dementia

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Urinary Incontinence in Dementia Incont Pelvic Floor Dysfunct 2008; 2(2):63-66 Review Urinary Incontinence in Dementia Der-Sheng Han, M.D., Yen-Ho Wang, M.D.1 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation1, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan ^_pqo^`q mobs^ibk`b rêáå~êó=áåÅçåíáåÉåÅÉ=ErfF=áå=ÇÉãÉåíá~=áë=~=Åçããçå=éêçÄäÉã=ïÜáÅÜ aÉãÉåíá~=êÉÑÉêë=íç=~=Öêçìé=çÑ=ÇáëçêÇÉêë=íÜ~í=êÉëìäí=áå=áãé~áêÉÇ Å~å=äÉ~Ç=íç=ÅçãçêÄáÇáíáÉëI=äçïÉê=èì~äáíó=çÑ=äáÑÉI=~åÇ=ÖêÉ~í=ÉÅçåçãáÅ ÅçÖåáíáçåI=ÇÉÅêÉ~ëÉÇ=ÑìåÅíáçå~ä=éÉêÑçêã~åÅÉ=áå=êçìíáåÉ=~ÅíáîáíáÉëI=~åÇ ÅçëíK=fí=ìëì~ääó=ÉãÉêÖÉë=~í=íÜÉ=ëí~ÖÉ=çÑ=ãçÇÉê~íÉ=ÇÉãÉåíá~K=qÜÉ=éêÉî~J ÇÉÅäáåÉ=áå=ëçÅá~ääó=~ÅÅÉéí~ÄäÉ=ÄÉÜ~îáçêK=qÜÉ=Çá~Öåçëáë=çÑ=^äòÜÉáãÉê’ë äÉåÅÉ=ê~íÉ=çÑ=rf=áë=Q=íáãÉë=ãçêÉ=Åçããçå=áå=éÉçéäÉ=ïáíÜ=ÇÉãÉåíá~=íÜ~å ÇáëÉ~ëÉ=E^aFI=íÜÉ=ãçëí=Åçããçå=Å~ìëÉ=çÑ=ÇÉãÉåíá~=Ñçê=áåÇáîáÇì~äë=SR 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Accepted: November 1, 2007 Address correspondence to: Dr. Yen-Ho Wang, Department of Physical Medicine and íáçåë=xOMzI=Ñ~ääëI=Ñê~ÅíìêÉë=xONzI=~åÇ=äçï=èì~äáíó=çÑ=äáÑÉ=xOOzK=fí=~äëç=áåJ Rehabilitation, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, ÅêÉ~ëÉë=íÜÉ=ÇÉéÉåÇÉåÅÉ=äÉîÉä=çÑ==é~íáÉåíëI=~åÇ=êÉëìäíë=áå=É~êäáÉê=áåëíáíìJ 10002, Taiwan íáçå~äáò~íáçå=xOPzK=cìêíÜÉêãçêÉI=rf=Ü~ë=ÄÉÉå=~ëëçÅá~íÉÇ=ïáíÜ=~å=áåJ E-mail: [email protected] ÅêÉ~ëÉÇ=êáëâ=çÑ=ëìáÅáÇÉ=xOQz=~åÇ=ãçêí~äáíó=xORzK SP Review m^qelmevpflildv ^ëëçÅá~íÉÇ=ÇáëÉ~ëÉë=Å~å=Å~ìëÉ=çê=Éñ~ÅÉêÄ~íÉ=rfK=qÜÉ=ÑçääçïáåÖ Ç~í~=ëÜçìäÇ=ÄÉ=çÄí~áåÉÇX=~=ÇÉí~áäÉÇ=Çìê~íáçå=çÑ=ëóãéíçãëX=ÑêÉèìÉåÅóI aÉíêìëçê=çîÉê~ÅíáîáíóI=ÄçíÜ=áÇáçé~íÜáÅ=~åÇ=åÉìêçÖÉåáÅI=ï~ë=éêÉîáJ îçäìãÉI=~åÇ=íáãáåÖ=çÑ=áåÅçåíáåÉåÅÉX=éêÉÅáéáí~åíë=íç=áåÅçåíáåÉåÅÉ çìëäó=ÄÉäáÉîÉÇ=íç=ÄÉ=íÜÉ=ã~àçê=Å~ìëÉ=çÑ=áåÅçåíáåÉåÅÉ=áå=ÇÉãÉåíá~=xOSzK EëåÉÉòáåÖI=ÅçìÖÜáåÖI=ÉñÉêÅáëÉI=~åÇ=Å~ÑÑÉáåÉI=~äÅçÜçä=~åÇ=ÉñÅÉëëáîÉ `Éåíê~ä=åÉêîçìë=äÉëáçåëI=äÉ~ÇáåÖ=íç=äçëë=çÑ=íÜÉ=áåÜáÄáíçêó=áåÑäìÉåÅÉ=çå 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  • 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.
