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Occurrence of selected lower urinary tract symptoms in patients of a day hospital for neurotic disorders

Article

Occurrence of selected lower urinary tract symptoms in patients of a day hospital for neurotic disorders

Abstract

Objectives: To assess the occurrence of selected lower urinary tract symptoms in the population of patients with neurotic and personality disorders. Methods: This was a retrospective analysis of occurrence, co-existence and severity of two selected lower urinary tract symptoms in 3,929 patients in a day hospital for neurotic disorders. The KO "O" symptom checklist was used to measure the study variables. Results: Although the symptoms associated with micturition are not the most prevalent symptoms of neurotic disorders, neither are they the most typical ones, the prevalence of urinary frequency referring to the last week before psychotherapy evaluated among the patients of a day hospital, was approximately 50%. Involuntary micturition, a symptom with a significant implication on the self-esteem and social functioning was much less common; it was reported by approximately 5% relatively healthy and young group of patients. Major bother from urinary frequency was reported by 9-14% of patients, whereas from involuntary micturition by only 0.6%-1% of the surveyed patients. Conclusions: Selected urological symptoms seem to be prevalent among the patients with neurotic and personality disorders, and are independent of the specific diagnosis or patients' gender. Their co-existence with other symptoms of neurotic disorders reported by the patients indicates their strongest relationship with the somatoform, dissociative, sexual and agoraphobic disorders.
Psychiatr. Pol. ONLINE FIRST Nr 45 1–25
Published ahead of print 16 July, 2016
www.psychiatriapolska.pl
ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE)
DOI: http://dx.doi.org/10.12740/PP/OnlineFirst/61109
Occurrence of selected lower urinary tract symptoms
in patients of a day hospital for neurotic disorders
Jerzy A. So b ski 1, Michał Skals ki2, Tomasz Gołą bek 3,
Agata Świ erk os z , Mikołaj Pr z yd acz 3, Katarzyna Kl a sa 4,
Krzysztof Ru t ko w sk i 1, Edyta De m bi ńsk a1, Michał Mi el i mą ka1,
Katarzyna Cy r an k a1, Piotr L. Ch ło s ta 3, Dominika Du d ek 5
1Department of Psychotherapy, Jagiellonian University Medical College
2Department of Adult Psychiatry, University Hospital in Krakow
3Department of Urology, Jagiellonian University Medical College
4Department of Psychotherapy, University Hospital in Krakow
5Department of Aective Disorders, Chair of Psychiatry, Jagiellonian University Medical College
Summary
Aim. To assess the occurrence of selected lower urinary tract symptoms in the population
of patients with neurotic and personality disorders.
Material and methods. This was a retrospective analysis of occurrence, co-existence and
severity of two selected lower urinary tract symptoms in 3,929 patients in a day hospital for
neurotic disorders. The KO“O” symptom checklist was used to measure the study variables.
Results. Although the symptoms associated with micturition are not the most prevalent
symptoms of neurotic disorders, neither are they the most typical ones, the prevalence of
urinary frequency referring to the last week before psychotherapy evaluated among the pa-
tients of a day hospital, was approximately 50%. Involuntary micturition, a symptom with
a signicant implication on the self-esteem and social functioning was much less common;
it was reported by approximately 5% relatively healthy and young group of patients. Major
bother from urinary frequency was reported by 9–14% of patients, whereas from involuntary
micturition by only 0.6%–1% of the surveyed patients.
Conclusions. Selected urological symptoms seem to be prevalent among the patients
with neurotic and personality disorders, and are independent of the specic diagnosis or
patients’ gender. Their co-existence with other symptoms of neurotic disorders reported by
The study was not sponsored.
Jerzy A. Sobański et al.
2
the patients indicates their strongest relationship with the somatoform, dissociative, sexual
and agoraphobic disorders.
Key words: neurotic disorders, urological symptoms, symptom checklist
Introduction
The co-existence of urological, neurotic, anxiety, depressive and post-traumatic
symptoms is common and has been described for years by psychiatrist, urologists
and gynecologists [1–6]. Unfortunately, the variable terminology is used in dierent
periods of popularity of diverse classications and terms which were often too brief
(depression), vague (anxiety disorders) or simply general (psychological burdens,
stress e.g. [7]). More and more so the research evidence is based on strong data from
reproducible questionnaire-based surveys, using validated tools i.e., the depression
or anxiety severity scales [8], as well as carried out among dierent cohorts – general
population versus urological patients [1, 9], psychiatric patients or in patients from the
specic subpopulations [8, 10–12].Additionally, the results of these studies are often
biased due to the co-existence of functional urological symptoms with other symptoms
of the psychological origin and in the context of stressful circumstances [13].
For practical reasons, instructions and various psychometric tools, such as Polish
Symptom Checklist KO“O” use common language expressions and refer to subjective
patient’s experiences during approximately one week period prior to the study. Conse-
quently, a degree of inaccuracy in the description of symptoms of neurotic disorders is
being generated, as if they were obtained during an uncontrolled and unbiased interview.
Therefore, patients using checklists describe a broader spectrum of complaints during
direct questioning about the rst or the most important (according to the examining cli-
nician) symptoms, hence minimizing the risk of data contamination related to so-called
specication of neurotic disorders [14]; which is also conicting “narrower” denitions
of single coded disorders within the International Classication of Diseases (ICD) or
the Diagnostic and Statistical Manual of Mental Disorders (DSM). Thus, based on the
studies, majority of patients with neurotic disorders show clear trait symptoms representa-
tive of a number of various syndromes, as well as of some other disorders to a lesser
degree, however [15–17]. Moreover, these symptoms before treatment can highly vary
[18], undermining thereby the main classication systems [19, 20]. Doctors other than
psychiatrists can struggle with diagnosing, in relation to the somatoform disorders. Due
to high variability of these disorders, they may mimic other conditions, which combined
with the abundance of symptoms, a low probability of somatic origin, subtility, as well
as in the presence of psycho-social context, and a relatively good general patient condi-
tion allows a reliable diagnosis. Apart from the somatization, a lot of patients with the
neurotic personality and the behavioral disorders report or manifest tension, anxiety, fear
and disorders of experiencing, while others suer mainly from the behavioral disorders.
The “pseudo-urological” complaints, such as avoidance or dicult urination in unfamiliar
places or in the presence of other people [21, 22] which, as a consequence, can result
3
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
in a fear of leaving own house or reducing the intake of liquids to a bare minimum, are
particularly burdensome for these patients. Other dysfunctions can be associated with
excessive experiencing of a urinary urgency or can be triggered when being secluded,
or with a limited access to the toilet, together with a need to leave the room and/or to
seek attention of others. Most genuine “urological” symptoms are: disordered pattern of
micturition such as increased frequency of micturition, urinary incontinence, but above
all the nocturnal enuresis (particularly embarrassing symptom often reported by many
patients to have occurred in their childhood and/or adolescence). Urological complaints
are often accompanied by either increased or reduced intake of uids with a clear psy-
chological component (stress-related dry mouth and uid intake).
Current studies have suggested the association between a spectrum of lower urinary
tract symptoms and mental disorders (anxiety and depression), as shown Gołąbek et
al. [1], or in the study by Perry et al. where a half of the examined women reported
concurrent anxiety and LUTS [23]. It remains challenging to prove causality between
i.e. embarrassment and fear and dicult urination or between agitation and urgency,
wetting and sadness, embarrassment and social isolation – it is not clear which oc-
curred rst. Therefore, the classication of a “shy bladder” into the category of social
phobia has not been unanimously conrmed [7, 24].
Thus, the aim of this study was to estimate the occurrence of urological complaints
in patients with neurotic, personality and behavioral disorders, and to analyze such
patients’ age, gender, and co-existing symptoms.
Aim
To estimate burden of selected subjective lower urinary tract symptoms in the
population of patients with neurotic and personality disorders.
Material and methods
Decision about the psychiatric treatment in a day hospital was based on 2 psychi-
atric assessments, a psychological consultation and several questionnaires allowing
to exclude schizophrenic, aective and exogenous or pseudoneurotic disorders, and
severe somatic illnesses, including urological diseases [25]. The symptom checklist
KO“O” was completed during evaluation for the treatment by 3,929 patients treated
in a day hospital between 1980 and 2002, and served to ascertain the symptoms in
terms of their possible neurotic disorder origin [26–28]. Patients were instructed to
answer 138 closed questions in order to determine the occurrence and severity of 135
symptoms during a seven-day period prior to the study [26, 27]. The symptom checklist
additionally allowed to determine the severity of symptoms in the group, which was
included in the scales [29], and global severity of symptoms (OWK) [27].
Assessment of urological symptoms was based on two variables within the symp-
tom checklist KO“O” (“132. Frequent need to urinate” and “111. Involuntary urination,
Jerzy A. Sobański et al.
4
table continued on the next page
for example, bed wetting”). The instructions specied time of onset of symptoms as
the period of 7 days preceding the study, and provided the scale for patient’s subjective
assessment of the severity of symptoms as “0-a-b-c”, where “0” meant “symptom did
not appear”, “a” – “symptom appeared, but was only slightly severe”, “b” – “symptom
was moderately severe, “c” – “symptom was extremely severe”. This is why it was
impossible to exactly determine whether patients’ responses depicted either diurnal or
nocturnal frequency, or both. It also was impossible to determine whether involuntary
urination was accompanied by urinary incontinence or whether it was rather stress
urinary incontinence, or complete involuntary day or night time urination.
Additional structured information referring to various aspects of patients’ life was
obtained from the Biography Survey (structured closed questions interview) [30].
The majority of 3,929 subjects were diagnosed with one of the neurotic disorders
or a personality disorder with a secondary neurotic disorder. Information with regard
to the selected socio-demographic characteristics of the studied group was included in
the Results section of this paper (Table 1). The data obtained from a routine diagnostic
screening was used from the consented patients. The data was encrypted and anony-
mously stored and analyzed (Bioethics Committee consent no. 122.6120.80.2015).
Odds ratios (ORs) for the co-existence of variable and nominal values for the co-
existence of symptoms were calculated using logistic regression method [17, 31–40].
The dierences between the distributions of variables were estimated according to the
features of variables distribution by means of parametric and non-parametric tests.
Correlations between the variables were calculated using Spearman’s rank correlation.
The package STATISTICA PL version 12 was used.
