Maura Rossi

Childhood and adolescent migraine: A neuropsychiatric disorder?

Migraine is a neurological disorder characterized by unilateral head pain, nausea and/or vomiting and altered sensory perception (particularly phono- and/or photophobia). It is a common and disabling condition in children and adolescents, just as it is in adults; its origins, pathophysiology and long-term course are still not fully understood. Biological factors are currently held to be crucial in the aetiopathogenesis of primary headaches, such as migraine. In children and adolescents, we hypothesize that for migraine to develop, life events and their psychological processing are fundamental and can act in two different ways: either as a predisposing factor, inducing a chronic state of anxiety or depression (even subclinical), or as a trigger factor, activating a cascade of psychological events which, in turn, activate the biological mechanisms that produce the migraine attack. According to our hypothesis, psychological processing of life events (i.e. how the child perceives and mentally processes them) is the main factor in migraine aetiopathogenesis. This hypothesis has important implications in terms of diagnostic and therapeutic choices for children and adolescents with migraine.

The Effectiveness of Hospitalization in the Treatment of Paediatric Idiopathic Headache Patients

Background: Headache is a disease that has a high social impact in the paediatric as well as in the adult population, often resulting in a significant reduction in the young patient’s quality of life, reflected primarily in a greater number of days off school and increasingly frequent recourse to symptomatic drugs. The idea for this study came from the clinical impression that some paediatric headache patients might benefit more from inpatient than outpatient care. Aim: The aim of our study was to compare the effectiveness of hospitalization to outpatient care of patients with newly diagnosed frequent and disabling headache. Methods: A pragmatic randomized open-label trial was conducted at the Child Neurology Clinic of the University of Pavia, Italy. Children and adolescents with a 2- to 6-month moderate-to-severe migraine or tension-type headache history were randomized to hospital admission or outpatient assessment and followed for 6 months. The efficacy of the two therapeutic strategies was measured by counting the number of responders in each arm. Other end points included the mean frequency and duration of attacks, the number of drug prescriptions taken to control pain, and the number of patients and physicians expressing satisfaction with treatment. Results: The study population included 27 girls and 23 boys aged 8 through 18 years with migraine (23 cases) or tension-type headache (27 cases). Compared to outpatient assessment, hospital admission was correlated to a significant increase in the number of responders: 0 vs. 44% (1 month), 0 vs. 68% (3 months), and 12 vs. 68% (6 months). The mean frequency and duration of attacks were significantly lower in hospitalized patients (p < 0.0001). Hospitalization was correlated with a significant reduction of patients with severe headache (p < 0.005), a reduction of drug use, and a higher number of satisfied patients and physicians (p < 0.05). Logistic regression analysis confirmed the higher responder rate among hospitalized patients after adjusting for age, sex, diagnosis, and headache characteristics or admission. Conclusions: We think hospitalization reduces the emotional mechanisms that provoke stress in children and often induce or favour headache attacks. If these mechanisms can be interrupted, the management of disease may become easier and with enduring benefits.

Pharmacological Treatment of Anorexia Nervosa: A Retrospective Study in Preadolescents and Adolescents

To date, studies addressing the role of pharmacotherapy in the treatment of anorexia nervosa are limited, especially in childhood and adolescence. The aim of this retrospective naturalistic study was to evaluate the efficacy and safety of pharmacotherapy in 19 anorexic preadolescents and adolescents referred, for the first time, to a specialist psychiatry unit. Almost all the patients showed an improvement both in their eating behaviors, and in their mood and obsessive symptoms. No evidence was found of dangerous adverse events. Combined with a multidisciplinary approach that includes nutritional rehabilitation and psychotherapy, adjunctive pharmacotherapy may be useful in addressing both eating disorder psychopathology and comorbid psychiatric disorders.

Are vascular disorders more prevalent in the relatives of children and adolescents with migraine

The objective of the study was to assess whether a family history of vascular disorders is more common in children and adolescents with migraine than in the general population. Family history of stroke, arterial hypertension, myocardial infarction and diabetes was investigated by history taking in relatives of ambulatory children and young adults with migraine and in a control group. The odds ratios (ORs) with 95% confidence intervals (95% CI) were used as a risk measure. Using univariate and multivariate (logistic regression) analysis, family history was assessed in the whole sample and in subgroups by sex and age, degree of relationship (parents and grandparents vs. relatives), disease type (migraine with and without aura), and type of vascular disorder. The sample included 143 cases (migraine with aura 35, migraine without aura 108) and 164 controls aged 324 years (mean 12 ± 3.8 years). Patients with migraine were at increased risk of vascular disorders in parents and grandparents but not in all relatives. Multivariate analysis indicated family history of stroke as most common only in boys. In conclusion, our study provides some clues to the assumption that migraine and vascular disorders have common pathogenic mechanisms and that genetic susceptibility plays a role in increasing the risk of migraine in the offspring of families with one or more cerebrovascular or cardiovascular conditions.

