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Normal Pressure Hydrocephalus: Diagnosis and Treatment Options

Normal Pressure Hydrocephalus: Diagnosis and Treatment Options

Teaser: 

Alfonso Fasano, MD, PhD

Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada, Krembil Research Institute, Toronto, Ontario, Canada.

CLINICAL TOOLS

Abstract: Normal pressure hydrocephalus (NPH) is a relatively frequent but underdiagnosed geriatric disorder with symptoms of impaired gait and balance, overactive bladder, and cognitive decline in the presence of neuroimaging evidence of ventriculomegaly. Cerebrospinal fluid shunting is an effective treatment, although patients' response is variable, sometimes of short duration, and not always predictable. This might be due to poor patient selection or delayed surgery. Nevertheless, recent trials have indicated that shunt surgery is cost-effective and should therefore be recommended. Family physicians and general neurologists play a crucial role in ensuring a proper diagnosis and timely intervention.
Key Words: normal pressure hydrocephalus, diagnosis, treatment.

Family physicians have a crucial role in ensuring a proper diagnosis and timely intervention. In this respect, a few rules should be remembered:
1. NPH is common among elderly populations in Western countries, but it is largely underdiagnosed and undertreated.8
2. NPH is one of the few reversible chronic neurological conditions in the elderly because neurosurgical shunting is an effective treatment, especially if performed early.36
3. Gait and balance impairment are early signs of NPH and not all 3 of the triad symptoms should be present in order raise a suspicion of NPH and refer the patient to a neurologist.36
4. Any patient with at least one symptom of the NPH triad should undergo a brain MRI or computed tomography CT (if MRI is contraindicated).36
5. Important MRI/CT findings are an Evans index >0.3 and DESH, which should be investigated because it might mimic brain atrophy.33
A suspicion of NPH should be raised for those patients with gradually progressive gait disorders characterized by instability (broad base) and shuffling steps; no other parkinsonian signs should be noticed, particularly in the upper body. Urinary dysfunction might be absent and cognitive problems are typically less severe than the motor problem (particularly at onset). In a patient with a clinical suspicion of NPH, brain MRI should be ordered and a referral to a neurologist should be made.
The neurologist will exclude other neurodegenerative conditions and other clinically relevant diseases affecting gait (e.g. neuropathy, spinal stenosis). Afterwards a tap test will be arranged, bearing in mind that the sensitivity of the test is far from ideal and that patients are prone to placebo response. When the suspicion of NPH remains high (also in case of negative tap test) a referral to neurosurgeon is made by the neurologist. In less clear-cut cases, another tap test or prolonged lumbar drainage can be done. Some other cases are only clinically followed-up, however taking into account that a delayed intervention might not provide the benefit of early surgery.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Neurology-Movement Disorders, normal pressure hydrocephalus, diagnosis, treatment
Disclaimer: 
This article was published as part of Managing the Health of Your Aging Patient: Therapies that Could Help Improve Quality of Life eCME resource. The development of Managing the Health of Your Aging Patient: Therapies that Could Help Improve Quality of Life eCME resource was supported by an educational grant from Medtronic Canada.

Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

Teaser: 

Dean Elterman, MD, FRCSC, Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON.

This supplement provides an overview of nocturia, its impact on patients and various treatment options available to the general practitioner. Nocturia is a common condition, whereby patients are awakened from sleep with the need to urinate. Typically associated with older patients, it can also occur in younger populations. It is often underreported and attributed to aging by patients, indicating the importance of screening by physicians.

Its causes are numerous and multisystem in nature, including congestive heart disease, kidney dysfunction, diabetes and nocturnal polyuria – an over production of urine at night. Nocturia is a lower urinary tract symptom, and may be seen with several common urologic conditions such as overactive bladder and benign prostatic hyperplasia.

Nocturia is particularly important because of its impact on quality of life. Frequently waking to pass urine can leave patients chronically fatigued and sleep deprived, leading to impairment during the day and at work. For those at risk of falls and fractures it can be a cause, especially with poor visibility at night. Patients who are unable to make it to the washroom urgently may experience episodes of incontinence during the night. As a possible symptom of many different diseases, nocturia may be the presenting complaint that prompts further investigations and eventually leads to a diagnosis and treatment. It may be associated with other urinary tract conditions including infection and inflammation. Its diagnosis is equally important because of available treatments for either the underlying disease or for nocturnal polyuria—a common cause of nocturia.

