Paola Alessandra Lecce

Psychiatric Symptoms and Quality of Life in Patients Affected by Epidermolysis Bullosa

The aim of our study was to provide a psychosocial and psychiatric evaluation of patients with epidermolysis bullosa (EB; a rare genetic disorder characterized by skin fragility), to assess psychological status, ascertain the presence of any psychiatric disorders and understand the impact of EB on quality of life. Twenty-five patients were assessed using a case record form and several standardized instruments. In 82% of patients, EB had a negative impact on quality of life and 80% of patients experienced psychiatric symptoms. Our findings revealed a high prevalence of psychosocial problems and psychiatric symptoms in patients with EB and suggested that a combined bio-psychosocial approach is the most appropriate therapeutic intervention.

Psychopathology in children and adolescents with primary headaches: categorical and dimensional approaches.

Background Recurrent headache is common in childhood, but there is not a great amount of data on the associations between headaches and psychopathology in children. Objective The aim of this study is to examine the relationships between primary headaches and psychopathology in children, using both the categorical and dimensional assessment. Methods The sample consisted of 70 patients with primary headache compared to a matched sample of 50 healthy children. Psychiatric comorbidity was defined according to the diagnostic criteria of the Diagnostic and Statistical Manual of Disorders. Child psychopathology outcomes were assessed using child- and parent-reported standardized instruments. Results Internalizing and externalizing problems were significantly represented among children with headaches compared to the control group, respectively 63% and 27%, without significant differences between migraine and tension-type headache children. Moreover, a total of 26% of the children with a headache reported psychiatric comorbidity such as anxiety and mood disorders. Conclusion The dimensional approach improves accuracy in the recognition of emotional and behavioral problems compared to the categorical approach; however, the use of both of these approaches could be useful for clinical practice, treatment and research.

Familial liability, obstetric complications and childhood development abnormalities in early onset schizophrenia: a case control study

BackgroundGenetic and environmental risk factors and gene-environment interactions are linked to higher likelihood of developing schizophrenia in accordance with the neurodevelopmental model of disease; little is known about risk factors and early development in early-onset schizophrenia (EOS) and very early-onset schizophrenia (VEOS).MethodsWe present a case-control study of a sample of 21 patients with EOS/VEOS and a control group of 21 patients with migraine, recruited from the Child Neuropsychiatry Unit, Department of Neurologic and Psychiatric Science, University of Bari, Italy. The aim was to assess the statistical association between VEOS/EOS and family history for psychiatric disorders, obstetric complications and childhood developmental abnormalities using 2 × 2 tables and a Chi Squared or Fisher test.ResultsThe results show a statistical association between EOS/VEOS and schizophrenia and related disorders (P = 0.02) and personality disorders (P = 0.003) in relatives, and between EOS/VEOS and developmental abnormalities of early relational skills (P = 0.008) and learning (P = 0.04); there is not a statistically relevant difference between cases and controls (P > 0.05) for any obstetric complications (pre, peri and postpartum).ConclusionsThis study confirms the significant role of familial liability but not of obstetric complications in the pathogenesis of VEOS/EOS; the association between childhood developmental abnormalities and EOS/VEOS supports the neurodevelopmental model of disease.

Leiter-R versus developmental quotient for estimating cognitive function in preschoolers with pervasive developmental disorders

The utility of the developmental quotient (DQ) obtained with the Psychoeducational Profile Revised (PEP-R) was assessed as a means of estimating cognitive ability in young children with pervasive developmental disorders. Data from the PEP-R were analysed in a sample of 44 children aged from 2.0 to 5.9 years (mean 3.46 ± 1), 13 with an autistic disorder and 31 with a pervasive developmental disorder not otherwise specified. DQ scores were compared with scores from the Leiter International Performance Scale Revised-Visualization and Reasoning Battery (Leiter-R) in the same 44 children. Overall and domain DQs on the PEP-R were significantly correlated with Leiter-R scores. This study suggests that DQ scores obtained from the PEP-R in preschool children with pervasive developmental disorders may be a viable alternative to the Leiter-R as an assessment tool.

Mental health in migrant schoolchildren in Italy: teacher-reported behavior and emotional problems.

The migration process is a cause of physical and social stressors that may lead to mental health problems, particularly in children. In Italy, there are few studies about migrant children’s mental health; thus, the aim of this study is to compare the prevalence and types of emotional and behavioral problems in migrant schoolchildren to those of native Italian children. The research involved migrant (first- and second-generation) and native schoolchildren attending kindergarten, primary, and secondary school. A questionnaire was administered to parents to collect information about the sociodemographic characteristics of the children. All teachers filled in the Teacher’s Report Form for migrant and native children. The findings show that teachers detect academic and adaptive problems more easily in migrant schoolchildren, but they are probably less aware of the children’s psychological problems. The observations made in this study provide a starting point in understanding the psychological status and main problems noted among migrant children.

A childhood case of symptomatic essential and psychogenic palatal tremor

Palatal tremor is a rare movement disorder characterized by rhythmic contractions of the soft palate. It is most often symptomatic, secondary to brainstem or cerebellar disease and, in rarer cases, is categorized as essential in the absence of documented brain lesions. There have also been reports in the literature of cases of palatal tremor described as psychogenic because they were associated with psychological or psychiatric disorders. We describe the case of a 12-year-old boy with palatal tremor presenting clinical features of symptomatic essential and psychogenic palatal tremor, thus suggesting a neuropsychopathological continuum between the different forms of disease.