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  • 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.
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  • 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).
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  • Mental Health Disorders: Strategies for Approach & Treatment
    3/20/2019 Mental Health Disorders: Strategies for Approach & Treatment Transform 2019: OPTA Annual Conference Columbus, Ohio April 6th, 2019 Dawn Bookshar, PT, DPT, GCS Ian Kilbride, PT Marcia Zeiger, OTRL Objectives Participants will: • Understand the prevalence and impact of mental health disorders in client populations • Understand clinical conditions, and associated characteristics of common mental health diagnoses • Apply effective treatment approaches for clients with mental illness. • Produce effective clinical documentation to support intervention for clients with mental illness Mental Illness (MI) www.schizophrenia.com 1 3/20/2019 Mental Illness (MI) The term mental illness refers collectively to all diagnosable mental disorders defined as sustained abnormal alterations in thinking, mood, or behavior associated with distress and impaired functioning which substantially interferes with or limits one or more major life activities. National Institute of Mental Health Prevalence of MI • More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime. • 1 in 5 Americans will experience a mental illness in a given year. • 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Centers for Disease Control & Prevention Prevalence of MI in LTC • 2/3 of people in nursing homes have a mental illness. • Nursing home residents with a primary diagnosis of mental illness range from 18.7% among those aged 65-74 years to 23.5% among those aged 85+ years. • Dementia, Alzheimer disease, and mood disorders are the most common diagnoses of mental illness in long-term care settings. Centers for Disease Control & Prevention 2 3/20/2019 Prevalence of MI in LTC Ohio • Residents with a diagnosis of schizophrenia and bipolar disorder increased from 9% to 16% between 2001 to 2016.
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  • Trauma: What Lurks Beneath the Surface
    \\jciprod01\productn\N\NYC\24-2\NYC204.txt unknown Seq: 1 15-MAR-18 13:45 TRAUMA: WHAT LURKS BENEATH THE SURFACE SARA E. GOLD* Scholarship in the behavioral health field demonstrates that an overwhelming majority of clients experiencing urban poverty, and particularly low-income clients living with chronic medical and mental health issues, have endured trauma as children and adults. While legal scholars and service providers have begun to discuss the role that trauma plays in the client’s interactions with the lawyer, the dialogue has largely focused on trauma relevant to the subject matter of the legal representation. This article expands current scholarship by asserting that given the prevalence of trauma, the lawyer serving the urban poor should presumptively adopt a trauma-informed prac- tice approach regardless of the subject matter of the representation. The lawyer engaging in a trauma-informed practice can enrich the client experience generally and enrich it significantly for the many clients who come to the lawyer-client relationship with a history of trauma. I. INTRODUCTION When we first met Ms. A.,1 she was thirty years old and raising * Clinical Law Instructor, University of Maryland Francis King Carey School of Law. I would like to thank Robert Dinerstein, Naomi Mann, Kate Mitchell, and Jennifer Rosen Valverde who provided invaluable feedback at the 2016 NYU Clinical Law Writers’ Work- shop. I would also like to thank the participants in the 2016 American Association of Law Schools (AALS) Clinical Conference Scholarship Working Group, and the Fall 2016 Uni- versity of Maryland Carey School of Law and University of Baltimore Law School Junior Faculty Workshop for their thoughtful comments and support.
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  • 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.
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  • 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.
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  • 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.
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  • 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.
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  • 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.
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