Child Psych Eating Disorders 2

14問 • 9ヶ月前

問題一覧

Normal Sequence of Developing Bladder and Bowel Control

1. Nocturnal fecal continence 2. Diurnal fecal continence 3. Diurnal bladder control 4. Nocturnal bladder control

-Repeated voiding of urine into bed or clothes, whether involuntary or intentional. -The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. -Chronological age is at least 5 years (or equivalent developmental level). -The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder). Specify whether: -Nocturnal only: Passage of urine only during nighttime sleep. -Diurnal only: Passage of urine during waking hours. -Nocturnal and diurnal: A combination of the two subtypes above

DSM-5 Criteria: Enuresis

Is nocturnal, does not involve bladder dysfunction, and includes no daytime symptoms. • Most common • May produce more urine at night • May have decreased functional bladder

Monosymptomatic enuresis

What types of enuresis are more common in males and females?

• Nocturnal enuresis more common in males • Diurnal enuresis more common in females

Compare and contrast primary vs secondary enuresis

• Primary – individual never established urinary continence • Begins at age 5 • Secondary – disturbance develops after a period of urinary continence • Most common onset between ages 5 and 8 years

Neurological Exam: gait, strength testing, deep tendon reflexes • Throat and Neck Exam: tonsils, thyroid • Ultrasound of Genitourinary • Skin Exam: gluteal clefts, tufts of hair, hemangiomas • Abdominal Exam: masses • Routine Blood Draw: Na, K, urea, creatinine • Urine analysis: UTIs, hematuria, specific gravity

Physical Evaluation: Enuresis

Psychopharmacologic Treatment : Enuresis

Desmopressin (DDAVP) – 1st line for treatment of enuresis Imipramine – may want to consider 1st if no insurance Oxybutynin – 1st line treatment for those unable to tolerate DDAVP or Imipramine TCAs, SSRIs & Psychostimulants

Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional. • At least one such event occurs each month for at least 3 months. • Chronological age is at least 4 years (or equivalent developmental level). • The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation. Specify whether: -With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history. -Without constipation and overflow incontinence: There is no evidence of constipation

DSM-5 Criteria: Encopresis

Spastic pelvic floor syndrome

Anismus

Primary Encopresis

soiling in a child who has never gained bowel continence for six months or more

Secondary Encopresis

soiling in a child who has previously acquired bowel control

Encopresis with Constipation and Overflow Incontinence

Retentive Encopresis

Encopresis without Constipation and Overflow Incontinence

Non retentive Encopresis

Increases anal sphincter pressure, resulting in decreased bowel incontinence

Loperamide

Patho Renal

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