Noemi Faedda

Alexithymia and psychopathological symptoms in adolescent outpatients and mothers suffering from migraines: a case control study

BackgroundHeadache is a common disorder affecting a growing number of children and adolescents. In recent years, there has been an increase in scientific interest in exploring the relationship between migraine and emotional regulation, and in particular, the impact of emotional dysregulation on mental and physical health. The present study aims to explore the relationship between migraine and alexithymia among adolescents and their mothers as well as the impact of this association on mental health. An additional aim is to verify whether alexithymia may be a predictor of psychopathological symptoms in adolescents and mothers with migraines.MethodsA total of 212 subjects were involved in this study. The sample was divided into (a) Experimental Group (EG) consisting of 106 subjects (53 adolescents and 53 mothers) with a diagnosis of migraine according to International Classification of Headache Disorders (ICHD-3) and (b) Control Group (CG) including 106 subjects (53 adolescents and 53 mothers) without a diagnosis of migraine. All participants completed the Toronto Alexithymia Scale to assess alexithymia and the Symptom Checklist-90-R to assess psychopathological symptoms.ResultsHigher rates of alexithymia were found in the adolescents and mothers of the EG in comparison to the adolescents and mothers of the CG. Furthermore, adolescents and mothers experiencing both migraine and alexithymia, demonstrated a higher risk of psychopathology.ConclusionsFindings from this study provide evidence that the co-occurrence of migraine and alexithymia increases the risk of psychopathology for both adolescents and their mothers.

Behavioral management of headache in children and adolescents

Headache is the most frequent neurological symptom and the most prevalent pain in children and adolescents, and constitutes a serious health problem that may lead to impairment in several areas. Psychosocial factors, social environment, life events, school and family stressors are all closely related to headaches. A multidisciplinary strategy is fundamental in addressing headache in children and adolescents. Applying such a strategy can lead to reductions in frequency and severity of the pain, improving significantly the quality of life of these children.It has been demonstrated that behavioral intervention is highly effective, especially in the treatment of paediatric headache, and can enhance or replace pharmacotherapy, with the advantage of eliminating dangerous side effects and or reducing costs. Behavioral interventions appear to maximize long-term therapeutic benefits and improve compliance with pharmacological treatment, which has proven a significant problem with child and adolescent with headache.The goal of this review is to examine the existing literature on behavioral therapies used to treat headache in children and adolescents, and so provide an up-to-date picture of what behavioral therapy is and what its effectiveness is.

Migraine in childhood: biobehavioural or psychosomatic disorder?

It is well documented that headache is a multifactorial disorder which includes not only genetic, biological, medical and neuropsychological factor but also psychological and personality traits. The close relationship between stress and migraine attacks and the significant psychiatric comorbidities in migraine provide evidence of a “paradigm” of tight interaction between somatic and psychological aspects in paediatric migraine. In particular in younger children, an uncomfortable situation, a psychological problem or an emotional distress is rarely expressed directly but usually through physical symptoms. So migraine may be considered as a disorder of psychobiological adaptation in which genetic predisposition interplays with internal and/or external environmental influences such as psycho-emotional, climatic, hormonal, dietary or other factors.

The role of attachment insecurity in the emergence of anxiety symptoms in children and adolescents with migraine: an empirical study

BackgroundIt is widely recognised that there are associations between headache, psychiatric comorbidity and attachment insecurity in both adults and children. The aims of this study were: 1) to compare perceived attachment security and anxiety in children and adolescents with migraine without aura and a healthy control group; 2) to test whether the child’s perceived security of attachment to the mother and the father mediated the association between migraine and anxiety.MethodsOne hundred children and adolescents with Migraine without Aura were compared with a control group of 100 children without headache. The Security Scale (measures perceived security of attachments) and the Self-Administered Psychiatric Scales for Children and Adolescents, a measure of anxiety symptoms, were administered to all participants.ResultsThe clinical group had lower attachment security than the control group and higher scores on all anxiety scales. Anxiety was negatively correlated with attachment. Children’s attachment to their mother mediated the increase in global anxiety in the clinical group. Insecure paternal attachment was associated with greater insecurity in maternal attachment, suggesting that there is a complex pathway from migraine to anxiety symptoms mediated by perceived insecurity of paternal attachment and hence also by perceived insecurity of maternal attachment.ConclusionThese results suggest that insecure parental attachment may exacerbate anxiety in children and adolescents with migraine and point to the importance of multimodal interventions, perhaps taking account of family relationships, for children and adolescents with migraine.

