[Unidentified bright objects and neuropsychiatric disturbances]. / Unidentified bright objects: evoluzione neuroradiologica delle lesioni e correlazioni neuropsichiatriche in pazienti pediatrici affetti da neurofibromatosi tipo 1.

AIM: The neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disease. In 40-70% of cases are described signal hyperintensity on MRI, called unidentified bright objects (UBO). Their correlation with clinical disorders is still debated. The present study investigated the correlation between the UBOs and neuropsychiatric outcomes overall, observes the long-term through the comparison of MRI brain and considers the utility of including MRI early in the investigation of NF1. METHODS: We included 100 patients (age 2-18 years) with NF1. The parents were given a medical questionnaire to fill, a clinical neurologic examination (Touwen) was performed and brain MRI were analyzed during the years. RESULTS: In 72% of cases were detected UBO's last MRI. It was observed that the UBO's tend to shrink over time and in some cases to disappear in pre-adolescent. There were significant correlations between UBOs and minor disturbances in motor function (P=0.004) and between UBO's and cognitive deficits (P=0.016). The 79.62% of the patients is followed by a specialist in neuropsychiatry, as correlated significantly (P=0.027) with changes on MRI. CONCLUSIONS: Given the correlation between UBO's, neurological disorders, cognitive and behavioral, suggest be included in the diagnostic protocol MRI brain areas as T2H can be considered predictive for a neuropsychiatric disorder.

Learning disabilities: case study of the Piedmont Region in the years 2006-2007-2008.

AIM: The aim of the study is to analyse the comorbidity of learning disabilities (LD), its variation relating to the age of the children and to interpret the possible meaning of these data. METHODS: All patients in age of compulsory education (aged 5-16) diagnosed as LD in Piedmont, registered in the Regional Informative System NPI.net, in the years 2006-2007-2008, were considered. The cases were divided in two age ranges: from 5 to 11 years the first one, from 12 to 16 years the second one. The cases were further subdivided according to comorbidity with 5 diagnostic categories, identifying: Pure LD; 2) LD + psychiatric disorders; 3) LD + psycho-developmental risk; 4) LD + not psychiatric disease; 5) LD + borderline intellectual functioning and mental retardation. The average values computed for each group of comorbidity in the three years for the two age ranges were statistically compared. RESULTS: A major number of LD was observed in the age range 12-16; here LD is more often associated to psychiatric disorders and psycho-developmental risk. LD is more often pure from 5 to11 years. CONCLUSION: LD may be an inducing factor for psychiatric pathologies and situations of psychodevelopmental risk. However the major amount of LD in the age range 12-16 may be due to the rising of psycho-developmental risk factors and of social-environmental disadvantage; so these data may underline a form of "adolescence uneasiness", evident in school, in patients without major neurologic, psychiatric and cognitive disorders. The available data collection system facilitated this study.

Amenorrhea in eating disorders: poor stability of symptom after a one-year treatment.

OBJECTIVE: To examine whether patients with Eating Disorders (ED) who restore menses differ from those who remain amenorrheic after treatment and to provide longitudinal data about this debated criterion of Anorexia Nervosa (AN). METHODS: 184 outpatients were recruited: 50 patients with AN Restrictive type, 75 amenorrheic Eating Disorder Not Otherwise Specified (EDNOS) patients, 24 patients who recovered from AN with persistent amenorrhea, and 35 amenorrheic patients without ED. All participants were clinically assessed by psychiatrists and gynaecologists at the beginning of treatment and at the one-year follow-up. They also completed several psychometric tests: Eating Disorder Inventory-2, Temperament and Character Inventory, and Beck Depression Inventory. RESULTS: After treatment, a large portion of the sample resumed menses but very few recovered completely from the ED. No psychopathological variables could clearly predict the recovery of menses in the different groups. However, Body Mass Index and some biological variables were associated with restoration of menses in ED patients. CONCLUSION: Resumption of menses was not associated with a less severe eating symptomatology at the beginning of treatment nor with unequivocal psychopathological changes after treatment. It is important that clinicians consider not only the presence or absence of regular menses but also that they improve both ED screening and assessment in amenorrheic patients. Amenorrhea does not seem to represent a specific predictor of severity of illness or to show prognostic value.

Screening anxious-depressive symptoms and pain in medical inpatients.

