Slovenian Version of the Drug-Induced Extrapyramidal Symptoms Scale: Evaluation of Interrater and Test-Retest Reliability.

AIM: The Drug-Induced Extrapyramidal Symptom Scale (DIEPSS) is a multidimensional rating scale for the assessment of drug-induced extrapyramidal symptoms (EPS), developed in 1994. It is suitable for evaluating EPS considering the degree of influence EPS has on daily activities and the subjective distress that it causes. METHOD: This study to evaluate the interrater and test-retest reliability of the DIEPSS Slovenian version conducted at the University Medical Center Maribor in Slovenia in November 2018. RESULTS: Six raters performed the interrater assessment of 135 DIEPSS video clips with recordings of patients with EPS. A second assessment was then performed by 2 raters to evaluate the test-retest reliability, which was high (interclass correlation coefficients from 0.743 to 0.936). CONCLUSIONS: The results for the Slovenian language version of the DIEPSS show high interrater and test-retest reliability, with high concordance rates for all evaluated items (interclass correlation coefficient > 0.8).

Adolescents With Autism Spectrum Disorder and Anorexia Nervosa Comorbidity: Common Features and Treatment Possibilities With Cognitive Remediation Therapy and Oxytocin.

Autistic traits or autism spectrum disorder (ASD) can be found in 4% to 52% of anorexic patients, which makes the treatment of these patients very challenging. In this review, possible ways to treat ASD and anorexia nervosa (AN) comorbidity in children and adolescents are summarized. Over recent years, the focus has shifted from searching for the evidence of connections between these two disorders, which have started with Gillberg's study in 1983, to searching for more effective and holistic treatment of this comorbidity. The latter is known to contribute to more severe courses and worse prognosis, which is probably related to the obstacles in both diagnosing and treating. Since AN usually starts in early adolescence and high-functioning ASD children seem to begin struggling with increased pressure in adolescence, while various comorbidities can occur, it is important to improve the treatment of this comorbidity in young patients and to tailor it specifically in terms of diagnosing. In this paper, a literature review is conducted on common features and promising treatment possibilities. We describe cognitive remediation therapy and the promising pharmacotherapeutic candidate oxytocin with a special focus on adolescents.

A Pilot Randomized Control Trial With the Probiotic Strain Lactobacillus rhamnosus GG (LGG) in ADHD: Children and Adolescents Report Better Health-Related Quality of Life.

Objectives: This double-blind pilot randomized placebo-controlled trial examined the possible effect of the probiotic strain Lactobacillus rhamnosus GG ATCC53103 (LGG) on symptoms of attention-deficit/hyperactivity disorder (ADHD), health-related quality of life (QoL), and serum levels of cytokines in children and adolescents with ADHD. Methods: This trial evaluated 32 drug-naive children and adolescents aged between four and 17 years with a diagnosis of ADHD. The study subjects were randomly assigned to either the group that received LGG or the group that received the placebo. Assessments, comprising the ADHD Parent-Report Rating Scale-IV: Home Version; the Child Self-Report and Parent Proxy-Report of the Pediatric Quality of Life Inventory TM (PedsQL TM ) 4.0 Generic Core Scale; the Parent Form (CBCL/6-18) and the Teacher Report Form (TRF) of the Child Behavior Checklist (CBCL) for ages 6-18 of the Achenbach System of Empirically Based Assessment (ASEBA); and the serum cytokines; were compared between the groups at the baseline and after 3 months. Results: Thirty-five participants were randomized, with 32 completing the study (91.4% retention). There was a significant improvement in the PedsQL Child Self-Report Total Score after 3 months of treatment in the probiotic (p = 0.021, d = 0.53), whereas there was no significant improvement in the placebo group (p = 0.563, d = 0.04). The results of psychometric parameters assessed by parents and teachers were not so straightforward. There were statistically significant differences in the levels of serum cytokines between the groups after the 3-month treatment period: IL-6 in both the probiotic (p = 0.004, d = 0.73) and the placebo groups (p = 0.035, d = 0.94); IL-10 (p = 0.035, d = 0.6); IL-12 p70 (p = 0.025, d = 0.89); and TNF-α (p = 0.046, d = 0.64) in the probiotic group only. Conclusions: Children and adolescents with ADHD who received LGG supplementation reported better health-related QoL compared to their peers who received the placebo. This suggests that LGG supplementation could be beneficial. But results with psychometric tests conducted by parents and teachers as well as differences in the levels of inflammatory cytokines were ambiguous. Based on these results, we propose some study modifications: a longer observation period (6-12 months); inclusion of more children's self-report assessments; recruitment of non-drug naive patients and the possible omission of serum cytokines measurements. Clinical Trial Registration: Medical Ethics Committee (UKC-MB-KME-19-06/16).

Altered pain perception in self-injurious behavior and the association of psychological elements with pain perception measures: a systematic review.

BACKGROUND: The pathophysiology of non-suicidal self-injury (NSSI) is controversial. There is growing evidence of altered pain perception in people engaging in NSSI. Some hypotheses have been made on addictive aspects of this behavior. Pain and addictive behavior are modulated by the opioid system, which makes the endogenous opioids one of the candidate neurotransmitters related to NSSI. This article explains the theoretical background on NSSI as an addictive behavior, endogenous opioids involvement and pain perception changes in NSSI and updates the latest findings in this field. The main aim of this paper is a comprehensive review of published studies on pain perception in NSSI and an evaluation of the impact of NSSI functions and other psychological elements on pain perception measures. SUBJECTS AND METHODS: We have reviewed six studies of pain perception in participants with NSSI compared with controls. The participants of these studies were not mentally disabled or autistic and did not have a diagnosed personality disorder. RESULTS: The reviewed studies have demonstrated a higher pain threshold and longer pain tolerance or endurance in five of six studies. Emotional dysregulation was significantly associated with all pain perception variables in one study. Neuroticism, self-criticism and painful and provocative experiences revealed correlated with pain endurance or pain tolerance. No correlation between pain perception measures and dissociation, hopelessness or locus of control was found. CONCLUSIONS: Pain perception was altered in participants with NSSI. Pain perception was associated to emotional dysregulation, self-criticism, neuroticism and painful and provocative experiences. Because of the small number of studies reviewed, results should be seen as guidelines for further studies. They should be replicated on a bigger sample of studies. Further research should focus on pain perception measures in participants with NSSI and an excluded personality disorder.

Suicide attempts among adolescents in northeastern Slovenia: a 25 year report.

UNLABELLED: Slovenia is one of the countries with the highest national suicide rates (30/100,000/year). The rate of suicide attempts is accordingly high, for both adolescents and adults. Suicidal children and adolescents from the four North-eastern regions of Slovenia are hospitalised at the Child and Adolescent Psychiatry Unit of the General Hospital Maribor. The aim of this study was to show the pattern of changes in these hospitalisations along 25 years. METHOD: The data was collected retrospectively, using chart review of this unit by a psychiatrist for the years 1978 through 2004. RESULTS: The data consists of two different samples. The first sample contains gender distribution (n = 774) from 1978 to mid 2004 with 664 girls and 110 boys, and the second sample (n = 1,477) consisted of suicide attempts as well as alcohol (n = 772) and drug abuse (n = 115) data for the last decade. The number of hospitalisations was increasing in a wavy curve with average 7,5 times more admitted girls than boys. In 98%, the suicide method was intoxication, and most were additionally diagnosed with "adolescent crisis" (ICD-10: F93.8). CONCLUSION: The rise in the number of admitted suicidal adolescents was partly consequent to the improvement of their detection maybe because 25 years ago most of these cases were recorded as "accidental poisonings" and did not include the diagnosis of a suicide attempt. The socio-economic changes characteristic of a country in transition also contributed to this increase, as did the development of the Unit with more trained staff and advanced treatment.

Adult metachromatic leukodystrophy: disorganized schizophrenia-like symptoms and postpartum depression in 2 sisters.

We describe the cases of 2 sisters with adult metachromatic leukodystrophy (MLD). Whereas one sister presented with disorganized schizophrenia-like symptoms as the initial manifestation of MLD, the other remained symptom free except for a 4-week period of postpartum depression. In both patients, there was some residual activity of leukocyte arylsulfatase A (1.7% and 5.5% of normal), and a marked increase in urinary sulfatides was present, as measured by tandem mass spectrometry. An arylsulfatase A pseudodeficiency was therefore excluded. The most common mutations of the adult phenotype, Ile-179-Ser and Pro-426-Leu, were not found. In the literature, only 1 case of adult MLD manifesting as disorganized schizophrenia-like symptoms has been described, whereas postpartum depression has been so far unknown as a presenting symptom of MLD.