Neuropsychological Profile, Emotional/Behavioral Problems, and Parental Stress in Children with Neurodevelopmental Disorders

Background: The aim of our study was to trace a specific neuropsychological profile, to investigate emotional-behavioral problems and parental stress in children with Autism Spectrum Disorder Level 1/High functioning (ASD-HF), Specific Learning Disorders (SLD) and Attention Deficit/Hyperactivity Disorder (ADHD) disorders and to highlight similarities and differences among the three groups. Methods: We retrospectively collected the data from a total of 62 subjects with ASD-HF (n = 19) ADHD (n = 21), SLD (n = 22) and 20 typical development. All the participants underwent neuropsychological standardized test for the evaluation of cognitive profile (Wechsler Intelligence Scale for Children Fourth Edition—WISC-IV), behavioral and emotional problems (Child Behavior CheckList CBCL), and parental stress (Parental Stress Index Short Form—PSI-SF). The scores of the ASD-HF, ADHD, and SLD groups were compared using non-parametric statistic methods (Kruskall–Wallis H test and U Mann–Whitney for post-hoc analysis). Results: The ASD-HF group were significantly higher in all areas of the WISC-IV than the other two clinical groups. The SLD group performed significantly lower than ASD-HF in Working Memory Index. The SLD group showed lower scores on the somatic problems subscale than the other two groups. In the Difficult Child subscale of the PSI-SF, parents of ADHD children scored lower than the mothers of SLD subjects and higher than the fathers of SLD subjects. In all three groups there are specific deficiencies compared to the control group in the cognitive profile, behavioral and emotional problems, and parental stress. Conclusions: Our comparative analysis highlighted similarities and differences in three groups of children with different neurodevelopmental disorders, helping to better define cognitive, behavioral, and emotional characteristics of these children and parental stress of their parents

Psychogenic Seizures in Adolescents: An "Evergreen" Diagnostic Challenge

Paroxysmal events are classified as non-epileptic or epileptic symptoms. The first ones are distinguished in psychogenic and organic/physiological paroxysmal events (Lüders et al., 2019). In organic and physiological disorders there are several symptoms: inattention, daydreaming, staring, sleep myoclonus, stereotyped movements, hypnotic spasms, tonic postures, parasomnia, movement disorders. Psychogenic non-epileptic seizures (PNES) are not associated with abnormal brain EEG activity and cannot be explained by other neurological disorders. PNES are also defined as functional neurological disorders and are included among the Conversion Disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). This disorder is characterized by symptoms of impaired voluntary or sensorimotor function without the presence of other neurological or clinical conditions

Psychogenic Seizures in Adolescents: An “Evergreen” Diagnostic Challenge

Psychogenic non-epileptic seizures (PNES) are not associated with abnormal brain EEG activity and cannot be explained by other neurological disorders. PNES are also defined as functional neurological disorders and are included among the Conversion Disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is no doubt about the importance of an early and correct diagnosis of PNES. Diagnostic process is first based on an accurate clinical history. Video-EEG is considered the gold standard for the diagnosis, though it is often time consuming and it does not always allow to record an ictal event. When PNES is diagnosed, because it is not a seizure and no emergency treatment is required, the first goal is to ensure acceptance of the diagnosis. Initially, putative precipitating stressors need to be identified and addressed so that PNES can be contained and managed. Possible interventions for patients with PNES include psychotherapy, family counseling interventions, changes in the school environment and drug treatment. The latter may include anxyolytics and/or antidepressants; in case of a comorbid ADHD disorder, methylphenidate may be also considered.</em

