Valentina Baglioni

Intense imagery movements: a common and distinct paediatric subgroup of motor stereotypies.

The aim of this article is to describe a subgroup of children who presented with stereotyped movements in the context of episodes of intense imagery. This is of relevance to current discussions regarding the clinical usefulness of diagnosing motor stereotypies during development.

Health-related quality of life in patients with Gilles de la Tourette syndrome at the transition between adolescence and adulthood

Gilles de la Tourette syndrome (GTS) is a neurodevelopmental condition characterised by tics and co-morbid behavioural problems, affecting predominantly male patients. Tic severity typically fluctuates over time, with a consistent pattern showing improvement after adolescence in a considerable proportion of patients. Both tics and behavioural co-morbidities have been shown to have the potential to affect patients’ health-related quality of life (HR-QoL) in children and adults with persisting symptoms. In this study, we present the results of the first investigation of HR-QoL in patients with Gilles de la Tourette syndrome at the transition between adolescence and adulthood using a disease-specific HR-QoL measure, the Gilles de la Tourette Syndrome-Quality of Life-Children and Adolescents scale. Our results showed that patients with GTS and more severe co-morbid anxiety symptoms reported lower HR-QoL across all domains, highlighting the impact of anxiety on patient’s well-being at a critical stage of development. Routine screening for anxiety symptoms is recommended in all patients with GTS seen at transition clinics from paediatric to adult care, to implement effective behavioural and pharmacological interventions as appropriate.

Modelli di attaccamento e personalità nella depressione post partum

AIMS This study investigates the prevalence of post partum depression (PPD) in a sample of Roman women, and the role of socio-demographic variables, personality structure and maternal attachment patterns, in order to identify primary and secondary prevention strategies. METHODS Data were collected in two phases. During the third trimester of pregnancy, a sample of 453 women completed a socio-demographic data sheet and the Edinburgh Postnatal Depression Scale (EPDS). Among the patients scoring 12 or more at EPDS, 15 entered the second phase of the study and completed SCID-II and Adult Attachment Interview. PPD diagnosis was confirmed by the SCID-I. The study group was compared with a control group. RESULTS Among the 453 women who were evaluated, 92 (20.3%) scored ≥12 at EPDS, 39 has been enrolled and 15 entered the study. Presence of depressive symptoms was associated with: complications in pregnancy, previous psychiatric disorders, family and marital conflicts. 66.6% of depressed mothers showed more than one diagnosis on Axis II (particularly avoidant/dependent + borderline or histrionic + dependent). The AAI showed a prevalence of insecure (33.3%) and unresolved/disorganized (46.6%) attachment pattern in the clinical group. DISCUSSION AND CONCLUSIONS Our results suggest that psychological factors such as personality structure and attachment patterns are not only involved in post natal affective disorders, but have a key role in the onset and development of PPD.

Developmental Profile and Diagnoses in Children Presenting with Motor Stereotypies

Introduction Motor stereotypies represent a typical example of the difficulty in distinguishing non-clinical behaviors (physiological and transient) from symptoms or among different disorders [“primary stereotypies,” associated with autistic spectrum disorder (ASD), intellectual disabilities, genetic syndromes, and sensory impairment]. The aim of this study was to obtain an accurate assessment on the relationship between stereotypies and neurodevelopmental disorders. Methods We studied 23 children (3 girls), aged 36–95 months, who requested a consultation due to the persistence or increased severity of motor stereotypies. None of the patients had a previous diagnosis of ASD. The assessment included the Motor Severity Stereotypy Scale (MSSS), the Repetitive Behavior Scale-Revised (RBS-R), the Raven’s Colored Progressive Matrices, the Child Behavior CheckList for ages 1½–5 or 4–18 (CBCL), the Social Responsiveness Scale (SRS), and the Autism Diagnostic Observation Schedule-second edition (ADOS 2). Results All patients were showing motor stereotypies for periods of time varying from 6 to 77 months. The MSSS showed that each child had a limited number of stereotypies; their frequency and intensity were mild. The interference of stereotypies was variable; the impairment in daily life was mild. The RBS-R scores were positive for the subscale of “stereotypic behaviors” in all children. Moreover, several children presented other repetitive behaviors, mainly “ritualistic behavior” and “sameness behavior.” All patients showed a normal cognitive level. The CBCL evidenced behavioral problems in 22% of the children: internalizing problems, attention, and withdrawn were the main complaints. On the SRS, all but one of the tested patients obtained clinical scores in the clinical range for at least one area. On the ADOS 2, 4 patients obtained scores indicating a moderate level of ASD symptoms, 4 had a mild level, and 15 showed no or minimal signs of ASD. Discussion Motor stereotypies in children with normal cognitive level represent a challenging diagnostic issue for which a finely tailored assessment is mandatory in order to define a precise developmental profile. Thus, careful and cautious use of standardized tests is warranted to avoid misdiagnosis. Furthermore, it is hard to consider motor stereotypies, even the primary ones, exclusively as a movement disorder.

