Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association?

Round 1

Reviewer 1 Report

The aim of the meta-analysis conducted by researchers is to combine the results of several studies, which creates a more prospective approach to a given research problem and makes it possible to verify the knowledge of clinical trials, in which the small number of observations forces to draw more cautious conclusions from the data obtained. In the presented manuscript, the specific aim was not completely fulfilled, due to the fact that only one study was qualified after the introduction of critical selection of relevant studies. Hence, a constructive answer on the potential association of obsessive-compulsive disorders with urinary disorders cannot be given based on the results of this study.

Therefore, the meta-analysis was not conducted properly, so there is no basis for drawing conclusions about the assumed relationship.

One should consider what kind of substantive review of the studies was performed before commencing the meta-analysis. As it is known, the first step is to pose a research question/problem, the second to detect relevant studies on a specific topic. At this stage, it was possible to check specifically key data, such as whether there was a control group in the study. This is the main methodological flaw that actually disqualifies the publication in this form. As the authors themselves admit, the analysed database is extremely modest and drawing conclusions on its basis is burdened with a very large error, not to say impossible at the current stage of the analysed research. 

Paying attention to urological problems of patients with mental disorders is valuable. It allows for a more holistic view of both the psyche-soma relationship and awareness of the consequences associated with the use of specific drugs and broadly understood education and prevention.

Author Response

Comment 1: The aim of the meta-analysis conducted by researchers is to combine the results of several studies, which creates a more prospective approach to a given research problem and makes it possible to verify the knowledge of clinical trials, in which the small number of observations forces to draw more cautious conclusions from the data obtained. In the presented manuscript, the specific aim was not completely fulfilled, due to the fact that only one study was qualified after the introduction of critical selection of relevant studies. Hence, a constructive answer on the potential association of obsessive-compulsive disorders with urinary disorders cannot be given based on the results of this study.

Therefore, the meta-analysis was not conducted properly, so there is no basis for drawing conclusions about the assumed relationship.

One should consider what kind of substantive review of the studies was performed before commencing the meta-analysis. As it is known, the first step is to pose a research question/problem, the second to detect relevant studies on a specific topic. At this stage, it was possible to check specifically key data, such as whether there was a control group in the study. This is the main methodological flaw that actually disqualifies the publication in this form. As the authors themselves admit, the analysed database is extremely modest and drawing conclusions on its basis is burdened with a very large error, not to say impossible at the current stage of the analysed research.

Paying attention to urological problems of patients with mental disorders is valuable. It allows for a more holistic view of both the psyche-soma relationship and awareness of the consequences associated with the use of specific drugs and broadly understood education and prevention.

• REPLY 1: Thank you for the comment. We have acknowledged the points raised in our discussion of study limitations. We agree that the evidence base is admittedly limited, however, we believe this is an important meta-theoretical study on this issue nonetheless.

Reviewer 2 Report

I believe that this is one of the few metatheoretical studies on this issue. The work summarizes the results of authoritative evidence-based research. I recommend the article for publication.

Author Response

Comment 1: I believe that this is one of the few metatheoretical studies on this issue. The work summarizes the results of authoritative evidence-based research. I recommend the article for publication.

• REPLY 1: Thank you for your supportive comment and feedback.

Reviewer 3 Report

Dear Authors,

The paper entitled "Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association?" is an interesting and well-articulated paper in its aims and rationale. It is clear and concise and follows the procedures of well-conducted systematic reviews.
The only drawback of the paper is the brevity of the introduction. It would be convenient to introduce data related both to urination as a compulsion and to the cognitive-behavioural psychological treatment of functional urinary disorders (Mowrer & Mowrer, 1938)...
Their work is interesting and opens up a necessary avenue of research to enrich the knowledge of the field of study.
For all these reasons I have decided to accept your paper.

Best regards,

 

Author Response

Comment 1: The paper entitled “Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association?” is an interesting and well-articulated paper in its aims and rationale. It is clear and concise and follows the procedures of well-conducted systematic reviews.

The only drawback of the paper is the brevity of the introduction. It would be convenient to introduce data related both to urination as a compulsion and to the cognitive-behavioural psychological treatment of functional urinary disorders (Mowrer & Mowrer, 1938).

• REPLY 1: Thank you for your kind words and feedback. We have expanded our introduction section and also incorporated the points suggested. “Some case reports have suggested that urination could be a form of compulsion [8,9]; cognitive behavioural therapy (CBT) has been long applied in the treatment of functional urinary disorders [10].”

Reviewer 4 Report

This is a systematic review of the scientific literature on the association between Obsessive-Compulsive Disorders and Functional Urinary Disorders.

