DOCSLIB.ORG

Treatment Options for Clozapine-Induced Enuresis: a Review of Clinical Effectiveness

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read 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. RESEARCH QUESTIONS: 1. What treatments are available in Canada to treat clozapine-induced enuresis? 2. What are the potential adverse effects of treatments for clozapine-induced enuresis? METHODS: A limited literature search was conducted on key health technology assessment resources, including Ovid MEDLINE (1950 to August Week 3 2010), Ovid EMBASE (1996 to 2010 Week 34), PubMed, The Cochrane Library (Issue 8, 2010), University of York Centre for Reviews and Dissemination (CRD) databases, ECRI (Health Devices Gold), EuroScan, international health technology agencies, and a focused Internet search. The search was limited to English language, with no time limit for articles’ publication dates. No filters were applied to limit the retrieval by study type. SUMMARY OF FINDINGS: The literature search identified one prospective cohort study,6 and 13 case reports.4,12-23 There were no health technology assessments, systematic reviews, meta-analyses, randomized controlled clinical trials, uncontrolled clinical trials, or case control studies. Results from individual studies are summarized in Appendix 1 and the treatment strategies identified are listed in Appendix 2. Non-randomized studies Desmopressin There were six reports involving a total of ten patients that received desmopressin spray to treat their clozapine-induced nocturnal enuresis.4,15-19 The patients consisted of nine adults and one adolescent, ranging in age from 16 to 47 years. Five studies reported that the desmopressin was effective.4,16-19 One of these reports involved a patient who had received initial, unsuccessful treatment with tolterodine.19 The one case with negative results involved a patient that developed severe hyponatremia following two doses of desmopressin which required hospitalization in an intensive care unit. Hyponatremia is an important adverse event associated with treatment using desmopressin and the manufacturers recommend careful medical supervision when using this product. Furthermore, the patient that developed hyponatremia had a previously documented hyponatremic episode. The product monograph clearly indicates that desmopressin is contraindicated in patients with known hyponatremia.8 Two articles17,18 reported that no adverse events occurred with desmopressin treatment and three failed to report this information.4,16,19 The most common dosage was 10 μg/day in each nostril which is consistent with the average daily doses reported in the product monograph for desmopressin spray.8 Two case reports16,19 failed to provide the exact dosage used by the patients and only one reported the time to resolution.19 Anticholinergic agents There were two case series (n = 10) where patients were given the anticholinergic agent oxybutynin (5-15 mg/day) for nocturnal enuresis.16,17 Both articles stated that the treatment was effective; however, neither reported the time to resolution. The dosage was consistent with recommendations in the product monograph for oxybutynin.10 Frankenburg et al (1996)17 reported that no adverse events occurred with oxybutynin treatment and Lurie et al (1997)16 did not report the occurrence of adverse events in their study.16 Trihexiphenidyl, another anticholinergic agent, was reported to be effective at doses of 5 mg/day and 6 mg/day (n = 3).20,21 Poyurovsky et al (1996)20 stated that the nocturnal enuresis had resolved within five days of trihexiphenidyl treatment; however, Aggarwal et al (2009)21 did not report the time to onset for the therapeutic effect. Similar to oxybutynin, there were no adverse events in one study21 and other failed to provide this information.20 All patients in these case reports were adults; however, those receiving trihexiphenidyl were younger (range: 21-24 years) than those who received oxybutynin (range: 26-43 years). Antidepressants There was one case report where amitriptyline (25 mg/day), a tricyclic antidepressant, was provided to one patient (35 years of age) with clozapine-induced enuresis.12 The authors reported Treatment Options for Clozapine-Induced Enuresis 2 that after four days of amitriptyline therapy the enuresis had effectively resolved and that nocturnal and day-time sialorrhea were also improved. It was not reported if the patient experienced any adverse events due to the addition of amitriptyline to his/her therapeutic regimen. Antipsychotics Aripiprazole was used to treat three patients with clozapine-induced nocturnal enuresis at doses of 10-15 mg/day.13,14 The authors of these cases reported that the treatment was effective within 1 to 3 months. Rocha et al (2006)13 reported that no adverse events occurred after initiating treatment with aripiprazole and Lee and Kim (2010) did not report whether or not the patients experienced any adverse events.14 Another case involved ceasing treatment with clozapine and commencing therapy with olanzapine.23 The authors reported that the nocturnal enuresis remitted following this change in pharmacotherapy. The dosage of olanzapine was not reported nor was it reported if the patient experienced any adverse events from switching antipsychotics. The patients were all adults ranging in age from 27 years to 52 years. Adrenergic agonists Fuller et al (1996)6 conducted a small, prospective cohort study involving 16 patients with clozapine-induced urinary incontinence. The authors gave the patients ephedrine (25-150 mg/day) and reported improvement in symptoms of urinary incontinence in 15 patients within 24 hours of maximal