A Case of Hinman Syndrome(Nonneurogenic Neurogenic Bladder) / 신경정신의학

ABSTRACT

OBJECTIVES: The Hinman Syndrome is a condition representing urinary voiding dysfunction in a neurologically intact child. This syndrome probably is an acquired behavioral and psychosocial disorders. We present a case presenting voiding dysfuntion with no neurologic etiology. CASE: The department of urology consulted the department of psychiatry for a psychiatric evaluation of a 14-year-old girl with a history of recurrent urinary tract infections, enuresis, and urinary dribbling since early childhood. She visited the emergency room because of severe abdominal pain and hematuria. She was admitted to the department of urology. Neurological tests showed no abnormality, but a retrograde cystogram showed free vesicoureteral reflux to the level of the dilated intrarenal collecting systems. Marked blunting and dilatation of the calices suggested longstanding urinary flow obstruction. She had a history of separation anxiety disorder and was very competetive, perfectionistic, and nervous. She also had very poor relationships with her friends and had difficulties in managing them. After admission, she had stent operation and cystostomy. Antidepressant and anxiolytic medications with supportive psychotherapy were administered to treat anxiety, tension and depression. Gradually, her depressive symptoms and voiding difficulties improved. CONCLUSIONS: Psychological factors such as a perfectionistic and obsessive personality, a history of severe separation anxiety, stressors from poor interpersonal relationships and the failure of an entrance examination seem to have contributes to the development and exacerbation of the urinary dysfunction. Pharmacotherapy and supportive psychotherapy may be effective in treating associated psychiatric problems of these patients with hinman syndrome.