[Encopresis in children, the view of child psychiatry]. / Comment j'explore... L'encoprésie chez l'enfant, le point de vue pédopsychiatrique.

The article aims to provide a state of knowledge in the literature on encopresis in the child psychiatric population. The general definition of the symptom and its analysis are presented according to different approaches. Then, the clinic of encopresis is described according to its specificities. The main associated disorders and psychiatric/psychosocial risk factors are discussed in detail. Regarding patient care, the multidisciplinary approach, including the complementarity with the paediatrician, is essential in a number of cases. Finally, family approach and the impact of trauma would be interesting research perspectives.

L'article a pour objectif de proposer un état des connaissances dans la littérature au sujet de l'encoprésie parmi la population pédopsychiatrique. La définition générale du symptôme et son analyse sont exposées selon différentes approches. Ensuite, la clinique de l'encoprésie est abordée selon ses spécificités. Les principaux troubles associés et les facteurs de risques psychiatriques/psychosociaux sont alors abordés dans le détail. Au niveau de la prise en charge du patient, l'approche multidisciplinaire, dont la complémentarité avec le pédiatre, est primordiale dans un certain nombre de cas. Enfin, l'approche familiale et l'impact des traumatismes constitueraient des perspectives de recherche intéressantes.

A Child Psychiatry Perspective on Encopresis.

Fecal incontinence, known as encopresis, is the repetitive, intentional or unintentional passage of stool in inappropriate places in children who are developmentally four years old or older. Incontinence can have a chronic course and is associated with emotional distress and a substantial negative impact on quality of life. We review how a medical and behavioral health multidisciplinary approach provides the optimal clinical care for this condition, and we discuss how the unique skill set of the child psychiatrist may address the complex family dynamics and psychiatric comorbidities which may be preventing remission from this condition. Identifying and understanding these factors is essential in developing a comprehensive and effective treatment plan.

Encopresis Plus?

CASE: Dexter is a 12-year-old boy who presents with his maternal grandmother for follow-up to primary care for secondary encopresis. Dexter presented, 18 months ago, with a 3-month history of secondary encopresis. At that time, a comprehensive assessment revealed functional constipation resulting in encopresis. Dexter's symptoms resolved with a combination of medication management and behavioral strategies; laxatives were discontinued 12 months ago.Dexter's grandmother reports that for the past 6 months, her grandson developed encopresis once again. However, she notes that, although Dexter had small-volume episodes of soiling in the past, he is now passing fully formed stools into his underwear. These episodes usually occur once a day, either at home or at school. Frustrated, Dexter's grandmother has transitioned him to adult diapers.Dexter denies hematochezia, pain, dysuria, hematuria, urinary incontinence, dietary changes, or weight loss. He passes soft stool in his underwear once daily without blood or pain. When interviewed alone, Dexter denies drug use, depression, or significant social stressors. Surprisingly, he seems unconcerned about depression, drugs and social stress, and frequently laughs when discussing them. His physical examination, including a rectal examination, is normal.Dexter's medical history is notable for attention-deficit hyperactivity disorder, treated with stimulant medication. He was toilet trained at 3 years without any difficulty. He lives with his grandmother, who is his legal guardian; his mother has chronic mental health problems and substance abuse. Dexter maintains regular contact with his mother and reports that their relationship is positive.Dexter's grandmother is extremely distressed by his current presentation and notably, Dexter is not. What would you do next?

Evidence-Based Psychosocial Treatments for Pediatric Elimination Disorders.

Pediatric elimination disorders are common in childhood, yet psychosocial correlates are generally unclear. Given the physiological concomitants of both enuresis and encopresis, and the fact that many children with elimination disorders are initially brought to their primary care physician for treatment, medical evaluation and management are crucial and may serve as the first-line treatment approach. Scientific investigation on psychological and behavioral interventions has progressed over the past couple of decades, resulting in the identification of effective treatments for enuresis and encopresis. However, the body of literature has inherent challenges, particularly given the multicomponent nature of many of the treatment packages. This review identified 25 intervention studies-18 for nocturnal enuresis and 7 for encopresis-over the past 15 years and classified them according to the guidelines set forth by the Task Force on the Promotion and Dissemination of Psychological Procedures. For nocturnal enuresis, the urine alarm and dry-bed training were identified as well-established treatments, Full Spectrum Home Therapy was probably efficacious, lifting was possibly efficacious, and hypnotherapy and retention control training were classified as treatments of questionable efficacy. For encopresis, only two probably efficacious treatments were identified: biofeedback and enhanced toilet training (ETT). Best practice recommendations and suggestions for future research are provided to address existing limitations, including heterogeneity and the multicomponent nature of many of the interventions for pediatric elimination disorders.