This publication focuses on nocturnal polyuria as a common and treatable cause of nocturia. Diagnosis of nocturnal polyuria is made via history, physical exam and frequency-voiding charts. Treatment is tailored to the degree that the patient is symptomatic and begins conservatively with reduction in fluid intake (alcohol and caffeine) before bed, timed voiding and sleep hygiene. Many patients are unaware of the impact that their habits have on nocturia, and simple changes may be very effective.

Medical management involves desmopressin taken as an oral disintegrating tablet before bed which acts as an antidiuretic hormone to reduce urine production overnight in a short acting manner. Newer formulations have significantly lower rates of hyponatremia which must be measured before initiating therapy.

Related Terms: Men’s Health, Women’s Health, nocturia, nocturnal polyuria, Nocdurna, Desmopressin
Disclaimer: 
This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource. The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

Clinical Disorders of the Aging Spine

Clinical Disorders of the Aging Spine

Teaser: 
Edward P Abraham, MD, FRCSC,
Associate Professor of Surgery, Department of Orthopaedics, Dalhousie University Medical School, Saint John Campus, Saint John NB Canada Canada East Spine Centre, Horizon Health Network.
Hamilton Hall, MD, FRCSC,
Professor, Department of Surgery, University of Toronto, Executive Director, Canadian Spine Society, Toronto, ON.

CLINICAL TOOLS

Abstract: In spite of the slightly increased incidence of infections, malignancies and systemic illnesses affecting the older spine, about 90% of back pain in the elderly, as in younger patients, is mechanical. This article covers several of the common problems: neurogenic claudication, degenerative disc disease, degenerative spondylolisthesis, disc herniation, spinal deformity and osteoporotic compression fractures. Treatment is both non-operative and surgical and the decisions about which to choose and therefore when to refer depend as much on the age and functional capacity of the patient as upon the specific pathology.
Key Words: neurogenic claudication, degenerative disc disease, degenerative spondylolisthesis, disc herniation, spinal deformity, osteoporotic fractures, imaging.

The diagnosis of neurogenic claudication is made on the history of intermittent leg dominant pain brought on by activity, usually walking, and relieved by rest in flexion, usually by sitting down. The physical examination while the patient is at rest is often normal.
Mechanical back pain associated with disc degeneration is seldom an indication for surgery and can usually be adequately managed through a combination of education, activity modification, general fitness and exercises selectively tailored to improve the pain-producing positons and movements.
Disc herniation producing acute sciatica is uncommon in the older patient and the diagnosis should be made with caution. True radicular pain is constant and leg dominant. Referred, intermittent leg pain frequently accompanies back dominant pain and should not be treated as sciatica.
Enduring spine surgery is a major challenge for the elderly patient. The decision to operate must be made after comprehensive consultation, emphasizing the prolonged recovery and weighing the potential benefits against the inevitable risks, including the risk to life.
Osteoporotic vertebral body compression fractures frequently occur without a recognized history of trauma. The pain, often in the thoracic or upper lumbar area, appears suddenly, is aggravated by movement (particularly bending forward) and is reduced but not eliminated by lying down. The acute phase can last several weeks but usually subsides without specific treatment. Multiple compression fractures over time will produce a kyphotic spine.
Back pain in the elderly should be managed with a minimum of medication. Mechanical pain can usually be controlled with the appropriate mechanical measures and additional analgesia is not required. Recourse to pain medication as a first line of treatment is not recommended and when employed should be limited to non-narcotic formulations. With the possible exceptions of acute sciatica and recent vertebral compression fractures, opioids should not be used.
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Related Terms: Back Health, neurogenic claudication, degenerative disc disease, degenerative spondylolisthesis, disc herniation, spinal deformity, osteoporotic fractures, imaging
Disclaimer: 
This article was published as part of Managing the Health of Your Aging Patient: Therapies that Could Help Improve Quality of Life eCME resource. The development of Managing the Health of Your Aging Patient: Therapies that Could Help Improve Quality of Life eCME resource was supported by an educational grant from Medtronic Canada.

Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

Teaser: 

Dean Elterman, MD, FRCSC, 1Co-authors: Brandon Van Asseldonk B. Eng 2

1Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON

2Faculty of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Nocturia is a common urologic condition with prevalence increasing in the elderly and can result in fragmented sleep, impaired daytime functioning, and falls. It can be a symptom of BPH or OAB but is commonly multifactorial with fluid intake, sleep apnea, and diabetes contributing. Nocturia is often a result of nocturnal polyuria which is best diagnosed by recording voiding frequency and volumes. Treatment is driven by patient symptoms and reported level of bother, with first-line therapy being lifestyle modification and second-line therapy being desmopressin (Nocdurna).
Key Words: Nocturia, Nocturnal Polyuria, Nocdurna, Desmopressin.
Nocturia is a common urologic condition, particularly in elderly populations.
Nocturia, or waking twice or more during the night to void, can cause fragmented sleep and can impair function during the day.
It is essential that primary care physicians and specialists diagnose nocturia because it can lead to poor health, including conditions like: an increased risk of falls and accidents, cardiovascular disease, diabetes, depression, and increased morbidity and mortality.
A thorough history will aid in the diagnosis of nocturia.
Lifestyle modifications, including: timed voiding, dietary and fluid restrictions, medication timing, sleep hygiene, and evening leg elevation can provide some relief for nocturia patients.
Second-line treatment is the use of desmopressin, an antidiuretic that can reduce the number of nighttime voids and thus improve sleep, particularly in women.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Men’s Health, nocturia, nocturnal polyuria, Nocdurna, Desmopressin
Disclaimer: 

This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource.
The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

Spinal Cord Stimulation: An Under-utilized and Under-recognized Pain Treatment Modality

Spinal Cord Stimulation: An Under-utilized and Under-recognized Pain Treatment Modality

Teaser: 

Philip Chan, MD, FRCPC (Anesthesiology, Pain Medicine), FIPP,

Director, Chronic Pain Clinic, Department of Anesthesia/Chronic Pain Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Assistant Clinical Professor, Department of Anaesthesia, Faculty of Health Sciences, McMaster University, Program Director, Pain Medicine Residency Program, McMaster University, Medical Director, Neuromodulation Program, Hamilton Health Sciences Corporation, Hamilton, ON.

CLINICAL TOOLS

Abstract: There is increasing concern in Canada about the overuse and misuse of opioids. While there are no simple answers to this complex societal problem, adequate and timely access to proper multidisciplinary chronic pain care is important in decreasing the reliance on opioids when treating chronic pain in Canada. Neuromodulation therapy, especially spinal cord stimulation (SCS), offers patients the potential for pain relief without repeated injections or ongoing medication use. SCS is effective in the treatment of persistent postoperative neuropathic pain and complex regional pain syndrome. Prospective SCS candidates should undergo a full multidisciplinary assessment to evaluate both physical and psychological factors that may adversely affect results.
Key Words: chronic pain, spinal cord stimulation, opioids, neuropathic pain, persistent postoperative neuropathic pain.

The best studied indications for SCS are persistent postoperative neuropathic pain (so-called failed back surgery syndrome [FBSS]) and complex regional pain syndrome (CRPS).
The key to success with SCS is to generate a pattern of paresthesia that overlaps with the patient’s area of pain while avoiding extraneous paresthesia that may cause discomfort.
SCS is a cost-effective treatment, whereby the long-term savings in terms of diagnostic imaging, physician visits, medications, and rehabilitative services outweighed the higher upfront cost.
Contraindications for SCS implantation include: systemic infection, cognitive impairment, and low platelet counts.
Well-accepted positive predictive factors for long-term success with SCS include: patients whose etiology of pain have a predominately peripheral neuropathic pain component, treatment early in the course of the pain syndrome, and the presence of allodynia and other features suggestive of neuropathic pain. Significantly depressed mood, low energy levels, somatization, anxiety, and poor coping skills are important predictors of poor outcome.
SCS is a non-destructive procedure; the device can be explanted at any point if it no longer provides pain relief, and it does not preclude other treatment modalities, including spinal surgery, in the future.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Pain, chronic pain, spinal cord stimulation, opioids, neuropathic pain, persistent postoperative neuropathic pain
Disclaimer: 
This article was published as part of Managing the Health of Your Aging Patient: Therapies that Could Help Improve Quality of Life eCME resource. The development of Managing the Health of Your Aging Patient: Therapies that Could Help Improve Quality of Life eCME resource was supported by an educational grant from Medtronic Canada.

Teaser with 2 Mobile Images and YouTube Animation

Teaser with 2 Mobile Images and YouTube Animation

Teaser: 

Michael S. Taccone,1 Markian Pahuta,2 Darren M.Roffey,3,4 Eugene K. Wai,2,3,4

1Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.

2Division of Orthopedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.

3Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.

4Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

CLINICAL TOOLS

Abstract: Vertebral metastatic disease afflicts a significant proportion of cancer patients, most commonly those with breast and lung disease. Symptoms can include tumor-related pain, neurological deficit from spinal cord or nerve compression and pathological fracture with mechanical instability. Appropriate workup includes identifying the primary disease, defining the extent of spinal and extra-spinal pathology and classifying spinal stability based on the pattern of osseous involvement. Specific therapy for the vertebral metastatic disease can include pharmacologic therapy to deliver analgesia, steroids, bisphosphonate, anti-neoplastic therapy, radiation therapy as either primary or adjuvant therapy and surgical intervention for mechanical or neurologic instability.
Key Words: Vertebral metastatic disease, metastatic epidural spinal cord compression, spinal instability, spine surgery, spinal radiation therapy, pathologic fracture.

Red flags are non-specific and unreliable means of determining spinal malignancy in patients with back pain. Clinical suspicion combined with history and physical exam are best for increasing pre-test probability of imaging studies.
Initial evaluation and referral to definitive management should be made within 24 hours of detection of significant neurological deficit, significant metastatic epidural spinal cord compression or instability.
MRI is the imaging modality of choice for initial evaluation and assessment of overall spinal tumor burden.
Vertebral metastatic disease is very common in patients with cancer.
SINS, ESCCS, Tomita score, Tokuhashi score and the Modified Bauer scores are all important tools for determining the most appropriate referral.
In eligible candidates, surgery with adjuvant radiotherapy yields faster and more sustainable neurologic stability and recovery.
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Related Terms: Other, Vertebral metastatic disease, spine surgery, spinal radiation therapy

Faits en bref : Aperçu de la nycturie

Faits en bref : Aperçu de la nycturie

Teaser: 

Références

  1. Gilbert J. Nocturia and Diabetes. Journal of Current Clinical Care Educational Supplement. 017.
  2. Shapiro C. Nocturia & Sleep. Journal of Current Clinical Care Educational Supplement. 2017.
  3. Elterman D. Nocturia & Urology. Journal of Current Clinical Care Educational Supplement. 2017.
  4. Von Ruesten A, Weikert C, Fietze I, Boeing H. Association of sleep duration with chronic diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. PLoS One. 2012;7(1):e30972.
  5. InterAct Consortium, Scott RA, Langenberg C, et al. The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: the EPIC-InterAct study. Diabetologia. 2013;56(1):60-9.
  6. Redeker NS, Adams L, Berkowitz R, et al. Nocturia, sleep and daytime function in stable heart failure. J Card Fail. 2012;18(7):569-75.
  7. Morris JL, Sereika SM, Houze M, Chasens ER. Effect of nocturia on next-day sedentary activity in adults with type 2 diabetes. Appl Nurs Res. 2016; 32:44-46.
  8. Destors M, Tamisier R, Sapene M, et al. Nocturia is an independent predictive factor of prevalent hypertension in obstructive sleep apnea patients. Sleep Med. 2015;16(5):652-8.
  9. Ayik S, Bal K, Akhan G. The association of nocturia with sleep disorders and metabolic and chronic pulmonary conditions: data derived from the polysomnographic evaluations of 730 patients. Turk J Med Sci. 2014;44(2):249-54.
  10. Bliwise DL, Foley DJ, Vitiello MV, Ansari FP, Ancoli-Israel S, Walsh JK. Nocturia and disturbed sleep in the elderly. Sleep Med. 2009;10 (5):540–8.
  11. Stanley, N. The underestimated impact of nocturia on quality of life. Eur Urol. 2005;4(Suppl):17-19.
  12. Denys MA, Cherian J, Rahnama'i MS, O'Connell KA, et al. ICI-RS 2015-Is a better understanding of sleep the key in managing nocturia? Neurourol Urodyn. 2016 Sep 21 (in press).
  13. Hajduk IA, Strollo PJJ, Jasani RR, Atwood CWJ, Houck PR, Sanders MH. Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome--a retrospective study. Sleep. 2003;26(1):61-64.
  14. Yalkut D, Lee LY, Grider J, Jorgensen M, Jackson B, Ott C. Mechanism of atrial natriuretic peptide release with increased inspiratory resistance. J Lab Clin Med. 1996;128(3):322-328.
  15. McIntyre R. Nocturia and marjor Depressive Disorder. Journal of Current Clinical Care Educational Supplement. 2017.
  16. Breyer BN, Shindel AW, Erickson BA, Blaschko SD, Steers WD, Rosen RC. The association of depression, anxiety and nocturia: a systematic review. J Urol. 2013;190(3):953-7.
Related Terms: Urogenital Disorders, nocturia, nocturnal polyuria, Desmopressin

La nycturie et le diabète

La nycturie et le diabète

Teaser: 

Dr Jeremy Gilbert, M.D., FRCSC,

professeur adjoint, université de Toronto; endocrinologue, Sunnybrook Health Sciences Centre, Toronto (Ont.)


