Psychopathological risk in a sample of immigrant preadolescents in Italy.

BACKGROUND: Aim of the study was to collect information about emotional features in a sample of immigrant preadolescents in order to identify traits of emotional fragility or psychopathological risk factors. METHODS: The sample consists of 1206 preadolescents (180 immigrants, 1026 Italian natives) attending the third year of the middle schools. In order to assess anxiety levels and the presence of depressive symptoms the Self-Administered Psychiatric Scale (SAFA-A) and the Children's Depression Inventory (CDI) were administered. Coping strategies and behavior problems were evaluated by the Coping Inventory for Stressful Situation (CISS) and the Youth Self Report scale (YRS). All teachers filled out the Teacher's Report Form (TRF). Parents were asked to fill out a form on social-demographic features and the Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: Immigration resulted a risk factor for development of anxiety (OR=0.702), depression (OR=0.644), internalizing problems (OR=0.685), behavior problems (OR=0.622) and total problems (OR=0.719). Teachers observed more behavior problems and lower competences in immigrants than natives. Immigrants relied significantly more often on emotion-oriented coping strategies to resolve stressful situation than natives (P=0.045). Analyzing the immigrants' sample, second generation children reported significantly higher levels in total competence (school, activity and relationship) than first generation ones (P≤00.1); on the contrary there were no significant differences between the two groups concerning other behavioral and emotional problems or the preferred coping style. Natives' families reported significantly higher levels of perceived support than immigrant ones. CONCLUSIONS: Our findings confirm the hypothesis that preadolescent immigrants are more at risk for psychopathological risk factors than native peers.

Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features.

PURPOSE: Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS: The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS: AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION: Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

The Italian version of the Reflective Functioning Questionnaire: Validity within a sample of adolescents and associations with psychological problems and alexithymia.

OBJECTIVES: This study aims to test the psychometric proprieties of the Reflective Functioning Questionnaire (RFQ) applied to younger (13-16 years) and older (17-20 years) Italian adolescents examining (1) the factorial structure of RFQ; (2) its invariance across age and sex; (3) correlations between RFQ subscale scores, as well as the associations of the RFQ with (4) psychological problems and alexithymia dimensions. METHODS: A cross-sectional study was conducted with 593 adolescents between the ages of 13 and 20 years old recruited from the community within Italy. These participants completed the RFQ, Symptom Checklist-90, and Toronto Alexithymia Scale. RESULTS: The two-factor structure of the RFQ was confirmed. However, higher internal consistency of RFQ was obtained by removing two items that seemed problematic within this sample. Using a six-item version of RFQ, the two-factor structure was invariant across adolescent age and sex. Significant correlations among RFQ subscale scores, and between RFQ subscales with both psychological problems and alexithymia dimensions were found. CONCLUSIONS: Preliminary results reveal a short version of RFQ (six-item) is a suitable measure to assess mentalizing in adolescents in the Italian context.

Playing and virtual reality: Teleanalysis with children and adolescents during the COVID-19 pandemic.

What has come into question in our analytic practice with children and adolescents during the COVID-19 pandemic? Do the new practices related to the virtual allow the creation of a therapeutic playground and the continuity of an analytic process? In the literature, the effectiveness and the perplexities raised in teleanalysis with adults are described. Conversely, no research on the use of the virtual in child analysis is available. Given the specificity of the developmental age, the three authors present their clinical experience and theoretical and technical reflections on the remote setting with children and adolescents. Particular emphasis is given to the technical changes and to the deep meaning that these changes have had in reference to the analytic relationship. Using the Winnicottian theoretical vertex, the opposition between fetishistic and transitional use, the denial of separation and recognition of otherness in the analytic virtual space will be discussed using clinical examples. The video tool may generate in children a great excitement and unleash the infantile sexual perversions. The co-creation of an intermediate virtual playground allows sufficient psychic continuity to work on the unconscious material, and even to make emerge previous traumas that then find a chance to be worked-through.

Language-Related Skills in Bilingual Children With Specific Learning Disorders.

Purpose: The purpose of this study is to better understand the characteristics of the language-related skills of bilingual children with specific learning disorders (SLD). The aim is achieved by analyzing language-related skills in a sample of bilingual (Italian plus another language) and Italian monolingual children, with and without SLD. Patients and methods: A total of 72 minors aged between 9 and 11 were recruited and divided into four groups: 18 Italian monolingual children with SLD, 18 bilingual children with SLD, 18 Italian monolingual children without SLD, and 18 bilingual children without SLD. Each child underwent tests to evaluate different aspects of language skills: lexical and grammar, metalanguage and executive functions. Results: With regard to lexical and grammatical skills, the conditions of SLD and bilingualism both impact naming in terms of total number of errors for words with low frequency of use, while the condition of SLD has an effect on semantic errors for words with low frequency of use. The condition of bilingualism impacts on the total errors for words with high frequency of use and on circumlocution-type errors for words with low frequency of use. There were significant effects of bilingualism and SLD on the metalinguistic test for understanding implicit meaning, and an impact of SLD on phonological awareness was also found. Conclusion: The results suggest that both SLD and bilingualism have an effect on some lexical skills, in particular for words with low frequency of use. Both conditions, bilingualism and SLD, seem to impact on metalinguistic abilities that depend on lexical knowledge. These findings reinforce the importance of improving understanding of the neuropsychological profile of bilingual children with SLD.

QTc dispersion and interval changes in drug-free borderline personality disorder adolescents.

Emotional instability and dysregulation represent a core feature of borderline personality disorder (BPD) and abnormal patterns of sympathetic/parasympathetic activity have been repeatedly investigated in individuals with this disorder. Such abnormalities may represent the substrate for an arrhythmogenic risk that could materialize the following specific drug exposure. In this work, we decided to assess basal-corrected QT interval and dispersion (QTc and QTcd) for estimating such risk in a sample of drug-free adolescents with diagnosis of BPD. In this cross-sectional comparative study, we recruited n = 70 female adolescent BPD (14.7 ± 1.3 years), free of medications, alcohol or recreational drugs. Furthermore, n = 70 matched female healthy controls (CTRL, 14.6 ± 1.5 years) were enrolled. QTc and QTcd were manually assessed on a standard 12-lead ECG by a single experienced investigator who was unaware of clinical outcomes. QTcd was increased by 7 ms on average in BPD vs. CTRL (+ 18%, p = 0.03). QTc was decreased by about 15 ms on average in BPD vs. CTRL (p = 0.003). A mild correlation was found between QTc and QTcd in BPD (r = 0.25, p = 0.03) that was not present in CTRL. No correlation was found between either QTc or QTcd, and age in both groups. Mildly increased QTcd characterizes the cardiac activity regardless of drug exposure in female adolescents with BPD. This information may be of value to clinicians striving to use neuroleptic and antidepressant drugs with a lower risk of QTcd increase.

QT interval and dispersion in drug-free anorexia nervosa adolescents: a case control study.

Long QT values have been reported in patients with anorexia nervosa of the restricting type (ANr) potentially increasing the risk of fatal arrhythmia, especially if psychotropic drug treatment is required. Nevertheless, the previous studies on this topic are biased by drug exposure, long disease durations, and small sample sizes. This study is aimed at assessing QTc and QTcd values in ANr adolescents with recent onset and drug free, as compared to subjects affected by psychiatric disorders other than ANr. We evaluated QTc and its dispersion (QTcd) in a population of 77 drug-free ANr female adolescents and compared to an equal number of healthy controls (H-CTRL) and pathological controls (P-CTRL, mixed psychiatric disorders). The QT determination was performed on a standard simultaneous 12-lead ECG in blind by a single experienced investigator. QTc was calculated by the Bazett's formula and QTcd was determined as the difference between the maximum and minimum QTc intervals in different leads. Only for ANr patients, clinico-demographic data, hormones, and electrolytes were obtained. QTc was slightly reduced in ANr patients (27.7 ms, < 10%, p < 0.0003) vs. controls, while QTcd was increased in P-CTRL (30%, p < 0.0003). Heart rate was significantly lower in ANr patients vs. controls (25%; p < 0.003). Tyroid hormones and serum potassium showed weak although significant positive correlations with QTc in ANr patients. QTcd displayed a weak negative correlation with the BMI percentile (r = - 0.262, p = 0.03). We reject the hypothesis that QTc and QTcd are increased in drug-free ANr adolescents with a relatively short-disease duration. Further studies are needed to understand if the previously reported increase might be related to other associated chronic disorders, such as hormonal or electrolyte imbalance.

19q12q13.2 duplication syndrome: neuropsychiatric long-term follow-up of a new case and literature update.

Genetic syndromes are well characterized by the phenotypic point of view, but little is known about their progression and patients' quality of life. We report a 10-year neuropsychiatric follow-up of a boy with duplication of chromosome 19. Cytogenetic investigation was requested at the age of 5 years for psychomotor and speech delay. The genomic study identified an 8.17 Mb duplication on chromosome 19q12q13.2. We propose that the long-term follow-up of our patient would help to delineate the neuropsychiatric phenotype associated with 19q duplication. This study could be a model for further long-term research in the neuropsychiatric follow-up of patients with 19q duplication syndrome.

Anorexia nervosa of the restrictive type and celiac disease in adolescence.

BACKGROUND: Anorexia nervosa (AN) is usually present in adolescence with symptoms partially overlapping celiac disease (CD), but the relationship between these two conditions has received little attention in the literature. The aim of this work was to explore this relationship, considering if CD could be associated with specific baseline AN-related clinical features. METHODS: In this retrospective study, 82 adolescent female out- and inpatients with AN of the restrictive type (ANr), according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, were recruited. CD diagnosis and related serology were recorded, including tissue transglutaminase type-2 antibodies, endomysial antibodies, and antibodies against deamidated forms of gliadin peptides. Eating disorder inventory-3, Children's Depression Inventory, body mass index, age, and disease duration data recorded at the time of blood withdrawal were also obtained from each patient. RESULTS: Five (6.1%) subjects presented a CD disorder associated with AN: none of the collected psychometric measures was significantly correlated with any CD-related parameter or characterized as a specific subgroup. CONCLUSION: CD diagnosis or serology does not relate to ANr clinical or demographic characteristics. However, a slight increase in prevalence with respect to the general population might be hypothesized and possibly elucidated by further studies with an appropriate design.

Cognitive profiles in bilingual children born to immigrant parents and Italian monolingual native children with specific learning disorders.

PURPOSE: The aim of this study is to compare the Wechsler Intelligence Scale for Children® - fourth edition IV (WISC IV) intellectual profile of two groups of children with specific learning disorder, a group of bilingual children and a group of monolingual Italian children, in order to identify possible significant differences between them. PATIENTS AND METHODS: A group of 48 bilingual children and a group of 48 Italian monolingual children were included in this study. A preliminary comparison showed the homogeneity of the two groups regarding learning disorder typology and sociodemographic characteristics (age at WISC IV assessment, sex and years of education in Italy) with the exception of socioeconomic status. Socioeconomic status was then used as a covariate in the analysis. RESULTS: Even if the two groups were comparable in specific learning disorder severity and, in particular, in the text comprehension performance, our findings showed that the WISC IV performances of the bilingual group were significantly worse than the Italian group in Full Scale Intelligence Quotient (P=0.03), in General Ability Index (P=0.03), in Working Memory Index (P=0.009) and in some subtests and clusters requiring advanced linguistic abilities. CONCLUSION: These results support the hypothesis of a weakness in metalinguistic abilities in bilingual children with specific learning disorders than monolinguals. If confirmed, this result must be considered in the rehabilitation treatment.

Mindful approach to University education.

A mindful approach to education and training could improve students' reflective capacities and have positive effects on clinical practice because it facilitates a helping relationship. The main aims of this study were to investigate whether participation in a mindful-based University training was associated with increases in mindfulness skills as measured by the 5-Facet M Questionnaire, and to present the Italian validation of the questionnaire. Sixty-seven students from the course Neuro and Psychomotor Therapy were enrolled. They filled in the self-administered 5-Facet M Questionnaire before and 1 month after a mindfulness-based training, focused on role-playing and followed by a feedback group discussion. The Italian version of the 5-Facet M Questionnaire had good psychometric properties. The pre- and post-training analysis showed a significant increase in the subscale 'Observing'. Findings suggest that role-playing and feedback group sessions are valid tools to improve students' mindfulness skills.

Body experiences and psychopathology in idiopathic central precocious and early puberty.

BACKGROUND: Idiopathic central precocious (PP) and early puberty (EP) are frequently associated with psychopathological problems. The aim of this study was to evaluate the quality of body experiences and psychological aspects in girls with PP and EP, as well as the impact of these conditions on their families and the subjects' vulnerability. METHODS: Subjects with PP or EP, aged 7-15 years, were evaluated through the administration of a self-report questionnaire (Children's Depression Inventory, CDI), along with a projective test (Human Figure Drawing Test, HFDT). Their parents filled in a questionnaire about their child's behavior (Child Behavior Checklist 4-18, CBCL). RESULTS: Twenty-nine girls with PP or EP were compared to 55 age-matched healthy girls. The 13.8% of subjects with EP or PP presented depressive traits, and the 48.3% reported suicidal thoughts at the CDI (vs. CONTROLS: P<0.05). At the HFDT, a lower psychological maturity and a more negative self-image, that determine a vulnerability to psychopathology and mental suffering, were observed in those subjects with a past EP or PP, who entered in adolescence. CONCLUSION: EP and PP are complex conditions, which combine somatic symptoms with negative psychological sequelae, including an increased risk for depression and a distorted body perception. The use of projective tests for the assessment of body perception might help the clinician come to a deeper understanding of the therapeutic needs of girls with PP or EP.

Anxiety and Depression in Children With Nonverbal Learning Disabilities, Reading Disabilities, or Typical Development.

The main goal of the present study was to shed further light on the psychological characteristics of children with different learning disability profiles aged between 8 and 11 years, attending from third to sixth grade. Specifically, children with nonverbal learning disabilities (NLD), reading disabilities (RD), or a typical development (TD) were tested. In all, 15 children with NLD, 15 with RD, and 15 with TD were administered self-report questionnaires to assess different types of anxiety and depression symptoms. Both NLD and RD children reported experiencing more generalized and social anxiety than TD, the NLD children reported more severe anxiety about school and separation than TD, and the children with RD had worse depressive symptoms than those with NLD or TD.

Beta-amyloid plasma levels in adolescents with anorexia nervosa of the restrictive type.

BACKGROUND: Reduced plasma leptin and elevated homocysteine (Hcy) are known to lead to increased ß-amyloid (Aß) production, besides being hallmarks of anorexia nervosa (AN) of the restrictive type. AN subjects display several neuropsychiatric manifestations, which may entail Aß-mediated altered synaptic functions. The aim of this study consisted in assessing Aß plasma levels in AN patients. METHODS: A total of 24 adolescent female AN outpatients were recruited together with 12 age-comparable healthy controls. For each subject we assessed Aß40 and leptin plasma levels, as well as APOE genotype. Hcy plasma levels were also determined in AN patients who underwent clinical characterization, including the Eating Disorder Inventory-3 (EDI-3), the Children's Depression Inventory (CDI) and the estimation of the speed of BMI loss (DPI, disease progression index). RESULTS: Plasma Aß40 levels were similar between patients and controls, while a marked reduction was observed for leptin (∼80%) in AN patients. Aß40 plasma levels failed to correlate with leptin, while a linear correlation was present with Hcy (r = 0.50, p < 0.03). Examined clinical features were not related with Aß40 plasma levels, with the only exception of the DPI (r = 0.47, p < 0.03). CONCLUSION: This exploratory study does not support a significant role for altered Aß production in AN-associated dysfunctions. Further studies are required to clarify whether exceptions to this conclusion can be drawn for those patients expressing significantly elevated Hcy plasma levels or for those progressing more rapidly.

Global and regional brain volumes normalization in weight-recovered adolescents with anorexia nervosa: preliminary findings of a longitudinal voxel-based morphometry study.

The recent literature on anorexia nervosa (AN) suggests that functional and structural abnormalities of cortico-limbic areas might play a role in the evolution of the disease. We explored global and regional brain volumes in a cross-sectional and follow-up study on adolescents affected by AN. Eleven adolescents with AN underwent a voxel-based morphometry study at time of diagnosis and immediately after weight recovery. Data were compared to volumes carried out in eight healthy, age and sex matched controls. Subjects with AN showed increased cerebrospinal fluid volumes and decreased white and gray matter volumes, when compared to controls. Moreover, significant regional gray matter decrease in insular cortex and cerebellum was found at time of diagnosis. No regional white matter decrease was found between samples and controls. Correlations between psychological evaluation and insular volumes were explored. After weight recovery gray matter volumes normalized while reduced global white matter volumes persisted.

Paradoxical increase of plasma vitamin B12 and folates with disease severity in anorexia nervosa.

OBJECTIVE: Anorexia nervosa (AN) is a complex disorder involving severe psychological manifestations and multiple organ damage, including liver dysfunction. The primary aim of this study consisted in assessing plasma levels of vitamin B12 and folates with respect to liver function enzymes considering the liver-storage properties of this vitamin. METHOD: We recruited 70 restrictive type AN adolescents and the severity of psychopathological traits was assessed using EDI-3 scale. Plasma levels of vitamin B12 , folates, transaminases (AST, ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP) and cholinesterase (CHE) were determined. RESULTS: About 38.5% of patients displayed vitamin B12 values (H-B12) above the upper range of normal reference; 4.3% of patients had increased values of folates; 20 and 11.4% of patients displayed ALT and AST values above reference limits; none had GGT values above normal range. Albeit low CHE and ALP values were found in 55 and 20% of patients, respectively, a linear correlation with both transaminases was present only for vitamin B12 and folates; furthermore, H-B12 patients had both higher AST and ALT values. EDI- 3 subscores significantly correlated with vitamin B12 and folates plasma values and H-B12 patients displayed EDI-3 higher values. DISCUSSION: These data suggest that plasma levels of vitamin B12 might be an early marker of liver dysfunction, possibly also related to more severe psychopathological aspects. The identification of patients with higher fasting plasma vitamin B12 levels could therefore lead to earlier and more careful refeeding interventions. Further studies will clarify the potential role of this vitamin in AN clinical practice.

Alexithymia in parents and adolescent anorexic daughters: comparing the responses to TSIA and TAS-20 scales.

BACKGROUND: A growing body of literature has been focusing on individual alexithymia in anorexia nervosa, while there are only scarce and conflicting studies on alexithymia in the families of anorexic patients, despite the important role played by family dynamics in the development of the anorexic disorder, especially in adolescent patients. The aim of this study is to assess alexithymia in anorexic adolescent patients and in their parents using a multimethod measurement to gain more direct, in-depth knowledge of the problem. METHODS: Forty-six subjects, anorexic adolescent patients and their parents, underwent the Toronto Alexithymia Scale (TAS-20) along with the Toronto Structured Interview for Alexithymia (TSIA), which represents the first comprehensive clinically structured interview focused specifically on assessing alexithymia. The use of latent trait Rasch analysis allowed a comparison of the two instruments' sensitivity and ability to detect the presence and intensity of alexithymic components in patients and parents. RESULTS: Significant discordance was found between the two measures. The clinical instrument allowed detection of a greater level of alexithymia compared with the self-report, in particular in our adult parent sample. Moreover, a significant alexithymic gap emerged within families, particularly within parental couples, with noticeably more alexithymic fathers compared with the mothers. CONCLUSION: The TSIA clinical interview may be a more sensitive instrument in detecting alexithymia, minimizing parents' negation tendency. Clinical questions have arisen on how useful it would be to give greater weight to family functioning (ie, alexithymic gap) in order to predict the possibility of establishing a therapeutic alliance, and thus the outcome of the anorexic adolescent.

Autobiographical memory in adolescent girls with anorexia nervosa.

OBJECTIVE: The aim of the study is to investigate deficits in autobiographical memory in adolescents with anorexia nervosa (AN). METHODS: Sixty female individuals with AN and 60 healthy volunteers with an age range of 11-18 years were enrolled. The Autobiographical Memory Test (AMT), the Eating Disorder Inventory-3, the Toronto Alexithymia Scale-20 for the evaluation of alexithymia and Children's Depression Inventory to evaluate depressive traits were administered. In addition to classical AMT words, we proposed seven experimental cues, chosen from words often used by individuals with eating disorders in daily life. RESULTS: Girls with AN showed a massive overgeneral memory effect. This effect was not related to the presence of depression or alexithymia but increased with the duration of the disorder rather than with its severity. DISCUSSION: The alteration of autobiographical memory manifests in adolescence. Girls with AN showed a dysregulation of both negative and positive emotional experiences that seemed to be influenced by the disease duration.

Interstitial 11q deletion: genomic characterization and neuropsychiatric follow up from early infancy to adolescence and literature review.

BACKGROUND: Interstitial deletions of chromosome 11 long arm are rarely observed and the associated phenotype ranges from normal to severe, depending on the position and size of the deletion and on the presence of unmasked recessive genes on the normal homologous. To our knowledge 32 cases are reported in literature with three family cases. Phenotype-genotype correlation is not very clear and the most common features are characteristic facial dysmorphisms, palate anomalies and developmental delay. Growth retardation is not typical and other major malformations are reported in some cases. CASE PRESENTATION: We described a child with 11q interstitial deletion diagnosed at birth with hypotonia and minor dysmorphisms using standard cytogenetic techniques; array CGH was subsequently performed to define the deletion at a molecular level. CONCLUSIONS: This case gave us the opportunity to attempt a genotype-phenotype correlation reviewing the literature and to describe a rehabilitative program that improved the development perspectives of this child.

Diazepam binding inhibitor and dehydroepiandrosterone sulphate plasma levels in borderline personality disorder adolescents.

BACKGROUND: Borderline personality disorder (BPD) patients display a complex and heterogeneous clinical phenotype that plausibly implies variable underlying pathogenic mechanisms. A dysregulation of peripheral benzodiazepine receptors has previously been shown in BPD peripheral tissues, implying possible alterations of its ligand, the diazepam binding inhibitor (DBI) or of the downstream products of its activation, i.e. neuroactive steroids. METHODS: The aim of this work consisted in assessing, by ELISA, fasting plasma levels of DBI and dehydroepiandrosterone sulphate (DHEA-S), including cortisol and the cortisol-to-DHEA-S molar ratio (CDR), in 17 BPD adolescents versus 13 healthy controls, testing the possibility that clinical scales related to depressive or anxious traits (CDI, STAI-Y) or to disease severity (BPDCL) might be associated with a selective dysregulation of these parameters. RESULTS: DBI plasma levels were unchanged, while DHEA-S ones were significantly increased (approx. 70%) and the CDR decreased in BPD patients. No meaningful correlations with clinical variables emerged. CONCLUSION: Our results indicate that a dysfunction of the neurosteroid system might be operative in BPD in spite of unchanged DBI plasma levels and that DHEA-S might represent a generalized trait marker for the altered stress response that is associated with this disorder.