Perceived Family Functioning Profile in Adolescents at Clinical High Risk for Psychosis: Rigidity as a Possible Preventive Target

: The presence of a positive family relationship has been suggested as a protective factor from parental stress and from the development of full-blown psychosis. However, to date, there is limited research on family functioning in adolescents with psychosis and at clinical high risk for psychosis (CHR-P). This study is aimed at comparing family functioning and perceived stress in parents of adolescents with either CHR-P, early onset psychosis (EOP), or other psychiatric disorders (no CHR-P). As a secondary aim, it will correlate family functioning with parental perceived stress in order to find critical targets of intervention. We conducted a Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD)-compliant, real-world, cross-sectional study. One-hundred and eleven adolescents aged 12-17 who access the institute of hospitalization and care with scientific character (IRCCS) Mondino Foundation Neuropsychiatric services (Pavia, Italy) between 2017 and 2020 and their parents (n = 222) were included. Sociodemographic characteristics of adolescents and their parents were collected. Family functioning was evaluated through the Family Adaptability and Cohesion Evaluation Scale-IV (FACES-IV) and the level of stress through the Perceived Stress Scale (PSS). Twenty adolescents had EOP, 38 had CHR-P, and 59 had no CHR-P. In total, 2.6% of CHR-P adolescents were adopted, 76.3% had separated-divorced parents, and 34.2% of parents had a depressive disorder. Among the FACES-IV sub-scale, maternal rigidity was progressively increased from no-CHR-P to CHR-P to EOP group, with statistical differences between EOP and the other two groups (p = 0.01). CHR-P mothers and fathers showed a high level of PSS values, without group difference. Lastly, PSS values correlated positively with the Rigidity, Disengagement, and Chaos scale of FACES-IV and negatively with the Communication scale (p < 0.05). Our results suggest that family functioning has a central role and could represent a worthwhile target of intervention for adolescents at CHR-P, leading the way to new preventive approaches

DISTURBI ALIMENTARI RESTRITTIVI IN ADOLESCENZA: LE ALLENZE FAMILIARI POSSONO INFLUIRE SUL DECORSO? UNO STUDIO CLINICO SULLE RELAZIONI FAMILIARI PER UN APPROCCIO TERAPEUTICO PIÙ EFFICACE

L'obiettivo del presente lavoro è quello di approfondire le conoscenze sul ruolo delle dinamiche familiari nei disturbi alimentari restrittivi. Ci siamo concentrati su pazienti severi e afferiti ad un centro di terzo livello. I nostri pazienti hanno mostrato un rischio molto alto di sviluppare psicosi attenuata per intensità e frequenti comorbidità di stampo internalizzante. Se è presente un buon accordo nel rilevarle tra i genitori, sembra che ci siano visioni differenti rispetto ai problemi tra genitori e figlie. Abbiamo usato lo strumento dell'LTPc per indagare la presenza di alleanze familiari disfunzionali che effettivamente abbiamo trovato essere spesso collusive in queste famiglie. Inoltre, le fasi maggiormente compromesse sono state la triadica e quella relativa al funzionamento della coppia genitoriale. Inoltre, è emerso che i genitori, invece, considerano le loro famiglie come globalmente funzionali a differenza di quanto rilevato dai clinici. Le dinamiche familiari si sono dimostrate utili anche per predire l'outcome ed influenzare il tipo di intervento terapeutico. Infine, abbiamo sviluppato un nostro modello di intervento multiprofessionale integrato e studiato con LTPc come questo ha modificato dopo 6 mesi il funzionamento familiare.The aim of this work is to deepen the knowledge on the role of family dynamics in restrictive eating disorders. We focused on severe and third-level center patients. Our patients showed a very high risk of developing psychosis attenuated by intensity and frequent internalizing comorbidities. If there is a good agreement between parents to detect them, it seems that there are different views on the problems between parents and daughters. We used the LTPc tool to investigate the presence of dysfunctional family alliances that we actually found to be often collusive in these families. Furthermore, the most compromised phases were the triadic phase and that relating to the functioning of the parental couple. Furthermore, it emerged that parents, on the other hand, consider their families as globally functional, unlike what clinicians have observed. Family dynamics have also been shown to be useful for predicting outcome and influencing the type of therapeutic intervention. Finally, we developed our own integrated multi-professional intervention model and studied with LTPc as this modified family functioning after 6 months

Recent Advances in Child and Adolescent Psychiatry

The field of child and adolescent psychiatry is receiving growing attention, although a number of local differences still exist in terms of academic curricula, board certifications and even definitions of what is to be considered part of this field or not [...

