ABSTRACT
Elimination disorders are very common in children: 10 % of 7-year-olds wet at night (nocturnal enuresis), 2-3 % during daytime (diurnal urinary incontinence) and 1-3 % soil (faecal incontinence). In the past decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies, comorbid disorders and specific treatment options. The aim of the paper is to present a short overview of the proposed DSM-5, the ICCS and the Rome-III classification systems, of assessment and of treatment. The DSM-5 criteria no longer reflect current research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. Assessment of most elimination disorders can be performed in paediatric and child psychiatric primary care settings. The standard assessment consists of a thorough history, frequency/volume charts, specific questionnaires, a full physical examination, sonography and urinalysis. If possible, a child psychiatric assessment is performed. In all other settings, screening with a validated behavioural questionnaire and referral if indicated is recommended. All other investigations are indicated only in complicated cases and if an organic cause is to be ruled out. Treatment is symptom oriented and based on the exact diagnosis of the type of elimination disorder. Counselling is recommended in every case. Most elimination disorders can be treated by specific treatment programmes integrating cognitive-behavioural elements. Nocturnal enuresis is best treated with alarms. Medication can be indicated in nocturnal enuresis (desmopressin), urge incontinence (anticholinergics such as oxybutynin, propiverine, etc.) and faecal incontinence with constipation (polyethylene glycol). Comorbid behavioural and emotional disorders require additional treatment.
Subject(s)
Diagnostic and Statistical Manual of Mental Disorders , Elimination Disorders/diagnosis , Adolescent , Adolescent Psychiatry , Behavior Therapy , Child , Child Psychiatry , Counseling , Elimination Disorders/therapy , HumansABSTRACT
Los trastornos del control de esfínteres son uno de los problemas más comunes en la consulta del pediatra de Atención Primaria. Se expone un caso clínico de un niño de cuatro años que presenta encopresis funcional por rechazo a utilizar el inodoro, así como la intervención llevada a cabo en conjunto por Pediatría y Psicología Clínica. La exposición de este caso muestra cómo la misma manifestación puede esconder distintos problemas que requerirán diferentes abordajes terapéuticos. Asimismo, se pone de manifiesto la necesidad de prestar atención a los diversos contextos que rodean al niño (familia, escuela, profesionales), así como valorar la interacción y la influencia mutua de los síntomas de este con la actitud de los padres y con otros factores externos para entender y abordar el problema de forma más precisa y global (AU)
Toilet training disorders are commonly treated problems in Primary Health Care Pediatrician practice. A case study of a four year-old boy with functional encopresis and stool toileting refusal is presented; the interdisciplinary intervention conducted by specialized Pediatrics and Clinical Psychology is also discussed. This clinical case presentation shows that the same symptoms may underlie different problems which would require different therapeutic interventions. The need to pay attention to the contexts surrounding the child (family, school, professionals) is also highlighted; as well as assessing the interaction and reciprocal influence between the childs symptoms, the parents attitudes and other external factors, in order to understand and approach to the problem in a more comprehensive way (AU)
Subject(s)
Humans , Male , Child , Toilet Training , Elimination Disorders/diagnosis , Elimination Disorders/psychology , Elimination Disorders/rehabilitation , Encopresis/complications , Encopresis/diagnosis , Object Attachment , Language Development , Primary Health Care/methods , Primary Health Care/trends , Encopresis/physiopathology , Encopresis/psychology , Mobility Limitation , Dependent Ambulation/education , Dependent Ambulation/psychologySubject(s)
Humans , Male , Aged, 80 and over , Syncope/complications , Syncope/diagnosis , Syncope/drug therapy , Elimination Disorders/complications , Elimination Disorders/diagnosis , Hernia/complications , Hernia/diagnosis , Syncope/physiopathology , Syncope , Elimination Disorders , Electrocardiography, Ambulatory , /trends , Hernia , Herniorrhaphy/methodsABSTRACT
A case of a 6-year-old girl with multiple elimination disorders (nocturnal enuresis, functional urinary incontinence and fecal incontinence) and a fragile X-syndrome is described. The late diagnosis of the fragile X-syndrome had implications for treatment as well as for family interaction. With the knowledge of the diagnosis the parents reacted in a more understanding manner regarding the behavioral problems of the child, whereby the elimination problems were reduced. The need for further research on elimination disorders in children with genetic disorders is discussed.
Subject(s)
Elimination Disorders/diagnosis , Fragile X Syndrome/diagnosis , Behavior Therapy , Biofeedback, Psychology , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/genetics , Child Behavior Disorders/psychology , Child Behavior Disorders/therapy , Combined Modality Therapy , DNA Mutational Analysis , Delayed Diagnosis , Developmental Disabilities/diagnosis , Developmental Disabilities/psychology , Developmental Disabilities/therapy , Diagnosis, Differential , Elimination Disorders/psychology , Elimination Disorders/therapy , Female , Follow-Up Studies , Fragile X Syndrome/genetics , Fragile X Syndrome/psychology , Fragile X Syndrome/therapy , Humans , Intellectual Disability/diagnosis , Intellectual Disability/psychology , Intellectual Disability/therapy , Parent-Child Relations , Phenotype , Prognosis , Toilet Training , Treatment Failure , Urodynamics/physiologyABSTRACT
Elimination disorders are common in childhood and adolescence. Enuresis is defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards--after excluding organic causes. In the past few decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies and specific treatment options. The DSM-IV criteria no longer reflect this wealth of research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. These are presented and discussed. Integration of these into DSM-5 is highly recommended.
