title: Importance of neuropsychiatric evaluation in children with primary monosymptomatic enuresis.
abstract: 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.
  
  
  METHODS
  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). The NE group demonstrated significantly higher scores in the Child Behavior Check List, Conners' Multidimensional Anxiety Scale for Children, and the Child Depression Inventory compared than the HC group as well as the Yale Global Tic Severity Score and Child-Yale-Brown Obsessive Compulsive Scale scores (p < 0.01). Quality of life scores were significantly lower in the NE group than in the HCs group; specifically, between-group differences were significant in the relationship and self domains (p > 0.01 for both comparisons) (Figure).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Child and Adolescent Psychiatry Section, Department of Clinical and Experimental Medicine, Catania University, Via Santa Sofia 78, 95123, Catania, Italy. Electronic address: mariangelagulisano@gmail.com.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Gulisano
authors.affiliation: Child and Adolescent Psychiatry Section, Department of Clinical and Experimental Medicine, Catania University, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Domini
authors.affiliation: Child and Adolescent Psychiatry Section, Department of Clinical and Experimental Medicine, Catania University, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Capelli
authors.affiliation: Child and Adolescent Psychiatry Section, Department of Clinical and Experimental Medicine, Catania University, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pellico
authors.affiliation: Child and Adolescent Psychiatry Section, Department of Clinical and Experimental Medicine, Catania University, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Rizzo
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity / Q000639:trends; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D053206:Nocturnal Enuresis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Attention deficit hyperactivity disorder; Comorbidities; Enuresis; Obsessive–compulsive disorder; Quality of life; Tic disorder