Results
Table 1. Severity of neurotic symptoms, types of disorders according to the ICD-10
and socio-demographic features of the studied patients
Women (n = 2,582) Men (n = 1,347)
Age: Mean ± standard deviation (Median) 33±9 (33) 32±9 (28)
Diagnosis* (primary):
F44/45 Dissociative/conversion disorders or somatoform
disorders
F60 Specic personality disorders
F40/F41 Phobic anxiety disorder/other anxiety disorders
F48 Neurasthenia
F34 Dysthymia
F50 Eating disorders
F42 Obsessive-compulsive disorders
F43 Response to severe stress, and adjustment disorders
Unidentied
29%
23%
17%
7%
7%
5%
2%
1%
9%
25%
29%
16%
14%
5%
0%
2%
2%
8%
5
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
table continued on the next page
General severity of symptoms: M±SD (Median) 394±152 (387) 349±151 (336)
Education Lack/primary
Secondary (including students)
Higher
9%
57%
34%
12%
56%
32%
Employed
Unemployed
Pensioners
Students
59%
41%
10%
23%
70%
30%
7%
24%
Stable relationship/marriage
Unstable relationship/marriage
Single
43%
26%
31%
47%
21%
32%
No sexual intercourses
Sexual intercourses
Longer relationship
Fleeting, coincidental
Coincidental and longer
40%
60%
55%
3%
2%
35%
65%
53%
7%
5%
*Primary diagnoses were coded into the ICD-10 on the basis of medical history overview and the
analysis of the equivalence in the classication systems used in the past and those currently used.
SD = standard deviation
Correlation of occurrence and extreme severity of lower urinary tract symptoms
in women and men with approximated diagnosis of the type of mental disorder ac-
cording to the ICD-10
The prevalence of analyzed complaints was estimated in groups of women and
men taking into account the type of mental disorder (diagnosis coded in categories
of the ICD-10) on the basis of the analysis of the primary diagnoses and medical his-
tory). The results were presented in Table 2 and 3, in which the percentage, referring
to rare diagnoses or diagnoses dicult to identify (approximated – coded according
to ICD-10), were omitted.
Table 2. Percentages of the occurrence of complaints about urinary frequency
and urinary incontinence in groups of women and men – in total and the subgroups
in terms of diagnoses according to the ICD-10
Urinary frequency Urinary incontinence
Women Men Women Men
Total (nW = 2,582 nM = 1,347) *48% *44% 5% 4%
Comparison in periods 1980-1990r vs. 1990–2002r
Years1980-1990 (nW = 764 nM = 587) 47% 44% #3% 3%
Years 1991-2002 (nW = 1818 nM = 760) 48% 44% #6% 5%
Selected groups of diagnoses
Jerzy A. Sobański et al.
6
table continued on the next page
F44/45 Dissociative/conversion disorders or somatoform
disorders(nW = 741 nM = 336) 54% 49% **6% **4%
F60 Specic personality disorders (nW = 596 nM = 395) 44% 43% 5% 5%
F40/F41 Phobic anxiety disorder/other anxiety disorders
(nW = 440 nM = 208) 46% 41% ***4% ***2%
F48 Neurasthenia (nW = 193 nM = 191) 47% 43% 4% 4%
Statistically signicant dierences between pairs of percentages between the diagnoses (between the
lines) were marked: p < 0.0005, p < 0.01, #p < 0.05. Statistically signicant dierences between
women and men (between the columns) were marked: *p < 0.05, **0.01, ***0.001, ****p < 0.0001,
nW– number of diagnoses in the group of women, nM-number of diagnoses in the group of men. The
comparison between periods 1980–1990 vs. 1990–2002 – statistically signicant dierence was
marked # p < 0.05.
Overall, in groups of studied women urinary frequency was reported by 48% of
them and urinary incontinence, for example, bed wetting – by 5% (Table2). In the
group of the studied men urinary frequency was reported by 44% of them, and urinary
incontinence, for example, bed wetting – by 4% (Table 2). Urinary frequency was
therefore much more frequent than urinary incontinence, it also occurred signicantly
more often in the group of women than in the group of men (p < 0.05), similar dier-
ence for incontinence was not identied in the analysis adjusted for gender. The highest
percentages of urinary frequencyduringthe week preceding the study were reported
in the checklists of women with somatic or conversion/dissociative disorders (54%),
(this percentage turned out to be signicantly higher than in several other subgroups)
and men with the same diagnosis (49%), and the lowest in women with personality
disorders (44%) and men with anxiety disorders (41%) (Table 2). The statistically
signicant dierences between the percentages of reported urinary incontinence in
the analysis adjusted for gender was not found. Wetting occurred most frequently in
women diagnosed with somatic or conversion/dissociative and somatization disorders
(6%), and least frequently in the group of men with anxiety disorders (2%) (Table 2).
Table 3. The percentage of complaints about the most severe symptoms of urinary frequency
and the complaints about the most severe urinary incontinence in groups of women
and men – in total and subgroups in terms of diagnoses according to the ICD-10
The most severe
urinary frequency
The most severe
urinary incontinence
Women Men Women Men
In total (nW = 2,582nM = 1,347) ***13% ***9% 1.0% 0.6%
Comparison between periods 1980–1990 vs. 1990–2002 (no statistically signicant differences)
Years 1980–1990 (nW = 764 nM = 587) 14% 8% 1% 0%
Years 1991–2002 (nW = 1,818 nM = 760) 13% 9% 1% 1%
Selected groups of diagnoses
7
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
table continued on the next page
F44/45 Dissociative/conversion or somatoform
disorders (nW = 741 nM = 336) *14% *9% 0.9% 0.9%
F60 Specic personality disorders (nW = 596 nM = 395) #14% #9% 1.0% 0.8%
F40/F41 Phobic anxiety disorder/other anxiety
disorders (nW = 440 nM = 208) 12% 8% 0.5% 0.5%
F48 Neurasthenia (nW = 193 nM = 191) 10% 8% 0.5% 0.0%
The dierences between percentages in the test for two indicators for the dierences between the
diagnoses (between the lines) were not found. Statistically signicant dierences between the groups
of women and men (between the columns) were marked *#p < 0.05, ***p < 0.0005, nW – number of
diagnoses in the group of women, nM – the number of diagnoses in the group of men.
As shown in Table 3, also extremely severe (answer “c” in Symptom Checklist
KO“O”) urinary frequency was signicantly more common in the group of women
than in the group of men. Statistically signicant dierences in frequency dependent
on mental disorder were not found. However, for extremely severe urinary frequency
statistically signicant dierences in terms of gender were not found. It seems that
the sex-adjusted dierences relate more so to urinary frequency (signicantly more
often reported by women – both in extremely severe urination symptom (Table 3), and
a general occurrence of symptoms (Table 2), and for wetting they did not occur in the
whole studied group, even though they were observed in some subgroups of psychiatric
diagnoses – Table 2 (but not in case of extreme severity, Table 3).
The analysis of occurrence and extremely severe symptoms
in periods 1980–1990 vs. 1991–2002
In terms of frequency, statistically signicant dierences after adjusting for time
when patients rst commenced treatment (Table 2 and 3), were not found. Only one
small, but statistically signicant dierence (p > 0.05) was related to an increase in
percentage of urinary incontinence in the group of men after 1990 (Table 2).
Correlation of occurrence and extremely severe urological symptoms
with patients’ age
Table 4. Descriptive statistics of patients’ age in groups of patients depending
on the occurrence or extremely severe urinary frequency with statistical analysis
Women Men
No symptom Symptom
occurs
Extreme severity
of symptom No symptom Symptom
occurs
Extreme severity
of symptom
N1,349 1,233 325 756 591 115
age ***! 33 ± 9
33 (23; 38)
***34 ± 9
33 (28; 38)
! 34 ± 9
33 (28; 38)
^^^$ 31 ± 9
28 (23; 38)
^^^33 ± 9
33 (23; 38)
$ 33 ± 9
33 (23; 38)
Jerzy A. Sobański et al.
8
table continued on the next page
Statistically signicant dierences between groups depending on the occurrence or extreme severity
of symptoms estimated according to distribution by parametric (Student’s t-test) or non-parametric
(Mann-Whitney U test) tests, were marked ***p < 0.0001, ^^^p < 0.0005, !$ p < 0.05; Mean values
± standard deviations – (M±SD), as well as medians and quartiles – (Me (Q1; Q2) were presented.
Table 5.Descriptive statistics of groups of patients in terms of age depending on occurrence
or extremely severe urinary incontinence with statistical analysis
Women Men
No symptom Symptom
occurs
Extremely
severe symptom No symptom Symptom
occurs
Extremely
severe symptom
N2449 133 25 1294 53 8
Age 33 ± 9 ns
33 (28; 38)
34 ± 9 ns
33 (28; 43)
35 ± 9 ns
38 (28;43)
32 ± 9 ns
28 (23; 38)
31 ± 7 ns
28 (23; 38)
31 ± 5 ns
31 (28; 36)
Statistically signicant dierences between the groups depending on presence or extremely severe
symptoms were not found; Mean values ± standard deviations (M±SD), as well as medians and
quartiles –(Me (Q1; Q2) were presented.
As shown in Table 4, urinary frequency (in general as well as in its extreme sever-
ity) was reported by a signicantly older group of women and men (the signicance
of age dierence between women reporting this symptom was related to a signicant
shift of the lower quartile of distribution towards the higher values), while there were
no signicant dierences between distributions of age for the symptom of urinary
incontinence (Table 5).
The correlation of occurrence and extreme severity of urological symptoms with the
global neurotic symptom level (OWK) and subscales of KO“O”
Table 6. The descriptive statistics of global symptoms level (OWK) and the results
from the checklist scales in groups of patients depending on presence
of extreme severity of urinary frequency with statistical analysis
Women Men
No symptom Symptom occurs Extremely
severe symptom No symptom Symptom occurs Extremely
severe symptom
Number n = 1,349 n = 1,233 n = 325 n = 756 n = 591 n = 115
Global symptom level
(OWK)
***!!!338 ± 135
331 (237; 423)
***449 ± 149
440 (343; 546)
!!!519 ± 139
523 (413; 626)
^^^$$$293 ± 132
287 (196; 377)
^^^414 ± 149
405 (302; 514)
$$$477 ± 146
483 (362; 578)
1. Phobic disorders ***!!!13.9 ± 11.7
11.0 (4.0; 22.0)
***19.0 ± 13.0
18.0 (9.0; 29.0)
!!!22.6 ± 13.7
22.0 (12.0; 34.0)
^^^$$$10.4 ± 10.5
8.0 (0.0; 17.0)
^^^16.0 ± 12.3
14.0 (5.0; 25.0)
$$$18.8 ± 12.9
16.0 (8.0; 29.0)
2. Other anxiety
disorders
***!!!37.8 ± 15.6
38.0 (26.0; 50.0)
***45.8 ± 14.4
47.0 (36.0; 56.0)
!!!50.7 ± 12.7
52.0 (42.0; 61.0)
^^^$$$33.2 ± 14.8
33.0 (23.0; 43.5)
^^^41.7 ± 14.4
42.0 (32.0; 52.0)
$$$46.3 ± 13.1
47.0 (38.0; 56.0)
3. Obsessive-
compulsive
disorder
***!!!15.6 ± 10.7
14.0 (8,0; 22.0)
***21.7 ± 11.8
21.0 (12.0; 30.0)
!!!25.8 ± 12.4
26.0 (18.0; 35.0)
^^^$$$15.7 ± 10.9
14.0 (8.0; 23.0)
^^^22.6 ±1 2.4
22.0 (12.0; 32.0)
$$$27.5 ± 13.2
28.0 (16.0; 37.0)
9
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
4. Conversions ***!!!29.8 ± 22.1
26.0 (12.0; 44.0)
***45.8 ± 25.8
43.0 (25.0; 63.0)
!!!55.5 ± 26.1
55.0 (35.0; 75.0)
^^^$$$25.4 ± 20.1
22.0 (9.0; 36.0)
^^^42.4 ± 25.1
39.0 (22.0; 59.0)
$$$50.0 ± 27.1
51.0 (27.0; 71.0)
5. Autonomic
disorders (e.g.
