Mauro Ferrara

Decharges EEG localisees continues pendant le sommeil chez l'enfant

Continuous generalized spike-and-wave complexes occurring during slow-sleep were first observed in some children by Patry et al. (1971). A general review of the reported cases was made by Tassinari et al. (1984). We have observed a new clinical-EEGraphic picture. Spikes and spike-and-wave complexes localized to one hemisphere were recorded during at least 85% non-REM sleep both in 3 quadriplegic and in 3 hemiplegic mentally retarded children, aged from 2 years and 10 months to 11 years (mean age: 5 years and 2 months). Cyclic organization of sleep was almost normal. Wake EEG showed an epileptic focus. Brain CT showed midline defect and brain atrophy in quadriplegic patients, and a wide temporal-parietal porencephalic cyst in hemiplegic patients. This EEGraphic pattern was associated with a more pronounced mental impairment: neuropsychological improvement was observed in 2 cases, when continuous sleep discharges disappeared. As aforesaid, this picture seems to be related either to hemispheric or to midline brain defects. In our cases, sleep phase organization could be examined, while continuous generalized discharges occurring during sleep do not allow such a study.

Theory of mind in non-suicidal self-injury (NSSI) adolescents

UNLABELLED The aim of the present study is to investigate different facets of the theory of mind (ToM), i.e. first vs. third-person, first vs. second-order ToM, egocentric vs. allocentric perspective, in a clinical sample of 20 non-suicidal self-injury (NSSI) adolescent inpatients and 20 healthy controls. METHODS We investigated whether performance in ToM tasks was related to both the type and frequency of self-injuring behavior and attitude toward life and death, using a semi-structured interview and different self-report questionnaires. RESULTS NSSI participants performed less well than the control group in all the ToM dimensions investigated. Furthermore, ToM performance was negatively related to Attraction to Death, in terms of both the type and frequency of self-injuring behavior, and it was positively related to Attraction to Life. CONCLUSIONS These preliminary findings have interesting implications for future clinical investigations, in that they provide previously unavailable information regarding the association between ToM and NSSI behavior.

Impairment in Social Functioning differentiates youth meeting Ultra-High Risk for psychosis criteria from other mental health help-seekers: A validation of the Italian version of the Global Functioning: Social and Global Functioning: Role scales

Social and occupational impairments are present in the schizophrenia prodrome, and poor social functioning predicts transition to psychosis in Ultra-High Risk (UHR) individuals. We aimed to: 1) validate the Italian version of the Global Functioning: Social (GF: S) and Global Functioning: Role (GF: S) scales; 2) evaluate their association with UHR criteria. Participants were 12-21-years-old (age, mean=15.2, standard deviation=2.1, male/female ratio=117/120) nonpsychotic help-seekers, meeting (N=39) or not (N=198) UHR criteria. Inter-rater reliability was excellent for both scales, which also showed good to excellent concurrent validity, as measured by correlation with Global Assessment of Functioning (GAF) scores. Furthermore, GF:S and GF: R were able to discriminate between UHRs and non-UHRs, with UHRs having lower current scores. After adjusting for current GAF scores, only current GF:S scores independently differentiated UHR from non-UHR (OR=1.33, 95%CI: 1.02-1.75, p=0.033). Finally, UHR participants showed a steeper decrease from highest GF:S and GF: R scores in the past year to their respective current scores, but not from highest past year GAF scores to current scores. GF:S/GS: R scores were not affected by age or sex. GF:S/GF: R are useful functional level and outcome measures, having the advantage over the GAF to not confound functioning with symptom severity. Additionally, the GF:S may be helpful in identifying UHR individuals.

Developmental vulnerability to psychosis: Selective aggregation of basic self-disturbance in early onset schizophrenia

Trait-like anomalies of subjective experience (aka, Basic Self-disturbance or Self-disorder, SD) have been empirically identified as schizophrenia-specific markers of vulnerability in several clinical and genetic high-risk populations. However, such specificity is still to be tested in developmental years, where emerging psychopathology is less crystallized and diagnostic boundaries more blurred. Thus, the current study explores the distribution of SD in adolescent help-seekers (age range 14 to 18) and tests the specificity of SD with respect to the severity of their diagnostic staging (Early Onset schizophrenia-spectrum psychosis [EOP], ultra high-risk [UHR] and clinical help-seeking controls [CHSC]). For this purpose, 96 help-seeking adolescents consecutively referred to specialized Child and Adolescent Units for diagnostic evaluation, underwent a comprehensive psychopathological examination including the specific interview for SD (i.e. the Examination of Anomalous Self-Experience, EASE). One-way ANOVA was used to test the diagnostic distribution of SD (EASE score), whereas multinomial logistic regression was used to test the effect of SD on the diagnostic outcome. SD frequency (both in terms of EASE total score and domain sub-scores) was decreasing progressively from EOP to CHSC, with intermediate levels in UHR. The EASE total score increased the risk of belonging to the more severe diagnostic stages (i.e, UHR and EOP vs CHSC as reference class) and allowed the correct reclassification of the 75% of the sample. The results confirm the schizophrenia-spectrum specificity of SD in adolescence, highlighting their potential value for early differential diagnosis and risk stratification.

Diagnostic distribution of self-disorders in help-seeking adolescents: an early faeature of the schizophrenia spectrum

Aims: The first aim was to determine the cost-effectiveness of CBTuhr to prevent first-episode psychosis in ultra-high risk (UHR) at 18 and 48 months. The second aim was to develop an optimized prediction model of a first-episode psychosis. Methods: 196 help-seeking UHR patients participated in the Early Detection Intervention (EDIE) study in the Netherlands. All individuals were treated with routine care (RC) for non-psychotic disorders. The experimental group received add-on CBTuhr to prevent psychosis. Results: The CBTuhr intervention was cost saving at 18 and 48 months follow-up. This was achieved by less hospital admissions and a reduction in other service costs. Societal costs were reduced because more treated patients were employed. Prognostic modelling identified 3 UHR risk classes with 4%, 13% and 70% risk for transition within 18 months. In the highest risk class, transition to psychosis emerged on average ≥ 8 months earlier than in the lowest risk class. Conclusions: Using prognostic modelling and proactive care can accomplish health gain at lower costs.