Matricardi A
Servizio di Neuropsichiatria Infantile, E.O. Ospedali Galliera, Genova.
Minerva Pediatr. 1996 Jun;48(6):259-66.
The importance of the psychological aspects in treating the enuretic patient is often underestimated. The author reports 13 patients with functional enuresis, whose emotional implications of the symptom are very clear. In 7 patients a psychodiagnostic evaluation, with colloquia, tests, play and drawing, was carried out: the personality and family features of the children resulted similar to those described in literature (a too close mother-child relationship preventing child's separation, with both aggressiveness against mother and regression; depression; a difficult sexual identification). In 3 patients a psychotherapy lasting more than 6 months was undertaken. Psychologic care and short psychotherapy were always useful to relieve the neurotic symptoms connected with enuresis and to better child's personality; in some patients, they were not completely successful on the symptom, because this persisted although the number of episodes was reduced. The clinical approach depends on the type of enuresis. A psychologic care of the patients with secondary enuresis and of children with neurotic personality is necessary; in the other cases it is advisable to set up a therapeutic alliance with the child against his symptom, and to deal with the depressive traits related to it. We have to think of enuresis not as a border between organic and psychological, but as a problem in which the two aspects are closely linked together without excluding each other. The author believes that psychotherapy with enuretic patients is frequently lasting.
在治疗遗尿症患者时,心理因素的重要性常常被低估。作者报告了13例功能性遗尿症患者,其症状的情感影响非常明显。对7例患者进行了心理诊断评估,包括会谈、测试、游戏和绘画:这些儿童的个性和家庭特征与文献中描述的相似(母子关系过于亲密阻碍了孩子的分离,同时伴有对母亲的攻击性和退行;抑郁;性认同困难)。对3例患者进行了持续6个月以上的心理治疗。心理护理和短期心理治疗对缓解与遗尿症相关的神经症状以及改善孩子的个性总是有帮助的;在一些患者中,对症状的治疗并不完全成功,因为尽管发作次数减少了,但症状仍然存在。临床治疗方法取决于遗尿症的类型。对继发性遗尿症患者和具有神经质人格的儿童进行心理护理是必要的;在其他情况下,建议与孩子建立对抗其症状的治疗联盟,并处理与之相关的抑郁特征。我们不应将遗尿症视为器质性和心理性之间的界限,而应将其视为一个有机和心理两方面紧密相连且互不排斥的问题。作者认为,对遗尿症患者进行心理治疗通常需要持续较长时间。