Cardiovascular
system)
***!!!29.4 ± 15.6
29.0 (17.0; 40.0)
***39.2 ± 15.3
40.0 (28.0; 51.0)
!!!45.2 ± 14.5
47.0 (34.0; 56.0)
^^^$$$24.4 ± 15.1
24.0 (12.0; 36.0)
^^^34.3 ± 15.3
35.0 (23.0; 46.0)
$$$37.5 ± 16.1
36.0 (27.0; 50.0)
6. Somatoform
disorders
***!!!20.0 ± 13.6
18.0 (9,0; 29.0)
***37.7 ± 17.3
36.0 (25.0; 49.0)
!!!47.1 ± 16.5
46.0 (36.0; 59.0)
^^^$$$16.1 ± 12.3
14.0 (5.0; 24.0)
^^^33.9 ± 16.5
31.0 (22.0; 45.0)
$$$42.5 ± 17.7
42.0 (29.0; 54.0)
7. Hypochondriasis ***!!!12.2 ± 10.1
11.0 (4.0; 20.0)
***16.7 ± 10.6
17.0 (8.0; 26.0)
!!!18.6 ± 10.5
20.0 (9.0; 27.0)
^^^$$$12.7 ± 10.5
12.0 (4.0; 22.0)
^^^18.5 ± 10.3
20.0 (10.0; 27.0)
$$$21.3 ± 10.5
23.0 (13.0; 30.0)
8. Neurasthenia ***!!!44.8 ± 18.6
46.0 (32.0; 59.0)
***54.2 ± 16.8
56.0 (43.0; 67.0)
!!!59.1 ± 16.2
61.0 (50.0; 71.0)
^^^$$$40.1 ± 18.7
41.0 (26.5; 55.0)
^^^50.3 ± 17.1
52.0 (40.0; 63.0)
$$$55.5 ± 16.8
60.0 (46.0; 69.0)
9. Depersonalisation
and derealisation
***!!!11.2 ± 11.0
8.0 (4.0; 17.0)
***16,2 ± 13,0
14.0 (5.0; 25.0)
!!!20.2 ± 13.5
19.0 (9.0; 31.0)
^^^$$$10.7 ± 10.7
8.0 (0.0; 17.0)
^^^16.2 ± 12.8
14.0 (5.0; 26.0)
$$$18.6 ± 13.4
16.0 (8.0; 30.0)
10. Avoidance and
dependency
***!!!32.7 ± 17.4
32.0 (20.0; 45.0)
***40.2 ± 17,3
41.0 (27.0; 53.0)
!!!45.3 ± 16.7
47.0 (35.0; 57.0)
^^^$$$28.8 ± 17.9
28.0 (13.0; 42.5)
^^^36.9 ± 18.4
37.0 (23.0; 52.0)
$$$41.9 ± 17.8
43.0 (27.0; 57.0)
11. Impulsivity
and histrionic
personality
disorder
***!!!27.6 ± 13.1
28.0 (18.0; 37.0)
***32.9 ± 13.5
33.0 (23.0; 43.0)
!!!37.5 ± 12.6
39.0 (29.0; 48.0)
^^^$$$20.2 ± 12.7
18.0 (10.0; 29.0)
^^^27.8 ± 13.4
28.0 (18.0; 38.0)
$$$30.8 ± 12.9
29.0 (21.0; 41.0)
12. Inorganic sleep
disturbances
***!!!11.6 ± 8.4
12.0 (4.0; 19.0)
***14.6 ± 8.6
16.0 (8.0; 21.0)
!!!17.1 ± 8.6
19.0 (11.0; 25.0)
^^^$$$10.9 ± 8.2
11.0 (4.0; 18.0)
^^^14.0 ± 8.0
15.0 (8.0; 20.0)
$$$16.5 ± 7.2
17.0 (12.0; 22.0)
13. Sexual
dysfunctions
***!!!9.8 ± 9.8
7.0 (0.0; 16.0)
***13.4 ± 10.3
13.0 (4.0; 21.0)
!!!14.8 ± 11.1
14.0 (5.0; 24.0)
^^^$$$9.5 ± 9.4
7.0 (0.0; 16.0)
^^^13.4 ± 9.5
12.0 (5.0; 20.0)
$$$14.4 ± 9.3
14.0 (7.0; 21.0)
14. Dysthymia ***!!!27.9 ± 12.8
28.0 (19.0; 38.0)
***32.8 ± 12.1
34.0 (25.0; 42.0)
!!!35.9 ± 11.5
37.0 (29.0; 44.0)
^^^$$$23.9 ± 13.1
25.0 (13.0; 33.0)
^^^29.6 ± 13.0
30.0 (20.0; 39.0)
$$$32.7 ± 12.1
34.0 (25.0; 41.0)
Statistically signicant dierences between the groups depending on occurrence or extreme severity
of symptoms according to the distribution by parametric or non-parametric tests were marked
***^^^!!!$$$ p < 0.001.Mean values ± standard deviations – (M±SD), as well as medians and
quartiles Me (Q1; Q2) were presented.
Table 6 shows that both in the group of women and men both the occurrence, and
extremely severe urinary frequency in particular, were related to a signicantly higher
(p < 0.001) severity of symptoms: global symptom level (OWK) and all of 14 scales
of symptom checklist. Likewise, both the occurrence and extremely severe urinary
incontinence (Table 7) were noticed in the group of women and men with signicantly
higher global symptom level (OWK), and signicantly higher values of thirteen out
of fourteen scales of Symptom Checklist KO“O” – except for the scale 12 (inorganic
sleep disturbances) in the group of men (Table 7).
Jerzy A. Sobański et al.
10
Table 7. Descriptive statistics of global symptom level (OWK) and values of symptom
checklist scales in the groups of patients in terms of either occurrence
or extreme severity of urinary incontinence with statistical analysis
Women Men
No symptom Symptom
occurs
Extreme severity
of symptom No symptom Symptom
occurs
Extreme severity
of symptom
number n = 2,449 n = 133 n = 25 n = 1,294 n = 53 n = 8
Global symptom level
(OWK)
***!!!384 ± 148
376 (276; 482)
***526 ± 167
528 (405; 649)
!!!582 ± 142
584 (462; 651)
^^^$$$341 ± 148
329 (238; 444)
^^^476 ± 179
453 (361; 632)
$$$596 ± 165
590 (438; 724)
1. Phobic disorders ***!!!15.8 ± 12.4
14.0 (5.0; 24.0)
***25.8 ± 13.1
28.0 (15.0; 36.0)
!!!30.3 ± 10.6
29.0 (24.0; 36.0)
^^^$$12.6 ± 11.5
9.0 (4.0; 20.0)
^^^20.4 ± 13.7
21.0 (8.0; 33.0)
$$26.6 ± 9.7
30.5 (16.0; 34.5)
2. Other anxiety
disorders
***!!!41.4 ± 15.5
42.0 (30.0; 53.0)
***47.0 ± 14.8
50.0 (38.0; 58.0)
!!!52.4 ± 10.9
55.0 (47.0; 59.0)
^$$36.7 ± 15.1
37.0 (26.0; 48.0)
^41.8 ± 17.5
44.0 (27.0; 55.0)
$$51.6 ± 16.6
51.5 (45.5; 66.5)
3. Obsessive-
compulsive
disorders
***!!!18.0 ± 11.5
17.0 (9.0; 26.0)
***27.2 ± 12.2
27.0 (19.0; 37.0)
!!!30.0 ± 11.8
32.0 (23.0; 38.0)
^^^$$$18.4 ± 11.9
17.0 (9.0; 26.0)
^^^27.3 ± 13.7
27.0 (18.0; 38,0)
$$$38.6 ± 9.9
38.0 (30.5; 48.0)
4. Conversions ***!!!36.2 ± 24.4
32.0 (17.0; 52.0)
***59.8 ± 28.6
59.0 (39.0; 81.0)
!!!68.6 ± 27.0
75.0 (50.0; 88.0)
^^^$$$31.8 ± 23.3
28.0 (13.0; 46.0)
^^^57.3 ± 27.2
56.0 (38.0; 79.0)
$$$67.1 ± 23.3
69.5 (50.5; 85.0)
5. Autonomic
disorders (e.g.
