Association of serotonin receptor gene polymorphisms with anorexia nervosa: a systematic review and meta-analysis.

PURPOSE: Several studies have investigated the association between anorexia nervosa and polymorphisms of genes regulating serotonin neurotransmission, with a focus on the rs6311 polymorphism of 5-HTR2A. However, inconsistent results of these studies and conflicting conclusions of existing meta-analyses complicate the understanding of a possible association. We have updated these results and evaluated the involvement of other serotonin receptor gene polymorphisms in anorexia nervosa. METHODS: Adhering to PRISMA guidelines, we have searched studies on anorexia nervosa and serotonin-regulating genes published from 1997 to 2022, selected those concerning receptor genes and meta-analyzed the results from twenty candidate gene studies on the 5-HTR2A rs6311 polymorphism and the 5-HTR2C rs6318 polymorphism. RESULTS: Present analyses reveal an association for the 5-HTR2A rs6311 polymorphism, with G and A alleles, across eighteen studies (2049 patients, 2877 controls; A vs. G allele, Odds Ratio = 1.24; 95% Confidence Interval = 1.06-1.47; p = 0.009). However, after geographic subgrouping, an association emerged only in a Southern European area, involving five studies (722 patients, 773 controls; A vs. G allele, Odds Ratio = 1.82; 95% Confidence Interval = 1.41-2.37; p < 0.00001). No association was observed for the 5-HTR2C rs6318 polymorphism across three studies. CONCLUSIONS: To date, the involvement in the pathophysiology of anorexia nervosa of the 5-HTR2A rs6311 polymorphism appears limited to a specific genetic and/or environmental context, while that of the 5-HTR2C rs6318 polymorphism seems excluded. Genome-wide association studies and epigenetic studies will likely offer deeper insights of genetic and environmental factors possibly contributing to the disorder. LEVEL OF EVIDENCE: III Evidence obtained from well-designed cohort or case-control analytic studies. Clinical trial registration PROSPERO registration number: CRD42021246122.

Impact of Maternal-Newborn Separation in Italian Women with Suspected COVID-19 Infection on Psychopathological Symptoms and Quality of Interactions during Breastfeeding.

INTRODUCTION: Before the COVID-19 pandemic, proximity between mothers and their newborn infants was at the core of sanitary guidelines. With the aim of stopping the virus transmission from mothers to infants and possible physical dangers due to the infection, some hospitals discouraged or even prohibited skin-to-skin contact and breastfeeding. METHOD: This study recruited 180 dyads in private and public hospitals in Italy with the aim of verifying whether mother-infant separation after delivery is associated with higher maternal psychopathological distress (assessed through the SCL-90-R) and poorer quality of dyadic interactions during breastfeeding (evaluated through the SVIA). RESULTS: Our results showed that mothers separated from their infants displayed more anxiety, depression, and obsessive-compulsive symptoms and a lower quality of feeding interactions on all the subscales of the SVIA (mother's affective state; interactive conflict; food refusal behavior; dyad's affective state). CONCLUSION: In light of these results, our study suggests that separating mothers from their newborns is associated with increased psychopathological symptoms in mothers and poorer feeding interactions. These issues have been posited as key predictors of maladaptive outcomes in infants' later lives; therefore, health services must fully consider the short- and long-term consequences of separating mothers and infants in their policies in the event of future pandemics.

Disordered eating in early childhood: DRD4 and DAT1 gene polymorphisms and quality of mother-child interaction.

