Perfectionistic Children and Their Parents: Is There Room for an Intergenerational Transmission? A Study of a Clinical Sample of Italian Children and Their Parents.

INTRODUCTION: The relationship between maladaptive perfectionism and Internalizing (ID) and Externalizing Disorders (ED) in children needs to be better understood, along with the intergenerational transmission of these traits from parents to children. The present work aimed to share light on both these issues. METHOD: 39 children with ID, 19 with ED, and their parents were recruited*. The Multidimensional Perfectionism Scale, the Big Five Inventory, the Child and Adolescent Perfectionism Scale, and the Hierarchical Personality Inventory for Children were used. The association between parent personality and perfectionism traits and children's perfectionism dimensions was evaluated through hierarchical regression analysis. RESULTS: ID and ED groups did not differ significantly concerning perfectionism. Fathers presented higher scores than mothers in Self-Oriented Perfectionism, Other-Oriented Perfectionism, and Socially-Prescribed Perfectionism. Parents of children with ID report higher levels of Obedience in their children, while parents of children with ED reported higher levels of Creativity and Perseverance. Significant associations were found between perfectionism in parents and their children, as well as between perfectionism and the personality of children. CONCLUSION: Results suggest a transdiagnostic nature of Perfectionism and support the transgenerational transmission of the personality traits investigated.

Prolonged Social Withdrawal During Adolescence: Transdiagnostic Syndrome or a New Psychiatric Entity?

The Japanese term Hikikomori is used to describe a clinical condition in which young people present a prolonged social withdrawal and isolation. Hikikomori syndrome represents an emergent worldwide phenomenon but is still poorly reported and often misdiagnosed. This study investigates and describes an Italian hikikomori adolescent group. Socio-demographic and psychopathological profiles and the relationship between hikikomori and psychopathological conditions were analyzed. No gender difference, a medium-high intellectual level, and no correlation with socioeconomic status were highlighted among the clinical group. The relationship between social withdrawal and social anxiety was significant while no correlation was found with depressive symptoms. The presence of Hikikomori syndrome was also significant in Italian adolescents, suggesting that hikikomori is not a culture-bound syndrome related to the Japanese cultural context, but rather a syndrome occurring in the upper-medium class.

Validation of the Italian version of the clinician affective reactivity index (CL-ARI).

INTRODUCTION: Irritability represents a transdiagnostic symptom in youths, which can become a predictor of long-term psychosocial adversity. Yet, few tools investigate this symptom in childhood. The aim of this study was to evaluate the psychometric properties of the CL-ARI in an Italian population, analyzing the correlations between irritability and other pathological constructs. MATERIALS AND METHODS: A cross-sectional study was carried out in a Child Neuropsychiatry Unit in Rome. A transdiagnostic sample of 67 youths aged 7-17 years, which underwent to a psychodiagnostic evaluation, was administered by a clinician with the translated version of the CL-ARI, along with tools exploring irritability and other constructs (depressive symptoms, anxiety, global impairment in functioning). RESULTS: The most frequent diagnosis obtained by the psychodiagnostic evaluation was anxiety disorder, followed by disruptive mood dysregulation disorder (DMDD) and no diagnosis. Cronbach's alpha values revealed good internal consistency for the total score (0.86), as well as for the score of each subscale of the tool (0.81 for temper outbursts, 0.89 for irritable mood, 0.71 for impairment). Test-retest reliability showed excellent values (ICC 0.89 to 0.98), and criterion validity exhibited good correlation among the sub-scales and between each sub-scale and the total score. Finally, positive correlations were found between total scores of the parent and the child interview, and between the CL-ARI, the measure of DMDD severity (CGI) and of depressive symptoms (CDI 2). CONCLUSIONS: These data confirmed that the CL-ARI is a promising tool designed to intercept irritability, with good psychometric properties. Further research on the assessment of irritability is critical and thus encouraged.

A Narrative Review about Prosocial and Antisocial Behavior in Childhood: The Relationship with Shame and Moral Development.

We conducted a literature review aimed at identifying the origins of shame as well as its effects on moral development, especially in terms of behavioral outcomes, and we reflected on the practical implications of our findings. We explored the role of shame in moral development through cultural differences and parental influences, collecting evidence of psychopathological consequences of primary moral emotion dysregulation. These studies showed a dichotomous feature of shame, as a prosocial behavior enhancer in morally relevant situations and, simultaneously, a risk factor for aggressive and antisocial behaviors on other occasions. Dysregulated shame leads to maladaptive interpersonal behaviors, which could evolve towards psychopathological paths. Therefore, an integrated intervention is recommended in children with emotional/behavioral problems.

Irritability in developmental age: A narrative review of a dimension crossing paediatric psychopathology.