Cardiovascular
system)
***!!!33.6 ± 16.1
33.0 (21.0; 46.0)
***43.1 ± 15.1
44.0 (31.0; 55.0)
!!!51.6 ± 13.1
52.0 (45.0; 61.0)
^^^28.4 ± 15.8
28.0 (16.0; 40.0)
^^^38.2 ± 16.4
37.0 (26.0; 52.0)
ns 41.4 ± 22.0
45.5 (19.5; 61.5)
6. Somatoform
disorders
***!!!27.5 ± 17.1
25.0 (14.0; 38.0)
***47.2 ± 20.0
49.0 (31.0; 64.0)
!!!51.5 ± 19.5
54.0 (33.0; 66.0)
^^^$$23.3 ± 16.3
21.0 (11.0; 33.0)
^^^39.2 ± 19.6
39.0 (23.0; 55.0)
$$50.1 ± 26.4
50.0 (25.5; 74.0)
7. Hypochondriasis ***!!!14.1 ± 10.6
13.0 (4.0; 23.0)
***19.5 ± 9.7
21.0 (12.0; 28.0)
!!!24.1 ± 9.1
27.0 (21.0; 29.0)
^^15.1 ± 10.7
16.0 (4.0; 24.0)
^^19.0 ± 10.6
19.0 (9.0; 28.0)
ns 22.5 ± 10.8
24.5 (12.5; 32.5)
8. Neurasthenia ***!!49.0 ± 18.4
51.0 (37.0; 63.0)
***54.6 ± 18.0
56.0 (46.0; 70.0)
!!60.9 ± 16.9
59.0 (54.0; 77.0)
^^^$44.2 ± 18.7
46.0 (30.0; 59.0)
^^^54.0 ± 15.6
55.0 (44.0; 64.0)
$61.5 ± 11.6
61.0 (55.0; 65.5)
9. Depersonalizations
and derealizations
***!!13.2 ± 12.0
10.0 (4.0; 21.0)
***20.9 ± 14.9
21.0 (8.0; 33.0)
!!21.6 ± 14.3
19.0 (12.0; 31.0)
^^^$$$12.8 ± 11.8
9.0 (4.0; 20.0)
^^^20.9 ± 14.4
16.0 (9.0; 33.0)
$$$32.1 ± 14.1
35.5 (19.5; 40.0)
10. Avoidance and
dependency
***!!!35.8 ± 17.7
37.0 (22.0; 49.0)
***44.8 ± 16.3
48.0 (34.0; 57.0)
!!!49.7 ± 14.2
49.0 (42.0; 60.0)
^^^$$$32.0 ± 18.5
32.0 (17.0; 46.0)
^^^41.6 ± 18.3
41.0 (28.0; 57.0)
$$$58.6 ± 14.2
58.5 (55.0; 67.5)
11. Impulsivity
and histrionic
personality
disorder
***!!!29.7 ± 13.5
30.0 (20.0; 40.0)
***38.1 ± 12.5
38.0 (29.0; 48.0)
!!!40.5 ± 11.7
37.0 (34.0; 49.0)
^^^$$$23.2 ± 13.4
22.0 (13.0; 33.0)
^^^30.4 ± 15.0
33.0 (17.0; 42.0)
$$$41.0 ± 10.6
40.5 (33.5; 48.5)
12. Inorganic sleep
disturbances
***!!12.8 ± 8.6
13.0 (4.0; 20.0)
***17.6 ± 7.7
19.0 (13.0; 24.0)
!!18.6 ± 7.6
19.0 (14.0; 25.0)
ns $12.2 ± 8.3
13.0 (4.0; 19.0)
Ns 14.3 ± 8.1
15.0 (9.0; 20.0)
$19.0 ± 7.3
19.0 (12.5; 26.0)
13. Sexual
dysfunctions
***!11.3 ± 10.2
9.0 (0.0; 19.0)
***15.8 ± 9.9
17.0 (7.0; 23.0)
!16.6 ± 10.5
19.0 (7.0; 25.0)
^^11.1 ± 9.6
9.0 (4.0; 18.0)
^^15.0 ± 10.5
14.0 (7.0; 22.0)
ns 17.0 ± 12.4
16.0 (7.0; 28.5)
14. Dysthymia ***!!30.0 ± 12.7
31.0 (21.0; 39.0)
***35.1 ± 12.7
37.0 (27.0; 45.0)
!!38.2 ± 12.4
39.0 (32.0; 46.0)
^^^$$26.2 ± 13.3
27.0 (16.0; 36.0)
^^^31.8 ± 13.5
33.0 (27.0; 40.0)
$$38.9 ± 12.0
38.5 (34.5; 48.5)
11
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
Statistically signicant dierences between the groups depending on either occurrence or extremely
severe symptoms according to the distribution by parametric or non-parametric tests were marked
***^^^!!!$$$ p < 0.001, ^^!! p < 0.01, ^!$ p < 0.05.Mean values ± standard deviations – (M±SD),
as well as medians and quartiles (Me (Q1; Q2) were presented.
The analysis of correlation (non-parametric, Spearman’s method) between the vari-
ables described above, was conducted and the results were presented in Tables 8 and 9.
Table 8. Correlation between either the occurrence of symptoms or extremely severe
urinary frequency according to age and severity of neurotic symptoms
(Spearman’s r correlation coecient)
Women Men
Occurrence
of symptom
Extremely
severe symptom
Occurrence
of symptom
Extremely
severe symptom
Age of respondents
Age ***0.08 ***0.08 ***0.10 ***0.10
Global symptom level
OWK ***0.36 ***0.40 ***0.38 ***0.40
Scale components of Symptom Checklist KO“O”
1. Phobic disorders ***0.20 ***0.23 ***0.24 ***0.25
2. Other anxiety disorders ***0.26 ***0.29 ***0.27 ***0.29
3. Obsessive-compulsion disorders ***0.26 ***0.29 ***0.28 ***0.30
4. Conversions ***0.32 ***0.35 ***0.35 ***0.36
5. Autonomic disorders
(e.g. Cardiovascular system) ***0.30 ***0.33 ***0.30 ***0.31
6. Somatoform disorders ***0.50 ***0.54 ***0.53 ***0.55
7. Hypochondriasis ***0.21 ***0.23 ***0.27 ***0.28
8. Neurasthenia ***0.25 ***0.28 ***0.27 ***0.29
9. Depersonalizations
and derealization ***0.20 ***0.23 ***0.22 ***0.23
10. Avoidance and dependency ***0.21 ***0.24 ***0.21 ***0.24
11. Impulsivity and histrionic
personality disorder ***0.19 ***0.23 ***0.28 ***0.29
12. Inorganic sleep disorders ***0.17 ***0.20 ***0.19 ***0.21
13. Sexual dysfunctions ***0.18 ***0.19 ***0.22 ***0.22
14. Dysthymia ***0.19 ***0.22 ***0.21 ***0.22
Statistical signicance was marked ***p < 0.0005, **p < 0.005, *p < 0.05; signicant correlations
of R > 0.30 were marked in bold – (Spearman’s r correlation coecient).
Statistically signicant correlations, however, only weak ones (R < 0.11) between
extremely severe urinary frequency and age were found in both groups of women
Jerzy A. Sobański et al.
12
and men (Table 8). However, there was moderately strong (R 0.30–0.36), statistically
signicant correlation of the occurrence and extremely severe urinary frequency with
global symptom level (OWK), and with the scales number 4. (Conversions) and 5.
(Autonomic disorders of Cardiovascular system) and the strongest correlation with
the scale number 6. (Somatization disorders) (R > 0.5).
Table 9. Correlation of the occurrence and extreme severe symptom of urinary incontinence
with age and severity of neurotic symptoms (Spearman’s r correlation coecient)
Women Men
Occurrence
of symptom
Extremely
severe symptom
Occurrence
of symptom
Extremely
severe symptom
Age of respondents
Age ns 0.02 ns 0.02 ns – 0.01 ns – 0.01
Global symptom level
OWK ***0.18 ***0.18 ***0.15 ***0.14
Scale components of Symptom Checklist KO“O”
1. Phobic disorders ***0.16 ***0.16 ***0.11 ***0.12
2. Other anxiety disorders ***0.08 ***0.08 *0.06 *0.06
3. Obsessive-compulsion disorders ***0.16 ***0.16 ***0.13 ***0.13
4. Conversions ***0.18 ***0.18 ***0.18 ***0.18
5. Autonomic disorders
of cardiovascular system ***0.13 ***0.13 ***0.11 ***0.11
6. Somatoform disorders ***0.21 ***0.21 ***0.16 ***0.16
7. Hypochondriasis ***0.12 ***0.12 *0.07 *0.07
8. Neurasthenia ***0.07 ***0.07 ***0.10 ***0.10
9. Depersonalizations
and derealization ***0.12 ***0.12 ***0.12 ***0.12
10. Avoidance and dependency ***0.11 ***0.11 ***0.10 ***0.10
11. Impulsivity and histrionic
personality disorder ***0.13 ***0.13 **0.09 ***0.09
12. Inorganic sleep disorders ***0.12 ***0.12 Ns 0.05 ns 0.05
13. Sexual dysfunctions ***0.10 ***0.10 *0.08 *0.08
14. Dysthymia ***0.09 ***0.09 **0.09 **0.09
Statistical signicance was marked ***p < 0.0005, **p < 0.005, *p < 0.05; ns – statistically non-
signicant; correlations of more than 0.20 were marked in bold (Spearman’s r correlation coecient).
As shown in Table 9, no statistically signicant correlations were found between
the occurrence and extremely severe symptom of urinary incontinence and patients’ age
in both groups of women and men. Moreover, in the group of women only weak (but
13
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
table continued on the next page
statistically signicant) correlations (R < 0.2 were found for the global level symptom
(OWK) and for the thirteen scales of Symptom Checklist KO“O”, except for scale
number 6. (Somatoform disorders) for which a moderate correlation with both the oc-
currence and extremely severe symptom of urinary incontinence was found (Table 9).
In the group of men even a moderate correlation was not found (all R < 0.2). Moreover,
for the scale 12 (Inorganic sleep disturbances), no signicant correlation was found.
Co-existence of lower urinary tract symptoms with neurotic disorders
In order to determine whether the neurotic symptoms correlated the most with the
two studied urinary tract symptoms, the analysis of correlations between remaining
133 symptoms included in Symptom Checklist KO“O” was performed. The results of
the most strongly correlating (in the series of regression analysis with one variable)
variables, which describe the symptoms were presented in Tables 10–13.
Table 10. The results of logistic regression analyses with one variable conducted
in the group of women illustrating the strongest correlations for the occurrence
of frequent urination with other neurotic disorder symptoms
132. frequent need to urinate chi2OR (-95%CL; +95%CL)
111. involuntary urination e.g. bed wetting 49.47 ***3.87 (2.59; 5.79)
31. bloating, involuntary bowel emptying 185.19 ***3.01 (2.57; 3.54)
134. muscle pain, e.g. back pain etc. 149.71 ***2.80 (2.37; 3.31)
117. unspecied, migratory pain 145.33 ***2.63 (2.25; 3.09)
131. burning in the gullet, heartburn 135.30 ***2.62 (2.22; 3.09)
98. excessive thirst 132.21 ***2.52 (2.15; 2.95)
107. pain, other genital organs symptoms 101.47 ***2.47 (2.07; 2.95)
69. diarrhea 101.07 ***2.40 (2.02; 2.86)
49. dry mouth 113.55 ***2.40 (2.04; 2.82)
32. compulsion for unnecessary duplication of work 115.15 ***2.36 (2.02; 2.77)
Remaining 124 symptoms were omitted
Table presents the symptoms (except for second urological symptom) for which the regression
analysis found the strongest correlations of the coecients OR > 2.3 and values chi2 > 100; statistical
signicance of the coecients OR was marked ***p < 0.0001.Table includes the values of coecients
OR with 95% condence interval (-95%CL; +95%CL). Symptoms common for women and men
were highlighted
Table 11. Results of one variable logistic regression analysis conducted in the group
of men and women illustrating the strongest correlations for the occurrence
of urinary frequency along with other neurotic symptoms
132. frequent need to urinate chi2OR (-95%CL; +95%CL)
111. involuntary urination e.g. bed wetting 37.72 ***7.71 (3.60; 16.49)
Jerzy A. Sobański et al.