[REASONS AND CONSEQUENCES OF SOMATOFORM DISORDERS IN CHILDREN AND ADOLESCENTS].

The aim of our study was to find the reason of various forms of somatoform disorders (phobias, behavioral disorders, insomnia, tics, stuttering, enuresis, encopresis) in children and adolescents of various social status for diagnosis and treatment. We have examined 202 patients who referred to our clinic from 2012-2016. The age range was 2-18 years. After examination we have concluded the following recommendations: - to implement neuropsychological rehabilitation in order to stimulate mental development; - to work with speech therapist to improvement the speech; - to work individually with psychotherapist to improve the behavior; - to train the parent to manage the behavior at home; - to give the personal card containing information about exercises, games and puzzles to stimulate the development and in some cases to give individual educational program; - to give separate information to parents and in some cases to teachers of kindergartens and schools.

Encoprese e intervenção psicológica: revisão de literatura / Encopresis and psychological intervention: literature review / La encopresis e intervención psicológica: revisión de la literatura

Estudos têm demonstrado que a encoprese, transtorno relacionado ao controle esfincteriano, pode trazer impactos significativos para a vida do indivíduo, tais como baixa autoestima e déficit em interação social. Apesar de reconhecido o importante comprometimento que tal transtorno pode causar no desenvolvimento infantil, a literatura científica tem dado pouca importância ao tema, apresentando um baixo número de publicações sobre o assunto. Dessa forma, este artigo investigou as publicações nacionais em psicologia relacionadas à encoprese entre os anos de 1994 a 2013 nas bases de dados Lilacs e Scielo. Foram encontrados 231 artigos em toda a publicação para este assunto e período, e selecionados cinco para a análise, sendo aqueles que relatavam intervenção em encoprese. Desses artigos, quatro foram publicados na mesma revista e descreveram intervenções comportamentais, sendo três do mesmo autor. O quinto artigo era da abordagem psicanalítica. As pesquisas foram realizadas com crianças e adolescentes e as intervenções comportamentais tiveram êxito com remissão dos sintomas encopréticos. Os dados afirmam a deficiência em publicações na área e número restrito de pesquisadores investigando o tema, que é de relevância significativa.

Studies have shown that encopresis, related to bowel control disorder, can bring significant impact for the individual life, such as low self-esteem and deficits in social interaction. Despite the significant impairment recognized that this disorder can have on child development, the scientific literature has given little attention to the theme, with a low number of publications on the subject. Thus, this paper investigated Brazilian publications in psychology related to encopresis between 1994 and 2013 in data base Lilacs and Scielo. 231 articles were found and were selected those that reported only intervention in encopresis. There were five articles and four published by the same journal and described behavioral interventions, and one author wrote three. The other one was psychoanalytic. The surveys were conducted with children and adolescents and behavioral interventions have been successful with remission of encopresis symptoms. The data affirm the deficiency in publications in the area and possibly limited number of psychologists investigating the issue, which is of significant importance.

Los estudios han demostrado que la encopresis, relacionado con el trastorno intestinal control, pueden aportar importantes para la vida del individuo, tales como la baja autoestima y déficit en los efectos de interacción social. A pesar del deterioro significativo reconocido que este trastorno puede tener en el desarrollo del niño, la literatura científica ha prestado poca atención al tema, con un bajo número de publicaciones sobre el sujeto. Por lo tanto, este trabajo investiga las publicaciones brasileñas en psicología relacionada con encopresis entre los años 1994 y 2013 en las basis Lilacs e Scielo. Se encontraron 231 artículos e seleccionaron solamente artículos que informaron la intervención in encopresis. Se encontraron cinco artículos, y cuatro en la misma revista con intervenciones conductuales, siendo tres de lo mismo autor. Lo quinto articulo era de la psicoanálisis. Las encuestas se llevaron a cabo con las personas y las intervenciones conductuales han tenido éxito con la remisión de los síntomas encopréticos. Los datos confirman la deficiencia en las publicaciones de la zona y posiblemente limitado número de psicólogos que investiga el asunto, que es de gran importancia.

Familial psychological factors are associated with encopresis.