OBJECTIVE: Irritability is an important theme in paediatric psychiatry considering its high frequency in developmental age, its association with negative outcomes and consequently significant public health impact. Present as main or associated feature of several psychiatric diagnoses, irritability represents a challenge for clinicians who try to understand its origin and role in developmental psychopathology. In this review we try to: (1) get an overview of this dimension and its relationship with each of the main neuropsychiatric disorders in paediatric population and (2) provide a summary of currently available instruments to assess irritability in children and adolescents. METHOD: In this narrative review, an overview of irritability in children and adolescents is proposed focusing on selected literature. RESULTS: Irritability as feature of many paediatric psychiatric conditions has been evaluated by many authors and included in classifications of paediatric psychiatric diseases. Framework of irritability evolved over time and dimension of irritability has been investigated using different tools and methodologies, both qualitative and quantitative. Metrics of irritability as clinical dimension are important in the diagnostic process of paediatric diseases. CONCLUSION: Investigating the presence of irritability in all children with related disorders is mandatory if we consider the risk for functional impairment and affective and behavioural disorders associated with high levels of irritability. Using rigid threshold in developmental age to differentiate physiological from pathological irritability could lead many children having subthreshold levels of irritability to receive no diagnosis and, consequently, no treatment where instead a dimensional approach to irritability could allow to identify prodromal phase and prevent the evolution towards clinical pathological expressions.

Hypermentalizing as a marker of borderline personality disorder in Italian adolescents: a cross-cultural replication of Sharp and colleagues' (2011) findings.

BACKGROUND: Extant literature indicates that Borderline Personality Disorder (BPD) may be reliably assessed in adolescence. Sharp and colleagues' (2011) suggested that mentalization could be an important early target for intervention in BPD adolescents and showed that hypermentalizing may represent an important marker to distinguish emerging BPD from adolescent turmoil. We aimed at testing if both dimensionally-assessed and categorically-diagnosed BPD was selectively associated with hypermentalizing errors on the Movie for the Assessment of Social Cognition (MASC) task in Italian adolescent inpatients and community adolescents. FINDINGS: The sample was composed of 58 Italian adolescents who were consecutively admitted to an adolescent psychiatry unit in Rome, Italy. BPD was assessed using the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD); the MASC task was used to assess mentalizing. Findings supported the hypothesis of a specific link between BPD features and hypermentalizing in adolescent inpatients. Both dimensionally-assessed and categorically-assessed BPD showed significant and non-negligible associations with hypermentalizing. The overall performance on the MASC task significantly discriminated BPD adolescents from Italian community-dwelling adolescents. CONCLUSIONS: Our findings supported the hypothesis that specific deficits in mentalization-namely, hypermentalizing-may play a crucial role in the developmental pathway leading to emerging BPD in adolescence.

Don't Judge a Book by Its Cover: Factitious Disorder Imposed on Children-Report on 2 Cases.

Factitious Disorder Imposed on Another (FDIA), also known as Munchausen Syndrome by Proxy (MSbP) is a very serious form of child abuse. The perpetrator, usually the mother, invents symptoms or causes real ones in order to make her child appear sick. Usually this is due to a maladaptive disorder or to an excessive of attention-seeking on her part. We report here two new cases of FDIA. The first one is a 9-year-old boy with a history of convulsive episodes, reduced verbal production, mild psychomotor disorder and urological problems who underwent several invasive procedures and hospitalizations before a diagnosis of FDIA was made. The second is a 12 year-old girl with headache, abdominal pain, lipothymic episodes, seizures and a gait impairment, who was hospitalized in several hospitals before an FDIA was diagnosed.

Reliability and clinical usefulness of the personality inventory for DSM-5 in clinically referred adolescents: A preliminary report in a sample of Italian inpatients.

BACKGROUND: The DSM-5 Alternative Model of Personality Disorders (AMPD) provides the opportunity to integrate the needed developmental perspective in the assessment of personality pathology. Based on this model, Krueger and colleagues (2012) developed the Personality Inventory for DSM-5 (PID-5), which operationalizes the proposed DSM-5 traits. METHODS: Eighty-five consecutively admitted Italian adolescent inpatients were administered the Italian translation of the PID-5, in order to obtain preliminary data on PID-5 reliability and clinical usefulness in clinically referred adolescents. RESULTS: With the possible exception of the PID-5 Suspiciousness scale, all other PID-5 scales evidenced adequate internal consistency reliability (i.e., Cronbach's α values of at least .70, most being greater than .80). Our data seemed to yield at least partial support for the construct validity of the PID-5 scales also in clinical adolescents, at least in terms of patterns of associations with dimensionally assessed DSM-5 Section II PDs that were also included in the DSM-5 AMPD (excluding Antisocial PD because of the participants' minor age). Finally, our data suggested that the clinical usefulness of the PID-5 in adolescent inpatients may extend beyond PDs to profiling adolescents at risk for life-threatening suicide attempts. In particular, PID-5 Depressivity, Anhedonia, and Submissiveness trait scales were significantly associated with adolescents' history of life-threatening suicide attempts, even after controlling for a number of other variables, including mood disorder diagnosis. DISCUSSION: As a whole, our study may provide interesting, albeit preliminary data as to the clinical usefulness of PID-5 in the assessment of adolescent inpatients.