14
table continued on the next page
133. torticollis 67.81 ***3.61 (2.62; 4.96)
31. bloating, involuntary bowel emptying 126.00 ***3.58 (2.85; 4.49)
98. excessive thirst 107.63 ***3.22 (2.57; 4.03)
107. pain/aches, other genital organs symptoms 60.80 ***3.14 (2.34; 4.23)
94. excessive saliva in the mouth 83.22 ***3.11 (2.42; 3.99)
131. burning in the gullet, heartburn 84.28 ***2.81 (2.25; 3.51)
32. compulsion for unnecessary duplication of work 82.94 ***2.78 (2.22; 3.47)
37. exaggeration in avoiding illness 77.72 ***2.69 (2.15; 3.36)
11. itchiness of skin, transient skin rashes 68.85 ***2.66 (2.11; 3.37)
136. nausea, sickness 70.04 ***2.58 (2.06; 3.24)
129. muscle tension 68.70 ***2.57 (2.05; 3.22)
109. photosensitization, hypersensitivity to sound and touch 69.99 ***2.56 (2.05; 3.20)
43. temporary paresis of arms or legs 45.00 ***2.55 (1.93; 3.38)
93. muscle spasms 69.29 ***2.54 (2.04; 3.18)
63. temporary loss of sight or hearing 59.17 ***2.53 (1.99; 3.21)
135. buzzing in the ears 66.26 ***2.53 (2.02; 3.17)
Remaining 117 symptoms were omitted
Table presents the symptoms (except for second urological symptom) for which the regression
analysis found the strongest correlations of the coecients OR > 2.5 and values chi2 > 45; statistical
signicance of the coecients OR was marked ***p < 0.0001.Table includes the values of coecients
OR with 95% condence interval (-95%CL; +95%CL). Symptoms common for women and men
were highlighted.
The occurrence of urinary frequency in both men and women correlated the most
with the co-existence of the following symptoms: involuntary micturition, bloated
stomach and involuntary bowel emptying, excessive thirst, pain and other genital
organs symptoms, “heartburn”, unnecessary duplication of work (Table 10 and 11).
Strong correlation with muscle pains and migratory pains, dry mouth and diarrhea
were found only in the group of women.
However, in the group of men strong correlations with other symptoms were noted –
several from the groups of conversions/dissociations and others, such as excessive saliva
in the mouth, hypochondriac avoidance, itchiness and nausea, etc. (Table 10 and 11).
Table 12. The results of single variable logistic regression analyses conducted in the group
of women illustrating the strongest correlations for the occurrence of urinary incontinence
with other neurotic symptoms
111. involuntary urination, e.g. bed wetting chi2OR (-95%CL; +95%CL)
87. unpleasant feelings connected with self-abuse 160.92 ***7.93 (5.48; 11.45)
107. pain, other genital organs symptoms 109.04 ***5.73 (3.99; 8.24)
15
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
133. torticollis 97.20 ***5.11 (3.59; 7.29)
51. faintness 84.81 ***4.58 (3.23; 6.50)
43. temporary paresis of arms or legs 79.65 ***4.35 (3.08; 6.16)
61. agoraphobic anxiety 67.72 ***3.94 (2.78; 5.59)
132. frequent need to urinate 49.47 ***3.87 (2.59; 5.79)
76. breaking things in anger 63.23 ***3.78 (2.67; 5.35)
94. excessive saliva in the mouth 63.03 ***3.76 (2.66; 5.31)
117. unspecied migratory pains 45.00 ***3.70 (2.47; 5.57)
Remaining 124 symptoms were omitted
Table presents the symptoms (except for second urological symptom) for which the regression
analysis found the strongest correlations of the coecients (OR > 3.5) and values (chi2 > 45);
statistical signicance of the coecients OR was marked ***p < 0.0001. Table includes the values
of coecients OR with 95% condence interval (-95%CL; +95%CL). Symptoms common in women
and men were highlighted.
Table 13. The results of single variable logistic regression analyses conducted in the
group of men illustrating the strongest correlations for the occurrence of urinary
incontinence(question 132) with other neurotic symptoms
111. involuntary urination e.g. bed wetting chi^2 OR (-95%CL; +95%CL)
132. frequent need to urinate 37.72 ***7.71 (3.60; 16.49)
107. pain, other genital organs symptoms 53.21 ***6.8 (3.64; 11.19)
43. temporary paresis of arms or legs 32.37 ***4.45 (2.55; 7.78)
123. loss of balance 23.52 ***4.16 (2.23; 7.74)
133. torticollis 24.46 ***3.86 (2.18; 6.84)
51. faintness 23.29 ***3.85 (2.14; 6.91)
73. temporary aphonia 23.08 ***3.60 (2.07; 6.27)
117. unspecied, migratory pain 18.43 ***3.59 (1.93; 6.69)
61. agoraphobic anxiety 21.83 ***3.50 (2.01; 6.11)
Remaining 125 symptoms were omitted
Table presents the symptoms (except for second urological symptom) for which the regression
analysis found the strongest correlations of the coecients (OR > 3.5) and values (chi2 > 15);
statistical signicance of the coecients OR was marked ***p < 0.001. Table includes the values of
coecients OR with 95% condence interval (-95%CL; +95%CL). Symptoms common for women
and men were highlighted.
Urinary frequency (second urological symptom), genital organs symptoms, tem-
porary paresis of the arms or legs, migratory pain, torticollis, agoraphobic anxiety
correlated with urinary incontinence both in women and men. Taking into account the
co-existence of urinary incontinence, a sense of discomfort associated with masturbation
Jerzy A. Sobański et al.
16
ranked high in women (but not in men). Other symptoms found in the analysis only in
the group of women were excessive salivation and breaking things out of anger. Tem-
porary aphonia and loss of balance strongly correlated with male urinary incontinence.
Discussion
This retrospective questionnaire-based study of 3,929 patients from a day hospital
for neurosis treatment conrmed the occurrence of two lower urinary tract symptoms.
Frequent need to urinate was a very common symptom – reported by almost half
of the respondents in the period of a week preceding the Symptom Checklist com-
pletion, and urinary frequency was reported signicantly more often in the group of
women than in men. Second symptom, urinary incontinence was reported much less
frequently in the studied population (about 5%). The dierences in the frequency of
urinary incontinence in terms of gender were not found and only a weak correlation
with age was found.
The above-mentioned observations may be explained by the fact that in the
studied group most of the respondents were relatively young, who, on one hand, did
not suer from serious burdens of the disease (which would warrant a psychotherapy
in a day hospital), and on the other did not have any symptomatic morphological or
functional lesions within the lower urinary tract which are typical for older people.
Diseases of the prostate associated with age in men, as well as the morphological
and functional lesions related to the bladder and the urethra common both in men
and women, may cause day and night time frequency, as well as the urinary incon-
tinence [41–43].
Analyses of both urinary frequency and urinary incontinence in patients with
neurotic and personality disorders were conducted from the most aggregated param-
eters, such as gender, duration of treatment (before vs. after 1990, the period of great
socio-cultural change in Poland, moreover, in the middle of the study), general primary
clinical diagnosis, global symptom level, through the groups of symptoms correspond-
ing to scales of the Symptom Checklist KO“O”, to the single symptoms – variables
of the questionnaire. Urinary frequency (both its occurrence and in extreme severity)
was connected, irrespective of the respondents’ gender, with signicantly high burden
of neurotic symptoms globally classied (as OWK coecient), as well as in the sub-
groups (scales of the Symptom Checklist). Similar, non-specic results were achieved
for much less frequent symptom – involuntary micturition (urinary incontinence).
In relation to the main groups of approximate diagnosis (coded according to the
ICD-10), the most commonly occurring in collectively created (estimating and cod-
ing the diagnoses made many years ago into ICD-10 specications) groups were the
conversion-dissociative and somatoform disorders. Similar results were obtained
with the use of correlation analysis, where correlations of occurrence and extremely
severe urinary frequency were found (the strongest with the scale number 6. (Soma-
toform disorders), slightly less strong correlations were noted with the scale number
17
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
4. (Conversions), and 5. (Autonomic disorders of Cardiovascular system). However,
correlations of urinary incontinence were weak and limited to the scale of conversion
in the group of women.
In the scope of analysis of single symptoms occurrence, the obtained results show
considerable correlation of the urinary tract complaints reported in the Symptom
Checklists, in particular with the somatoform or conversion disorders (and certain
correlation between both analyzed “urological” complaints). The co-existence of both
symptoms with complaints referring to the genital organs and reporting discomfort
associated with masturbation in the group of women (important symptoms in patients
with neurotic and personality disorders [31–34, 37] cannot be ignored either.
It should be emphasized that other numerous neurotic disorders co-existed with
the lower urinary tract symptoms, but they were less probable.
The methodological limitations of this work (long-term retrospective analysis of
a questionnaire study on a large group of day hospital patients) do not allow for the
extrapolation of its results in the population of psychiatric patients (wider than patients
qualied for the subsequent psychotherapy in psychotherapeutic centers with day
units for neuroses treatment), or in the group of primary care patients or specialized
urological centers. However, the results of this study, mainly due to a large number of
study patients and the subgroup analyses in terms of gender and the diagnosis (in terms
of age to the lesser degree), allow for the conclusion that the need of more detailed
exploration in these populations and with the use of more detailed tools (interview
and questionnaires) referring to the urological symptoms that patients are burdened
with, is justiable. The suggestions for further studies will allow to overcome present
limitations in the interpretation of the results of the study based on two questions only
including simple, colloquial expressions and descriptions combining the features of
various options of lower urinary tract symptoms.
Clinical experience of psychotherapy in day hospitals shows that episodes of inter-
rupting therapeutic sessions (individual or group), leaving to the toilet and the need of
micturition take place, however, they happen less frequently than due to panic attack
with typical symptom of increased heartbeat. Likewise, only single patients report the
fear of urination outside their place of residence or another familiar place. Slightly
larger group of patients does not come in time for the sessions due to increased need of
urination just before the start of the session or during breaks between the group sessions.
