John Hunter Children's Hospital, New Lambton Heights, NSW, Australia.
University of Newcastle, Newcastle, NSW, Australia.
Eur Child Adolesc Psychiatry. 2023 Oct;32(10):1989-1999. doi: 10.1007/s00787-022-02016-4. Epub 2022 Jun 29.
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. This review identifies the literature regarding the effects of behavioural pharmacotherapy on bladder functioning and possible bladder management strategies in children with concomitant behaviour and bladder disorders to enable clinicians to better manage both conditions. A PROSPERO registered PRISMA-guided review of three major databases was performed. After an initial scoping study revealed significant heterogeneity, a narrative approach was undertaken to discuss the results of all relevant cases relating to children being treated with pharmacotherapy for behaviour disorders and outcomes related to bladder function. Studies were screened to identify those that described effects of commonly prescribed medications in children with behavioural disorders such as stimulants, alpha 2 agonists, tricyclic antidepressants (TCA), serotonin and noradrenergic reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI) and antipsychotics, and the findings and implications were summarised. The review identified 46 studies relevant to behavioural pharmacotherapy and bladder function (stimulants (n = 9), alpha 2 agonists (n = 2), TCAs (n = 7), SNRIs (n = 8), SSRIs (n = 8) and antipsychotics (n = 6). Six studies focused specifically on bladder management in children with behavioural disorders with concurrent behavioural pharmacotherapy. 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.
儿童的膀胱功能障碍和行为障碍通常同时存在；因此，很难将它们分开治疗。药物治疗是行为障碍的常见治疗方法，这些药物可能会有意或无意地对膀胱产生积极或消极的后果。本综述旨在确定关于行为药物治疗对膀胱功能的影响以及在伴有行为和膀胱疾病的儿童中可能的膀胱管理策略的文献，以使临床医生能够更好地管理这两种疾病。在对三个主要数据库进行 PROSPERO 注册的 PRISMA 指导综述后，最初的范围研究显示出显著的异质性，因此采用叙述方法来讨论与接受药物治疗行为障碍的儿童有关的所有相关病例的结果以及与膀胱功能相关的结果。筛选研究以确定那些描述了在患有行为障碍的儿童中常用药物（如兴奋剂、α 2 激动剂、三环抗抑郁药（TCA）、5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI）、选择性 5-羟色胺再摄取抑制剂（SSRI）和抗精神病药）对膀胱功能的影响，并对研究结果和意义进行了总结。该综述确定了 46 项与行为药物治疗和膀胱功能相关的研究（兴奋剂（n=9）、α 2 激动剂（n=2）、TCA（n=7）、SNRI（n=8）、SSRI（n=8）和抗精神病药（n=6）。有 6 项研究专门针对伴有行为药物治疗的行为障碍儿童的膀胱管理。本综述确定了一些有用的因素，这些因素可能有助于临床医生预测在开始行为药物治疗后出现的意外膀胱影响，从而为治疗患有行为障碍的儿童的膀胱功能障碍提供最佳方法。有了这些证据，我们提供了一个有用的决策算法，以帮助临床医生管理这两种疾病。
