Obsessive-compulsive disorder in childhood and adolescence.

Obsessive-compulsive disorder (OCD) is a common psychiatric condition during childhood and adolescence, which continues to be underestimated and undertreated. For these reasons, it constitutes a primary cause of major disabilities in those ages and, sometimes, of permanent impairments later on. In these last few years, childhood and adolescence OCD has attracted an increasing focus which has promoted a deeper awareness of this illness, a better recognition with earlier interventions, as well as the set-up of more tailored and specific strategies, including psychotropic drugs. The aim of this paper is to present a critical review of paediatric OCD, with a special attention towards the most compelling reports available up to now and towards the most interesting areas for future research.

Early cognitive and communication development in children with focal brain lesions.

Early cognitive and language development of children with congenital focal brain lesions, documented by magnetic resonance imaging, was studied in 18 cases, 9 with left-hemisphere damage and 9 with right-hemisphere damage, at about 2 (Time 1) and 4 years of age (Time 2). All of the children showed normal cognitive development, but their global Griffiths Developmental Scales scores were lower at Time 2, and developmental profiles across individual subscales revealed side-specific effects, resembling the adult left/right cerebral hemisphere lesion model. Expressive lexicon and grammar were delayed, more often in left-hemisphere-damaged than in right-hemisphere-damaged children, at Time 1 and Time 2. Functional findings were not related to the size and location of the brain lesion, whereas the presence of epilepsy was a highly significant predictor of cognitive and language outcome, irrespective of the side of the lesion. The stable disadvantage in the verbal domain shown by left-hemisphere-damaged children within the age range of this study might suggest that the left hemisphere has some initial bias for language learning. The effects of right-hemisphere damage were more variable and emerged at a later stage of language development.

Increased density of the platelet serotonin transporter in autism.

BACKGROUND: Various data have shown the involvement of serotonin (5-HT) in autism. The presence of the 5-HT transporter in platelets, similar to the same structure located in presynaptic serotonergic neurons, has produced a series of studies aimed at assessing its functionality in this disorder, but the ensuing findings are quite controversial. For this reason, we investigated the 5-HT transporter by means of the specific binding of [3H]-Paroxetine ([3H]-Par), which is currently considered the first-choice ligand for labeling it, in platelets of 20 autistic children and adolescents, as compared with healthy control subjects. METHODS: Twenty children and adolescents of both sexes suffering from autism according to DSM IV criteria were included in the study and compared with a similar group of healthy control subjects. Platelet membranes and the binding of [3H]-Par were carried out according to standardized protocols. RESULTS: The results showed a significantly higher density of [3H]-Par binding sites in autistic children than in healthy control subjects. CONCLUSIONS: These findings support the presence of a serotonergic dysfunction in autism and would suggest that the 5-HT transporter may have a specific role in this disorder, also in the light of its recently proposed role in brain development.

Adolescents with borderline intellectual functioning: psychopathological risk.

This paper presents a qualitative analysis of cognitive and emotional functioning in intellectually borderline adolescents (IQ ranging from 71 to 84) and the consequences for personality and social development. Psychopathological risk, particularly in terms of mood disorders, conduct disorders, and intellectual deterioration, is analyzed, with the distinction made between "excited" and "inhibited" forms. Conceptualizations intellectually borderline adolescents have of their own mental functioning are described in light of the notion of cognitive self--the ability to understand and control internal and external reality. The implications for psychotherapy and rehabilitation are discussed.

Paroxetine in depressed adolescents with intellectual disability: an open label study.

The aim of this study was to evaluate the efficacy and side-effects of paroxetine treatment in adolescents with mild intellectual disability and major depressive disorder (MDD). Seven adolescents (14.7-18.4 years of age) were treated with paroxetine (dosage 20-40 mg day-1). Clinical changes were assessed at the beginning of the pharmacological treatment and after 9 weeks utilizing the DSM-IV diagnostic criteria and the Montgomery-Asberg Depression rating Scale (MADRS). Four out of the seven subjects did not fulfil the DSM-IV diagnostic criteria after the 9-week treatment. The mean decrease in the total score on the MADRS was significant (41%). Some items of the MADRS showed significant improvement: inner tension (66%); lassitude (55%); apparent sadness (53%); inability to feel (44%); and reported sadness (43%). Three subjects showed sedation, two subjects gastrointestinal complaints and one subject insomnia; all these symptoms were transitory and not severe. No behavioural activation was evident. This preliminary, uncontrolled study of a few cases suggests that adolescents with intellectual disability and MDD may respond to paroxetine, and that adverse side-effects are mild.

[Neuropsychological follow-up in congenital hypothyroidism]. / Il follow-up neuropsichico dell'ipotiroidismo congenito.

Thyroid hormones play a key role in a number of critical neuromaturational processes, including neurogenesis, neuronal migration, synaptogenesis and myelination. Even in case of early treated CH children we cannot exclude the consequences of thyroid hormones deficiency in the critical pre and post-natal period. So, it is still useful to follow-up the neuropsychological development of CH children. IRCCS "Stella Maris" has been involved in research in this subject for several years with the collaboration the Institute of Endocrinology and of the Institute of Pediatrics (University of Pisa). According to our experience and to the results literature we propose to continue the follow-up studies with a simple, unique methodology that could be diffused to every screening center in Italy.