The authors of this study cannot recall any case reported directly by the patient – of an
episode of involuntary, uncontrolled micturition during the psychotherapeutic sessions.
However, it is not out of the question that such situations take place particularly in
case of women with gynecological and urological symptoms, but they are concealed
(e.g. by using diapers or pads), or some patients do not decide for the participation
in a group therapy in a day hospital (which might mean more severe “urological”
symptoms in a wider population than analyzed). The obtained results of the study are
considered important because the “pseudourological” symptoms are neither frequently
Jerzy A. Sobański et al.
18
nor easily reported directly by the patients with neurotic disorders who do not have
to be aware – neither do their doctors – of the psychogenic nature of their symptoms.
Only weak correlation between urinary frequency and age, irrespective of gender,
was observed. As far as incontinence is concerned, there was a lack of such correlation
in both groups, even a weak one (statistically insignicant correlation coecients).
This could be explained by relatively young patient age and relatively good overall
health. This fact can conrm psychogenic nature of the symptom.
The observation that both of the “urological” symptoms, the occurrence of symp-
toms and their extremely severe form correlated with signicantly higher global symp-
tom level (OWK) and signicantly higher scales of the Symptom Checklist, suggests
that they also correlated with an intense discomfort/distress (not necessarily caused
by the occurrence of these symptoms).
The strongest correlations (coexistence) of urinary frequency in both women and
men were related to the second urological symptom (urinary incontinence), as well as
similar symptom of diculties in controlling physiological functions (bloating and
bowel emptying), symptoms probably related to the physiology of excessive micturi-
tion – excessive thirst (the latter one can be related to psychogenic polidypsia [44–46])
and genital organs symptoms that might belong to the group of sexual disorders (e.g.
erectile dysfunction [47] and other sexual dysfunctions [48, 49] obviously including
those associated with age [50]) or complex urological disorders – urethral pain syn-
drome of complex etiology among others of psychogenic nature [51]), and the part of
a group of obsessive-compulsive disorder – compulsive repeating (literature reports
such a connection in children [52]).
Depending on gender – it turned out that the symptoms of migrating pain (most
probably of somatoform disorder, dissociative or conversion disorder), and similar
symptoms related to functional digestive disorders (heartburn, diarrhea) often referring
to neurotic symptoms (e.g. [38]) more strongly correlated with the urge of frequent
urination in the group of women (more prone to the urological pain symptoms [51]).
It seems that those accompanying symptoms are relatively more frequent in the context
of sexual traumas [10, 53]. However, the following symptoms correlated with the urge
of frequent urination in the group of men: dissociation disorders – temporary paresis,
sight weakness, hearing deciency and other sensory function decits – buzzing in the
ears and photosensitivity, hypersensitivity to sound, touch as well as muscle tension
and muscle spasms, hypochondria and avoidance behavior.
Both in women and men, urinary incontinence was related to frequent urination
(second urological symptom), the genital organs complaints, temporary paresis of the
limbs, migratory pains, torticollis, agoraphobic anxiety (most probably in relation to
the diculty in controlling, among others, this scope of physiology while being far
from safe place).
In women (but not in men) high rank in terms of co-existence with urinary incon-
tinence was reached by the discomfort associated with masturbation (the fact that can
19
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
be related to symbolism of “wetting” in the context of physiology of sexual pathology
of excitement in women). It is worth mentioning that in literature the occurrence of
urological symptoms in women was associated with distorted sexual life with partners
suering from erectile dysfunction [54], and other dysfunctions of a relationship [55].
The observation of a strong correlation between the urological symptoms and genital
organs complaints seems to be important as well, which is supported in clinical experi-
ence by frequent reporting urological or gynecological symptoms such as inamma-
tion, irritation, vaginal discharge, infection etc. as “easier to report” or “incorrectly
located”. Such a tendency to omit, avoid, distort sexual thread also was supported by
clinicians and the medical students [56, 57].
Other symptoms found in this analysis in relation to urinary incontinence, but only
in women, were excessive salivation and breaking things out of anger – both possible
for interpretation as associated with anger. In the group of men the loss of balance
and temporary aphonia (histerical mutism) were the symptoms strongly correlating
with urinary incontinence.
Obsessive-compulsive disorder symptoms were found to correlate with the pseudo-
urological symptoms and could refer to toilet activities, but unfortunately the available
data cannot support this assumption.
It seems interesting that the correlations between the pseudo-urological and pseudo-
cardiac symptoms (also during the analyses of co-existence of “cardiac” symptoms
with other symptoms [39]), which can result from “separate directions” of autonomous
stimulation in relation to the genitourinary and the digestive system versus cardiovas-
cular system were not found.
Additionally, the group of single anxiety symptoms – apart from the agoraphobic
anxiety associated with the symptom of involuntary micturition (or at least the sense
of it) – did not correlate with the lower urinary tract symptoms. This might seem sur-
prising especially in relation to panic attacks (described to have correlated with the
urinary tract symptoms, for example, [58]), however, rapidly increasing symptoms
from the cardiovascular system dominate within the group, and any possible occur-
rence of urge urinary incontinence during a panic attack was not suciently reported
in the Symptom Checklist.
It is interesting that the correlation of urinary incontinence with the group of
symptoms forming the scale of the Inorganic sleep disturbances did not appear – the
correlation with bed wetting (e.g. [59, 60]) was expected.
Another group of potential correlations seems to be anger syndrome which did not
appear among those and most strongly correlated with the pseudo-urological symp-
toms (apart from the above-mentioned excessive salivation and breaking things – the
symptoms which do not unequivocally belong to direct outburst of anger as they might
include e.g. responses related to clumsiness and dropping things in anger). The obser-
vation is in accordance with the results of Sobański et al. [40], who showed complete
lack of any signicant correlation of urinary incontinence with the symptom of anger
Jerzy A. Sobański et al.
20
outburst, suggesting that even if (as in children) in the studied adult patients the wetting-
anger correlation would exist, the aware experiencing of anger practically excludes it.
Individual contexts of the urological symptoms occurrence in the studied patients
were not available. They could allow for symbolical interpretations of some of the
situation-symptom correlation (e.g. frequent micturition – lack of interest in work,
regression – wetting etc.), which would create favorable circumstances for interpre-
tation useful in psychotherapy, which is a basic method of neurotic and personality
disorder treatment.
Recommendations for diligent screening in terms of psychiatric nature among the
urological patients [61–66], as well as the psychiatric symptoms in terms of urological
background should be advocated [67].
Conclusions
1. The most common lower urinary tract symptoms – in the form of urination fre-
quency – occurred in nearly half of the studied patients (48% women and 44%
men) with neurotic and personality disorders treated in psychotherapeutic day
unit, and the greatest severity aected as much as 13% of women and 9% of men.
2. Urinary incontinence, the most serious burden for only a small number of patients
(5% of the respondents, and extreme severity only about 1%). Both analyzed
symptoms more frequently referred to women.
3. In the analysis of frequency of occurrence and severity of the “urological” symp-
toms in patients diagnosed during1980–1990 vs. 1991–2002 periods, signicant
dierences, apart from the increase in the percentage of urinary incontinence
occurrence, were not found.
4. For both symptoms – frequent and involuntary urination, both their occurrence,
as well as extreme severity signicantly correlated with patients’ global burden
of neurotic symptoms, regardless of gender.
5. Only weak correlation between urinary frequency and patients’ age, regardless of
gender, was found. In groups of women and men there was no, even weak, cor-
relation for the symptom of urinary incontinence
6. Analysis of co-existence with other neurotic symptoms indicated the strongest
correlations between urinary frequency and somatoform and autonomous digestive
disorders, bloating, diarrhea, thirst and pain syndromes of genital organs in both
women and men. Furthermore, the group of co-existing conversion-dissociative
symptoms seemed to be important in men.
7. Urinary incontinence both in women and men signicantly correlated with pain
syndromes of genital organs (in women also with the discomfort associated with
masturbation), which may suggest the need to extend the clinical interview in
these patients by this area.
Acknowledgement: We would like to thank Dr Maciej Sobański for the statistical support
21
Occurrence of selected lower urinary tract symptoms in patients of a day hospital
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Address: Jerzy A. Sobański
Unit for Diagnostics of Neurotic and Behavioral Disorders
Department of Psychotherapy
Jagiellonian University Medical College
31-138 Kraków, Lenartowicza Street 14
... Ważnym obszarem trudności doświadczanych przez pacjentów cierpiących na objawy urologiczne są problemy z zakresu funkcjonowania seksualnego oraz łączące się z nimi wtórne dysfunkcje związku [21][22][23][24][25][26][27][28][29]. Jednocześnie w tej grupie chorych często stwierdza się urazy seksualne [4,12,30], również wiążące się z negatywną/ niską samooceną, poczuciem winy, gorszości i wtórnymi dysfunkcjami seksualnymi. ...
... [1] wskazują na możliwość odwołania się do koncepcji osi pęcherz-jelita-mózg (bladder-gut-brain axis -BGBA) i sugerują, że zaburzenia funkcjonalne stanowią efekt silnej reakcji na trudności czy wydarzenia urazowe w dzieciństwie, skutkujące doświadczanym dystresem emocjonalnym i somatycznym (bodily distress), przy czym czynnikiem ryzyka ich wystąpienia może być według autorów neurotyczność lub tendencja do negatywnej emocjonalności. Założenia takie potwierdzają niedawne badania na polskiej grupie pacjentów z zaburzeniami nerwicowymi, u których dwa rodzaje objawów z dolnego odcinka układu moczowego (poczucie częstego oddawania moczu i bezwiedne moczenie u mężczyzn oraz nasilony częstomocz u kobiet) wiązały się [29] z karaniem za masturbację lub zabawy seksualne, a także z prawdopodobnie stanowiącym konsekwencję karania [35], zgłoszonym przez kobiety dyskomfortem dotyczącym masturbacji -powiązanym z bezwiednym moczeniem [28]. Urazowy wpływ przemocy lub nacisku podczas pierwszych stosunków seksualnych pokazuje we wcześniejszej publikacji [29] powiązanie objawów bezwiednego oddawania moczu z "raczej" niechcianą lub zapamiętaną jako gwałt inicjacją seksualną, jednym z czynników ryzyka zaburzeń seksualnych w wieku dorosłym [35,[39][40][41][42]. ...