Social Cognition in Neuropsychiatric Disorders in Pediatric Age

Objective: The purpose of our study was to assess social cognition in adolescents and children with epilepsy or Specific Learning Disorder (SLD) compared to typical individuals. It was verified whether the age of onset, duration and drug therapy of epileptics can influence this ability and if there is a correlation between Social Cognition, intelligence and executive functions. Methods: This is an observational cross-sectional study that included a total of 125 subjects between 7 and 16 years (62 with focal epilepsy and 63 with SLD). The control group included 32 healthy subjects. Study subjects were evaluated with neuropsychological tools to evaluate executive functions (EpiTrack Junior), Social Cognition (NEPSY-II), and intelligence; a nonverbal cognitive test (Raven's Matrices) was used in subjects with Epilepsy, while WISC-IV was administered to SLDs. Results: the groups of subjects scored significantly lower than the controls in Social Cognition. The results showed a positive correlation between affect recognition scores and executive function in both groups. In patients with epilepsy the deficit in Affect Recognition appeared to be linked with early age of onset of epilepsy, long term of disease and lack of non-verbal intelligence; a high frequency of seizures, on the other hand, was related to poor performance in the Theory of Mind (ToM). In the SLD group there was no correlation between social cognition and intellectual level. Conclusions: The results of our study suggest that individuals with focal epilepsy or SLD have deficits in the recognition of facial emotions and ToM compared to their peers. In epilepsy group, the Social Cognition deficit seems to be linked to characteristics of epilepsy, particularly the deficits in the recognition of facial emotions seems linked to problems in nonverbal intelligence and in executive function. In the SLD group, however, the ability to recognize emotions was correlated only with executive functions

Social Cognition in Neuropsychiatric Disorders in Pediatric Age

Objective: The purpose of our study was to assess social cognition in ad-olescents and children with epilepsy or Specific Learning Disorder (SLD) compared to typical individuals. It was verified whether the age of onset, duration and drug therapy of epileptics can influence this ability and if there is a correlation between Social Cognition, intelligence and executive functions.Methods: This is an observational cross-sectional study that included a total of 125 subjects between 7 and 16 years (62 with focal epilepsy and 63 with SLD). The control group included 32 healthy subjects. Study sub-jects were evaluated with neuropsychological tools to evaluate executive functions (EpiTrack Junior), Social Cognition (NEPSY-II), and intelli-gence; a nonverbal cognitive test (Raven's Matrices) was used in subjects with Epilepsy, while WISC-IV was administered to SLDs.Results: the groups of subjects scored significantly lower than the con-trols in Social Cognition. The results showed a positive correlation be-tween affect recognition scores and executive function in both groups. In patients with epilepsy the deficit in Affect Recognition appeared to be linked with early age of onset of epilepsy, long term of disease and lack of non-verbal intelligence; a high frequency of seizures, on the other hand, was related to poor performance in the Theory of Mind (ToM). In the SLD group there was no correlation between social cognition and in-tellectual level.Conclusions: The results of our study suggest that individuals with focal epilepsy or SLD have deficits in the recognition of facial emotions and ToM compared to their peers.In epilepsy group, the Social Cognition deficit seems to be linked to char-acteristics of epilepsy, particularly the deficits in the recognition of facial emotions seems linked to problems in nonverbal intelligence and in exec-utive function.In the SLD group, however, the ability to recognize emotions was corre-lated only with executive functions.</p

Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis

Background: Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, and cyanosis. Since sodium nitrite is a preservative, the ingestion of foods containing an excessive amount of this substance can also cause acute intoxication up to death. The present review is aimed at guiding health professionals in the identification and management of sodium-nitrite-related intoxications and deaths. Methods: A systematic literature search was carried out on PubMed by following the PRISMA statement’s criteria. A total of 35 studies with 132 cases were enrolled, and the data were cataloged in Microsoft Excel. To establish the causal correlation between sodium nitrite ingestion and death, the Naranjo Adverse Drug Reaction Probability Scale was used. Results: In addition to the small number of cases that have currently been published, the study demonstrated that there was a general methodological discrepancy in the diagnostic process. However, some interesting results have emerged, especially in post-mortem diagnostics. Conclusion: Sodium-nitrite-related deaths represent a challenge for forensic pathologists; therefore, it is important to promptly recognize the essential features and perform the necessary and unrepeatable examinations for the correct diagnosis of the cause of death

