The Use of Psychotropic Medication in Pediatric Oncology for Acute Psychological and Psychiatric Problems: Balancing Risks and Benefits

Severe acute behavioral and emotional problems represent one of the most serious treatment-related adverse effects for children and adolescents who have cancer. The critical and severe nature of these symptoms often makes necessary the use of psychotropic drugs. A working group composed of experts in multiple disciplines had the task of creating an agreement regarding a management plan for severe acute behavioral and emotional problems (SABEPs) in children and adolescents treated for cancer. To obtain global information on the use of psychotropic drugs in pediatric oncology, the working group first developed and mailed a 15-item questionnaire to many Italian pediatric oncology centers. Overall, an evident lack of knowledge and education regarding the use of psychotropic medications for the treatment of SABEPs was found. Thus, by referring to an adapted version of the Delphi method of consensus and standard methods for the elaboration of clinical questions (PICOs), the working group elaborated evidence-based recommendations for psychotropic drugs in the pediatric oncology setting. Furthermore, based on a thorough multivariate analysis of needs and difficulties, a comprehensive management flow was developed to optimize therapeutic interventions, which allows more accurate and efficient matching of the acute needs of patients while guiding treatment options

Sintomatologia e risposte psicologiche dei genitori di fronte alla malattia del figlio

La ricerca nasce da un interesse verso la sofferenza psicologica di genitori di bambini con malattia oncologica. Lo scopo era di evidenziare le aree di disagio più presenti, verificare l’andamento della sofferenza dei genitori durante il percorso di malattia e quale ruolo assumano le differenze di genere, tra madri e padri, nelle risposte psicologiche. Il campione era costituito da 39 genitori (23 madri; 16 padri) di bambini con diagnosi oncologica. Lo strumento utilizzato è stato il Symptom Questionnaire, SQ (Kellner 1976), questionario self-report composto da 4 scale (depressione, ansia, somatizzazione, ostilità), compilato dai partecipanti in tre fasi del periodo di malattia del bambino: alla diagnosi, dopo 1 mese dalla diagnosi e dopo 3 mesi. Le analisi statistiche hanno evidenziato un decremento significativo, nel tempo, nella sottoscala ansia, che al momento della diagnosi indicava il punteggio più elevato. Le differenze tra madri e padri sul grado di sofferenza mostrato (valori più alti nelle madri), risultano significative solo dopo le dimissioni dall’ospedale. È stato possibile documentare, quindi, la presenza di un elevato livello di sofferenza nel genitore al momento della diagnosi e una graduale riduzione di tale sofferenza nel tempo. Le differenze di genere, non risultano significative nelle prime fasi di malattia, ma si riscontra un aumento di sintomi somatici nelle madri dopo le dimissioni del bambino. Lo studio ha evidenziato la necessità di fornire un assiduo e adeguato supporto psicologico rivolto, non solo al paziente pediatrico ma, anche, alle figure di attaccamento.Physical symptoms and psychological responses of the parents of a child with oncological disease The purpose of this research was to deepen the knowledge on the psychological distress of parents of children with oncological diseases. The aim of this study was to identify which areas are the most affected by suffering, check the progress of the parents’ suffering during the course of illness and to assess the role of gender differences in mothers and fathers in psychological reactions. Thirty-nine parents (23 mothers, 16 fathers) of children diagnosed with cancer were recruited. They were asked to complete the Italian version of the Symptom Questionnaire (Kellner, 1976). The SQ is a 92 item yes/no questionnaire with four subscales: Depression, Anxiety, Anger-Hostility, and Somatic Symptoms. Participants filled out the questionnaire in three different phases of their child’s disease: diagnosis (T1), one month after (T2), and three months after (T3). Statistical analysis showed a significant decrease of suffering over time, especially in the Anxiety Scale (highest scores at T1). Gender differences (mothers vs. fathers) were found. Mothers had higher scores than fathers, but only after the hospital discharge. Overall, results showed a gradual decrease in the levels of distress of parents from T1 to T3. In regard to gender differences, there were no significant differences during the first phases of the illness, but an increase was found in somatic symptoms in mothers, after their child was discharged from the hospital. This study has highlighted the need to provide an adequate and non-stop psychological support; not only for the pediatric patient but also for his/her caregivers

DERMATITE ATOPICA: LA CONSULTAZIONE PSICOLOGICA IN ALLERGOLOGIA PEDIATRICA I parametri percettivi del sonno e del prurito e l\u2019intervento psicoeducativo

Abstract La dermatite atopica \ue8 una delle pi\uf9 frequenti dermatosi presenti in et\ue0 pediatrica. L\u2019approccio multidisciplinare alla cura prevede, oltre alla presenza del dermatologo e del pediatra allergologo, anche uno specifico intervento dello psicologo. L\u2019approccio psicologico si avvale di una pluralit\ue0 di strumenti e di una specifica metodologia, orientata al paradigma dell\u2019Educazione Terapeutica: il colloquio psicologico ad orientamento educativo, l\u2019indagine psico-diagnostica per il paziente e i genitori, le strategie di coping, la psicoterapia. In questo lavoro vengono illustrati i dati raccolti relativi all\u2019indagine che abbiamo condotto su un campione di 50 famiglie con pazienti pediatrici atopici

The Impact of Music Therapy in a Pediatric Oncology Setting: An Italian Observational Network Study

Background: Music Therapy (MT) is a non-pharmacological, art-based intervention that employs music experiences within a therapeutic alliance to attend to clients’ physical, emotional, cognitive, and social requirements. This is the first study aiming at investigating the impact of MT on the psychological facets of children suffering from cancer. Methods: The study, combining the AQR and m-YPAS assessment tools, evaluated behavioral, sound–musical, and interactive parameters in pediatric oncology patients undergoing MT sessions during hospitalization. Fifty patients admitted to the Paediatric Oncology and Haematology Unit at Policlinico S. Orsola Hospital in Bologna, Italy, were enrolled, irrespective of their treatment regimen. Data collection occurred on the first day of the MT session between 3 p.m. and 5 p.m., with observations conducted by independent observers. In addition to traditional statistical analysis, network analysis was used to explore the combined interactions of all parameters, effectively discerning the distinctive roles played by each one during therapy sessions and their influence on all others. Results: Network analysis highlighted distinct patterns of interactions among parameters during the various sessions, emphasizing the role of positive emotions and a calm setting, the child’s ability to take the initiative in sessions, their sense of agency, and the parent’s role in guiding them. Significant differences were recorded at each time point between all variables considered. Conclusions: The results of this innovative study may pave the way for future multicenter studies aimed at further exploring the role of MT in children undergoing both curative and palliative treatments for cancer

Consensus Conference on Clinical Management of pediatric Atopic Dermatitis.

The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease

Consensus Conference on Clinical Management of pediatric Atopic Dermatitis

The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease