Is Refractory Urgency/Frequency Syndrome Associated with Neuropsychiatric Disorders?
Purpose We have noted that a certain group of patients with Urgency/Frequency syndrome (UFS) were refractory to conventional treatment. We noted a high number of these refractory patients had some form of Neuropsychiatric disorders (NPD),could there possibly be an association between these two conditions. Material and methods We identified 326 patients seen in the last year in our office with a diagnosis of UFS. Of these we saw 140 pts more than once and adequate follow up was available. We eliminated 33 pts who had UTI s and this left us with 107 pts (73 male, 44 female) with pure UFS. Treatment consisted of Bowel Program (BP), anticholinergics (AC) and alpha blockers (AB) if needed. Results 26 Pts (45%) responded to BP, while 8 pts (12%) responded to BP+AC. 8 pts (12%) responded to a combination of BP+AC+AB regimen. 18 pts (30%) responded to BP+AB therapy. There were 47 non responders to the above regimens. Of these pts we found that 20 pts had a history of a NPD or a first order family member had such a disorder. A total of 25 pts had NPD of the 5 that responded 4 had anxiety and 1 parent had a diagnosis of anxiety. Of the patients with NPD we found that 11 had ADD/ADHD, 8 had anxiety disorders, 2 were autistic, 1 had depression. The parents of these pts, 5 had anxiety, and 1 had depression. Conclusions We have found that the majority of pts responded to a BP regardless of the fact that they did not exhibit signs of stool hoarding. We also found that BP and AB therapy was more effective than BP and AC. Of note was that close to 50% of the patients that were refractory to treatment regimens were diagnosed with some form of NPD in the child or in the parent. This association should be taken into account when encountering patients resistant to conventional therapy and a push for neuropsychiatric evaluation should be recommended in these patients.