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Introduction: Nocturnal enuresis (bed-wetting) is a hereditary, medical condition, which effects both children and adults (1). Beside this there is few studies on pevalance of enuresis nocturna (EN) among adults. EN cases are seldomly reported. Although most of the patients recover spontaneusly from EN, in the resistant cases illness persist through adulthood (2). The patients who have frequent bed-wetting in their childhood have greater risk for persistence of symptoms (3).
Case: A 29-year-old single, male patient does not work. The patient has been suffering from bed-wetting at nights, 2-3 times per week since his early childhood. He reports that he never had a long period free from bed-wetting at nights. He was suffering from bedwetting only at nights and never had daytime wetting. The patient reported that bedwetting becomes more frequent when he was under stress or felt unhappy about something and decreased in frequency when he felt less stressed out. While his military service, for a short period his symptoms had stopped when his millitary service was over his symptom has started again. In last six months, after he has suffered from thoughts of worthlessness, relationship issues with his father, and some economic problems his bed-wetting frequency increased. After his first application to the Erenkoy Mental Health Training And Research Hospital outpatient clinic, a consultation with a neurologist and a urologist was planned. He had been examined separately by a urologist, a neurologist and a psychiatrist. Several investigations had been performed in which they could not detect any organic disease. These investigations included urine analysis, abdominal USG, cranial MRI, and EEG. According to the results of these investigations, organic etiology was ruled out and 25 mg/day imipramine had been commenced. Later we increased imipramine dosage to 50 mg/day and added behavioral homework to the treatment. In his familiy history, there were similar symptoms in his brother wich had persisted until age 15th, and in his cousin which had persisted until he turned to 19 years old. The treatment response of the patient was good; his compliance with pharmacological treatment and behavioral therapy techniques was good.
Discussion: Our case, according to DSM-IV-TR diagnostic criteria, was fulfilling the criteria for enuresis nocturna and major depressive disorder on axis I. His problems about his functionality and his relationship with his father have caused an increase in his depressive symptoms and his bed-wetting. We think that patient's good response to treatment is related to his high motivation in his first psychiatric application and his compliance with behavioral threapy. It is compatible with literature data that the relatives of the patient have similar symptoms.
References:
1. Yalu? Y, Ünsalan N, Özten E, Öztep Kuruo?lu S, Tufan AE. Eri?kinde ikincil enürezis nokturna: Bir olgu sunumu. Anadolu Psikiyatri Dergisi 2006; 7:185-190
2. Burgu B, Gokce MI, Gucuk A, Soygur T. Prospective evaluation of factors affecting the response and relapse rates to desmopressin therapy in male monosymptomatic enuretic adults. Urology 2009; 74: 915–919
3. Yeung CK, Sihoe JD, Sit FK, Bower W, Sreedhar B, Lau J. Characteristics of primary nocturnal enuresis in adults: an epidemiological study. BJU Int 2004; 341-345 Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S185