dosing. There were no adverse events reported for these patients. The patients in this study were heterogeneous with regard to the dosages of clozapine (range: 200-700 mg/day); concomitant use of medications; and age (range: 32-69 years). Other approaches Frankenburg et al (1996)17 reported that the clozapine-induced enuresis was resolved in one patient by using an alarm clock set to wake the patient in the middle night. Once woken the patient could voluntarily empty his/her bladder. Pojurovsky et al (1995)22 used 40-80 mg/day of verapamil, an L-type calcium channel blocker, to treat two patients with clozapine-induced enuresis.22 The authors noted that the 80 mg/day treatment was effective and that the enuresis had resolved after one day. The patient experienced bradycardia (reduction of 11-22 beats/min) for five days after the first dose of 40 mg/day verapamil and for 4 days following the first dose of 80 mg/day verapamil. Kho et al (2001)23 also reported individual cases where clozapine-induced nocturnal enuresis was resolved following initiation of valproic acid (1500 mg/day) to control seizures (n = 1) and with the initiation of insulin to control diabetes (n = 1). The duration between initiating these therapies and resolution of the enuresis was not reported by the study authors. Limitations There were no randomized controlled trials, uncontrolled clinical trials, larger cohort studies, or case control studies identified. The evidence identified in this review consists of case reports4,12-23 and one small (16 patients), prospective cohort study.6 These study designs are typically considered poor for accurately assessing the effectiveness of interventions and may carry a high risk of bias. Planning and conducting a controlled clinical trial could be difficult in this population as the true prevalence of clozapine-induced enuresis has yet to be determined. Treatment Options for Clozapine-Induced Enuresis 3 Among the included studies, six failed to provide a clear indication of the time required to resolve the enuresis following treatment.4,16-18,20,23 The dosage of clozapine was heterogeneous between the various patients described in the case reports (range: 150-900 mg/day); however, no one exceed the maximum recommended dose of 900 mg/day and most were within the expected
Load more

Recommended publications
  • 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]
  • 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.
    [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]
  • Schizophrenia Care Guide
    August 2015 CCHCS/DHCS Care Guide: Schizophrenia SUMMARY DECISION SUPPORT PATIENT EDUCATION/SELF MANAGEMENT GOALS ALERTS Minimize frequency and severity of psychotic episodes Suicidal ideation or gestures Encourage medication adherence Abnormal movements Manage medication side effects Delusions Monitor as clinically appropriate Neuroleptic Malignant Syndrome Danger to self or others DIAGNOSTIC CRITERIA/EVALUATION (PER DSM V) 1. Rule out delirium or other medical illnesses mimicking schizophrenia (see page 5), medications or drugs of abuse causing psychosis (see page 6), other mental illness causes of psychosis, e.g., Bipolar Mania or Depression, Major Depression, PTSD, borderline personality disorder (see page 4). Ideas in patients (even odd ideas) that we disagree with can be learned and are therefore not necessarily signs of schizophrenia. Schizophrenia is a world-wide phenomenon that can occur in cultures with widely differing ideas. 2. Diagnosis is made based on the following: (Criteria A and B must be met) A. Two of the following symptoms/signs must be present over much of at least one month (unless treated), with a significant impact on social or occupational functioning, over at least a 6-month period of time: Delusions, Hallucinations, Disorganized Speech, Negative symptoms (social withdrawal, poverty of thought, etc.), severely disorganized or catatonic behavior. B. At least one of the symptoms/signs should be Delusions, Hallucinations, or Disorganized Speech. TREATMENT OPTIONS MEDICATIONS Informed consent for psychotropic
    [Show full text]
  • Current P SYCHIATRY
    Current p SYCHIATRY N ew Investigators Tips to manage and prevent discontinuation syndromes Informed tapering can protect patients when you stop a medication Sriram Ramaswamy, MD Shruti Malik, MBBS, MHSA Vijay Dewan, MD Instructor, department of psychiatry Foreign medical graduate Assistant professor Creighton University Department of psychiatry Omaha, NE University of Nebraska Medical Center Omaha, NE bruptly stopping common psychotropics New insights on psychotropic A —particularly antidepressants, benzodi- drug safety and side effects azepines, or atypical antipsychotics—can trigger a discontinuation syndrome, with: This paper was among those entered in the 2005 • rebound or relapse of original symptoms Promising New Investigators competition sponsored • uncomfortable new physical and psycho- by the Neuroleptic Malignant Syndrome Information Service (NMSIS). The theme of this year’s competition logical symptoms was “New insights on psychotropic drug safety and • physiologic withdrawal at times. side effects.” To increase health professionals’ awareness of URRENT SYCHIATRY 1 C P is honored to publish this peer- the risk of these adverse effects, this article reviewed, evidence-based article on a clinically describes discontinuation syndromes associated important topic for practicing psychiatrists. with various psychotropics and offers strategies to NMSIS is dedicated to reducing morbidity and anticipate, recognize, and manage them. mortality of NMS by improving medical and psychiatric care of patients with heat-related disorders; providing
