Interstitial cystitis: successful management by increasing urinary voiding intervals.

A variant of the interstitial cystitis (IC) syndrome, minimal or no pain or significant pain that has been lessened by another therapy, can be clinically improved by retraining of the individual's voiding pattern. Patients with greater pain but capable of completing this protocol also may be helped. While this group of patients fills the diagnostic criteria of IC and has many of the classic changes, many differ in that they have minimal or no pain, while simultaneously they have a dysfunctional bladder as expected from long-term low-volume voiding. All patients were placed on a protocol which focused on progressively increasing intervals between voids. Fifteen to thirty minutes initially were added to their present voiding time. The same increase was added to the voiding pattern every three or four weeks until an interval of three to four hours between voids was achieved. Twenty-one patients fit the criteria to be entered into this study. Overall 71 percent (15/21) had successful management of their symptoms and reported a 50 percent decrease in their symptoms of urinary urgency, frequency, and nocturia. Nineteen percent (4/21) reported 25 percent decrease in symptoms and 10 percent had no change. Presence of significant pain adversely affects outcome, 3/7 (with pain) improvements versus 12/14 (without pain). For all patients there was a significant increase in bladder capacity (92 mL average before study and 179 mL after) and average daily voids (13.2/day prestudy and 7.4 post-therapy). These differences in voided profiles were statistically significant (p value less than 0.01).

The chronic patient with a nonpsychotic diagnosis.

In a population of almost 1,100 patients in an urban hospital's aftercare program for the chronically mentally ill, 137 patients (12.5 per cent) were found to have nonpsychotic diagnoses. Patients with nonpsychotic diagnoses tended to be older at the first psychiatric contact, a preponderance were first-born or only children, and a higher percentage had been or were presently married. The therapist's possible role in the prevention of chronicity in nonpsychotic patients is discussed; therapists may contribute to the creation of chronic patients, the authors say, by fostering the emergence of increased dependency needs in patients who initially present with acute symptoms. The limitations of psychotherapeutic intervention must be stressed to psychotherapy students, and psychotherapy with nonpsychotic patients should be time-limited and focused on problem-solving.