Department of Child and Adolescent Psychiatry, Uludağ University, Turkey.
Department of Pediatric Nephrology, Ondokuz Mayıs University, Turkey.
J Pediatr Urol. 2019 Aug;15(4):343.e1-343.e5. doi: 10.1016/j.jpurol.2019.04.002. Epub 2019 Apr 5.
Enuresis nocturna (EN) is very common worldwide, and psychiatric disorders are 1.3-4.5 times higher in children with EN. When the authors focus on symptoms of individuals with EN, they figured out that the individuals were impaired in social and emotional skills because of the dramatic consequences of EN. The authors presume that, despite a lack of psychiatric comorbidity, primary enuresis nocturna (PEN) itself and its consequences may increase adolescents' social anxiety (SA), leading to adulthood mental diseases.
In this study, the authors aimed to investigate the presence of SA of adolescents with monosymptomatic PEN without any psychiatric comorbidity by comparing them with their healthy peers.
The study was composed of 56 children who applied to pediatric nephrology outpatient clinic and were diagnosed with monosymptomatic PEN and 42 healthy controls. The psychiatric diagnoses were made by a child psychiatrist, with the help of a semistructured interview (Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, K-SADS-PL), and patients were required to fill out the Screen for Child Anxiety and Related Disorders, Social Anxiety Scale for Adolescents (SAS-A), and Children's Depression Inventory (CDI) scales with the help of a clinical psychologist. The physical examination made by a pediatric nephrologist and dysfunctional voiding and incontinence scoring system questionnaire were used to evaluate the voiding dysfunction in children.
There was no significant difference in the total depression and anxiety scores between the groups (p > 0.05). There was a significant difference between the two groups in the subscale of SA (t = 2.67 p = 0.009) (Table). Social Anxiety Scale for Adolescents (p < 0.001) and subscales of SAS-A (Fear of Negative Evaluation [p < 0.001], General Social Avoidance and Distress [p = 0.003], Social Avoidance and Distress in New Situations [p < 0.001]) scores were significantly higher in the patient group.
The authors want to emphasize the comorbid SA of adolescents diagnosed with PEN. This anxiety may disturb adolescents' health in two ways: first, with the help of direct consequences of the SA and second, being late for seeking help for the EN and possible delay in EN treatments. The main limitation of this study is the assessments of the prior mental status of subjects were made by K-SADS-PL, thus remaining a recall bias. A follow-up study may be more objective.
So all adolescents diagnosed with PEN should require a detailed mental examination to prevent further negative consequences and provide more comprehensive treatment. Also, the study needed to be repeated in larger samples, and prospective studies should be designed to enhance authors' understanding.
遗尿症在全球范围内非常普遍，患有遗尿症的儿童患精神障碍的几率是普通儿童的 1.3-4.5 倍。当作者们关注遗尿症患者的症状时，他们发现这些患者由于遗尿症的严重后果，在社会和情感技能方面存在障碍。作者推测，尽管没有精神共病，原发性遗尿症（PEN）及其后果本身可能会增加青少年的社交焦虑（SA），导致成年后患精神疾病。
本研究旨在通过与健康对照组相比，调查无任何精神共病的单症状性 PEN 青少年的 SA 存在情况。
该研究由 56 名因单症状性 PEN 就诊于儿科肾病门诊的儿童和 42 名健康对照组成。精神科诊断由儿童精神科医生通过半结构化访谈（儿童情感障碍和精神分裂症现状和终生版本 Kiddie 时间表，K-SADS-PL）进行，并要求患者在临床心理学家的帮助下填写儿童焦虑和相关障碍筛查表、青少年社交焦虑量表（SAS-A）和儿童抑郁量表（CDI）。由儿科肾病学家进行的体格检查和功能性排尿和失禁评分系统问卷用于评估儿童的排尿功能障碍。
两组总抑郁和焦虑评分无显著性差异（p>0.05）。两组在社交焦虑亚量表（t=2.67，p=0.009）方面存在显著差异（表）。青少年社交焦虑量表（p<0.001）和 SAS-A 亚量表（对负面评价的恐惧 [p<0.001]、一般社交回避和痛苦 [p=0.003]、新情境下社交回避和痛苦 [p<0.001]）得分在患者组中显著更高。
作者强调了被诊断为 PEN 的青少年的共病社交焦虑。这种焦虑可能以两种方式干扰青少年的健康：一是通过社交焦虑的直接后果，二是延迟寻求遗尿症的帮助和可能延迟遗尿症的治疗。本研究的主要局限性在于，受试者先前的精神状态评估是通过 K-SADS-PL 进行的，因此存在回忆偏倚。后续研究可能更客观。
因此，所有被诊断为 PEN 的青少年都应进行详细的精神检查，以防止进一步的负面后果，并提供更全面的治疗。此外，还需要在更大的样本中重复这项研究，并设计前瞻性研究以加深作者的理解。