Headache and Alexithymia in Children and Adolescents: What Is the Connection?

Background: Headache is one of the most common complaints in children and adolescents and comorbidity rates are very high and the major associated diseases are depression, anxiety, atopic disorders, sleep, and behavioral disorders. In recent years, it has been highlighted that difficulties regulating emotions such as alexithymia have also been associated with diagnosis of somatization. Methods: We carried out a mini review analyzing the relation between alexithymia and primary headache (e.g., migraine and tension type headache) in children and adolescents by synthesizing the relevant studies in the literature on PubMed, PsycINFO, and Google Scholar. Search terms were “alexithymia” combined with the “primary headache,” “migraine,” “tension type headache,” “children,” and “adolescents.” Results: All analyzed studies found higher levels of alexithymia in children and adolescents with headache than control groups but there are different opinions about the relationship between headache and alexithymia. For example, some studies suggest that the association between headache and alexithymia in children may be due to an incomplete development of emotive competency or a general immature cognitive development, instead other studies found a correlation between headache symptoms, insecure attachment, and alexithymia. There seems to be also differences between children with migraine compared to those with tension type headache (TTH). Conclusion: There are some studies on adults suffering from headache or migraine and alexithymia, but there is only a moderate amount of research on pediatric age with different opinions and theories about this relationship. Further studies on children and adolescents are necessary to effectively understand this relationship and to help children to reduce headache and improve emotional consciousness.

P015. Externalizing behaviours in children with headache and epilepsy: a case-control study

Background Epilepsy and migraine are chronic neurological disorders with episodic manifestations that are commonly treated in neurological practice and frequently occur together [1]. These two disorders share several pathophysiological mechanisms. These mechanisms especially involve neurotransmitter and ion channel dysfunctions [2]. Children with epilepsy or headache are at risk of behavioural disorders that can affect their quality of life. Aim of this study was to analyze the possible correlation between externalizing problems and migraine or epilepsy in children.

Face memory and face recognition in children and adolescents with attention deficit hyperactivity disorder: A systematic review

HIGHLIGHTSA systematic review focused on facial recognition in ADHD children and adolescents is proposed.The literature on this argument focused mainly on hot aspects (e.g. emotion recognition, theory of mind) of face recognition.The literature on this argument taking no account of neuropsychological and cognitive elaboration of faces in ADHD children.Previous studies showed a wide and heterogeneous use of tasks to assess emotion recognition and facial expressions.The abilities of memory and recall for faces in ADHD children and adolescents, did not receive much attention in literature. ABSTRACT This review focuses on facial recognition abilities in children and adolescents with attention deficit hyperactivity disorder (ADHD). A systematic review, using PRISMA guidelines, was conducted to identify original articles published prior to May 2017 pertaining to memory, face recognition, affect recognition, facial expression recognition and recall of faces in children and adolescents with ADHD. The qualitative synthesis based on different studies shows a particular focus of the research on facial affect recognition without paying similar attention to the structural encoding of facial recognition. In this review, we further investigate facial recognition abilities in children and adolescents with ADHD, providing synthesis of the results observed in the literature, while detecting face recognition tasks used on face processing abilities in ADHD and identifying aspects not yet explored.

Migraine and attachment type in children and adolescents: what is the role of trauma exposure?