BACKGROUND: The aim of this study was to assess maternal psychiatric symptoms, family functioning and parenting styles in children with encopresis. METHODS: Forty-one children with encopresis were compared to 29 children without any psychiatric disorder. RESULTS: Higher maternal psychiatric symptoms were found in children with encopresis. The general family functioning and strictness/supervision in parenting were significant predictors of encopresis. CONCLUSIONS: Family functioning may be screened in children with encopresis, especially when standard interventions have had limited success. Identification and treatment of familial factors may enhance the treatment efficacy in encopresis.

[Classification of enuresis/encopresis according to DSM-5]. / Klassifikation der Enuresis/ Enkopresis im DSM-5.

Elimination disorders are common in childhood and adolescence. Enuresis is traditionally defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards - after all organic causes have been excluded. In the past decades, many subtypes of elimination disorders have been identified with different symptoms, etiologies, and specific treatment options. Unfortunately, the DSM-5 criteria did not integrate these new approaches. In contrast, classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence as well as the ROME-III criteria for fecal incontinence offer new and relevant suggestions for both clinical and research purposes.

Comparison of familial and psychological factors in groups of encopresis patients with constipation and without constipation.

The study aimed to evaluate the differences between groups of encopresis patients with constipation and without constipation. The Symptom Checklist- 90-Revised, the COPE Questionnaire, the Relationship Scales Questionnaire, the McMaster Family Assessment Device and the Parenting Style Scale were used to evaluate, respectively, maternal psychiatric symptoms, coping abilities, attachment style, family functioning and children's perceptions of parenting behaviors. Psychiatric diagnoses were evaluated using the K-SADS. A higher level of maternal psychiatric symptoms, impaired role and affective involvement functioning of the family and less psychological autonomy were observed in the group of encopresis patients with constipation than in the group of encopresis patients without constipation. No significant differences were found between the groups in psychiatric comorbidities, maternal coping abilities and attachment style. The two groups had a similar pattern of comorbid psychiatric disorders and maternal psychological factors, although some familial factors-related mainly to parental authority-were differentiated in the encopresis with constipation group.

Encopresis: Not just an accident.

Encopresis is a medical condition that can be seen in the school setting with children of all ages, though primarily at the early childhood and elementary level. This condition can cause a great amount of frustration with the student, family, and teachers due to the child's inability to control elimination patterns. The school nurse must be aware of the warning signs that a student may be experiencing encopresis in order to promote treatment. This article will assist the school nurse in understanding typical causes for functional encopresis, knowing how to help a student who soils, and developing an individualized healthcare plan that assists a student to become continent of stool again. Encopresis is not just an accident.

Quality of life in pediatric patients with unremitting constipation pre and post Malone Antegrade Continence Enema (MACE) procedure.

OBJECTIVE: The primary aim of this study was to determine if there is a change in the quality of life in pediatric patients with unremitting functional constipation and/or encopresis after undergoing a MACE procedure. METHODS: Patients, ages 5 to 18 years with unremitting constipation and a normal evaluation, including anorectal manometry and colonic manometry, who opted to undergo a MACE procedure were contacted to participate in the study. Patients with congenital anorectal malformations as well as spinal cord disorders were excluded from the study. The patient's parent/guardian completed the PedsQL(TM) Generic Core Scales QOL survey prior to the operation, 6 months, and 12 months after the procedure. RESULTS: A total of 15 consecutive patients meeting protocol criteria were recruited within a period of 20 months. The mean age at the MACE procedure was 9.8 years (range 7.0-11.1). 5 patients were female. The mean QOL score pre-MACE was 64.1. At 6 months post-MACE the mean overall QOL score was 90.2, and it was 92.0 at 12 months. All 15 patients at the 6 month follow up had significant improvement in their QOL (p=1.9 × 10(-7)) and all subcategories of QOL were significantly improved as well. CONCLUSIONS: A MACE procedure is of benefit to otherwise normal pediatric patients who have unremitting functional constipation with failure of medical treatment. Our patients had a significant improvement in all QOL categories and overall QOL.

[Louis, anxiety faced with the other and language]. / Louis, l'autre et le verbe.

Faced with a child's psychosis--and its occurrences--the psychologist must remain humble. Team work will help to modify the massive transference which sometimes binds the psychologist to the psychotic subject (erotomania or persecution).

Encopresis in children. Outcome and predictive factors of successful management.

