Podcast
Questions and Answers
Desmopressin can be used with the enuresis alarm to speed the acquisition of bladder control.
Desmopressin can be used with the enuresis alarm to speed the acquisition of bladder control.
True
Imipramine and desmopressin have also been used to treat enuresis.
Imipramine and desmopressin have also been used to treat enuresis.
False
The guidelines for the treatment of enuresis are provided by Walle et al. (2012).
The guidelines for the treatment of enuresis are provided by Walle et al. (2012).
True
Anticholinergic agents and desmopressin have been used together to speed bladder control.
Anticholinergic agents and desmopressin have been used together to speed bladder control.
Signup and view all the answers
Desmopressin has been used as a standalone treatment for enuresis.
Desmopressin has been used as a standalone treatment for enuresis.
Signup and view all the answers
Imipramine is an anticholinergic agent used for the treatment of enuresis.
Imipramine is an anticholinergic agent used for the treatment of enuresis.
Signup and view all the answers
An enuresis alarm can be used in conjunction with imipramine to speed the acquisition of bladder control.
An enuresis alarm can be used in conjunction with imipramine to speed the acquisition of bladder control.
Signup and view all the answers
Functional enuresis includes the repeated voluntary voiding of urine.
Functional enuresis includes the repeated voluntary voiding of urine.
Signup and view all the answers
Enuresis can be only nocturnal (bedwetting) and cannot occur during daytime.
Enuresis can be only nocturnal (bedwetting) and cannot occur during daytime.
Signup and view all the answers
Children usually achieve both daytime and night-time continence by the age of 3 or 4 years.
Children usually achieve both daytime and night-time continence by the age of 3 or 4 years.
Signup and view all the answers
Nocturnal enuresis is referred to as primary when there has been a preceding period of urinary continence.
Nocturnal enuresis is referred to as primary when there has been a preceding period of urinary continence.
Signup and view all the answers
Functional enuresis can occur in the presence of an identified physical disorder.
Functional enuresis can occur in the presence of an identified physical disorder.
Signup and view all the answers
Secondary nocturnal enuresis occurs when there has been a preceding period of urinary continence.
Secondary nocturnal enuresis occurs when there has been a preceding period of urinary continence.
Signup and view all the answers
Children typically take more than 5 years to achieve daytime and night-time continence.
Children typically take more than 5 years to achieve daytime and night-time continence.
Signup and view all the answers
The TADS study found that the most effective treatment for moderate to severe depression in adolescence is cognitive behaviour therapy alone.
The TADS study found that the most effective treatment for moderate to severe depression in adolescence is cognitive behaviour therapy alone.
Signup and view all the answers
According to a network meta-analysis, cognitive behaviour therapy is one of the most effective psychotherapies for depression in children and adolescents.
According to a network meta-analysis, cognitive behaviour therapy is one of the most effective psychotherapies for depression in children and adolescents.
Signup and view all the answers
Childhood and adolescent depression is rarely chronic and recurrent.
Childhood and adolescent depression is rarely chronic and recurrent.
Signup and view all the answers
Around 50-70% of children and adolescents with depression will develop subsequent depressive disorders within five years.
Around 50-70% of children and adolescents with depression will develop subsequent depressive disorders within five years.
Signup and view all the answers
Interpersonal therapy is considered ineffective for treating depression in children and adolescents.
Interpersonal therapy is considered ineffective for treating depression in children and adolescents.
Signup and view all the answers
There is an increased risk of depression in adulthood for children who have experienced depression.
There is an increased risk of depression in adulthood for children who have experienced depression.
Signup and view all the answers
Educational underachievement and interpersonal difficulties are commonly associated with childhood depression.
Educational underachievement and interpersonal difficulties are commonly associated with childhood depression.
Signup and view all the answers
Parental depression and family discord have a negative impact on child depression.
Parental depression and family discord have a negative impact on child depression.
Signup and view all the answers
Sleep deprivation does not influence depression in children.
Sleep deprivation does not influence depression in children.
Signup and view all the answers
Children with ADHD and their parents have increased rates of behavioural disorders and irritability.
Children with ADHD and their parents have increased rates of behavioural disorders and irritability.
Signup and view all the answers
A higher IQ is associated with greater resilience against depression.
A higher IQ is associated with greater resilience against depression.
Signup and view all the answers
The response rate of adolescents to fluoxetine alone was higher than to cognitive behaviour therapy alone at 12 weeks.
The response rate of adolescents to fluoxetine alone was higher than to cognitive behaviour therapy alone at 12 weeks.
Signup and view all the answers
Fluoxetine is the only antidepressant currently considered to have a favourable risk-benefit ratio.
Fluoxetine is the only antidepressant currently considered to have a favourable risk-benefit ratio.
Signup and view all the answers
A comorbid medical illness is not associated with depression in children.
A comorbid medical illness is not associated with depression in children.
Signup and view all the answers
Major unipolar depression is a significant global health problem, with the highest incident risk being during adulthood.
Major unipolar depression is a significant global health problem, with the highest incident risk being during adulthood.