Subject(s)
Diagnostic and Statistical Manual of Mental Disorders , Elimination Disorders/diagnosis , Adolescent , Child , Elimination Disorders/classification , HumansABSTRACT
REASONS: Schizophrenia is typically an adult neurodevelopmental disorder that has its antecedents in childhood and adolescence. Little is known about disorders "usually first diagnosed in infancy, childhood and adolescence" (e.g., childhood-onset disorders) in "prodromal" teens at heightened clinical risk for psychotic disorder. MAIN FINDINGS: Childhood-onset disorders were prevalent in putatively prodromal teens, including anxiety and disruptive disorders, attention-deficit/hyperactivity disorder (ADHD), and, surprisingly, elimination disorders. These may reflect developmental antecedents in psychotic disorders such as schizophrenia. KEY DATA AND STATISTICS: A case series of 9 teens (ages 13-17) identified as prodromal to psychosis were evaluated with the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). Childhood-onset diagnoses commonly endorsed (threshold or subthreshold) included ADHD (5/9), oppositional defiant disorder (5/9), enuresis or encopresis (4/9), conduct disorder (2/9), separation anxiety (3/9), and transient tic disorder (2/9). Enuresis was identified in 3 of the 4 older teens (ages 15-17). MAJOR CONCLUSIONS: An understanding of the childhood-onset disorders that occur in teens at risk for psychotic illnesses, such as schizophrenia, can shed light on the pathophysiology of schizophrenia and potentially inform early identification and intervention.
Subject(s)
Age of Onset , Psychotic Disorders/diagnosis , Adolescent , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Conduct Disorder/diagnosis , Elimination Disorders/diagnosis , Enuresis/diagnosis , Female , Humans , Male , Risk Factors , Tic Disorders/diagnosisABSTRACT
Several studies have documented low rates of agreement between clinician- and researcher-generated diagnoses. However, little is known about whether this lack of agreement has implications for the processes and outcomes of subsequent treatment. To study this possibility, the authors used diagnostic agreement to predict therapy engagement and outcomes for 197 youths treated in 5 community mental health clinics. Diagnostic agreement predicted better therapy engagement, with the agree group having fewer therapy no-shows and cancellations and a decreased likelihood of therapy dropout. Additionally, support for a link between agreement and treatment outcomes was found, as the agree group obtained larger reductions in parent-reported internalizing problems during treatment. These findings suggest that diagnostic accuracy may be an important precursor to successful treatment and highlight the importance of future research to find ways to incorporate standardized diagnostic procedures into clinical care settings.
Subject(s)
Community Mental Health Services/statistics & numerical data , Mental Disorders/diagnosis , Outcome and Process Assessment, Health Care/statistics & numerical data , Personality Assessment/statistics & numerical data , Psychotherapy/statistics & numerical data , Adolescent , Age Factors , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/therapy , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Attention Deficit and Disruptive Behavior Disorders/psychology , Attention Deficit and Disruptive Behavior Disorders/therapy , Child , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Depressive Disorder/therapy , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Elimination Disorders/diagnosis , Elimination Disorders/epidemiology , Elimination Disorders/psychology , Elimination Disorders/therapy , Female , Humans , Internal-External Control , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Mental Disorders/therapy , Observer Variation , Patient Care Planning/statistics & numerical data , Patient Dropouts/psychology , Patient Dropouts/statistics & numerical data , PrognosisSubject(s)
Elimination Disorders , Behavior Therapy , Child, Preschool , Constipation/diagnosis , Constipation/etiology , Constipation/therapy , Elimination Disorders/diagnosis , Elimination Disorders/etiology , Elimination Disorders/therapy , Enuresis/diagnosis , Enuresis/etiology , Enuresis/therapy , Humans , Medical History Taking , Parenting , Physical Examination , SyndromeABSTRACT
Este trabalho teve como objetivo estudar a ação da monensina em animais em estresse térmico sobre o desempenho, digestibilidade do alimento, parâmetros ruminais, concentrações de Ca, P, Mg, Na, Zn e Cu no soro sangüíneo e retenção e absorção destes minerais. Foram utilizados 24 bezerros machos da raça Holandesa (peso médiio 82 kg), estrutua de tramentos de fatorial 2 x 2, dois níveis de suplemntaç+o: 0 mg de monensina e 85 mg de mononsina/animal/dia e duas temperaturas: temperatura ambiente (24,3 ºC) e de estresse térmico (33,2 ºC)...