Juvenile sex offenders: Personality profile, coping styles and parental care

In recent years, there has been an increasing interest in juvenile sex offenders showing that this population is highly heterogeneous. The aim of the present study was to identify possible different profiles that could help understand the motivation behind offending, comparing 31 Juvenile Sexual Offenders (JSOs), 31 Juvenile Sexual Non Offenders (JSNOs) and 31 Juvenile Non Offenders (Control Group). A data collection form, the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) or Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Coping Inventory for Stressful Situations (CISS) and the Parental Bonding Inventory (PBI) were administered to all participants. The results show that JSOs differs from JNSOs in some domains, such as living in single-parent homes, while maintain some common aspects such as academic failure and previous sexual intercourse. Moreover, JNSOs showed more abnormal personality traits, such as Authority Problems, MacAndrew Alcoholism, Acknowledgement and Alcohol-Drug Problem Proneness compared to JSOs and the Control Group, while JSOs and JNSOs use a coping strategy more oriented to Avoidance and Distraction compared to the Control group. Finally, JSOs described the relationships with fathers characterized by higher care and protection than JNSOs. These findings provide additional evidence with respect the prevention and treatment of criminal sexual behavior in adolescent.

Depressive and adjustment disorders - some questions about the differential diagnosis: case studies.

Background Diagnosis and treatment of mood disorders in youth are still problematic because in this age the clinical presentation is atypical, and the diagnostic tools and the therapies are the same as that used for the adults. Mood disorders are categorically divided into unipolar disorders (major depressive disorder and dysthymic disorder) and bipolar disorder in Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision), but mood symptoms are also comprised in the diagnostic criteria of the adjustment disorder (AD), which occur in many different psychiatric disorders, and may also be found in some physical conditions. The differential diagnosis is not much addressed in the midst of clinical investigation and so remains the major problem in the clinical practice. Aims The associations between some variables and the depressive disorder and AD were analyzed to make considerations about differential diagnosis. Patients and methods We reported a retrospective study of 60 patients affected by depressive disorder and AD. The analysis has evaluated the association between some variables and the single diagnostic categories. We have considered 10 variables, of which 6 are specific to the disorders, and 4 have been considered related problems. Results The statistical analysis showed significant results for the associations of 3 variables (prevalent symptoms, treatment, and family history) with the single diagnostic categories. Conclusion The discriminate analysis resulted in statistically significant differences between patients with depressive disorders and those with AD on 3 variables, of which 2 are specific to the disorders, and 1 is included in the related problems. The other variables were weakly associated with the single diagnostic categories without any statistically significant differences. The 3 variables that were associated with the single diagnostic categories support the distinct construct validity of the 2 diagnostic categories, but, to date, it is difficult to establish if these variables can be considered diagnostic predictors. On the other hand, the other variables did not support the distinct construct validity of the 2 diagnostic categories, which suggest an overlapping and dimensional concept. The spectrum approach could unify categorical classification that is essential with a dimensional view. Combination of dimensional and categorical principles for classifying mood disorders may help to reduce the problems of underdiagnosis and undertreatment.

Parental bonds in adolescent perpetrators of sexual violence

A deep understanding of the characteristics of sex offenders may serve to improve clinical prevention and treatment programs. Mostly, however, this knowledge can aid in the creation of better re-education and rehabilitation programs as well as criminological treatment. In prison systems outside of Italy, the use of treatment programs specifically designed for sex offenders is commonplace, whereas in Italy, there is only sporadic experimentation in this field which is aimed at evaluating adults. If this is true for adults, it is even more so for the minors who commit this type of crime that gives rise to worry and a great sense of alarm. The aim of this work is to show the preliminary results of an empirical study that explores the mental representations of the parents of minors who commit acts of sexual violence towards other. This study is an ongoing in collaboration with the Juvenile Justice Center (Centro Giustizia Minorile) of the Region of Apulia, whose first data on 10 juvenile perpetrators of such specific crimes are presented here.

Parenting Stress and Emotional/Behavioral Problems in Adolescents with Primary Headache

Primary headache is a frequent and disabling disorder, common among children and adolescents, and it is a painful syndrome often accompanied by functional impairment and associated with emotional and behavior problems. The aim of this study was to investigate parenting stress and emotional/behavioral problems in adolescents affected by primary headache compared with healthy adolescents. The study population consisted of 35 adolescents and a control group of 23 healthy subjects. The assessment included the administration of clinical standardized scales such as Parent Stress Index-Short Form, Pediatric Migraine Disability Assessment Score Questionnaire, and Child Behavior Checklist (CBCL). Headache group and control group did not differ in terms of parenting stress (p = 0.29). On the contrary, headache group showed more internalizing problems (p = 0.023), affective problems (p = 0.01), anxious (p = 0.001), and somatic complaints (p < 0.001) compared with control group. In addition, we found a significant correlation between PSI domains and specific CBCL subscales in the headache group. The findings emphasize the need for expanded intervention in the clinical treatment of pediatric headache, a treatment that may also include the family members. Further research is needed.