PURPOSE: Eating disturbances are complex heritable conditions that can be influenced by both genetic and environmental factors but are poorly studied in early development. The aim of this research was to investigate the association of genetic polymorphisms within dopaminergic pathways with early feeding problems. METHODS: We analyzed the presence of VNTR polymorphisms of DRD4 (rs1805186) and DAT1 (rs28363170) in overeating (N = 45), undereating (N = 48) and control (N = 44) young children. We also assessed presence of externalizing, internalizing and dysregulation symptoms by the Child Behavior Checklist and quality of mother-child interactions during feeding by the Italian adaptation of the Scale for the Assessment of Feeding Interaction, respectively. RESULTS: Both polymorphisms were associated with children's eating behavior, psychological symptoms and quality of interaction with their mothers, suggesting that: (a) the DRD4 4-repeat allele behaves as a protective factor, the 2-repeats and 7-repeats alleles as risk factors, for undereating behavior, the general quality of mother-child interaction and internalizing, externalizing and dysregulated symptoms; and (b) the DAT1 9-repeats allele behaves as a protective factor, the 10-repeats allele as a risk factor, for overeating behavior, the general quality of mother-child interaction, internalizing, externalizing and dysregulated symptoms. Finally, a gene x gene interaction is suggested between the DAT1 9-repeat or 10-repeat allele and the DRD4 4-repeat allele. CONCLUSIONS: Our results suggest a role for DRD4 and DAT1 in an early susceptibility to eating disturbances. LEVEL OF EVIDENCE III: Evidence obtained from well-designed case-control analytic study.

The impact of COVID-19 pandemic on psychopathological symptoms in mothers and their school-age children before, during and after the COVID-19 pandemic peak.

The COVID-19 pandemic had an impact on children's and caregivers' mental health. We investigated psychopathological symptoms in a group of non-at-risk and a group of at-risk mothers and their school-age children from the pre-pandemic period to the lockdown period and to the post-lockdown period. We used the SCL-90/R to assess mothers' psychological symptoms, the CBCL 1½-5, and the CBCL 6-18 for the perceived children's emotional-behavioral functioning. Analysis of variance was conducted to assess significant differences in the groups over the three assessment points. Linear regressions were run to investigate the effect of maternal psychological symptoms on their children's functioning. In the non-at-risk group, maternal psychopathological symptoms significantly varied during the pandemic. Children's Aggression scores decreased after the lockdown, while Depression scores significantly increased during lockdown and after. The mothers in the at- risk group presented overall decreasing scores over the three assessment points. Children's Aggression scores did not increase during lockdown. Depression scores did not show significant changes over the three assessment points. Overall, our results showed that mothers' psychopathological risk did not influence specific areas of children's emotional/behavioral functioning, but it had an effect on the general offspring psychological well-being.

Mother-child interactions during feeding: A study on maternal sensitivity in dyads with underweight and normal weight toddlers.

During the second year of life, mother's sensitivity in encouraging child autonomy supports children's emotional-affective individuation. In the feeding context, there is a clear transition from dependence on the mother to an emerging autonomy. Several studies have found an association between children's poor growth which is not related to organic pathologies, and maladaptive mother-child interactions that are characterized by poor maternal sensitivity. Despite this evidence, no studies have investigated maternal sensitivity to specific child's cues, such as demands for autonomy, during feeding interactions between mothers and their underweight children. This study aimed to assess how mothers' psychopathological risk and toddler's dysregulation profile are associated with mother-toddler interactional quality during feeding, with particular attention to mothers' sensitivity to child's specific cues (e.g. need of autonomy, requests for cooperation, request to stop the interaction, etc.). One hundred fifty mother-toddler dyads (N = 73 with underweight children and N = 77 with normal weight children) with children aged between 18 and 30 months, were recruited. Mother-toddlers feeding interactions were assessed through specific rating scales applied to the video-recorded interactions and mothers filled out questionnaires on children's emotional-behavioral functioning and their own psychopathological risk. Results showed a significant association between the quality of mother-toddler feeding interaction and children's weight. Underweight children showed less demand for autonomy and request for cooperation than normal weight children. Moreover, mothers of underweight children were less sensitive to toddler's cues of wanting to stop the interaction and demands for autonomy compared to mothers of normal weight children. Lower facilitations were associated with toddler's more dysregulated profile and with mother's higher psychopathological risk, and high toddler's dysregulation profile was associated with lower maternal sensitivity to child's cues of wanting to interrupt interactions and with worse mother's mood. Assessing maternal sensitivity in relation to toddler's specific cues might be particularly relevant in the feeding context. It might help to detect some dysfunctional interactive patterns and allow the implementation of prevention and treatment programs.

Potential for diagnosis versus therapy monitoring of attention deficit hyperactivity disorder: a new epigenetic biomarker interacting with both genotype and auto-immunity.

In view of the need for easily accessible biomarkers, we evaluated in ADHD children the epigenetic status of the 5'-untranslated region (UTR) in the SLC6A3 gene, coding for human dopamine transporter (DAT). We analysed buccal swabs and sera from 30 children who met DSM-IV-TR criteria for ADHD, assigned to treatment according to severity. Methylation levels at six-selected CpG sites (among which, a CGGCGGCGG and a CGCG motif), alone or in combination with serum titers in auto-antibodies against dopamine transporter (DAT aAbs), were analysed for correlation with CGAS scores (by clinicians) and Conners' scales (by parents), collected at recruitment and after 6 weeks. In addition, we characterized the DAT genotype, i.e., the variable number tandem repeat (VNTR) polymorphisms at the 3'-UTR of the gene. DAT methylation levels were greatly reduced in ADHD patients compared to control, healthy children. Within patients carrying at least one DAT 9 allele (DAT 9/x), methylation at positions CpG2 and/or CpG6 correlated with recovery, as evident from delta-CGAS scores as well as delta Conners' scales ('inattentive' and 'hyperactive' subscales). Moreover, hypermethylation at CpG1 position denoted severity, specifically for those patients carrying a DAT 10/10 genotype. Intriguingly, high serum DAT-aAbs titers appeared to corroborate indications from high CpG1 versus high CpG2/CpG6 levels, likewise denoting severity versus recovery in DAT 10/10 versus 9/x patients, respectively. These profiles suggest that DAT 5'UTR epigenetics plus serum aAbs can serve as suitable biomarkers, to confirm ADHD diagnosis and/or to predict the efficacy of treatment.

IMPACT OF PARENTAL BINGE EATING DISORDER: EXPLORING CHILDREN'S EMOTIONAL/BEHAVIORAL PROBLEMS AND THE QUALITY OF PARENT-CHILD FEEDING INTERACTIONS.

This study examines psychopathological problems in children of parents with binge eating disorder (BED), particularly the effect of parental diagnosis on their offspring's psychopathology and the mediating power of the quality of parent-infant feeding interactions. Two hundred parents and their offspring were administered a questionnaire for the assessment of their children's psychopathology at 18 (T1) and 36 (T2) months of age. An observational measure to evaluate feeding interactions was administered at T1. Children with both parents with BED showed the highest affective, anxiety, oppositional/defiant, and autism spectrum problems, but no influence of paternal diagnosis was found on the offspring's psychopathology. Maternal BED had an influence on children's affective and autism spectrum problems, and diagnosis of BED in both parents had an effect on infants' affective problems. Paternal BED had an effect on oppositional/defiant problems through the quality of father-infant interactions, and maternal BED had an effect on the offspring's affective and anxiety problems through the mediation of mother-infant interactions. These results suggest the importance of intervention programs focusing both on parental psychopathology and on mother-child and father-child feeding interactions in families with parents with BED.

Mothers with depression, anxiety or eating disorders: outcomes on their children and the role of paternal psychological profiles.

The present paper aims to longitudinally assess the emotional functioning of children of mothers with depression, anxiety, or eating disorders and of mothers with no psychological disorders and to evaluate the possible mediating role of fathers' psychological profiles on children's internalizing/externalizing functioning using SCID I, SCL-90/R and CBCL/1½-5. The results showed maternal psychopathology to be strongly related to children's maladaptive profiles. Children of mothers with depression and anxiety showed higher internalizing scores than children of other groups. These scores increased from T1 to T2. Children of mothers with eating disorders showed higher and increasing externalizing scores than children of other groups. The data showed that fathers' interpersonal sensitivity, depression, anxiety and psychoticism significantly predicted internalizing problems of the children. Moreover, interpersonal sensitivity and psychoticism significantly predicted externalizing problems. Our results confirmed the impact of maternal psychopathology on maladaptive outcomes in their children, which suggests the importance of considering paternal psychological profiles.

Mother-child and father-child interaction with their 24-month-old children during feeding, considering paternal involvement and the child's temperament in a community sample.

The article aims to study mother-child and father-child interactions with 24-month-old children during feeding, considering the possible influence of time spent by the parent with the child, the infantile temperament, and the parental psychological profile. The families were recruited from 12 preschools in Italy (N = 77 families). Through an observation of the feeding [Scala di Valutazione dell'Interazione Alimentare (SVIA - Feeding Scale; I. Chatoor et al., ; L. Lucarelli et al., )], self-reporting [Symptom Checklist-90-Revised (SCL-90-R; L.R. Derogatis, ), and report-form questionnaires [Italian Questionnaires on Temperament (QUIT; G. Axia, )], and information provided by the parents about the amount of time spent with their children, results showed that the overall quality of father-child interactions during feeding is lower than that of mother-child interactions. Fathers showed higher psychological symptoms than did mothers. No associations were found between the fathers' psychopathological risk and the quality of interactions with their children during feeding. Mothers' psychopathological risks predicted less contingent exchanges interactions with their children during feeding. Children's temperaments significantly influence mother-child interactions, but no association exists between maternal involvement and the quality of interactions with their children. Paternal involvement predicts a better quality of father-infant interactions when associated with a child's higher scores on Social Orientation. The quality of parents' interactions with their children during feeding are impacted by different issues originating from the parent's psychological profile, the degree of involvement, and from the child's temperament.

Parental Neglect and Childhood Obesity Amidst COVID-19: A Developmental Psychopathology Perspective on Health and Developmental Risks.

The COVID-19 pandemic has profoundly impacted the mental health and developmental trajectories of children and adolescents, catalyzing a range of psychological and behavioral issues due to enforced lockdowns and other restrictions. This text explores these impacts through the lens of developmental psychopathology, which integrates clinical psychology and developmental science to examine the emergence and evolution of psychological disorders across a lifespan. This paper highlights how pandemic-related disruptions have exacerbated conditions such as anxiety and depression and, notably, increased childhood obesity due to changes in lifestyle and reductions in physical activity. The analysis includes a discussion of how isolation has not only restricted access to educational and psychological resources but also increased the risk of parental mental illness and related familial stress, thereby intensifying issues of neglect and their consequent impact on child health. By employing a developmental psychopathology framework, this paper argues for the necessity of targeted interventions that address these complex interplays of genetic, environmental, and psychological factors. Such interventions aim to support children through structured educational and health-oriented strategies, ensuring their well-being amidst the ongoing challenges posed by the pandemic. This approach underscores the importance of early, multifaceted strategies involving parents, educators, and healthcare providers to foster healthier developmental outcomes for children facing unprecedented global health crises.

Further Evidence on Online Video-Feedback Intervention: Enhancing Parent-Child Interactions and Reducing Disordered Eating in Children.

BACKGROUND: This study evaluated the effectiveness of an online intervention designed to improve parent-child interactions and address disordered eating behaviors in children. Using remote video-feedback sessions based on observations of mother-child feeding interactions, the intervention offers a cost-effective and environmentally friendly alternative to traditional in-person methods. AIMS: The study aimed to assess the impact of online intervention on the quality of mother-child interactions during feeding and its effectiveness in reducing psychopathological symptoms in both mothers and children. METHODS: The intervention was conducted entirely online, with improvements measured using SVIA scores for mother-child interactions and the SCL-90/R Global Severity Index (GSI) for maternal psychopathological symptoms, alongside evaluations of children's emotional and behavioral functioning, particularly anxiety, depression, and aggression. RESULTS: The intervention significantly improved the quality of mother-child interactions across all SVIA subscales and led to reductions in maternal symptoms of depression and anxiety, as well as decreases in children's emotional and behavioral symptoms. CONCLUSIONS: These findings suggest that online video-feedback interventions can effectively enhance mother-child relationships and reduce psychopathological symptoms in both mothers and children, although further research with larger sample sizes and more robust statistical analyses is needed to confirm these results.

Mothers with Dysregulated Eating and Their Offspring's Emotional/Behavioral Functioning during the COVID-19 Pandemic: A Descriptive Study.

