Empatia affettiva e cognitiva in adolescenti con anoressia nervosa

Scopo dello studio è delineare il profilo empatico, affettivo e cognitivo, in adolescenti con Anoressia Nervosa (AN). A tal proposito, abbiamo confrontato 21 pazienti di sesso femminile con AN con un gruppo di 45 ragazze di pari età, utilizzando l’Interpersonal Reactivity Index (IRI). Abbiamo poi correlato le caratteristiche empatiche del gruppo di osservazione con: entità del disturbo alimentare (considerando il BMI, la durata di malattia e l’EAT-26); eventuali tratti psicopatologici associati, (misurati dalla CBCL 6-18, dalla YSR 11-18 e dall’EDI 3); eventuale presenza di alessitimia (attraverso la TAS-20). Le pazienti mostrano importanti deficit dell’empatia cognitiva, soprattutto nella scala Perspective Taking (PT), al contrario, non ci sono differenze, rispetto ai controlli, nelle due scale affettive dell’IRI. Il deficit di empatia cognitiva non presenta correlazioni né con gli indici di gravità del disturbo alimentare, né con la presenza di tratti psicopatologici. Inoltre, le pazienti mostrano alti livelli di alessitimia, che tuttavia sono indipendenti dal deficit di PT

Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice

OBJECTIVES: The acute tolerability of methylphenidate (MPH) in children with attention-deficit/hyperactivity disorder (ADHD) has been studied mainly in research samples. Taking advantage of the mandatory test-dose procedure required for starting MPH in Italy, this study aimed to assess the incidence of intolerable adverse events after initial exposure to MPH in routine clinical practice. METHODS: The medical records of 480 consecutively treated, previously drug-naïve children and adolescents with ADHD (90% male, mean age 10.6 ± 3.0 years) were retrospectively analyzed. All children received an initial single dose of MPH immediate release (5 or 10 mg) followed by a 4-hour direct medical observation. Heart rate and blood pressure were measured at dosing and 1, 2, and 3 hours afterwards. If the first dose was well tolerated, the child continued treatment with MPH 5–20 mg daily, and was reassessed a week later. RESULTS: Eleven patients (2.3%, 95% CI 1.1–4.1) interrupted treatment within a week of initiation because of the following adverse events: irritability (n = 3), tics worsening (n = 3), reduced appetite (n = 1), enuresis (n = 1), hallucinations (n = 1), hyperfocus (n = 1), and ‘rebound’ behavioral worsening (n = 1). The most common adverse events were reduced appetite (20%), irritability (14.2%), headache (10.6%), sleep problems (9.4%), stomachache (9.4%), and tics (5%). Intellectual disability increased the risk of any adverse event in general and of irritability in particular. No cardiovascular symptom was clinically reported. However, routine assessments of vital signs during the first 3 hours after the first dose of MPH showed that 9% of the children had a 20% increase in heart rate, 8.8% had a 20% increase in diastolic blood pressure and 4.5% had a 20% increase in systolic blood pressure. Of these, 25.2% still had an elevated heart rate 1 week later. CONCLUSIONS: Among stimulant-naïve children in clinical practice, the incidence of acute MPH intolerance can be estimated to be between 1.2 and 4.1%. An asymptomatic elevation in cardiovascular parameters can be observed in about 1 out of 10 children and warrants monitoring during ongoing treatment

Perspective taking in adolescenti con anoressia nervosa: uno studio di eye-tracking

Abbiamo indagato i tratti autistici e le abilità di perspective taking di un gruppo di 24 adolescenti con Anoressia Nervosa (AN) appaiato per genere, età e QI ad un gruppo di 23 soggetti sani. Entrambi i campioni hanno completato un task al computer nel quale un director forniva indicazioni su quali oggetti, posti all’interno di uno scaffale, spostare. Il task comprendeva 36 trials, raggruppati in tre tipologie (con distrattore dimensionale - con distrattore spaziale - controllo). Le misure di accuratezza, le misure temporali e di eye-tracking sono state correlate con: tratti autistici, caratteristiche empatiche, livelli di alessitimia, entità del disturbo alimentare e tratti psicopatologici associati. Si rilevano tratti autistici più marcati nel campione clinico rispetto a quello di controllo. Al paradigma di perspective taking, i soggetti con AN mostrano latenze più lunghe nel fornire le risposte, sia nella condizione con distrattore, sia nella condizione controllo. Talo dato potrebbe indicare che le pazienti impiegano un tempo maggiore per “mettersi nei panni dell’altro” rispetto ai soggetti sani e, allo stesso tempo, una difficoltà di analisi visuospaziale. La durata dei trials non differisce in entrambe le condizioni (con distrattore-controllo) tra i due gruppi, pertanto, i soggetti con AN sono più rapidi nel fornire la risposta corretta, elemento che potrebbe essere spiegato con gli elevati livelli di perfezionismo che caratterizzano la patologia. Per entrambe le condizioni (con distrattore-controllo), emergono correlazioni con i tratti autistici. Nei soggetti con AN, una ridotta capacità di attention switching inficia le prestazioni temporali in entrambe le condizioni. Per quanto riguarda la condizione con distrattore dimensionale, nella quale si chiede al soggetto di focalizzarsi su aspetti dimensionali dell’oggetto (grande-piccolo), abilità sociali ridotte, come anche una maggiore severità del disturbo alimentare e una più spiccata psicopatologia associata, si ripercuotono negativamente sulla qualità della risposta

Biological Bases of Empathy and Social Cognition in Patients with Attention-Deficit/Hyperactivity Disorder: A Focus on Treatment with Psychostimulants

