Academic journal article Indian Journal of Psychiatry

Behavior Profile of Children with Nephrotic Syndrome

Academic journal article Indian Journal of Psychiatry

Behavior Profile of Children with Nephrotic Syndrome

Article excerpt

Byline: Prathama. Guha, Arun. De, Malay. Ghosal

Background: Nephrotic syndrome, a primarily paediatric disease, is associated with a high relapse rate. Studies have reported behavioral and psychological difficulties in children with nephrotic syndrome, their caregivers and siblings, a factor that is likely to influence the overall outcome of the disease in an adverse manner. In clinical practice, however, the psychosocial aspects of care may be overlooked in the pressure to treat the disease process, unless their importance is stressed by appropriate evidence. Objectives: The study aims to assess the prevalence of behavior abnormalities in children with nephrotic syndrome attending the renal clinic of a state medical college in eastern India and to compare this with the prevalence in a control group of school children without any detectable physical illness. It also aims to explore the relationship between sociodemographic, disease, and treatment related variables and behavioral abnormalities in the nephrotic syndrome group. Materials and Methods: We assessed the prevalence of behavior abnormalities in 50 consecutive children with nephrotic syndrome attending the renal clinic of a state medical college and 51 school children as controls using the Developmental Psychopathology Checklist (DPCL). We also assessed the statistical association between sociodemographic, disease and treatment related variables and behavior profile in the nephrotic children group. Results: Prevalence of behavior disturbance in children with nephrotic syndrome was 68%, significantly higher than that in the control group (21.6%). The behavior abnormalities found in the nephrotic syndrome group were hyperkinesis, obsessive compulsive neurosis, conduct disorder, and emotional disorder, in that order. Frequency of relapse and low socioeconomic status showed significant association with presence of behavior disturbance in the nephrotic syndrome group. This association persisted even after adjusting for other sociodemographic, disease, and treatment related variables, including steroid therapy.

Introduction

Nephrotic syndrome is primarily a paediatric disease, its prevalence in children being 15 times greater than in adults. A vast majority of children with nephrotic syndrome suffer from the relatively benign steroid sensitive minimal change disease. The relapse rate, however, continues to be high, and the chances of relapse after a first episode is still as high as 30 to 40%.[sup] [1] Any chronic physical illness, especially in children, has biological, behavioral, and social manifestations that have implications for the mental health, social and personality development of the child, and family coping.[sup] [2] This would naturally apply to children with nephrotic syndrome too, because of its long drawn relapsing and remitting course.[sup] [3],[4] Prolonged corticosteroid treatment may also contribute to behavioral disturbances in this especially vulnerable population. However, in busy clinical practice the psychosocial aspect of care may be overlooked in the pressure to treat and control disease processes, unless their importance is stressed by appropriate evidence.[sup] [2],[5],[6]

There have been a few studies in India and abroad documenting the behavioral difficulties in children suffering from nephrotic syndrome,[sup] [7],[8],[9] but these need to be replicated in clinic as well as community based populations. Our study aims to measure the prevalence of behavioral problems in children with nephrotic syndrome attending a special clinic at a state medical college. This is compared to the prevalence of behavioral problems in a control group of school children with no detectable physical illness. It also aims to look into the association, if any, between behavioral problems and sociodemographic as well as disease related factors, including use of corticosteroids.

Materials and Methods

Sample selection All consecutive patients between 5 and 15 years, attending the renal clinic of the Calcutta Medical College and Hospital, Kolkata, Eastern India, were included in the study, provided they fulfilled our inclusion and exclusion criteria. …

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