Inhibition is impaired in children with obsessive-compulsive symptoms but not in those with tics: Action Inhibition in Tourette and Ocd Patients

Background: Impaired inhibitory control is thought to be a core deficit in psychiatric disorders where patients exhibit problems with controlling urges. These problems include the urge to perform movements typical of Tourette syndrome and the urge to execute compulsive actions typical of obsessive‐compulsive disorder. However, the picture emerging from studies that address this issue is controversial. Furthermore, most studies have only focused on reactive control (the ability of subjects to react to a stop signal), but not on proactive control (the ability of patients to shape their response strategies in anticipation of known task demands).

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.

Pharmacological Strategies in the Prevention of Migraine in Children

Preventative treatment of migraine is not only based on drugs. A balanced, flexible and individual treatment must include both non-pharmacological methods, such as bio-behavioral strategies as well as pharmacological measures [1].

Self-, parent-, and teacher-reported behavioral symptoms in youngsters with Tourette syndrome: A case-control study

Dear Editor, We read with great interest in the Eur J Paediatr Neurol the recent contribution by Termine et al., who investigated the usefulness of selfand proxy-report instruments in assisting the clinical assessment of young people with Tourette Syndrome (TS). The authors found that self-report instruments have limited usefulness in differentiating the TS group from the control group in regards to behavioural symptoms. They concluded that young patients with TS tend to underestimate the severity of their behavioural and emotional problems, possibly due to lack of insight, denial or intrinsic limitations of self-report instruments in this age group. On the premise that the selfand proxy-report scales are a valid supplement of the direct clinical examination, we would like to pay attention to some clinical variables of TS that could offer a further key of reading of these results. Recently, we examined a sample of 31 young patients with TS, comparable for age, gender and age at onset of tics to patients of Termineet al., andwe evaluated themwith a similar assessment protocol, using self-report (SAFA and CDI) and proxy-report (CBCL, CPRS and CTRS) instruments. The two samplesdiffered for someclinical characteristics; ourgrouphad a higher tic severity: indeed, even if themean total YGTSS score wassimilar (37.7 15.7vs37.1 22.5 inourvsTermine’ssample, respectively), the number of patients on pharmacotherapy for ticmanagementwashigher inour sample than in theTermine’s sample (14/31 vs 7/23, respectively). On the other hand, Termine’s TS patients had significantly higher CY-BOCS scores. Most of the total and subscale scores of self-report and proxy-report instruments strikingly overlapped in the two samples. On the contrary, our group obtained significantly higher mean scores in comparison with that of Termine et al. in the CBCL’s clinical scales for Internalization, AnxiouseDepressed and Total score. Moreover, in a large part of SAFA subscales our patients obtained higher mean scores, even if these differences were not significant: however, it must be noticed that these scores could differentiate our TS group from Termine’s control group. In attempt to explain these differences, we examined our sample according to those clinical meaningful variables that could be correlated to the severity of symptoms. Specifically,we stratified our patients based on median age at evaluation ( 12 yrs vs>12 yrs),medianduration of symptoms ( 6 yrs vs>6 yrs), and use of anti-tic pharmacological therapy (NO vs YES). When considering age at evaluation, we noticed that most of item scores of SAFA Anxiety and SAFA Depression were higher in older patients. In particular, the subitems of the SAFA Anxiety e Separation anxiety and Critical itemand of the SAFA Depression e Sense of inadequacy and Critical itemwere significantly different. On the contrary, the duration of TS symptoms was correlated to significantly higher scores in the total and compulsion subscales of the CY-BOCS. Finally, no significantly differences in selfand proxyinstrument scores were found between patients treated or not with anti-tic pharmacotherapy. In conclusion, the discrepancies between Termine’s data and ours seem to be related to the characteristic phenotypic variability and the plasticity of the clinical expression of the TS spectrum. However, in this regard, in such a limited number of participants it is not possible to recognize univocal characteristics through all ages and levels of impairment of the TS. Thus, in our opinion the underestimation of behavioural and emotional problems severity in TS could be attributed to some clinical characteristics e age of patients and severity of symptoms e more than to a lack of insight, denial or intrinsic limitation of self-report instruments.