Signup and view all the answers
Depressive illness during adolescence can lead to negative long-term consequences, including poor educational performance and poor employment attainment.
Depressive illness during adolescence can lead to negative long-term consequences, including poor educational performance and poor employment attainment.
Signup and view all the answers
Normal variations in mood or depressive symptoms are covered in this section of the text.
Normal variations in mood or depressive symptoms are covered in this section of the text.
Signup and view all the answers
In adolescence, depressive mood may be more immediately obvious than anger and withdrawal from social contact with peers.
In adolescence, depressive mood may be more immediately obvious than anger and withdrawal from social contact with peers.
Signup and view all the answers
Healthy children experiencing grief may lose interest, concentrate poorly, and sleep badly.
Healthy children experiencing grief may lose interest, concentrate poorly, and sleep badly.
Signup and view all the answers
A depressive illness during adolescence is not associated with additional psychiatric comorbidity.
A depressive illness during adolescence is not associated with additional psychiatric comorbidity.
Signup and view all the answers
In adolescence, depressive mood can be expressed through deliberate self-harm and substance abuse.
In adolescence, depressive mood can be expressed through deliberate self-harm and substance abuse.
Signup and view all the answers
Children with depression often express their feelings of sadness in the same way as adults.
Children with depression often express their feelings of sadness in the same way as adults.
Signup and view all the answers
The prevalence of major depressive disorder in pre-pubertal children is about 4%.
The prevalence of major depressive disorder in pre-pubertal children is about 4%.
Signup and view all the answers
Following puberty, the 1-year prevalence of major depressive disorder is higher in females than in males.
Following puberty, the 1-year prevalence of major depressive disorder is higher in females than in males.
Signup and view all the answers
Increased cortisol secretion has been identified as a risk factor for child and adolescent depression.
Increased cortisol secretion has been identified as a risk factor for child and adolescent depression.
Signup and view all the answers
The major pubertal and brain maturation processes have no influence on the aetiology of depression in adolescents.
The major pubertal and brain maturation processes have no influence on the aetiology of depression in adolescents.
Signup and view all the answers
The heritability of major depression in adolescents is lower than in younger children.
The heritability of major depression in adolescents is lower than in younger children.
Signup and view all the answers
SSRIs have shown clinical benefit for moderate to severe depression in children.
SSRIs have shown clinical benefit for moderate to severe depression in children.
Signup and view all the answers
Tricyclic antidepressants have been proven to be significantly effective in treating childhood depression.
Tricyclic antidepressants have been proven to be significantly effective in treating childhood depression.
Signup and view all the answers
Negative genetic biases are considered a risk factor for depression in children and adolescents.
Negative genetic biases are considered a risk factor for depression in children and adolescents.
Signup and view all the answers
Psychological treatments such as cognitive therapy and family therapy are often based on evidence from trials with pre-pubertal children.
Psychological treatments such as cognitive therapy and family therapy are often based on evidence from trials with pre-pubertal children.
Signup and view all the answers
Nocturnal enuresis can solely be attributed to delayed maturation of the nervous system without environmental stressors.
Nocturnal enuresis can solely be attributed to delayed maturation of the nervous system without environmental stressors.
Signup and view all the answers
The prevalence of nocturnal enuresis at 5 years of age in the UK is approximately 10%.
The prevalence of nocturnal enuresis at 5 years of age in the UK is approximately 10%.
Signup and view all the answers
More than 50% of children who wet their bed at night also suffer from daytime enuresis.
More than 50% of children who wet their bed at night also suffer from daytime enuresis.
Signup and view all the answers
Approximately 70% of children with enuresis have a first-degree relative who has experienced the same condition.
Approximately 70% of children with enuresis have a first-degree relative who has experienced the same condition.
Signup and view all the answers
The proportion of children with psychiatric disorders among enuretic children is lower compared to other children.
The proportion of children with psychiatric disorders among enuretic children is lower compared to other children.
Signup and view all the answers
Stressful events are linked with the onset of primary nocturnal enuresis.
Stressful events are linked with the onset of primary nocturnal enuresis.
Signup and view all the answers
Early childhood difficult temperament and behaviour problems are risk factors for later bedwetting.
Early childhood difficult temperament and behaviour problems are risk factors for later bedwetting.
Signup and view all the answers
Exposure to family adversity and stress in early childhood has no impact on the development of enuresis.
Exposure to family adversity and stress in early childhood has no impact on the development of enuresis.
Signup and view all the answers
Revoking punishment and disapproval are recommended strategies in managing functional enuresis.
Revoking punishment and disapproval are recommended strategies in managing functional enuresis.
Signup and view all the answers
Modern enuresis alarms are carried in the child’s pocket.
Modern enuresis alarms are carried in the child’s pocket.
Signup and view all the answers
Study Notes
Enuresis
- Desmopressin can be used in conjunction with the enuresis alarm to speed up the acquisition of bladder control.
- Imipramine and anticholinergic agents have also been used for the treatment of enuresis.
Functional Enuresis
- Repeated involuntary voiding of urine after the age of usual continence, with no identified physical disorder.
- Can be nocturnal (bedwetting), diurnal (daytime wetting), or both.
