Importance of neuropsychiatric evaluation in children with primary monosymptomatic enuresis

Background Nocturnal enuresis (NE) is an involuntary voiding during sleep. It is a very common disorder in school-age children. Comorbid psychopathologies are common in patients affected by enuresis. According to the ICCS, the rate of behavioral and emotional disorders in children with enuresis is doubled compared with healthy control (HC) children. Objective The aim of the present study was to investigate the prevalence of neuropsychiatric comorbidities in children affected by NE. Study design Two hundred children with a diagnosis of enuresis were recruited from the Neuropsychiatric Unit of Catania University and 200 age-matched neurologically intact HC children were recruited from local schools. The inclusion criteria were a normal IQ and the absence of other pathological clinical conditions such as diabetes or kidney malformation. The exclusion criteria were failure to complete the initial evaluation or clinical/diagnostic procedures, inability (because of young age) to complete study questionnaires, and severe neurological or physical impairment. Results Age and gender proportions were not significantly different between the groups. In the NE group, 138 subjects (69%) had a familial history of NE, compared with 24 subjects (12%) in the HC group (p   0.01 for both comparisons) ( Figure). Discussion The present case-control study evaluates the prevalence of different neuropsychiatric comorbidities in children with NE as diagnosed according to the new ICCS criteria. An important finding was that neuropsychiatric conditions were more prevalent in NE patients than in age-matched HC subjects. To the best of our knowledge, this is the first study to report associations between enuresis and obsessive compulsive disorder as well as tic disorder, and is the first to describe the comparative psychopathological profiles of 200 children with enuresis and 200 matched HC children. Conclusion The results suggest that clinicians should not underestimate the effects of enuresis on psychosocial development. Childhood NE should be managed carefully and comprehensively in order to prevent the development of more serious behavioral problems in the future. Figure.  Comparison between nocturnal enuresis patients and healthy control children (p ≤ 0.000). CDI = Child Depression Inventory; MASC = Multidimensional Anxiety Scale for Children; YGTSS = Yale Global Tic Severity Score; C-YBOCS = Children-Yale–Brown Obsessive Compulsive Scale; CBCL = Child Behavior Check-List; QoL = Quality of life; Rel = relationship. Figure options Download full-size image Download high-quality image (101 K) Download as PowerPoint slide