The topic is important and further studies are needed to investigate this possible association. The methodology the authors used is adequate. However, some limitations emerge that lead to discourage publication of the manuscript in its current form.

A direct and specific sentence about the main hypothesis of the review is missing.

Two additional studies (Oades & Daniels, 1999; Arlen et al., 2014) could be included in the review and/or could be useful in the discussion.

The discussion reports that "These patients appear to respond to antidepressants", however, the treatment of OCD may be very complex in some cases, and could require other add-on drugs and/or physical therapies (Del Casale et al., 2019).

Another aspect concerns the possibility that, in addition to the serotonergic and antipsychotic drugs, clomipramine could also induce urinary symptoms in patients with OCD (Hermesh et al., 1987), as it can happen with benzodiazepines and other drugs (Verhamme et al., 2008).

Scientific English language should be improved in form and syntax.

References

• Arlen AM, Dewhurst LL, Kirsch SS, Dingle AD, Scherz HC, Kirsch AJ. Phantom urinary incontinence in children with bladder-bowel dysfunction. Urology. 2014 Sep;84(3):685-8. doi: 10.1016/j.urology.2014.04.046. PMID: 25168551.
• Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Curr Neuropharmacol. 2019;17(8):710-736. doi: 10.2174/1570159X16666180813155017. PMID: 30101713; PMCID: PMC7059159.
• Hermesh H, Aizenberg D, Weizman A, Lapidot M, Munitz H. Clomipramine-induced urinary dysfunction in an obsessive-compulsive adolescent. Drug Intell Clin Pharm. 1987 Nov;21(11):877-9. doi: 10.1177/106002808702101105. PMID: 3678059.
• Oades RD, Daniels R. Subclinical polydipsia and polyuria in young patients with schizophrenia or obsessive-compulsive disorder vs normal controls. Prog Neuropsychopharmacol Biol Psychiatry. 1999 Nov;23(8):1329-44. doi: 10.1016/s0278-5846(99)00069-x. PMID: 10631761.
• Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf. 2008;31(5):373-88. doi: 10.2165/00002018-200831050-00002. PMID: 18422378.

Author Response

Comment 1: A direct and specific sentence about the main hypothesis of the review is missing.

• REPLY 1: Thank you for your comment. We have now added a direct and specific sentence about the main hypothesis of the review in the introduction section. “It was hypothesized that patients with OC symptoms would also have an increased occurrence of functional urinary symptoms.”

 

Comment 2: Two additional studies (Oades & Daniels, 1999; Arlen et al., 2014) could be included in the review and/or could be useful in the discussion.

• REPLY 2: Thank you for the comment. We have reviewed our search strategy and study abstraction; Arlen et al. (2014) has now been included in Table 1. Oades & Daniels (1999) was excluded as it only studied subclinical polydipsia and polyuria, and did not report the occurrence or prevalence of functional urinary disorders but is now mentioned in the discussion section. “Psychogenic polydipsia is more common in patients with schizophrenia than patients with OCD [21].”

 

Comment 3: The discussion reports that “These patients appear to respond to antidepressants”, however, the treatment of OCD may be very complex in some cases, and could require other add-on drugs and/or physical therapies (Del Casale et al., 2019).

• REPLY 3: Thank you for the comments. This has now been incorporated into the manuscript. “These patients appear to respond to antidepressants. The treatment of OCD may be very complex and refractory in some cases, and could require add-on atypical antipsychotic medication and psychotherapies [23].”

 

Comment 4: Another aspect concerns the possibility that, in addition to the serotonergic and antipsychotic drugs, clomipramine could also induce urinary symptoms in patients with OCD (Hermesh et al., 1987), as it can happen with benzodiazepines and other drugs (Verhamme et al., 2008).

• REPLY 4: Thank you for the comments. This has now been incorporated into the manuscript. “In addition to the serotonergic and antipsychotic drugs, clomipramine could also induce urinary symptoms in patients with OCD [30], as can happen with benzodiazepines and other drugs [31].”

 

Comment 5: Scientific English language should be improved in form and syntax.

• REPLY 5: Thank you for the comment. We have done a close edit of the entire manuscript for language and syntax.

Round 2

Reviewer 1 Report

The authors have significantly corrected the inference based on the analysed articles. The analysis and discussion is careful, which is considered an important correction. They explained the lack of basis for meta-analysis.

It is still worth emphasising that this is a preliminary analysis, which may be a prediction for methodologically well-designed studies.

Reviewer 4 Report

The authors adequately addressed the raised issues.