Recent Advances in Child and Adolescent Psychiatry

The field of child and adolescent psychiatry is receiving growing attention, although a number of local differences still exist in terms of academic curricula, board certifications and even definitions of what is to be considered part of this field or not [...

Psychological Therapy in Adolescents with Chronic Daily Headache

Chronic daily headache is a serious disease, causing significant problems in terms of reduced quality of life and disability, with pain localized to the head (headache) occurring 15 or more days per month for more than 3 months (>180 days per year). Drugs, both used as preventive medications or as pain-killers, are insufficient for the management of these patients; a more global approach has been advocated. This paper reviews existing data concerning different psychological approaches, with a focus on adolescence. This leads to evidence still unanswered questions but also the importance to include psychological treatments in the management of this potentially disabling condition

Delayed appearance of refeeding syndrome in a patient with anorexia nervosa: A case report

Refeeding syndrome (RFS) can be a severe and life-threatening complication of anorexia nervosa (AN) associated with electrolyte abnormalities and organ damage, and occurs with the transition from a prolonged catabolic to anabolic state, particularly with an overzealous nutrient supply. There is no unequivocal definition of RFS, although hypophosphatemia is recognized as a crucial factor in its pathogenesis. RFS can be responsible for cardiovascular complications, such as heart failure, left ventricular damage, and arrhythmias, because of different potential mechanisms: electrolyte imbalances, increased retention of sodium and liquids secondary to insulin secretion, and excessive fat emulsion supplementation. We report on the case of a 13-y-old male patient with severe AN in whom a delayed and reversible myocardial dysfunction was documented during cautious nutritional replenishment, even in the absence of serum electrolyte imbalances. Seven days after the inception of integrative enteral nutrition, heart failure was unexpectedly documented as follows: reduction in fraction ejection, presence of mild bilateral perimalleolar edema, and increased n-terminal prohormone of brain natriuretic peptide. A more pronounced water restriction protocol and delayed achievement of goal feeding rate, resulting also in lower sodium intake, were implemented to reduce cardiac overload with a full resolution of the complication in approximately 2 mo. Refeeding patients with AN could be complicated by heart failure despite cautious nutritional replenishment and regardless of electrolyte imbalance, even in a later phase of recovery. Therefore, strict adherence to recommendations for nutritional replenishment and close monitoring of cardiac function should always be considered when refeeding patients with AN

The impact of family alexithymia on the severity of restrictive eating disorders in adolescent patients

Abstract Background Alexithymia is the inability to identify and describe one’s own emotions. Adolescents who suffer from Restrictive Eating Disorders (REDs) show a higher prevalence of alexithymia than the general population. Methods The study explored the correlation between levels of alexithymia in mothers, fathers, and adolescents affected by REDs and patients’ ability to recognize their emotions. The study also aimed to evaluate if patients’ emotional distress can significantly impact the severity of their disorder and functioning measured by the Clinical Global Impression Scale - Severity (CGI-S) and the Children’s Global Assessment Scale (CGAS). We enrolled 67 families of adolescents affected by REDs. Parents and patients’ levels of alexithymia were assessed through the Toronto Alexithymia Scale (TAS-20). Spearman’s correlation shows a statistically significant correlation between mothers and patients’ levels of alexithymia. Results Our findings also suggest that fathers and mothers’ TAS scores correlate with each other. However, there is no statistically significant relationship between the influence of the TAS scores of fathers and sons/daughters. Conclusions In conclusion, mothers’ level of alexithymia could influence both fathers and patients’ difficulty in identifying and describing their own emotions. This relationship can be investigated further when considering externally oriented thinking. However, the severity of the disease and overall functioning do not appear to be affected by patients’ levels of alexithymia

Corrigendum: Perceived Family Functioning Profile in Adolescents at Clinical High Risk for Psychosis: Rigidity as a Possible Preventive Target

This corrects the article DOI: 10.3389/fpsyt.2022.86120