Pollakiuria and its relationship with obsessive compulsive disorder

B rie f C om m un ic at io n Introduction Some children have a severe urinary frequency with an abrupt onset. They void every 15 minutes during the day, without daytime incontinence, dysuria, nocturia, or urinary tract infection (UTI). These symptoms are most common in children between 4 and 6 years old. Additionally this disorder is more common in boys. Pollakiuria or daytime frequency syndrome of children is the term used to describe this condition. No anatomic problem is detected in the child, as it is a functional disorder. The symptoms often occur before the child starts preschool, or if the child undergoes family stress (1-3). The symptoms mostly start before school age. These children should be evaluated regarding presence of UTI. The physicians should ensure the child empties his/her bladder reasonably. Sometimes, pinworms can also cause these symptoms. This is a self-limiting condition that gets resolved in 2 to 3 months. The administration of an anticholinergic agent has rarely been effective (4-6). Obsessive compulsive disorder is a chronic disabling sickness characterized (7,8). Cleaning compulsions and washing are common in children (9,10). Very few studies have assessed the association between pollakiuria and obsessive-compulsive disorder (OCD) (11-14). Objectives This study was designed to evaluation and correlation between OCD and day time frequency syndrome.


Introduction
Some children have a severe urinary frequency with an abrupt onset.They void every 15 minutes during the day, without daytime incontinence, dysuria, nocturia, or urinary tract infection (UTI).These symptoms are most common in children between 4 and 6 years old.Additionally this disorder is more common in boys.Pollakiuria or daytime frequency syndrome of children is the term used to describe this condition.No anatomic problem is detected in the child, as it is a functional disorder.The symptoms often occur before the child starts preschool, or if the child undergoes family stress (1)(2)(3).The symptoms mostly start before school age.These children should be evaluated regarding presence of UTI.
The physicians should ensure the child empties his/her bladder reasonably.Sometimes, pinworms can also cause these symptoms.This is a self-limiting condition that gets resolved in 2 to 3 months.The administration of an anticholinergic agent has rarely been effective (4)(5)(6).Obsessive compulsive disorder is a chronic disabling sickness characterized (7,8).Cleaning compulsions and washing are common in children (9,10).Very few studies have assessed the association between pollakiuria and obsessive-compulsive disorder (OCD) (11)(12)(13)(14).

Objectives
This study was designed to evaluation and correlation between OCD and day time frequency syndrome.

Patients and Methods
In this study, we selected 76 children with pollakiuria in the case group and 76 healthy children in the control group.The study was conducted in Amir-Kabir hospital, Arak, Iran.The exclusion criteria were; 1) children with psychological disorders and/or mental retardation or nervous system disorders.2) Children whose parents did not cooperate fully-for example, did not fill the forms completely.The children of the control group were selected from pediatrics with UTI and normal DMSA renal scan, kidney sonography, and voiding cystourethrogram (VCUG).The diagnosis of OCD was conducted through interviews, OCI-CV tests, and the psychiatrist's approval.The comparison was based on DSM-IV-TR diagnostic criteria (15,16).

Ethical issues
The research followed the tenets of the Declaration of Helsinki; informed consent was obtained; and the research was approved by the ethical committee of Arak University of Medical Sciences (#92-146-8).

Statistical analysis
Results were analyzed using descriptive statistics and chisquare test.The analysis was conducted by SPSS version 16 and a P value less than 0.05 was considered significant.

Results
Overall, 152 children (76 as a case group and 76 as a control group) were selected for our study.The demographic factors were studied and matched in 2 groups.The average of age in children in the case and control teams was calculated at 8.13±1.39 years and 8.19±2.026years (Table 1).The obsessive disorder was noted in 5 (6.6%) of case group (pollakiuria) and 8 (10.5%) of control group (P = 0.282) (Table 2).

Discussion
In this study, we compared OCD in children with and without pollakiuria.To the best of our knowledge, this is the first study that has studied OCD in children with pollakiuria.The distribution of obsession in children showed no meaningful relationship between OCD disorder and urination frequency disorders.Koff et al reported that dysfunctional elimination syndromes are associated with late reflux disappearing and an increase in urinary infection (14).Mota et al highlighted that wrong training may be a causative factor for bladder and intestinal disorders (17).Fonseca et al pointed out a high prevalence of lower urinary tract symptoms in children with nocturia.They found the association of nocturia with other urinary symptoms was usual (18).

Conclusion
In our study we found no definite relationship between obsession and urinary disorders.However, this study requires more investigation.Similar studies with a higher proportion of samples at different centers are recommended in order to help these patients.

Limitations of study
Low proportion of patients is a limitation of our study.

Table 1 .
Mean of children age

Table 2 .
Frequency of OCD in children