OBJECTIVE: Research on the psychopathological effects of the COVID-19 pandemic has not specifically focused on mothers with dysregulated eating and their children. METHODS: This study aimed to observe whether the symptoms of mothers with binge eating episodes (assessed through the SCL-90/R and the TFEQ-R18) worsened from the pre-pandemic period (T1) to the pandemic period (T2). In addition, we sought to assess whether the levels of internalizing/externalizing and dysregulation symptoms in children (assessed through the CBCL 6-18) worsened from T1 to T2. RESULTS: Our results showed that the values obtained for mothers in the SCL-90/R were significantly higher at T2 (during the pandemic), particularly for Depression, Phobic Anxiety, Interpersonal Sensitivity, and Obsessive-Compulsive subscales. Moreover, in both the Emotional Eating and Uncontrolled Eating subscales of the TFEQ-R18, mothers at T2 scored substantially higher than mothers at T1. The emotional/behavioral functioning of children was more maladaptive at T2, according to mothers, especially for the subscales of Withdrawn, Anxious/Depressed, and Aggressive Behavior. Children also had significantly higher scores on the Internalizing and Externalizing subscales, as well as greater symptoms of dysregulation. CONCLUSIONS: This study contributes to demonstrating that the COVID-19 pandemic may have had increased maladaptive emotional/behavioral functioning in children and their mothers with dysregulated eating.

Stability of and Change in Psychopathological Risk Levels in Pre-Early Adolescents before, during, and after Their Study Sojourns: A Descriptive Study.

BACKGROUND: Adolescents can benefit from studying abroad in terms of personal development, cross-cultural encounters, and academic enrichment. This article digs into the psychological challenges that students may face before and during their study abroad, focusing on the emotional components of their experiences. METHODS: The current descriptive study sought to assess the stability or change in levels of psychopathological risk in a sample of N = 195 adolescents before and during a study abroad sojourn. To examine psychological symptoms in pre-adolescents, teachers were asked to complete a report-form questionnaire. RESULTS: The findings of this study revealed that students' psychological functioning changed significantly after their study abroad experience. Anxious/depressed and withdrawn ratings specifically increased from the pre-sojourn assessment (T1) to the evaluation during the stay (T2), then remained consistent (T3). In addition, the scores for rule-breaking and aggressive conduct changed, increasing from T1 to T2 and then decreasing from T2 to T3. This trend implies that teenagers may struggle with behavioral challenges early in their study abroad experience, but subsequently adjust and improve their conduct as they grow more used to the new environment. CONCLUSIONS: this research offers insight into the emotional and behavioral issues that adolescents face when studying abroad, underlining the significance of treating psychopathological risk factors in this demographic.

Peripartum Depressive Symptoms in Fathers during the COVID-19 Pandemic.

Background: This research investigates peripartum depression in fathers during COVID-19, focusing on how pandemic-related distress is associated with paternal depressive symptoms and the quality of father-child feeding interactions. The primary objective was to understand if the pandemic has influenced depressive symptoms in new fathers and how these symptoms impact their interactions with their children, especially during feeding. Methods: Utilizing a cross-sectional design, the research employs online surveys and remote observation to gather data from 243 Italian fathers. The analysis involves established psychometric tools like the Symptoms Check-List/90R and the Peritraumatic Distress Index to assess the severity of depressive symptoms and their correlation with father-child interaction exchanges, observed through the SVIA. Results: The fathers' peritraumatic distress due to COVID-19 was significantly and positively associated with the level of their depressive symptoms and negatively correlated with the quality of their feeding interactions with their children. Moreover, elevated levels of peritraumatic stress were notably predictive of higher instances of depressive symptoms in the fathers. Further, higher levels of stress associated with COVID-19 were predictive of a poorer quality of father-child interactions. Conclusions: This research highlights the need for inclusive perinatal support programs, offering foundational insights into paternal mental health during pandemics.

Feeding disorders of early childhood: an empirical study of diagnostic subtypes.

OBJECTIVE: The aim of this study was to examine the differences among three subtypes of feeding disorders (FD), defined through the criteria of the DC:0-3R: "Infantile Anorexia" (IA), "Feeding Disorder Associated with Insults to the Gastrointestinal Tract" (FDIGT), and "Sensory Food Aversions" (SFA), by exploring mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes. METHOD: The sample consisted of 146 Italian mother-child pairs, of which 51 children with IA, 47 children with FDIGT, and 48 mothers and their children with SFA. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their children's temperament and emotional/behavioral functioning. RESULTS: Analyses revealed significant differences between the diagnostic groups of FD in relation to mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes. DISCUSSION: Both interactional and individual variables may contribute differently to specific FD and outcomes during childhood. Definitions by FD subtypes, using operational diagnostic criteria, and the assessment of mother-child interactions are relevant to target interventions strategies to treat specific disorders.