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Objectives: Evaluation of the association between the occurrence of lower urinary tract symptoms in patients qualified for psychotherapy and the severity and profile of their neurotic personality disorders. Material and methods: Retrospective analysis of questionnaires included in the medical records of 2,450 patients qualified for psychotherapy in 2004-2014 in terms of correlations between the symptoms of pollakiuria and unconscious urinary incontinence, and the global severity of neurotic symptoms (OWK), global severity of neurotic personality disorders (XKON) and abnormal values of 24 scales of the KON-2006 questionnaire. Correlations in the form of OR coefficients with 95% confidence intervals were estimated using logistic regression analyzes. Results: Lower urinary tract symptoms are associated with a significantly greater severity of neuroticism, both described by the global severity of symptoms (OWK) as well as by the global neurotic personality disorder index (XKON) and abnormal values of the KON-2006 questionnaire scales. The occurrence of both symptoms was associated with the following scales: 'Negative self-esteem' and 'Envy', the occurrence of pollakiuria - with the scales 'Feeling of being dependent on others', 'Demobilization', 'Conviction of life helplessness' and 'Feeling of lack of influence', the occurrence of unconscious urinary incontinence - with the scales 'Feeling of being alienated' and 'Exaltation' for both genders, and only in men 'Risk avoidance' (low 'Risk tendencies'), 'Conviction of life helplessness', 'Difficulties in interpersonal relations'. Extreme severity of pollakiuria was more strongly associated with many of the mentioned scales, and also slightly differently with other scales, e.g., in men - with the 'Sense of overload' and 'Imagination, fantasizing'. Conclusions: Neurotic personality traits described by abnormal values of the KON-2006 questionnaire scales are associated with the presence (and also to some extent with the severity) of psychogenic lower urinary tract symptoms. Connections may be bi-directional - in some cases experiencing and self-description of personality traits may be secondary to suffering associated with pollakiuria and incontinence.
... Co-existence of anxiety disorders (panic attacks, agoraphobia, several compulsions), depressive disorders and sexual dysfunctions with LUTS has been documented in many reports [11,59,60], some of them associate micturition disorders with phobias (particularly with social phobia [3,4], similarly, coexistence of LUTS with stress-related disorders such as ASD an PTSD [4], PTSD [61,62] and with traumatic events [63], particularly with psychosexual traumas (e.g., rapes) [5,[64][65][66]. The obtained results seem to show the probability of indirect correlation of traumas and sexual dysfunctions, as well as "urological" symptoms related to them with conflicts in a current relationship and with separation difficulties, patients' tendency to "urethral regression", which was presented in literature in 1986 [21]. ...
... All above-mentioned observations show significant influence of risk factors for sexual dysfunctions' occurrence and relationship dysfunctions on urological symptoms' pathogenesis, also those described for the cohort of patients with neurotic and personality disorders [35][36][37][38][39][40]. These observations were advocated by the association of urological complaints with genital organs symptoms and discomfort related to masturbation in women [60]. ...
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Objectives: To assess the correlation of subjectively estimated biographical context and lower urinary tract symptoms reported by patients with neurotic and personality disorders. Methods: This was a retrospective analysis of the biographical context of co-existence of urinary frequency and urinary incontinence reported by 3,929 patients in a day hospital for treatment of neurotic disorders. The symptom checklists KO "0" were completed by patients prior to any treatment. Results: Urinary frequency reported by patients in a day hospital for treatment of neurotic disorders was associated with the difficulties from their childhood and adolescence (i.e. with perception of inferiority with regard to one's family and among siblings, parents' low education level), as well as the disparities in terms of sexual education and troubled relationships. Conclusions: In the studied group of patients with neurotic and personality disorders, selected lower urinary tract symptoms were associated with adverse life circumstances from childhood and adolescence (which can show the tendency towards regression and protracted character to experience of family's dysfunction due to feeling of being neglected or abandoned), as well as, to a larger or a smaller degree, their consequences - dysfunctions in adulthood, relationship/marriage, functioning at work and dealing with finances. These associations indicated the probable significance of experiencing these aspects of life in patients, not only in day hospitals or psychiatric hospitals which reported "pseudo-urological complaints", but also in at least part of urological patients - going to hospitals due to neurotic disorders, particularly those occurring in a somatic form.
... Its manifestations include emotional-affective symptoms, disturbance in somato-vegetative functions and mental exhaustion. A patients suffering from neuroses are aware of the fact of their disease and remain critical of their condition or external circumstances [8][9][10]. ...
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The paper presents the results of a study of dynamic changes in the severity of depression, it’s somatic manifestations, basic beliefs and dysfunctional attitudes in the course of treatment which included rational psychotherapy. The study sample consisted of 48 men and women with different forms of prediagnosed neurotic disorder aged 25-44 years (M = 32.6, SD = 5.3 (43.7% men)). Methods: Beck Depression Inventory (BDI, N.V. Tarabrina, 2001), Beck Anxiety Inventory (BAI, N.V. Tarabrina, 2001), Janoff-Bulman The World Assumptions Questionnaire (M.A. Padun, A.V. Kotelnikova, 2007), A. Beck, A. Weissman Dysfunctional Attitudes Scale (DAS, M.L. Zakharova, 2013). Statistical analysis included Kruskal-Wallis H-test and one-way ANOVA with post-hoc analysis. As a result of the study, it was possible to identify gender differences in the dynamics of cognitive-affective manifestations of depression, somatic manifestations of depression and dysfunctional relationships. It has been found that women demonstrate greater progress in stabilizing their emotional state and developing the skills to recognize their dysfunctional thoughts. At the same time, men are distinguished by a more pronounced dynamics of change in beliefs about their own value, the ability to manage events and luck.
... This study was carried out in a unique population of people diagnosed with depressive disorders. Recently, Polish works investigating the occurrence of LUTS in the course of neurotic disorders have appeared [22,23]. They mainly concerned the relationship between psychological factors and LUTS and they did not examine issues related to the somatic etiology of LUTS. ...
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Objectives: The aim of the present study was to investigate the correlation between lower urinary tract symptoms (LUTS) and severity of depressive symptoms in patients treated for depression. Methods: 102 patients (43 males, 59 females) aged 20-67 (M = 46.1) treated for depression were included in this cross-sectional analysis. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR). LUTS were examined with the International Prostate Symptom Score (IPSS). In order to analyze the impact of presented symptoms, both urological and psychiatric, on quality of life of analyzed individuals the 30-item General Health Questionnaire (GHQ-30) was used. Results: The average IPSS score in women was significantly higher than in men (9.59 vs. 6; p = 0.04). Patients suffering from at least moderate depression assessed with QIDS-SR had significantly higher scores in IPSS (9.76 vs. 4.1; p = 0.002). Severity of all LUTS assessed with IPSS correlated with QIDS-SR score in examined men (p < 0.05). In women, the total IPSS score correlated with the QIDS-SR score (p < 0.05) and with the total GHQ-30 score (p < 0.05). Anumber of other significant (p < 0.05) correlations were observed between the total IPSS score and certain items' scores in the GHQ-30 both in men and women. Conclusions: LUTS are common among patients with depression. There is a correlation between severity of depressive symptoms and LUTS. LUTS affect quality of life and well-being as well as cause marked distress in depressed patients. Comorbidity of LUTS and depression should draw attention of both psychiatrists and urologists and enhance interdisciplinary treatment approach. Further prospective and cohort studies are essential to reveal more details of the correlation between LUTS and depression.
... Wydaje się, że wyniki z tej grupy ankietowanych lepiej korelują z danymi z badań przeprowadzonych wśród pacjentów. Wywiad obejmujący 4000 chorych z dziennego szpitala psychiatrycznego ujawnił, że aż 50% z nich może zgłaszać objawy z dolnego odcinka dróg moczowych [20]. Przytoczone wcześniej badanie EpiLUTS pokazało, że występowanie LUTS istotnie koreluje z poziomem lęku i depresji. ...
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Aim. Lower urinary tract symptoms (LUTS) are highly prevalent and costly condition worldwide. Numerous studies have demonstrated their negative impact on health-related quality of life (HRQL), as well as on physical and mental health. The co-existence of LUTS and psychiatric symptoms is common and has been described by psychiatrists, urologists and gynecologists. However, data are lacking regarding the perception of urological symptoms by psychiatrists in their day-to-day clinical practice. Methods. 31-question survey was designed to learn what is the perception of LUTS among psychiatrists. Survey link was sent by email to all psychiatrists registered to the Polish Association of Psychiatry via the association’s email lists. The SurveyMonkey website was used as a platform where responses were collected and stored. Results. 953 physicians completed the questionnaire. Majority of investigated psychiatrists only ‘occasionally’ask their patients about voiding dysfunctions. Respondents estimated the frequency of voiding dysfunctions in their patients as ‘moderately frequent’with a ‘10–30%’ prevalence. However, discrepancies between different subgroups of psychiatrists have been noted. Furthermore, psychiatrists may not be fully aware of the effects of psychiatric treatment (psychotherapy/pharmacotherapy) on LUTS improvement, as well as possible deteriorations of voiding dysfunctions with psychiatric disorder progression. Conclusions. This survey showed that the perception of urological symptoms by psychiatrists in their patients may be limited. Therefore, it is necessary to adequately inform and educate psychiatrists in terms of the impact of urological symptoms on patients’management, prognosis and quality of life.
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Introduction: Gastrointestinal symptoms are very common in the general population. Many of them coincide with mental disorders (especially with neuroses, stress-related disorders, somatisation disorders, autonomic dysfunction, and anxiety) that are associated with psychological trauma, conflicts, and difficulties with interpersonal relationships. Aim: Assessment of the association between gastrointestinal complaints and stressful situations in relationships, among patients admitted to day hospital for neurotic and behavioural disorders. Material and methods: Analysis of the likelihood of co-occurrence of abdominal symptoms and stressful situations, reported by patients before admission, in a large group of subjects treated with psychotherapy. Results: Gastrointestinal symptoms were highly prevalent in the studied group (they were reported by 40-50% of patients). The most common complaints in women were: loss of appetite (52%), nausea (49%), and constipation and flatulence (45%). In men the most prevalent symptoms were: loss of appetite (47%), heartburn (44%), and flatulence (43%). Functional gastrointestinal symptoms (especially vomiting in cases of nervousness in females or heartburn in males) were significantly associated with greater likelihood of current difficulties in interpersonal relationships, such as conflicts with partner/spouse or parent. Conclusions: The results suggest that in many cases symptoms of anxiety disorders or somatisation disorders coexisted with irritable bowel syndrome and functional dyspepsia.