Impact of COVID-19 Pandemic on Children and Adolescents with Neuropsychiatric Disorders: Emotional/Behavioral Symptoms and Parental Stress

The objective of our study was to evaluate the impact of the COVID-19 pandemic on the emotional and behavioral symptoms in minors with neuropsychiatric disorders and on parental stress through a standardized neuropsychological assessment, comparing the data collected before the pandemic with those collected during the lock-down. Another goal of our study was to analyze the relationship between parental stress and behavioral/emotional symptoms in children. Our study was conducted on 383 families of patients who had already been referred at the Child Neuropsychiatry Unit of the University Hospital of Salerno for different neuropsychiatric conditions. All the parents completed two neuropsychological standardized questionnaires for the assessment of parental stress (PSI—Parenting Stress Index-Short Form) and the emotional/behavioral problems of their children (Child Behaviour CheckList). The data collected during the pandemic were compared with those collected from questionnaires administered during the six months preceding the pandemic, as is our usual clinical practice. The comparison between the mean scores of PSI and CBCL before and after the pandemic showed a statistically significant increase in all subscales analyzed in the total sample. The correlation analysis showed significant positive relationship between the subscale Total Stress of PSI and the subscales Total Problems and Internalizing Problems of CBCL. Our study suggested that the COVID-19 pandemic and the corresponding measures adopted led to an increase in internalizing and externalizing symptoms in children and adolescents with neuropsychiatric disorder. Similarly, parental stress increased during COVID-19 and ahigher level of stress in parents can be related to the internalizing symptoms of their children

Usefulness of hybrid SPECT/CT for the 99mTc-HMPAO-labeled leukocyte scintigraphy in a case of cranial osteomyelitis

Cranial osteomyelitis is a potentially fatal lesion. White blood cell scanning (WBC) with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. In this report we show the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of soft tissue and cranial bone infections. 99mTc-HMPAO-labeled leukocytes scintigraphy was performed on an elderly diabetic man with an intracranial mass lesion and with suspected temporal bone infection. Planar scans were acquired 30 min, 4 h, and 24 h after injection. SPECT/CT was obtained 6 h after tracer injection, using a dual-head camera coupled with a low-power X-ray tube. The scintigraphic results were matched with the results of surgery and of clinical follow-up. The planar images alone were true-positives for abscess in this patient. SPECT/CT improves the accuracy of99mTc-HMPAO scintigraphy especially in discriminating between soft-tissue and bone involvement. In fact, SPECT/CT also showed temporal bone osteomyelitis. This result indicates that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection

Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review

Fentanyl is a synthetic L-opioid receptor agonist, approximately 100 times more potent than morphine, that is experiencing an upward trend in the field of abuse. Fentanyl patches’ abusive consumption can occur either by transdermal absorption or through other atypical and ingenious routes. In the present case, a 29-year-old man with a history of illicit drug use was found dead in a suburban neighborhood of an Italian city. At autopsy, lungs appeared increased in weight and showed minute subpleural hemorrhages. Airways contained abundant reddish foamy material; in addition, a fentanyl patch protective film was found inside the left main bronchus. Toxicological analysis revealed the presence of morphine, fentanyl, BEG and ethyl alcohol in peripheric blood; 6-MAM was also revealed in urine. Findings collected during post-mortem investigations allowed us to identify fentanyl consumption as the cause of death. Fentanyl consumption presumably took place by chewing of a transdermal patch, with subsequent aspiration of the protective film. The pathophysiology of death can be identified as combined respiratory failure—both central suppression and a fentanyl-induced increase in muscular stiffness; a further minor contribution may be identified in the mechanical airflow obstruction caused by the presence of the protective film at the bronchial level