A six-year prospective study on children of mothers with eating disorders: the role of paternal psychological profiles.

BACKGROUND: Several studies have suggested that maternal eating disorders (EDs) represent a significant risk factor for children's affective and behavioral development. Yet, little emphasis has been placed on the paternal role. OBJECTIVES: The present longitudinal study aimed to clarify the role of maternal EDs and the influence of paternal psychological profiles on children's emotional development. METHOD: Our sample was composed of N = 64 families with firstborn children selected through preschools, primary schools, and outpatient clinics in central Italy. Parents and children participated in a 6-year longitudinal protocol that included a diagnostic interview conducted by clinicians (Structured Clinical Interview for DSM-IV Axis I Disorders [SCID-I]), a self-report (Symptom Checklist-90-Revised [SCL-90-R]), and a parental report-form questionnaire (Child Behavior Checklist [CBCL]). RESULTS: The influence of mothers' EDs on their children's emotional development was confirmed. Moreover, fathers' anxiety and obsessive-compulsive problems in association with mothers' EDs and depressive symptoms influenced the onset of both internalizing and externalizing difficulties in their children over time. CONCLUSION: Our results suggest that fathers' psychopathological risk affects the development of emotional problems in children with mothers who have EDs.

Implementing Sensitivity and Contingency in Medical Contexts: The Case of Prematurity.

In the context of relational situations, sensitivity and contingency are identified as pivotal variables that contribute to the enhancement of patients' overall wellbeing [...].

Epidemiology, Etiology and Intervention Strategies for Peri-Partum Depression in Mothers.

The prevalence of peri-partum depression (PPD) varies widely across countries, with rates ranging from 10% to 15% depending on the screening method used and the country studied [...].

Breastfeeding Apps: A Descriptive Report.

BACKGROUND: Women are increasingly using breastfeeding apps to facilitate and organize breastfeeding; however, no study has so far focused on maternal psychopathological risk and on the quality of dyadic exchanges in this field. AIM AND METHODS: This preliminary, descriptive study aimed at evaluating levels of psychopathological symptoms (through the SCL-90/R) and for the quality of the interactions they have with their children during feeding (through the SVIA) in mothers who use breastfeeding apps with different grades of engagement. RESULTS: Data analyses showed that mothers with a mild use of the apps present a higher quality of dyadic interactions during feeding and lower psychopathological risk. CONCLUSIONS: The cross-sectional and descriptive nature of this study does not allow any causal conclusions. However, results suggest that the higher the engagement and use of breastfeeding apps, the lower the quality of feeding interactions and the higher the maternal psychopathological risk.

Eating Disorders and Internalizing/Externalizing Symptoms in Adolescents before and during the COVID-19 Pandemic.

OBJECTIVE: This study aimed at assessing the prevalence of eating disorders and symptoms of dieting, food preoccupation, and oral control and internalizing/externalizing problems in a group of adolescents before and during the COVID-19 pandemic. METHODS: A sample of N = 813 adolescents (age range = 14-15 years) was recruited in the general population and administered the SCOFF, EAT-26 and YSR questionnaires at two assessment points: before the COVID-19 pandemic outbreak and during it. RESULTS: In males and females, the YSR scores at T1 were significantly lower than T2, especially for the subscales of Withdrawn, Somatic complaints, Anxious/depressed, Social problems. As for the EAT-26 scores, adolescents scored significantly lower at T1 for all four subscales of dieting, food preoccupation and oral control. The prevalence of eating disorders among males and females increased respectively from 13.2% to 18.4% and from 17.5 to 25.3 from T1 to T2. CONCLUSION: This study confirms previous research showing an increase in eating disorders prevalence and higher psychopathological symptoms both in males and females adolescents during the pandemic.