OUTILS CLINIQUES

Résumé : Une diminution de la durée et de la qualité du sommeil peut nuire au sommeil lent profond ou sommeil réparateur, et est associée à une augmentation du risque d'apparition d'un diabète sucré de type 2. Il est particulièrement important de traiter la nycturie ainsi que les perturbations de la durée et de la qualité du sommeil qui en résultent pour les patients ayant reçu un diagnostic de diabète sucré de type 2, pour empêcher l'aggravation des symptômes et l'apparition potentielle de complications graves. De la desmopressine par voie sublinguale à faible dose (25 µg pour les femmes ou 50 µg pour les hommes) a permis d'atténuer efficacement la nycturie, avec l'objectif d'améliorer le sommeil lent profond.
Mots clés : diabète sucré de type 2, durée du sommeil, qualité du sommeil, hygiène du sommeil, sommeil lent profond, équilibre glycémique optimal, desmopressine.

Le diabète de type 2 est une maladie chronique de plus en plus courante.
Le nombre de cas de diabète de type 2 a augmenté ces dernières années, proportionnellement à l'augmentation des taux d'obésité, de l'IMC et de la sédentarité des populations adultes.
Les recherches ont montré qu'une diminution de la durée et de la qualité du sommeil peut nuire au sommeil lent profond, et est associée à une augmentation du risque d'apparition d'un diabète sucré de type 2.
Il pourrait être utile de traiter la nycturie des patients atteints d'un diabète sucré de type 2, ainsi que les perturbations de la durée et de la qualité du sommeil, afin d'atténuer les symptômes d'hyperglycémie et de réduire potentiellement le risque d'apparition de complications graves.
La survenue du sommeil lent profond coïncide avec les changements hormonaux qui influent sur la régulation de la glycémie.
Lorsque des chercheurs ont empêché la survenue du sommeil lent profond chez des adultes jeunes et en bonne santé, ils ont remarqué que ces derniers présentaient une diminution significative de la sensibilité à l'insuline.
De la desmopressine par voie sublinguale à faible dose (25 µg pour les femmes ou 50 µg pour les hommes), associée à l'obtention d'un équilibre glycémique optimal, a permis d'atténuer efficacement la nycturie de patients atteints de diabète sucré de type 2.
Lorsque les épisodes de nycturie diminuent ou disparaissent, le sommeil lent profond s'améliore.
Veuillez vous abonner pour accéder à l’article complet pour lequel ces outils ont été conçus. L’abonnement ne coûte que 20 $ US par an et vous permettra d’accéder à tout le contenu de qualité de www.healthplexus.net ― un portail éducatif qui héberge 1 000 évaluations cliniques, études de cas, supports visuels éducatifs et bien plus encore ―, et de l’application mobile.
Related Terms: Men’s Health, Women’s Health, diabète sucré de type 2, durée du sommeil, qualité du sommeil, hygiène du sommeil, sommeil lent profond, équilibre glycémique optimal, desmopressine
Disclaimer: 
Cet article a été rédigé pour faire partie de la ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE. La ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE a pu être élaborée grâce à une subvention pédagogique de Ferring Inc.

La nycturie et le sommeil

La nycturie et le sommeil

Teaser: 

1Dr Colin M. Shapiro, MBChB, Ph. D., MRCPsych, FRCP(C),2Coauteur : Sharon A. Chung, Ph. D.

1Toronto Western Hospital, Toronto (Ont.)

2Youthdale Treatment Centres et Paediatric Sleep Research Inc.

OUTILS CLINIQUES

Abstract: La nycturie (lorsque le patient se réveille au moins deux fois par nuit pour uriner) est associée à de nombreux troubles de la santé physiques et mentaux. Quelle que soit la relation de cause à effet entre la nycturie et ces troubles, le traitement de la nycturie et des perturbations associées du sommeil lent profond est essentiel pour éviter des troubles de la santé à long terme et un plus grand risque de décès pour la personne.
Mots clés : nycturie, sommeil, santé physique, santé mentale, sommeil lent profond.