In recent years, there has been growing interest in investigating the effect of specific pharmacological treatments for ADHD not only on its core symptoms, but also on social skills in youths. This stands especially true for ADHD patients displaying impulsive aggressiveness and antisocial behaviors, being the comorbidity with Disruptive Behavior Disorders, one of the most frequently observed in clinical settings. This systematic review aimed to synthesize research findings on this topic following PRISMA guidelines and to identify gaps in current knowledge, future directions, and treatment implications. Search strategies included the following terms: ADHD; methylphenidate and other ADHD drugs; empathy, theory of mind and emotion recognition. Full-text articles were retrieved and data from individual studies were collected. Thirteen studies were finally included in our systematic review. Ten studies assessing changes in empathy and/or theory of mind in patients with ADHD treated after pharmacological interventions were identified. Similarly, seven partially overlapping studies assessing changes in emotion recognition were retrieved. Despite a great heterogeneity in the methodological characteristics of the included studies, most of them reported an improvement in emphatic and theory of mind abilities in youths with ADHD treated with psychostimulants and nonstimulant drugs, as well as positive but less consistent results about emotion recognition performances

The impact of internalizing symptoms on autistic traits in adolescents with restrictive anorexia nervosa

Background: Although previous studies indicated a positive association between restrictive anorexia-nervosa (AN-R) and autistic traits, the potential interference of psychiatric internalizing comorbidity on this association is not yet fully investigated. Materials and methods: The aim of this study was to explore autistic traits and internalizing psychopathology in adolescents (age range: 11.7–17.2 years) with AN-R. Twenty-five patients referred to two tertiary-care hospitals were compared to a large control group (N=170) with no differences in age and sex. AN-R patients and controls filled out instruments assessing autistic traits (autism spectrum quotient [AQ]), psychopathology (youth self-report [YSR] 11–18), and eating patterns (eating attitude test [EAT]). In order to disentangle the possible mediating role of internalizing symptoms on autistic traits, two separate control groups (called True and False healthy control, both composed of 25 eating-problem-free participants) were derived from the whole control group on the basis of the presence or absence of internalizing problems in the YSR. Results: AN-R patients scored significantly higher on AQ compared to the whole control group and to controls without internalizing problems (True HC), but these differences disappeared when only controls with internalizing problems (False HC) were considered. Conclusion: Autistic traits in AN-R individuals may have been overestimated and may partly be due to comorbid internalizing symptoms in investigated patients

Emotional dysregulation and callous unemotional traits as possible predictors of short-term response to methylphenidate monotherapy in drug-naïve youth with ADHD

Background: emotional dysregulation (ED) and callous unemotional (CU) traits can be associated with ADHD in youth, influencing its natural history and outcome, but their effect on medication efficacy is unexplored. We examined whether two measures of baseline ED and CU traits, the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) and the Antisocial Process Screening Device (APSD), respectively, were predictors of change of ADHD-Rating Scale (ADHD-RS) after a 4-week methylphenidate (MPH) monotherapy.Methods: 43 patients (37 males, 8–16 years, mean 9.9 ± 2.7 years) were included. Hierarchical linear regression models were used to explore whether CBCL-DP and APSD might predict ADHD-RS score, controlling for baseline severity.Results: saseline CBCL-DP predicted higher post-treatment ADHD-RS scores in total and hyperactivity-impulsivity, but not in inattention subscale. Baseline APSD was not significantly related to ADHD-RS scores at the follow-up.Limitations: small sample size, lack of gender diversity, non-blind design and short period of observation.Conclusion: ED, assessed with that CBCL-DP, might be a negative predictor of change of hyperactive-impulsive symptoms after MPH treatment and should be systematically assessed at baseline

Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders and Catatonia: The “Iron Triangle” Rediscovered in a Case Report

Catatonia is a complex neuropsychiatric syndrome, occurring in the context of different psychiatric and neurodevelopmental disorders, in neurological and medical disorders, and after substance abuse or withdrawal. The relationship between Autism Spectrum Disorder (ASD), Schizophrenia Spectrum Disorders (SSDs) and catatonia has been previously discussed, with the three disorders interpreted as different manifestations of the same underlying brain disorder (the “Iron Triangle”). We discuss in this paper the diagnostic, clinical and therapeutic implications of this complex relationship in an adolescent with ASD, who presented an acute psychotic onset with catatonia, associated with mixed mood symptoms. Second-generation antipsychotics were used to manage psychotic, behavioral and affective symptoms, with worsening of the catatonic symptoms. In this clinical condition, antipsychotics may be useful at the lowest dosages, with increases only in the acute phases, especially when benzodiazepines are ineffective. Mood stabilizers with higher GABAergic effects (such as Valproate and Gabapentin) and Lithium salts may be more useful and well tolerated, given the frequent association of depressive and manic symptoms with mixed features

Could You Give Me the Blue Brick? LEGO®-Based Therapy as a Social Development Program for Children with Autism Spectrum Disorder: A Systematic Review

LEGO®-based therapy is a social skills development program aimed at children with autism spectrum disorder (ASD). A systematic review of the literature was conducted using PRISMA guidelines. PubMed, Scopus and Web of Science bibliographic databases were searched from their date of inception to August 2020. The review included 19 studies. Studies were classified according to experimental designs (e.g., Randomized Control Trial, Non-Randomized Studies of Interventions and case report and series) and a narrative synthesis of each was provided, along with a critical discussion of the strengths and weaknesses of the available literature on the topic. Although LEGO®-based therapy appears a promising treatment for social interaction in ASD, the findings of LEGO®-based therapy studies should be interpreted and generalized with caution, due to the low quality of the studies and the small sample sizes