2020, vol. 77, br. 12, str. 1332-1335
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Psihogeni dijabetes insipidus - prikaz bihejvioralne psihoterapije
Psychogenic diabetes insipidus: A case report of behavioral psychotherapy
aUniverzitet u Nišu, Medicinski fakultet, Srbija + Klinički centar Niš, Klinika za zaštitu mentalnog zdravlja, Srbija bGeneral Hospital, Leskovac cUniverzitet u Nišu, Medicinski fakultet, Srbija dKlinički centar Niš, Klinika za dečje interne bolesti, Srbija
e-adresa: doc.stankovic@gmail.com
Sažetak
Uvod. Psihogeni dijabetes inspidus je potencijalno životnougrožavajuće stanje koje se manifestuje kao poremećaj žeđi sa ekscesivnim unosom tečnosti (više od 3 litre dnevno) i očuvanom funkcijom neurohipofize i bubrega. Prikaz bolesnika. Prikazan je dečak uzrasta 4 godine i 8 meseci sa simptomima polidipsije, poliurije, nokturije i malnutricije. Pedijatrijskim ispitivanjem i učinjenim laboratorijskim analizama nije postavljena jasna diferencijalna dijagnoza između psihogenog i nepsihogenog dijabetesa insipidusa. Psihijatrijska konsultacija imala je za cilj sagledavanje mogućnosti postojanja kompulzivnog uzimanja tečnosti i primenu terapije sprečavanja. Diferencijacija se odvijala u dve etape. U prvoj etapi dete je odvojeno od majke u kraćim intervalima, a u drugoj fazi uključene su bihejvioralne intervencije: distrakcije pažnje i pozitivno i negativno potkrepljivanje odlaganja kompulzivnog uzimanja tečnosti. Majka je obučavana metodama operantnog uslovljavanja, nagrađivanja i uskraćivanja privilegija, kao i metodama izlaganja, sprečavanja i relaksacije deteta. Predložen je nastavak multidisciplinarnog lečenja (pedijatrijskog, konsultativno psihijatrijskog i bihejvioralno psihoterapijskog). Procena efekata bihejvioralne terapije, sagledana je nakon četiri i dvanaest nedelja. Dečak je smanjio dnevni unos tečnosti za 3,5 L, a dobio je 1 kilogram u telesnoj masi, uz značajno produženje intervala u uzimanju tečnosti. Postignuti terapijski efekat nije mogao biti objašnjen pedijatrijskim tretmanom uvedenim pre primene bihejvioralne terapije i psihoedukacije majke. Zaključak. Konsultacije i multidisciplinarni pristup različitih profila zdravstvenih radnika u rešavanju predominantno somatskih poremećaja psihogenog dijabetesa insipidusa kod dece treba da budu istaknuti kao način lečenja.
Abstract
Introduction. Psychogenic diabetes insipidus is potentially a life-threatening condition manifesting as a psychogenic thirst disorder with excessive fluid intake (more than 3 L per day) and a preserved function of neurohypophysis and kidneys. Case report. We presented a boy aged 4 years and 8 months with symptoms of polydipsia, polyuria, nocturia and malnutrition. Pediatric examination and laboratory analysis were performed, but clear discrimination between psychogenic and nonpsychogenic diabetes insipidus could not be made. A psychiatric consultation was performed to examine the possibility of compulsive fluid taking. The differentiation was performed in two stages. In the first stage, the child was separated from the mother in short intervals. In the second stage, the behavioral psychotherapy interventions were performed: distraction of attention, and positive and negative reinforcement for delaying compulsive fluid taking. The mother was trained to use methods of operant conditioning, privilege and deprivation, as well as methods of exposure and response prevention and relaxation of the child. It was suggested to continue with multidisciplinary treatment (pediatric, liaison psychiatric and behaviour psychotherapeutic). Evaluation of behaviour therapy was performed after 4 and 12 weeks. During 4 weeks of follow-up, the boy reduced the daily fluid intake by 3.5 L, and added 1 kg of body weight. Also, intervals between fluid intake were significantly extended. This therapeutic effect could not be explained by the pediatric treatment introduced prior to the application of behaviour therapy and psychoeducation of the mother. Conclusion. Consultations and multidisciplinary approach by different health specialists in resolving of a number of predominantly somatic disorders in children with psychogenic diabetes insipidus should be highlighted as a way of treatment.
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