Psych - Elimination Disorders

ELIMINATION DISORDERS ANNA JOSEFINA VAZQUEZ-GENUINO, MD Child, Adolescent & Adult Psychiatrist

ENCOPRESIS  EPIDEMIOLOGY  95%

(+) Bowel Control by 4 y/o  99% (+) Bowel Control by 5 y/o  Absent ≥ 16 y/o  Incidence: M 6x > F

ENCOPRESIS  ETIOLOGY  Chronic

Constipation   1) Painful Defecation  Phobia to Pain  2) Chronic Rectal Distention  Loss Rectal Tone & Desensitization to Pressure  Overflow Encopresis

ENCOPRESIS  ETIOLOGY  Maternal

Hostility  Harsh & Punitive Parent  (+) Sexual Abuse  (+) Disruptive Life Event  Regressive Bvr

ENCOPRESIS  DIAGNOSIS  w/

or w/o Constipation & Overflow Incontinence  @ least 4 Y/O  Involuntary / Intentional Defecating into Inappropriate Places  1x/ month x 3  R/O Substance, Medical Condition

ENCOPRESIS  DIFFERENTIAL

DX  Aganglionic Megacolon- Hirschsprung’s D  Faulty Nutrition, Structural Dis of Anus, Rectum & Colon, Medicinal Adverse Effects, Endoc, Neuro Dis  Sexual / Physical Abuse

ENCOPRESIS  COURSE

& PROGNOSIS  Self Ltd, Rare beyond Mid Adol  Depend on Physiological/ Medical Factors  Impacted Feces, Megacolon, Anal Fissures  Ostracized & Rejected  Low Self Esteem

ENCOPRESIS  TREATMENT  Medical

& Psych Evaln  Medical Tx for Constipation- Lax  Psych Tx, Beh Mod, Regular Timed Toilet Trng, Relax Tech  Supportive PsychTx, Family Educ

ENURESIS: Epidemiology Prevalence Rates % Age ( yrs) 82 <3 49 3 26 4 7 5 3 10 1.5 14 1 Adult

ENURESIS  ETIOLOGY  Physiological

Factors  Dev Enuresis & Bvr Patterns Maintain Maladaptive Urination  Genetic  Psychosocial Stressors

ENURESIS  ETIOLOGY  Hinman’

Syndrome – Overactive Detrussor MM in Bladder + Habitual Voluntary Tighten Ext Sphincter Urge to Urinate  Urge to Urinate Dim & Bladder doesn’t Empty  Enuresis @ Night

ENURESIS  DIAGNOSIS @

least 5 y/o  Involuntary or Intentional Voiding Urine into Clothes/ Bed  2x/ wk x 3 consecutive mos or  Cause Distress or Impairment in Funct  R/O Substance, Medical Condition  Nocturnal/ Diurnal/ Both

ENURESIS  DIFFERENTIAL

DX

ENURESIS  DIAGNOSIS

ENURESIS  COURSE

& PROGNOSIS

ENURESIS  TREATMENT  Review

Toilet Trng  Educate Parents  Classic Conditioning  Behavior Mod- Star Chart  Bladder Training  Restrict Fluids  Increase Fiber Diet

ENURESIS  TREATMENT  Rx

if Enuresis  Impaired Social, Family, School Funct, Bvr, Diet, Fluid Restrict not Effective  Imipramine, Desmopressin, Reboxetine  Psychotx