Behavioural Medicine & Psychiatry

Question 1

nocturnal enuresis definition

Answer 1

involuntary bedwetting overnight > 6 years of age

Question 2

biggest risk factor for nocturnal enuresis

Answer 2

family history

Question 3

definition secondary nocturnal enuresis

Answer 3

bed wetting occurs after the child has been previously dry at night for >6m

Question 4

When is urinalysis appropriate in nocturnal enuresis

Answer 4

• new bed wetting
• presence of daytime symptoms
• symps suggestive of UTI and DM

Question 5

Timings of when to stop using an enuresis alarm

Answer 5

Reassess after 4w - continue if early signs of response. If 2w of dry nights - stop alarm

If not dry after 3m - consider stopping

Question 6

Pharmacological Rx nocturnal enuresis

Answer 6

Desmopressin (ADH)
- Can use when rapid control is needed
- Use if alarm therapy not working
- Can also use as combo

TCA/imipramine

Anticholinergics/oxybutinin

Question 7

Fluid restriction when on desmopressin

Answer 7

Restrict 1h before taking the tab and 8 hours afterwards

Question 8

How to stop desmopressin

Answer 8

Reassess after 4w

Then withdraw for one week every 3m

Question 9

Pharmacological rx for tourettes

Answer 9

clonidine

Question 10

Lithium monitoring

Answer 10

Prior - ECG, LFTs, TFTs

5-7 days after
- plasma lithium levels

Then repeat every 5-7 days until therapeutic levels reached

Then recheck levels every 3-6m to ensure stable

TFTs, U&Es every 6m