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Introduction: The overactive bladder syndrome (OAB) is one of the most common and bothersome subsets of lower urinary tract symptoms (LUTS), affecting predominantly the aged population, with a worldwide distribution. This syndrome has not been completely understood, yet the aging process and the decreased blood flow to the bladder have been highlighted as closely related to this phenomenon. Materials and methods: We performed a search on the online database PubMed/MEDLINE with the following MESH terms: 'Overactive Bladder AND (Ischemia OR Aging OR Vascular Disease)'. We considered manuscripts written in English and published in the last 10 years (2004-2014, October). Additional manuscripts, such as referenced by reviews, were further included. Results: The aging process and the structural and functional changes resulting from an ischemic process emerge as important features that contribute to OAB. The ischemic-induced molecular and structural modifications that occur in the bladder have only recently been the objective of thorough studies, which link cardiovascular risk factors, vascular lesions and OAB. New animal models are being created to test new areas of treatment or prevention of ischemic-induced bladder dysfunction. Conclusion: Recent data point out that several physiological and pathological modifications that occur in the bladder associated with OAB and aging are closely related to ischemia.
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Background: The relationship between lower urinary tract symptoms (LUTS) and common mental health disorders such as depression and anxiety in men remains unclear. Inflammation has recently been identified as an independent risk factor for LUTS and depression. This study aimed to assess the association between depression, anxiety and LUTS, and the moderating influence of systemic inflammation, in the presence of other biopsychosocial confounders. Methods: Participants were randomly-selected from urban, community-dwelling males aged 35-80 years at recruitment (n = 1195; sample response rate:67.8%). Of these, 730 men who attended baseline (2002-5) and follow-up clinic visits (2007-10), with complete outcome measures, and without prostate or bladder cancer and/or surgery, neurodegenerative conditions, or antipsychotic medications use, were selected for the present study. Unadjusted and multi-adjusted regression models of incident storage and voiding LUTS and incident depression and anxiety were combined with serum inflammatory markers (high-sensitive C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), myeloperoxidase (MPO), soluble e-selectin (e-Sel)) and socio-demographic, lifestyle, and health-related factors. Hierarchical multiple regression was used to assessed the moderating effect of inflammatory markers. Results: The incidence of storage, voiding LUTS, depression and anxiety was 16.3% (n = 108), 12.1% (n = 88), 14.5% (n = 108), and 12.2% (n = 107). Regression models demonstrated that men with depression and anxiety at baseline were more likely to have incident storage, but not voiding LUTS (OR: 1.26, 99%CI: 1.01-4.02; and OR:1.74; 99%CI:1.05-2.21, respectively). Men with anxiety and storage LUTS at baseline were more likely to have incident depression (OR: 2.77, 99%CI: 1.65-7.89; and OR:1.45; 99%CI:1.05-2.36, respectively), while men with depression and voiding LUTS were more likely to have anxiety at follow-up (OR: 5.06, 99%CI: 2.81-9.11; and OR:2.40; 99%CI:1.16-4.98, respectively). CRP, TNF-α, and e-Sel were found to have significant moderating effects on the development of storage LUTS (1.06, 0.91-1.96, R2 change: 12.7%), depression (1.17, 1.01-1.54, R2 change: 9.8%), and anxiety (1.35, 1.03-1.76, R2 change: 10.6%), respectively. Conclusions: There is a bidirectional relationship between storage, but not voiding, LUTS and both depression and anxiety. We observed variable moderation effects for selected inflammatory markers on the development of depression, anxiety and storage LUTS.
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Patients of various medical fields report symptoms unexplained by other than psychological / psychiatric medical reasons. Some of them are looking for treatment because of cardiovascular ailments, mainly in the form of rapid heart rate, palpitations and pain localized in the chest. Typical cardiac diagnosis, usually reveling the absence of organic reasons of these conditions, brings little information about stressful life events and psychological predispositions of these patients. Identifying co-occurrence of "cardiac" symptoms with other symptoms typical for neurotic disorders and difficult live circumstances may facilitate not only psychiatric diagnosis. To determine psychosocial context of psychogenic disorders of the heart and the chest in patients with neurotic disorders as well as co-occurrence of other symptoms. Medical records of patients from the years 1980-2002 containing self-report questionnaires collected in the form of anonymous database were examined. Analysis of the relationship between symptoms reported in the Symptom Checklist and biographical circumstances described in the Live Inventory before admission to the day hospital for neurotic disorders treatment was performed using simple logistic regression analyzes leading to the estimation of OR coefficients and their 95% confidence intervals RESULTS: Very common, present in most subjects, symptoms of tachycardia / palpitations or chest pain were associated significantly with circumstances such as suboptimal conflict resolution through passive aggression or fights, uncertainty in the relationship, a sense of being worse than the partner, difficult financial situation. In addition, the "pseudo-cardiac" symptoms were also associated with recollected from childhood risk factors, such as having low income numerous family of origin, a sense of worseness of the family of origin, the feeling of hostility or lack of support from parents. Doctors of all specialties who come into contact with patients experiencing pseudo-cardiac type symptoms should expect their psychological reasons and make a simple interview to clarify the presence of burdensome biographical circumstances. Identification and discussing with the patients the difficult experiences can help to convince them to look for psychological help or treatment with psychotherapy.
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Introduction. The symptoms of dissociation, depersonalization and derealization are often associated with exposure of patients to mental and physical injuries, usually occurring in childhood. Most of these observations were carried out in populations of patients with various disorders (posttraumatic, conversion-dissociation, personality disorders – especially borderline), who reported their exposure to adverse life circumstances through questionnaire interviews. Aim. Assessment of the risk associated with various traumatic events in childhood and adolescence concerning the symptoms of pain and tactile dissociation, depersonalization and derealization. Material and method. The coexistence of the earlier life circumstances and the currently existing symptoms was examined on the basis of KO “0” Symptom Checklist and Life Inventory, completed prior to treatment in a day hospital for neurotic disorders. Results. In the group of 2582 women, patients of a day hospital for neurotic and personality disorders, the symptoms of pain and tactile dissociation, depersonalization and derealization were present in 24-36 % of patients, while the maximum severity of these symptoms reported approximately 4-8 % of patients. The studied patients reported the exposure during childhood and adolescence (before 18yo) to numerous traumatic events of varying severity and frequency, including hostility of one parent (approximately 5% of respondents), the sexual initiation before 13yo (1%), worse than peers material conditions (23%), harassment of the family of origin (2%), reluctance of their peers (9%). Conducted regression analysis showed illustrated by the coefficients OR (odds ratios) a statistically significant relationship between the majority of the analyzed symptoms and many of the listed events, such as being regarded as worse than siblings, mother’s anger in the situation of the patient’s disease in childhood, lack of support, indifference of parent, poverty and worseness of the family of origin, inferior position in the classroom and the school grades, total sexual unawareness, incest or its attempt. Conclusions. The symptoms of dissociation, depersonalization and derealization occurred in significantly more patients reporting burdening life events – difficult situations in childhood and adolescence. Therefore, in clinical practice in patients presenting such symptoms, regardless of diagnosis (e. g. a specific neurotic disorder), we can expect revealing information about such events.
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Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction.
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This study investigated the relationship of personality, depression, somatization, anxiety with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the International Prostate Symptom Score (IPSS), 44-item Big Five Inventory (BFI), the Patient Health Questionnaire-9 (PHQ-9), the PHQ-15, and 7-item Generalized Anxiety Disorder Scale (GAD-7). The LUTS/BPH symptoms were more severe in patients with depression (p=0.046) and somatization (p=0.024), respectively. Neurotic patients were associated with greater levels of depression, anxiety and somatisation (p=0.0059, p=0.004 and p=0.0095, respectively). Patients with high extraversion showed significantly low depression (p=0.00481) and anxiety (p=0.035) than those with low extraversion. Our exploratory results suggest patients with LUTS/BPH may need careful evaluation of psychiatric problem including depression, anxiety and somatization. Additional studies with adequate power and improved designs are necessary to support the present exploratory findings.
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Lower urinary tract symptoms (LUTS) have a negative impact on the quality of life, and may relate to anxiety and depression. The objective of this study was to test the hypothesis that LUTS are associated with anxiety and depression using a nationwide population-based database in Taiwan. Data were obtained from a random population sample of about one million enrollees in the National Health Insurance program from 2001 to 2009, and consisted of 22,980 LUTS patients and 45,960 matched controls. The records of healthcare seeking for anxiety and depression were collected 2 years before and after the diagnosis of LUTS. The results showed that patients with LUTS had a significantly higher prevalence of anxiety or depression than the matched controls (11.45% vs. 5.72%). After controlling for sociodemographic variables and other major systemic diseases, the odds ratios for anxiety, depression, either anxiety or depression, and both anxiety and depression, were 2.05, 2.19, 2.14, and 2.56, respectively. There was an association between LUTS and the stress-related common mental disorders, and there seemed to be an additive effect of anxiety and depression on the association with LUTS. These findings imply a psychological role in the pathogenesis or sequelae of LUTS.
Article
Lower urinary tract symptoms (LUTS) remain highly prevalent worldwide, and are well known to negatively impact patients’ quality of life, sleep and psychosocial wellbeing. Conversely, both depression and anxiety have been shown to have a negative effect on perception, development and prolongation of LUTS. This paper provides an overview of an association between the lower urinary tract symptoms, depression and anxiety. It also explores possible common mechanisms underlying the causes of both conditions. There has been a large body of evidence linking LUTS with anxiety and/or depression. Studies have documented not only a significant impact of LUTS on the psychosocial wellbeing, but also showed a strong negative effect of depression and anxiety on perception, development and prolongation of LUTS. High level of psychiatric morbidity has important implications on the appropriate management in patients with LUTS, as well as LUTS may have important implications on development and management of depression and anxiety. Therefore, clinicians should be aware of the bidirectional association between LUTS and anxiety and/or depression, as some patients may require a multidisciplinary approach and a combined treatment. The precise common mechanism underlying LUTS, depression and anxiety remain largely unknown and further research is needed to elucidate the underlying pathophysiological pathways.
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Urethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome may occur in men but is more frequent in women. The exact etiology is unknown but infectious and psychogenic factors, urethral spasms, early interstitial cystitis, hypoestrogenism, squamous metaplasia as well as gynecological risk factors are discussed. These aspects should be ruled out or confirmed in the diagnostic approach. Despite the assumption of a multifactorial etiology, pathophysiologically there is a common pathway: dysfunctional epithelium of the urethra becomes leaky which leads to bacterial and abacterial inflammation and ends in fibrosis due to the chronic impairment. The therapeutic approach should be multimodal using a trial and error concept: general treatment includes analgesia, antibiotics, alpha receptor blockers and muscle relaxants, antimuscarinic therapy, topical vaginal estrogen, psychological support and physical therapy. In cases of nonresponding patients intravesical and/or surgical therapy should be considered. The aim of this review is to summarize the preliminary findings on urethral pain syndrome and to elucidate the diagnostic and therapeutic options.