La nycturie est un trouble qui conduit le patient à se réveiller au moins deux fois par nuit pour uriner.
La nycturie est associée à des troubles qui entraînent une mauvaise santé physique et mentale.
La nycturie perturbe le sommeil lent profond réparateur.
La desmopressine peut allonger le délai avant le premier réveil, voire éliminer ce réveil; elle permet donc d'augmenter la durée de sommeil lent et d'accroître ainsi les bienfaits associés sur la santé physique et mentale du patient.
La nycturie est associée à une multitude de troubles physiques et mentaux.
La nycturie touche plus fréquemment les patients âgés.
Les médecins doivent effectuer un dépistage des troubles du sommeil, notamment pour les personnes âgées qui signalent se réveiller au moins deux fois par nuit pour uriner.
Veuillez vous abonner pour accéder à l’article complet pour lequel ces outils ont été conçus. L’abonnement ne coûte que 20 $ US par an et vous permettra d’accéder à tout le contenu de qualité de www.healthplexus.net ― un portail éducatif qui héberge 1 000 évaluations cliniques, études de cas, supports visuels éducatifs et bien plus encore ―, et de l’application mobile.
Related Terms: Men’s Health, Women’s Health, nycturie, sommeil, santé physique, santé mentale, sommeil lent profond
Disclaimer: 
Cet article a été rédigé pour faire partie de la ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE. La ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE a pu être élaborée grâce à une subvention pédagogique de Ferring Inc.

La nycturie et le trouble dépressif majeur

La nycturie et le trouble dépressif majeur

Teaser: 

Dr Roger S. McIntyre, M.D., FRCP(C),

professeur titulaire, psychiatrie adulte et systèmes de santé, UHN - Toronto Western Hospital, Toronto (Ont.)

OUTILS CLINIQUES

Résumé : Les recherches ont montré que la nycturie et le trouble dépressif majeur sont souvent corrélés. Une anamnèse exhaustive et un examen physique sont donc nécessaires lorsque les patients manifestent des symptômes qui pourraient être associés à une nycturie. Il est rare que les patients consultent uniquement pour le traitement de la nycturie. Le clinicien doit donc poser des questions directes au patient et faire appel à un calendrier mictionnel pour déterminer si des maladies ou des troubles sous-jacents sont présents. Les cliniciens doivent également garder à l'esprit que des patients atteints d'un trouble dépressif majeur peuvent souffrir de nycturie, puisque les taux de nycturie sont considérablement plus élevés dans cette population. Des modifications du comportement peuvent se révéler insuffisantes à elles seules pour améliorer la nycturie lorsque des symptômes cliniques de dépression sont également présents. Les traitements pharmacologiques peuvent soulager les symptômes lorsque la nycturie et un trouble dépressif majeur coexistent.
Mots clés : Nycturie, trouble dépressif majeur, anxiété, lithium, ISRS, calendrier mictionnel, hygiène du sommeil, desmopressine.

Les recherches ont montré que la nycturie et le trouble dépressif majeur sont souvent corrélés.
Le clinicien doit absolument obtenir une anamnèse exhaustive du patient, puisque les patients mentionnent souvent les symptômes associés à la nycturie plutôt que la nycturie même.
Le calendrier mictionnel est un outil fiable qui permet au clinicien de déterminer s'il existe des maladies ou des troubles sous-jacents, ce qui l'aidera à décider du traitement.
Étant donné que la coexistence d'une nycturie et d'un trouble dépressif majeur peut entraîner une mauvaise santé physique et mentale, le clinicien doit envisager un traitement pharmacologique de la nycturie si les modifications comportementales s'avèrent inefficaces.
Lorsqu'un patient souffre de nycturie, le clinicien doit également rechercher un éventuel trouble dépressif majeur.
Par rapport à la population générale, les personnes qui souffrent de nycturie sont plus susceptibles de mentionner des sentiments d'anxiété et de dépression.
Les personnes qui souffrent d'un trouble dépressif majeur sont plus susceptibles de souffrir de nycturie.
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Related Terms: Men’s Health, Women’s Health, nycturie, trouble dépressif majeur, anxiété, lithium, ISRS, calendrier mictionnel, hygiène du sommeil, desmopressine
Disclaimer: 
Cet article a été rédigé pour faire partie de la ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE. La ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE a pu être élaborée grâce à une subvention pédagogique de Ferring Inc.