Investigation and comparison of types of anxiety disorders in children with and without functional constipation referred to the pediatric clinic of Amir Kabir Arak Hospital.

Dissertation:

To receive a professional doctorate degree in the field of medicine

Farsi abstract

Title: Investigation and comparison of anxiety disorders in children with and without functional constipation referred to the pediatric clinic of Amir Kabir Arak Hospital

Introduction: Functional constipation is a common disorder in children between 5 and 12 years old. Based on the evidence, psychiatric disorders can be effective in the etiology or clinical course of functional constipation in children. The purpose of this study is to investigate and compare the types of anxiety disorders in children with and without functional constipation referred to the pediatric clinic of Amir Kabir Hospital in Arak. This case-control study was conducted on 200 children aged 8-15 years of both sexes who were referred as outpatients to the pediatric clinic of Amirkabir Hospital in Arak, Iran. From this number, 100 children with functional constipation as the case group and 100 children from among the healthy children who were outpatients at the pediatric clinic of Amir Kabir Hospital as the control group were included in the study based on the study entry and exit criteria, and in a simple random manner. Demographic and clinical information checklist, and Spence children anxiety scale (SCAS) (parent form) were completed for children. Finally, the information was analyzed using t-test and chi2 statistical tests in SPSS 18 statistical software.

Results: The distribution of age (p=0.585), sex (p=0.113), weight (p=0.067) and height (p=0.113) of children in the two groups of case and control had no significant difference. The mean total score of the Spence anxiety scale in the case group was significantly higher with 33.06±14.4 than the control group with 24.8±14.9 (p=0.001). According to the results, unlike the average scores of panic disorder and agoraphobia (p=0.854), fear of physical harm (p=0.962) and social fear (p=0.471) which were not significantly different between the two groups, the average scores of separation anxiety disorder (p=0.001), general anxiety (p=0.003) and obsessive-compulsive disorder (p=0.001) in the group of children with functional constipation were significantly higher than Children were the control group.

Discussion and conclusion: According to our study, anxiety in children with functional constipation is more than healthy children, among which separation anxiety, general and obsessive-compulsive were significant. However, due to the lack of studies in this field, it is recommended to conduct more studies in this field in the future.

Key words: Constipation, children, anxiety disorders

Abstract

Title: Comparison of different types of anxiety disorders in children with and without functional constipation referring to Amir Kabir Hospital of Arak

Authors: Dr. Hashemi M, Dr. Salehi B, Dr. Yousefichaijan P, Dr. Rafeie M. Sabersangari R

Introduction: Functional constipation (FC) is a common problem among children aged 5 to 12 years. Based on the evidence, etiology and clinical course of FC can be effective in children with psychiatric disorders. The aim of this study was to investigate different types of anxiety disorders in children with and without functional constipation referring to Amir Kabir Hospital of Arak, Iran.

Materials and Methods: One hundred 8-15-year-old children with FC and 100 healthy children without FC were included in this case-control study as case and control groups, respectively. The participants were selected from those children who were referred to the pediatric clinic of Amir Kabir Hospital of Arak (Iran) in the form of simple probability and based on inclusion and exclusion criteria.Questionnaire on demographic and clinical information, and the Spence Children's Anxiety Scale (Spence children's anxiety scale: SCAS) (parent form) was completed for children. Data were analyzed by t-test and Chi2 test in SPSS18.

Results: Distribution of age (p=0.585), gender (p=0.113), weight (p=0.67) and height (p=0.113) of children were not significantly different between the two groups. The mean of total score of anxiety scale in the case group (33.06±14.4) was significantly higher than the control group with 24.8±14.9 (p=0.001). Unlike panic disorder (p=0.854), fear of physical harm (p=0.962) and social phobia (p=0.471) between the two groups showed no significant difference, the mean scores of separation anxiety disorder (p=0.001), generalized anxiety disorder (GAD) (p=0.003) and obsessive–compulsive disorder (OCD) (p=0.001) in children with functional constipation were significantly higher than the control group.

Conclusion: According to our study, anxiety in children with functional constipation was higher than healthy children. However, due to the lack of studies in this regard, further studies are recommended in the future.

Key words: Child, Constipation, Anxiety Disorders

- Statement of the problem

Disorders or chronic diseases in the form of a problem that accompanies a person for a long period of time and affects different aspects of life It is determined (1). According to studies, any chronic disease is accompanied by a decrease in the quality of life, a drop in academic activity, and the frequent use of medical and surgical treatments and invasive or non-invasive medical procedures and their complications (1). In general, the association of psychiatric disorders with chronic medical conditions is significant, so that this association can be a stimulus for more disability in patients (1). One of the chronic and common disorders in childhood is constipation. Constipation is defined as passing stool 2 times or less per week or hard and lumpy stool that lasts for at least 2 weeks. (2) Constipation has various causes such as functional or habitual constipation and Hirschsprung (2).

Functional constipation is considered one of the most common digestive problems in children. (2) Functional or habitual constipation is a defecation disorder that can be seen in children from two years of age onwards, and consists of the voluntary holding of stool, in which case the child assumes a special position (for example, sticks the legs together). Voluntary retention of stool in these children causes an increase in stool diameter and painful defecation, and this problem aggravates stool retention. Organic causes do not play a role in this disorder. In these children, the large volume of feces in the rectum causes feces to leak from the anus. In the rectal tissue of these children, the anal sphincter is loose and the rectal ampoule contains feces. (2) Based on the evidence, this defecation disorder can be associated with mental problems, weakening of self-confidence, significant academic failure and behavioral disorders in children with it (3-5)

Anxiety disorders are one of the most common psychiatric disorders in the general population. These disorders are associated with many complications and are often chronic and resistant to treatment. According to DSM-IV-TR, anxiety disorders include: 1- Panic disorder with or without agoraphobia, 2- Agoraphobia with or without panic disorder, 3- Specific phobia, 4- Crowd phobia, 5- Obsessive-compulsive disorder, 6- Post-traumatic stress disorder (PTSD), 7- Acute stress disorder, 8- Generalized anxiety disorder (GAD) (6, 7).

Since anxiety disorders in childhood are predictors of other psychiatric disorders such as depression, personality disorders, and substance abuse in adolescence, youth, and adulthood (1), it is important to investigate this category of psychiatric disorders, especially in the context of chronic medical diseases.