Migraine and attachment insecurity in children and adolescents are often associated. The attachment system can significantly affect the emotional experience and clinical presentation of migraine. The prevalence of migraine in children and adolescent is about 7.7–9.1% and there is a recognized association between migraine and psychiatric comorbidities especially with anxiety disorders, mood disorders, and eating and sleep disorders [1]. Children and adolescents with migraine have an increased risk of developing major depressive episodes and consequently suicide. Furthermore, recent studies reported a significant relationship between migraine and insecure style of attachment. Bowlby defined attachment as a behavioral and cognitive system that regulates an individual’s sense of internal security. According to the most recent studies, traumatic experiences occurring to children with insecure attachment could trigger the activation of the stress mechanism due to the disorganization of the attachment style. Indeed, an increased cortisol secretion triggered by the hypophysis hypothalamus axis adrenal gland (HPA) activation might be responsible for anxiety dysregulation, increased intensity and frequency of headache attacks. Moreover, other researchers found that maltreatments and abuses during childhood increases vulnerability to develop migraine disorder in adulthood. Based on these premises, we have oriented our study on the following objectives: (1) to compare attachment type between children and adolescents with Migraine without Aura (MoA) and a healthy control group; (2) to compare the frequency of trauma exposure in both groups; (3) to examine whether there is a relationship between attachment and trauma impact in both groups; (4) to assess if attachment system or the exposure to trauma affect significantly the clinical presentation of migraine. We investigated these aims through a case-control study. The clinical group was recruited at the BCenter of diagnosis and treatment of Primary Headaches^ of the Department of Pediatrics and Child and Adolescent Neuropsychiatry BSapienza^ University of Rome, Policlinico Umberto I, made up of 101 subjects (55.4% girls; 44.5% boys) aged between 8 and 15 years (mean age 10.84). Children with diagnosis of a secondary headache, presence of diseases that can induce chronic pain, presence of medical or psychiatric comorbidity, patients free of migraine symptomatology for at least 6 months, and patients who stopped the therapy spontaneously were excluded. The control group was recruited in primary and secondary schools of Rome. They were 101 subjects (45.5% girls; 54.4% boys), with mean age of 10.20. The exclusion criteria applied include the following: diagnosis of primary headache or other diagnoses of organic or psychiatric diseases, children younger than age 8 year, and children older than age 15. Headache diagnosis was conducted with the Headache Questionnaire used to investigate the presence or absence of migraine according to the ICHD-3 beta criteria. Perceived attachment security was evaluated using SAT (separation anxiety test), a semiprojective test that allows, in its Italian version, to evaluate the mental models of normal and pathological attachment even in older children (4– 19 years). Finally, the Children’s Impact of Event Scale has been used to measure children and adolescents’ intensity perception of life stress event. With respect to the first objective, our results were in line with most previous studies [2], confirming that children with MoA show higher levels of insecurity attachment than their * Vincenzo Guidetti vincenzo.guidetti@uniroma1.it

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.

Effects of Add-On Ultramicronized N-Palmitol Ethanol Amide in Patients Suffering of Migraine With Aura: A Pilot Study

Background: Palmitoyl ethanol amide (PEA) is an endogenously produced substance showing anti-nociceptive effect through both receptor and non-receptor mediated effects at the level of different cellular and tissue sites. This study showed the results of a single blind study that was conducted to evaluate both the safety and the efficacy of ultramicronized PEA (umPEA; 1,200 mg/day) for up 90 days in patients suffering of Migraine with Aura (MA) treated with NSAIDs. Methods: A total of 20 patients, 8 male (33–56-years, average 41.4 ± 7.8) and 12 female (19–61-years, average 38.5 ± 11.9) with MA were admitted to our observation and diagnosed according to ICHD-3 criteria, they received umPEA (1,200 mg/day) in combination with NSAIDs for up to 90 days. They were revaluated at 30, 60, and 90 days after treatment. Results: umPEA administration induced a statistically significant and time dependent pain relief. In particular, these effects were evident at 60 days (male P = 0.01189; female P = <0.01) and they lasted until the end of the study (male P = 0.0066; female P = 0.01473). Conclusion: Although further studies are needed, our findings indicate that in patients suffering of MA treatment with umPEA had good efficacy and safety which candidate this compound as a therapeutic tool in pain migraine management.