    [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]
  • Antipsychotic Combinations
    Graylands Hospital DRUG BULLETIN Pharmacy Department Brockway Road Mount Claremont WA 6010 Telephone (08) 9347 6400 Email [email protected] Fax (08) 9384 4586 Antipsychotic Combinations Graylands Hospital Drug Bulletin 2008 Vol. 15 No. 3 February ISSN 1323-1251 Antipsychotic combinations Reasons for antipsychotic combinations Despite the development of efficacious medications for the treatment of schizophrenia, many people do There are a number of theoretical benefits and not respond adequately. To address this problem, reasons cited for antipsychotic combination the use of two or more antipsychotics simultaneously prescribing, these include: is a commonly employed treatment strategy. Although the use of combination antipsychotics is Complementary mechanisms of action4 (e.g. common in clinical practice, the risks and benefits adding an antipsychotic with strong dopamine have not been systematically evaluated to date. As a D2 blockade to a weak D2 blocker) result, current Australian treatment algorithms Partial replacement of antipsychotic action for including the Royal Australian and New Zealand drugs with intolerable adverse effects at higher College of Psychiatry Schizophrenia Guidelines and 5 doses (e.g. adding quetiapine to clozapine to the Western Australian Therapeutic Advisory Group minimise metabolic adverse effects) Antipsychotic Guidelines advise against the use of combined antipsychotics, except for short periods of Alternative where clozapine cannot be used6 changeover1,2. Most data on antipsychotic
    [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]
  • Doxepin Exacerbates Renal Damage, Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Urinary Chromium Loss in Obese Mice
    pharmaceuticals Article Doxepin Exacerbates Renal Damage, Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Urinary Chromium Loss in Obese Mice Geng-Ruei Chang 1,* , Po-Hsun Hou 2,3, Wei-Cheng Yang 4, Chao-Min Wang 1 , Pei-Shan Fan 1, Huei-Jyuan Liao 1 and To-Pang Chen 5,* 1 Department of Veterinary Medicine, National Chiayi University, 580 Xinmin Road, Chiayi 60054, Taiwan; [email protected] (C.-M.W.); [email protected] (P.-S.F.); [email protected] (H.-J.L.) 2 Department of Psychiatry, Taichung Veterans General Hospital, 1650 Taiwan Boulevard (Section 4), Taichung 40705, Taiwan; [email protected] 3 Faculty of Medicine, National Yang-Ming University, 155 Linong Street (Section 2), Taipei 11221, Taiwan 4 School of Veterinary Medicine, National Taiwan University, 1 Roosevelt Road (Section 4), Taipei 10617, Taiwan; [email protected] 5 Division of Endocrinology and Metabolism, Show Chwan Memorial Hospital, 542 Chung-Shan Road (Section 1), Changhua 50008, Taiwan * Correspondence: [email protected] (G.-R.C.); [email protected] (T.-P.C.); Tel.: +886-5-2732946 (G.-R.C.); +886-4-7256166 (T.-P.C.) Abstract: Doxepin is commonly prescribed for depression and anxiety treatment. Doxepin-related disruptions to metabolism and renal/hepatic adverse effects remain unclear; thus, the underlying mechanism of action warrants further research. Here, we investigated how doxepin affects lipid Citation: Chang, G.-R.; Hou, P.-H.; change, glucose homeostasis, chromium (Cr) distribution, renal impairment, liver damage, and fatty Yang, W.-C.; Wang, C.-M.; Fan, P.-S.; liver scores in C57BL6/J mice subjected to a high-fat diet and 5 mg/kg/day doxepin treatment for Liao, H.-J.; Chen, T.-P.
    [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]
  • 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]
  • Clozapine and Gastrointestinal Adverse Effects – a Pain in the Gut? Graylands Hospital Drug Bulletin 2004 Vol
    Clozapine and Gastrointestinal Adverse Effects – A Pain in the Gut? Graylands Hospital Drug Bulletin 2004 Vol. 12 No. 3 September ISSN 1323-1251 Gastrointestinal adverse effects of clozapine impaction5. The patient died three weeks after are very common and include nausea, presentation from refractory shock and vomiting and constipation. Other troublesome progressive multi-system organ failure, unwanted effects include dry mouth and despite maximal care. hypersalivation, which involve the autonomic nervous system. A further case involved a 29 year old man who had only been taking clozapine for 36 Constipation is a particularly common days2. He died after aspiration of vomitus adverse effect that has been reported to occur secondary to bowel obstruction. in 14-60% of patients1,2. The management of clozapine-induced constipation has been the Intestinal Obstruction/Occlusion subject of a past Drug Bulletin3. Clozapine’s association with constipation could be There is a French report of three cases of intestinal occlusion in clozapine treated explained by its potent anticholinergic 6 properties. patients, one of which was fatal . Another report describes two cases of Rarely, clozapine-induced constipation has 7 lead to serious complications including ileus, clozapine-induced intestinal obstruction . bowel obstruction and necrotising colitis. A One of these involved a 51 year old man with review was conducted to determine what no past history of constipation, who had been serious gastrointestinal adverse effects have taking clozapine for two months. He suffered been reported in the literature and these are from an intestinal obstruction, from which he discussed below. fully recovered and clozapine was recommenced. The other case involved a 35 Faecal Impaction year old woman who had been taking clozapine for four months when she There are three reported cases of death developed abdominal symptoms.
    [Show full text]