AIM: Several studies indicate a relationship among depression, anxiety, pain and hospitalization. Depression has a bidirectional relationship with cardiovascular disease, and it is observed in HIV-positive individuals, in cancer patients and it often complicates chronic pain. METHODS: In order to assess dimensionally depressive and anxious symptoms and pain in medical inpatients, 327 non-psychiatric inpatients were assessed using the Hospital Anxiety and Depression Scale (HADS) and Visual Analogical Scale (for pain, VAS). Inpatients were hospitalized for neurovascular disease, chronic medical illness, cancer, infectious disease, cardiovascular illness, orthopaedic surgery and general surgery. RESULTS: Very high anxiety levels were discovered in cardiovascular, general surgery, infectious and neurovascular patients, whereas depression levels were higher among cardiovascular and chronic patients. The highest levels of pain were found among patients admitted to the Oncology Unit and those suffering from chronic medical illness. A stronger, direct relationship was obtained between anxiety and depression than between pain and anxiety or depression. No statistical differences were found in men and women. Statistically speaking significant differences were found in wards. Pain is a significant predictive variable for anxiety and depression (P<0.001). CONCLUSION: Screening for anxiety and depression should be included in the clinical interview carried out by the nurse at the moment of admission to the ward.

Clinical, psychological and personality features related to age of onset of anorexia nervosa.

BACKGROUND: To investigate the relationship between age of onset and clinical and personality features of patients with anorexia nervosa (AN). SAMPLING AND METHOD: We assessed 250 outpatients with AN with the Temperament and Character Inventory, the Eating Disorder Inventory 2, the Beck Depression Inventory and the Body Shape Questionnaire. The patients were subdivided into 3 groups: early (n=73), intermediate (n=96) and late onset (n=81), based on age of onset of symptoms. RESULTS: The early-onset group shows higher body dissatisfaction, maturity fear, impulsivity and asceticism than the other 2 groups. This group shows a greater character fragility, as described in particular by a lower self-directedness, than the other 2 groups. CONCLUSIONS: Even several years after the onset of the disorder, early-onset subjects affected by AN seem characterized by a more disturbed personality, with a higher body dissatisfaction than late-onset subjects affected by AN and a pursuit of thinness based on an ascetic drive.

[Preadolescence and suicide attempts]. / Preadolescenza e tentativi di suicidio.

The authors refer their experience regarding suicide attempts in preadolescence, an age less discussed than adolescence in the international literature on the subject. A case-study of 27 patients (12 boys and 15 girls), all under 13 years and in-patients in the Child Neuropsychiatry Section of the Department of Pediatric and Adolescence Sciences of the Turin University during ten years (1990-1999), is described. Various criteria are taken into consideration, including incidence peaks, social extraction, birth order, methods used, psychiatric illness in the family, family break-ups, organic illness in the family, experience of loss, previous signs of emotional disturbance, precipitant events, any repeat attempts and the patients' psychopathological profiles, and the most important aspects are illustrated. The data resulting from the case-study show that suicide attempts by pre-teenagers are not as rare as commonly believed, especially at the age just before entering into true adolescence. The authors conclude by emphasising that suicide attempts seem to be a phenomenon involving particularly less well-off classes (a good 87% of the case-study); among the methods used, the ingestion of drugs is the most common, the incidence of psychiatric illness in the family (45%) is certainly relevant and in 70% of cases there were previous and evident signs of emotional disturbance. In consideration of the information already available and the findings reported in this study, attempted suicide attempts appear to be a <> and not a pathology, at which basis different psychopathological profiles can be found: it is a symptom of a serious emotional and relational problem, which rarely reveals itself suddenly and even more rarely is resolved without help.

Neurophysiologic exploration: a reliable tool in HIV-1 encephalopathy diagnosis in children.