The Rorschach test and Gilles de la Tourette’s syndrome: A pilot case–control study

BACKGROUND To date only three studies, all lacking a control group, have investigated the personality style underlying tic disorders or Tourettes syndrome (TS), using the projective Rorschach test. Despite the recent controversy about its proper use in clinical practice and research, the Rorschach test may be useful to explore personality organization in TS. The research hypothesis under investigation in this exploratory study was that young TS patients exhibit a peculiar personality organization, with significantly increased indicators of poor emotional control, aggression, anxiety and depression, on the Rorschach test, compared to healthy controls. METHODS We analyed the Rorschach protocols of 17 newly diagnosed paediatric TS patients and 17 age- and sex-matched healthy controls. RESULTS Compared with the controls young TS patients recorded significantly lower mean percentages of F and F+ responses and a significantly higher number of FM and FC responses, thus showing reduced control of emotions and difficulty in integrating aggressivity. Furthermore, associations emerged between comorbidity with ADHD and increased emotional instability and between severity of tics and of OCD and a pattern of emotional hyper-control and application of rigid defensive mechanisms. CONCLUSIONS These results seem to confirm the existence of a peculiar personality style in young TS patients and may have important implications, both pathogenetic and therapeutic.

The parental bonding in families of adolescents with anorexia: attachment representations between parents and offspring

Introduction The attachment theory is widely used in order to explain anorexia nervosa origin, course and treatment response. Nevertheless, very little literature specifically investigated parental bonding in adolescents with anorexia, as well as the parents’ own bonding and intergenerational transmission within the family. Purpose This study aims to identify any specific pattern of parental bonding in families of adolescents newly diagnosed with restricting-type anorexia, comparing them to the families of the control group. Patients and methods A total of 168 participants, adolescents and parents (78 belonging to the anorexia group and 90 to the control one), rated the perceived parental styles on the parental bonding instrument. The latent class analysis allowed the exploration of a maternal bonding latent variable and a paternal one. Results The main findings showed that a careless and overcontrolling parental style was recalled by the patients’ parents, and in particular by the fathers. As far as the adolescents’ responses were concerned, patients with anorexia did not seem to express differently their parental bonding perception from participants of the control group. Conclusion Clinical implications driven from the results suggest that a therapeutic intervention working on how the parents’ own attachment representations influence current relationships may help to modify the actual family functioning and thus the outcome of patients with anorexia.

Stress parentale in una casistica di soggetti in età evolutiva con disturbo pervasivo dello sviluppo

L’autismo e una sindrome comportamentale causata da un disordine dello sviluppo biologicamente determinato, con esordio nei primi 3 anni e che continua per tutta la vita. Le 3 aree prevalentemente interessate sono quelle relative ai disturbi di Relazione, Comunicazione e Linguaggio, Comportamento. La diagnosi si basa sui criteri del DMS-IV, che essendo parametri esclusivamente comportamentali rendono indispensabile il riferimento a scale di valutazione e a situazioni di osservazione standardizzate. Il trattamento dell’Autismo e estremamente complesso, le persone autistiche sono ancora oggi dolorosamente stigmatizzate a causa delle loro caratteristiche di anormalita e si basa sul lavoro con il bambino, terapie riabilitative ed educative specifiche, cure farmacologiche, lavoro con la scuola e con i genitori; trattamenti che devono essere effettuati in modo continuativo e complementare. Di particolare importanza e il lavoro con i genitori che si basa su una serie di regolari incontri volti ad instaurare un’alleanza terapeutica al fine di sopportare la sofferenza psichica ed impedire l’isolamento sociale. Lo scopo del nostro studio e valutare il livello di stress in genitori che hanno un figlio con Disturbo Pervasivo dello Sviluppo. Si tratta di uno studio multicentrico al quale hanno partecipato 92 bambini: 20 dei quali afferenti all’Istituto Dosso Verde di Pavia, 37 all’Azienda Ospedaliera Macchi di Varese e 35 alla Fondazione Casimiro Mondino di Pavia. Il protocollo di ricerca si basa sulla raccolta anamnestica dei genitori utilizzando interviste standardizzate e semistrutturate (GARS, ADI-R), di questionari somministrati ai genitori singolarmente (CBCL, PBI, EuroQol e PSI). Il bambino viene osservato e videoregistrato durante il gioco con i genitori e con il medico in ambiente semistrutturato. Alla seduta di gioco segue la compilazione di scale osservazionali (CARS, BSE ed ADOS). Infine viene effettuata una valutazione clinica e del livello di funzionamento intellettivo (Griffith’s Scale). Lo studio si e focalizzato sui risultati ottenuti dai singoli genitori al Parenting Stress Index (PSI); un questionario autosomministrato che fornisce un profilo di modalita di funzionamento familiare e stile genitoriale. Il test e suddiviso in 2 aree: dominio del bambino (Child Domain) e dominio del genitore (Parent Domain) a loro volta suddivise in varie sottoscale e fornisce un punteggio relativo allo Stress Totale. I risultati ottenuti evidenziano che lo stress materno e significativamente superiore allo stress paterno, questo puo dipendere da vari fattori, come il fatto che le madri trascorrono molto tempo con il figlio spesso addossandosi le problematiche psicopatologiche del bambino e ritenendosi responsabili dell’accudimento e della cura, conseguentemente a cio possono manifestare sensi di colpa e di inadeguatezza. Tali sentimenti associati all’incapacita di accettare le disabilita del figlio spingono i genitori a negarle o a nasconderle; questo comportamento porta ad una chiusura dei rapporti sociali contribuendo all’isolamento familiare. Le caratteristiche del bambino sono risultate essere un importante fattore nello sviluppo dello stress parentale come elemento destabilizzante nel rapporto genitori-figlio. In conclusione e importante sottolineare che il trattamento dei Disturbi Pervasivi dello Sviluppo si basa su un intervento riabilitativo complesso, intensivo e integrato per il bambino, accompagnato da un intervento sulla famiglia, volto a sostenere i genitori nel loro compito educativo e ad attivare al meglio le loro risorse come riabilitatori.