Optimising the management of children with concomitant bladder dysfunction and behavioural disorders - European Child & Adolescent Psychiatry
Source : https://link.springer.com/article/10.1007/s00787-022-02016-4
Bladder dysfunction and behavioural disorders in children are commonly concomitant; hence, it is difficult to treat each in isolation. Pharmacotherapy is common treatment for behavioural disorders, and these medications may have intended or unintended positive or negative bladder sequelae.
Conclusion/Relevance: This review identifies useful factors that may assist clinicians with predicting unintended bladder effects following initiation of behavioural pharmacotherapy to facilitate the best approach to the treatment of bladder dysfunction in children with behavioural disorders. With this evidence, we have provided a useful decision-making algorithm to aide clinicians in the management of these dual pathologies.
• Source: European Child & Adolescent Psychiatry
• Conclusion: “This review identifies useful factors that may assist clinicians with predicting unintended bladder effects following initiation of behavioural pharmacotherapy to facilitate the best approach to the treatment of bladder dysfunction in children with behavioural disorders. With this evidence, we have provided a useful decision-making algorithm to aide clinicians in the management of these dual pathologies.”
• Strong clinical therapy recommendations in children with nocturnal enuresis and behavioral disorders include alarms/desmopressin plus stimulants, TCAs, atomoxetine for refractory nocturnal enuresis, and reboxetine plus desmopressin.
• The authors recommended treating the behavioral disorder before the bladder condition. Poor attention and poor focus could play a role in the bladder dysfunction.
• The authors wrote, “Some of the central mechanisms between behaviour and bladder may be shared such as brainstem inhibition in ADHD leading to inability to detect bladder signals or decreased arousal to a full bladder or reduced central adrenergic stimulation. Hence, the untreated behavioural disorder will likely negatively impact on adherence and compliance with treatment of bladder dysfunction and thus should be addressed in the first instance.”
• The authors noted that data supporting the use of SNRIs in nocturnal enuresis and stress incontinence is compelling. Various large RCTS support the efficacy of SNRIs in helping treat symptoms either with or without other bladder-specific treatment.