BACKGROUND: HIV-1 related encephalopathy has a bad prognostic meaning in the course of AIDS disease, but the early association of different drugs can modify its course. For this reason it is very important to recognize CNS involvement as soon as possible. As shown in the literature, at least in adult studies, EEG and Evoked Potentials (EP) are good tools in evaluating CNS alterations. In children data are rare. METHODS: A ten-year prospective study of 44 infected children out of 142 born from HIV-1 positive mothers has been done. The children have been submitted to EEG recording every six months in the first 18 months of life and then every year, to multimodal EP every six months. A total of 357 EEG, 47 P-VEP, 62 F-VEP and 98 BAEP have been performed. RESULTS: EEG: we found no pathologic results in patients belonging to category A; results were pathologic in 17.7% in category B, in 47.7% in C and in 77% of encephalopathic patients. It seems that EEG alterations are parallel to disease progression, with a relative risk of developing encephalopathy (R.R. = 1.15) and of death (R.R. = 2.33) for patients belonging to category C. We obtained a statistically significant lengthening in BAEP interpeak latency of left ear in all groups. For patients in category C the risk of developing encephalopathy is statistically significant (p = 0.045; R.R. = 6.75) and risk of death is high (R.R. = 4). CONCLUSIONS: Neurophysiologic exams are a reliable tool for the diagnosis of encephalopathy, in addition to clinical evidence.

Evolution of HIV-1 encephalopathy in children.

BACKGROUND: This study has been conducted on a series of HIV-1 infected children, with the aim of illustrating the features of encephalopathy onset, its evolution and its influence on life expectancy. The most useful exams for diagnosis are also outlined. METHODS: The perspective study lasted from January 1989 to June 1997. Forty six symptomatic patients, out of 142 seropositive children, were followed up in the Department of Paediatric and Adolescence Sciences of the University of Turin. The patients, now between 1 yr 2 mth and 13 yr 9 mth old, were born from HIV-1 seropositive mothers; seroreverters have been excluded. Scheduled neuropsychiatric consultations were used, consisting of a neurologic exam and an interview with parents, cognitive evaluations, EEGs, Evoked Potentials and CT scans. The results have been evaluated with log-rank test for the analysis of the survival curves. RESULTS: We found a significantly higher mortality rate in encephalopathic versus non encephalopathic patients; encephalopathic patients, in whom neurologic signs began in the first year of life, have a worse prognosis than the other patients, in whom encephalopathy appeared later. We did not find a statistical correlation between clinical course and immunological deficit. The clinical features of encephalopathy are mainly characterized by pyramidal signs and cognitive deterioration. Clinical sign evolution is linked to the age of encephalopathy onset: plateau pattern encephalopathy, characterized by an early onset, severe motor signs and cognitive delay from the very beginning, shows a greater severity and a shorter survival than progressive encephalopathy, characterized by a slowly progressive evolution of pyramidal signs, to which a cognitive deterioration may be added. CONCLUSIONS: Neuropsychological exams can be helpful in the diagnosis and follow-up of encephalopathy.

Diagnostic value of multimodal evoked potentials in HIV-1 infected children.

Evoked potentials (EP) help guide the diagnosis of central nervous system involvement in demyelinating pathologies regarding both children and adults, and in human immunodeficiency virus-1 (HIV-1) correlated pathologies only in regard to adult patients. EP have been shown to be useful in highlighting early signs of the disease. We therefore studied EP in HIV-1 infected children with the aim of verifying the association of results with disease progression, clinical signs and electroencephalogram, and individualizing the most reliable test. Thirty-six patients (20 male and 16 female subjects, age range: 10 months to 12 years) belonging to a group of 45 symptomatic subjects seen at the Pediatric Department were included into the study from November 1991 to December 1994. Ten presented with neurological signs as of disease onset, eight others developed encephalopathy during the follow-up. One hundred seventeen EP, i.e., 27 pattern visual, 64 flash visual and 26 brain stem auditory EP, were recorded. Univariate statistical analysis using the Wilcoxon-Mann-Whitney U test and Student's t test was done. As a whole, we found 22.5% of abnormal EP in subjects without neurological signs and 28.3% in subjects with neurological signs. Results that were obtained suggested a close relationship between both the pattern of visual and brain stem auditory EP exams and disease progression.

EEG diagnostic and predictive value on HIV infection in childhood.

This prospective study evaluated the electroencephalographic (EEG) diagnostic and prognostic value in childhood HIV infection. It was carried out on 125 subjects and included all Piemonte's seropositive children. The EEG was repeated every three months during the first 15 months of life, and then, at least, annually in the P1 and P2 group. Data of group P2 was compared blindly to that of the seroconverted control group of the same age and risk. EEG results were normal in P0, P1 and control patients. In group P2, EEG was abnormal in 35.5% of subjects, of these 54.6% developed an encephalopathy with a delay of 2.5 months to 2 years 11 months. EEG is therefore useful to evaluate early CNS damage and to identify onset features and evolution of encephalopathy in P2 patients.