Antipsychotic medication in adolescents suffering from schizophrenia: a meta-analysis of randomized controlled trials.

BACKGROUND: The aim was to perform a meta-analysis on the efficacy, safety and tolerability of antipsychotic drugs in adolescents aged between 13 and 17 suffering from schizophrenia. METHODS: Enclosed studies - were multicentric, randomized, double-blind clinical trials; - included only adolescents (aged 13-17) with DSM-IV diagnosis of schizophrenia; - used standardized scales to assess efficacy, safety and tolerability of antipsychotics. RESULTS: All treatments resulted in significant improvements in Positive and Negative Syndrome Scale (PANSS) total score (p < 0.001), in PANSS positive subscale score (p < 0.001) and in Clinical Global Impression Scale-Severity of Illness score (p < 0.001) at the endpoint. Patients with a considerable weight gain were significantly higher in the olanzapine-treated group. Data about extrapyramidal side-effects were not available for olanzapine. Risperidone group was associated with a significantly major incidence of akathisia, tremor and dystonic events than controls. High dose of aripiprazole was associated with a significant major incidence of tremor and Parkinsonism (p < 0.01) than controls. CONCLUSIONS: Results demonstrated that antipsychotic treatment with risperidone, olanzapine or aripiprazole in adolescents affected by schizophrenia led to significant improvements in symptomatology. A pharmacological treatment for adolescents suffering from schizophrenia must fulfil several prerequisites, to grant the most favourable outcomes, avoiding acute and long term side-effects. Treatment with a 10 mg daily dose of aripiprazole was associated with the lowest incidence of extrapyramidal symptoms and showed no significant weight gain. If a treatment with antipsychotic drugs associated with significant weight gain as olanzapine or risperidone is needed, compensative measures should be soon considered.

[Autistic dimension in obsessive-compulsive disorder in adolescence]. / La dimensione autistica nel disturbo ossessivo-compulsivo in adolescenza.

AIM: This study examines the obsessive-compulsive disorder (OCD) with normal and poor insight of illness and it detects the presence of autistic traits. The aim is to establish the relationship between OCD and Autistic Spectrum Disorder (ASD): comorbidity or subtype of OCD? METHODS: The sample consists of 48 adolescents (aged 12-18) with a clinical diagnosis of OCD (according DSM-IV-TR). After administering the Children's Yale Brown Obsessive-Compulsive Scale (CYBOCS) and the Brown Assessement Beliefs Scale (BABS), the sample is divided into two groups according to insight of illness. Autism Diagnostic Observation Schedule (ADOS) and Social Communication Questionnaire (SCQ) were used to assist in the ASD diagnosis; Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) was administered to assess personality disorders. RESULTS: 47% of subjects presents poor insight and 27% are included within the diagnostic criteria for autistic spectrum disorder. Poor insight in obsessive-compulsive symptoms is significantly associated with the presence of autistic traits. There is also a significant association between cluster hoarding and poor insight. DISCUSSION: This study suggests the existence of an obsessive autistic atypical subtype, where the compulsive dimension of repetitive behaviours vanishes in an autistic dimension with stereotyped manifestations. Further research should be conducted to better understand this obsessive autistic atypical subtype and to put it in the obsessive-compulsive spectrum in adolescence.

[Obstetric complications and early-onset schizophrenia: a case-control study]. / Complicanze ostetriche e schizofrenia a esordio precoce: uno studio caso-controllo.

AIM: Research has suggested an association between obstetric complications and schizophrenia. METHODS: In this study data based on the obstetric birth case-notes of adolescent patients with diagnosed schizophrenia were compared to those of normal "healthy" same-aged control subjects. RESULTS: Complications involving a clear damaging potential (Level > 4 in the McNeil-Sjöström Scale) were seen significantly more often among cases than control subjects: 7% vs 2%, Fisher's exact test p < 0.04, odds ratio 4, 95%, CI: 1.048-15.26. DISCUSSION: Brain-damaging due to obstetric complications would seem to be a possible antecedent to a diagnosis of schizophrenia. Moreover, results support the evidence that obstetric adversity exerts an independent influence on the age at first presentation with schizophrenia. This finding suggests the existence of a causal relationship between obstetric adversity and age at onset of schizophrenia even if the small samples size limits the power of this study.