Most useful drug in Enuresis is
C i.e. TrimipramineNocturnal eneuresis can be managed by behavior therapy eg classic conditioning with eneuresis alarm (method of choice)Q, desmopressin, (drug of choice)Q & tricyclic antidepressant imipramineQ.Behavioral Therapy- Behavioral therapy eg classic conditioning with the bell (or buzzer) & pad apparatus (=Enuresis alrm system) is the most effective treatment for enuresis with minimum relapse.- Enuresis alarm system (i.e. classic conditioning behavioral therapy) is the method/treatment of choice. It is equally effective in children with or without concomitant mental disorders.Other Behavioral Modification & Motivation Therapy- Restriction of fluid intake after 8 p.m.- Interruption of sleep before the expected time of bed wetting- Bladder training aimed at increasing the holding time ofbladder, encouragement or reward for delaying micturation for increasing times during waking hours has also been used.- These behavioral modifications and motivational therapy (reward for being dry at night) may although sometimes be effective, these methods are decidedly inferior to the bell and pad.PsychotherapySuppoive psychotherapy to child & parents may deal with coexisting secondary emotional & family difficulties but is not effective alone in the sho term treatment of enuresis.PharmacotherapyMedication is considered when problem interfers significantly with child's functioning causing impairment in social, family, & school function & behavioral and fluid restriction have not been efficacious. Although the problem often recurres as soon as the medication is withdrawn. Approved drugs include - Desmopressin (DDAVP, an antidiuretic compound available as an intranasal spray) is the drug of choice.- Reboxetine, a norepinephrine reuptake inhibitor (non cardiotoxic)- Tricyclic antidepressant imipramineQ (not preferred d/t risk of sudden death in children with ADHD). -Anticholinergics, amphetamines, diazepam (no beneficial response)
Haloperiodol
Diazepam
Trimipramine
Chlorpromazine