Symptoms of attention-deficit hyperactivity disorder in an Italian school sample: findings of a pilot study.

OBJECTIVE: The objective of this study was to complete a teacher questionnaire on a sample of children (N = 232) in nine fourth grade classes in schools in two regions of central Italy to assess the frequency of occurrence of symptoms of attention-deficit hyperactivity disorder (ADHD) and the rates of probable cases in the sample. METHOD: Each ADHD symptom was rated by the teacher as either absent (0), sometimes present (1) or frequently present (2). RESULTS: Of the children 3.9% had eight or more DSM-III-R Criterion A symptoms of ADHD scored at a "frequent" level (score of 2) and were considered to be "likely cases" of ADHD; an additional 6.9% did not meet this threshold but had a total score of 16 or more on the scale and were considered to be "possible cases." CONCLUSIONS: The findings suggest the need for more systematic epidemiological investigations to evaluate the true prevalence of the syndrome and its risk factors in the Italian population.

[Neuropsychological development in children with focal brain injury]. / Neuropsicologia delle encefalopatie focali non evolutive dell'infanzia.

The study of children with focal brain injury has important implications from a clinical and theoretical perspective. Clinical data on children with congenital or early acquired lesions indicates that the cognitive sequelae are different from those resulting from similar damage sustained in adulthood. These differences depend in part on the differential effect that damage has on ongoing developmental process and in part on the different recovery capacity of the Central Nervous System of the child. From a theoretical perspective, focal lesion data is important for analyzing the issues of early neuropsychological functioning (especially in terms of early hemispheric specialization) and of plasticity and recovery of function of the CNS. This review analyzes the possible causes of this heterogeneity, that seems in part dependent on the interindividual variability of early neuropsychological organization and in part related to methodological factors such subject inclusion criteria and nature of neuropsychological measures. The review also discusses the role during development of the principal inter and intrahemispheric recovery mechanisms (special attention is given to intrahemispheric mechanisms which have been considered in the past as less determinant with respect to interhemispheric mechanisms). Furthermore, the role of lesion side as a prognostic parameter is discussed, specifically in terms of the evidence of a differential recovery capacity of left hemisphere with respect to the right. Various hypotheses have been put forward as possible interpretations of these data (maturational gradient, different neuropsychological organization of the two hemispheres), yet evidence is still controversial. If one considers the prognostic parameter--age of lesion onset--recent evidence does not confirm the hypothesis that the earlier the lesion, the greatest the recovery of function. Rather, it seems that relating age of lesion onset to other parameters, such as lesion side or size, has a greater and more reliable prognostic value. Another aim of the review is to analyze the effect that focal damage has on the dynamics of development. The fact that the effects of early damage might manifest themselves later in development, when the function in question is reaching a higher level of organization, underlines the importance of a longitudinal approach that assesses the developmental patterns of specific functions. Another issue discussed is the role of lesion side in determining specific cognitive impairment.(ABSTRACT TRUNCATED AT 400 WORDS)

[The assessment of neuropsychic aspects in dysmorphic syndromes (an introduction to the discussion)]. / La valutazione degli aspetti neuropsichici delle sindromi dismorfiche (introduzione sull'argomento).

The author reports brief notes on the neuropsychic aspects of dysmorphic syndromes. He suggests a diagnostic and follow-up protocol for the evaluation of learning capabilities, linguistic development and personality.

[The evolution of epilepsy in the most common genetic forms with mental retardation (Down's syndrome and the fragile X syndrome)]. / Evoluzione dell'epilessia nelle più frequenti forme genetiche con ritardo mentale (sindrome di Down e sindrome dell'X fragile).

Some chromosomal abnormality syndromes carry a higher risk of seizures than that found in the general population. Down's syndrome is considered to be the first and the most frequent chromosomal abnormality causing mental retardation. In spite of numerous reports and epidemiological surveys, the outcome of epileptic syndromes in patients with Down's syndrome (DS) is still largely unknown. We retrospectively studied 34 DS patients with epilepsy (14M; 20F). Epileptic syndromes were classified as: infantile spasms, 10 cases, i.e. 31%; Lennox-Gastaut syndrome, 5 cases, 15.5%; symptomatic generalized epilepsy, 1 case; idiopathic generalized epilepsy, 6 cases, 17.6%; partial symptomatic epilepsy, 10 cases, i.e. 31%. In 2 patients the epilepsy was unclassifiable. In all the patients the following evolutive particularities were noted: a) the infantile spasms to have a relatively mild prognosis, as 8/10 patients remained seizure-free, 3 of whom without treatment; b) no patient experienced febrile convulsions prior to the onset of epilepsy; c) Lennox-Gastaut syndrome had a relatively late onset (mean age 10 years, range 8-11.5); d) 7 patients (20.6%) developed reflex seizure. The fragile X syndrome is considered to be the second most frequent chromosomal abnormality causing mental retardation. The prevalence of epilepsy varies from 9.1% to 45% in the different series. In order to evaluate the prevalence rate of epilepsy and the previously hypothesized association with a particular electroclinical picture, we retrospectively studied 90 fragile X syndrome patients (80M, 10F) aged 4 to 25 years (mean age 13y6m).(ABSTRACT TRUNCATED AT 250 WORDS)