- Most children achieve daytime and night-time continence by 3 or 4 years of age.
- Nocturnal enuresis can be primary (no preceding period of urinary continence) or secondary (preceding period of urinary continence).
Depression in Children and Adolescents
- TADS study: combination of fluoxetine and cognitive behavior therapy is the best treatment for moderate to severe depression in adolescence.
- Network meta-analysis: interpersonal therapy and cognitive behavior therapy are the most effective psychotherapies for depression in children and adolescents.
Prognosis of Depression in Children and Adolescents
- Tends to be chronic and recurrent, with 60-90% remitting within one year.
- 50-70% will develop subsequent depressive disorders within five years.
- Increased risk of depression in adulthood, associated with educational underachievement and interpersonal difficulties.
Vulnerability Factors for Depression
- Genetic factors
- Cognitive distortion and rumination
- Emotion regulation difficulties
- Behavioral disorders and irritability
- Sleep deprivation
- Comorbid medical illness
Environmental Risk Factors
- Parental depression and family discord
- Child maltreatment
- Peer victimization
- Sexual minority status
- Bereavement
- Resilience
Treatment of Depression in Children and Adolescents
- Fluoxetine has a favorable risk-benefit ratio and is the only antidepressant currently considered beneficial.
- Combination of fluoxetine and cognitive behavior therapy is more effective than fluoxetine alone.
- Clinicians should monitor for the emergence or exacerbation of suicidality, especially with SSRIs and venlafaxine.
Childhood Depression
- Clinical picture of major depression in childhood and adolescence is similar to adults, but can be easily missed.
- Symptoms may include abdominal pains, headaches, anorexia, and enuresis.
Epidemiology of Childhood Depression
- Depressive symptoms are more common in adolescence.
- Estimates of major depressive disorder are less than 1% in pre-pubertal children, with an equal ratio of males to females.
- 1-year prevalence of around 4% following puberty puts females at a greater risk, with a 2:1 ratio of females to males.
Aetiology of Childhood Depression
- Individual, family, and social risk factors are strongly correlated.
- Causes of depressive disorder are similar to that seen in adulthood.
- Major pubertal and brain and cognitive maturation processes influence the aetiology and impact of depression.
Risk Factors for Childhood Depression
- Negative cognitive biases
- Increased cortisol secretion
- Genetic factors
- 5-HTTLPR variation
- Neurobiology
- Negative life events
- Temperament
Management of Childhood Depression
- General measures: reduce distressing circumstances and stressors, encourage expression of feelings, and consider depression in parents.
- Psychological treatment: cognitive therapy, interpersonal therapy, and brief family therapy.
- Medication: SSRIs have been shown to have clinical benefit for moderate to severe depression.
Nocturnal Enuresis
- Nocturnal enuresis can cause significant unhappiness and distress, especially if parents blame or punish the child.
- Limitations on activities, such as staying with friends or going on holiday, can worsen this unhappiness.
Epidemiology
- The prevalence of nocturnal enuresis occurring once a week or more is around 10% at 5 years of age, 4% at 8 years, and 1% at 14 years in the UK.
- Similar figures have been reported from the USA.
- Nocturnal enuresis occurs more frequently in boys.
- Daytime enuresis has a lower prevalence and is more common in girls than in boys.
- Over 50% of daytime wetters also experience nocturnal enuresis.
Aetiology
- Nocturnal enuresis can be caused by physical conditions, but more often it is due to a delay in the maturation of the nervous system, often combined with environmental stressors.
- There is a genetic contribution, with around 70% of children with enuresis having a first-degree relative who has been enuretic.
- Concordance rates for enuresis are twice as high in monozygotic twins as in dizygotic twins.
- Family influences, such as exposure to family adversity and stress, parenting style, and difficulties in toilet training, can contribute to enuresis.
- Most enuretic children are free from psychiatric disorder, but the proportion with psychiatric disorder is greater than that of other children.
- Early childhood difficult temperament and behaviour problems can be risk factors for later bedwetting.
- Enuresis is more frequent in large families living in overcrowded conditions.
- Stressful events can trigger the onset of secondary enuresis.
Assessment
- A careful history and physical examination are necessary to determine if the enuresis is primary or secondary and to exclude undetected physical disorders.
- The child should be screened for other psychiatric disorders and a history taken to determine if any difficult or distressing events contributed to the presentation.
- Questions should be asked about faecal soiling and urinary infection.
Management
- Primary care and paediatric services typically treat enuresis disorders.
- Any physical disorder should be treated.
- The child and parents should be informed that the condition is common and the child is not to blame.
- Punishment and disapproval are inappropriate and unlikely to be effective.
- Rewarding success without drawing attention to failure can be helpful.
- Restricting fluid before bedtime, voiding at daytime intervals and/or before bedtime, and using star charts can be effective.
- Enuresis alarms can be used for children who do not improve with these simple measures, with high reported success rates.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Learn about the different treatment options for enuresis, including desmopressin and imipramine, as well as the role of enuresis alarms in achieving bladder control. Understand the differences between nocturnal and diurnal enuresis.