OBJECTIVE: To elucidate our experience and outcome in the management of childhood encopresis, and to emphasize the factors that may predict successful management. METHODS: This prospective study was carried out between September 2003 and September 2011 in the Department of Pediatric Surgery, Al-Thoura Teaching Hospital, Al-Beida and Al-Butnan Medical Teaching Center, Tobruk, Libya. RESULTS: One hundred and thirty-two patients (117 male, 15 female) took part of the study. The male and female ratio was 7.8:1. The participants were patients aged 4-9 years. There were 30 (22.7%) patients between 4-5 years, 61 (46.2%) between 6-7 years, and 41 (31%) between 8-9 years. Nonretentive encopresis patients were 36 (27.2%) (Group I) and 96 (72.8%) patients had retentive encopresis (Group II). Patients with low fluid intake were 87 (65.9%) and low fiber diet were 91 (68.9%). Patients with delayed toilet training were 99 (75%). The total rate of successful conservative treatment was 70.5%. The rate of successful treatment in Group I was 94.4% and in Group II was 61.5%. We observed 18.2% of the patients had recurrence of encopresis. The factors found to predict good resolution rate after medical treatment included: cooperation of the parent and patient, female gender, ages above 5 years, and non-retentive encopresis. CONCLUSION: Encopresis remains a problem for the parents and the patients. Clinical evaluation is indispensable. Good outcome can be achieved effectively. Cooperative parents and patient, female gender, age above 5 years, and nonretentive encopresis are predictors for good response to medical treatment.

The scent of the other.

While there are many exchanges that take place during our early development, some have a more profound impact on our developmental trajectory than others. In the milieu of a disturbed mother-child dyad, what becomes of self and other object representations? How do the derivatives of trauma, neglect, and overstimulation become expressed and used during important life transitions? In this paper, convergent themes in the analysis of an eleven-year-old boy and a forty-year-old man illustrate how the evocative nature of smell was used as a means of holding on to early object ties and fantasies of a blissful union. I am proposing that by conceptualizing encopresis and the use of body odors as an expression of the individual's early trauma and object representations, we can advance our understanding of the tenacity of these symptoms and further develop appropriate and effective technical approaches. A select review of the literature is used to establish the relationship between earlier developmental phases and an internalization of early object relations relevant to this paper.

Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children.

BACKGROUND: Faecal incontinence is a common and potentially distressing disorder of childhood. OBJECTIVES: To assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children. SEARCH METHODS: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 October 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted authors in the field to identify any additional or unpublished studies. SELECTION CRITERIA: Randomised and quasi-randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of faecal incontinence in children. DATA COLLECTION AND ANALYSIS: Reviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta-analysis when appropriate. MAIN RESULTS: Twenty one randomised trials with a total of 1371 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons.Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow-up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months).In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65). AUTHORS' CONCLUSIONS: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence in children with functional faecal incontinence associated with constipation.

Encopresis: a medical and family approach.

Bowel control is an important developmental milestone for children. Failure to achieve or loss of bowel control by five years of age threatens both physical and mental health. Most children are successful at achieving bowel control by age four, but up to 3% of the pediatric population suffer from encopresis. Three in-depth case studies were reviewed, including the causes, symptoms, and treatment of this condition, one of which is presented in this article. Results indicate that treatment was successful when a combined approach using medical and behavioral strategies within the context of a developmental model was used. These results can be used by pediatric nurses, nurse practitioners, and pediatricians to assure more children will be identified and obtain the support they need for successful treatment of this complex condition.

Central nervous system processing of emotions in children with faecal incontinence.

AIM: Faecal incontinence (FI) is a common disorder involving both the enteric (ENS) and central nervous systems (CNS). The aim of the study is to analyze neurophysiologically the central processing of emotions in children with FI, healthy controls and children with Attention-deficit hyperactivity disorder (ADHD). METHODS: Fourteen children with FI and constipation, nine with non-retentive FI, 15 controls and 13 children with ADHD were examined. The methods included a physical exam, sonography, Child Behavior Checklist, a psychiatric interview and intelligence test. Acoustic evoked potentials were recorded according to standardized methodology. For the event-related potentials, 80 neutral, 40 positive and 40 negative pictures from the International Affective Picture System (IAPS), and 40 pictures depicting faeces were presented. RESULTS: Children with FI had significantly more intense responses for most stimuli over the frontal, central and parietal regions compared to controls. Stool pictures did not evoke stronger responses than other stimuli. Children with constipation elicited stronger responses. Children with ADHD did not differ from controls. Acoustic evoked potentials were comparable in all groups. CONCLUSIONS: Children with FI have increased responses in the processing of emotions. These can be interpreted as a neurobiological vulnerability, possibly due to the association of the ENS and CNS.