Studio sulle implicazioni psicoaffettive nel trapianto di cellule staminali emopoietiche (HSCT). Analisi retrospettiva in un campione di soggetti e famiglie dopo almeno 5 anni dal trapianto.

Background.Hematopoietic stem cell transplantation (HSCT) is now the therapeutic treatment for malignant and nonmalignant hematologic diseases and could represent a challenge to pediatric patients and their families. Advances in HSCT procedure have significantly increased the number of HSCT performed each year and have improved long term survival rates, so studies have shifted their focus from survival time to Quality of Life (QoL). Childhood HSCT survivors have been shown to be prone to develop psychological, cognitive, social and familiar, as well as medical, adverse outcomes. (Khera et al., 2012; Syrjala et al., 2012). The aim of the present study is to evaluate psychosocial and behavioral features and QoL of childhood HSCT survivors and their families (including siblings). Secondary aims are to evaluate the level of agreement between survivor-parents reports as for psychopathological areas and QoL; to evaluate parental stress and finally to identify risk and protective factors for mental health. Methods. Paediatric HSCT survivors (at least 5 years post transplantation) and their parent each completed a questionnaire package that included Achenbach test (Child Behaviour Checklist-CBCL; Youth Self Report-YSR), Pediatric Quality of Life Inventory 4.0 (PedsQL) and a brief unstructured text. Parents were also asked to complete an anamnestic interview and two other test: Short Form-36 (SF-36) and Parenting Stress Index scale (PSI). Siblings were asked to complete YSR and a brief unstructured text. Data were analysed using SPSS software. Results From 2012, 37 pediatric HSCT survivors (62% male) were enrolled in the study. The age at HSCT was 10 yrs on average (range 0,7-11,2 yrs). Fifty four percent of survivors were treated with allogenic unrelated HSCT. Seventy-four parent and 38 siblings were also tested. YSR scores exceeded the normative cut off for total competences (22%), social competences (13%) and somatic complains (8%), while CBCL scores were mainly pathological for total competences (49%), activities (22%) and somatic symptoms (11%). Symptoms reported to CBCL were more if: the survivor is female, there were a allogenic related HSCT, there were medical toxicities and if timing since communication of therapeutic choice and HSCT were longer. CBCL and YSR present a good level of agreement only for total competences scale (K=0.06, p= 0.002), somatic symptoms (K=0.21, p= 0.003) and attention problems (k=0.13; p=0.02). As for PedsQL, there was a poor level of agreement between survivors and parents only for physical area (K=0.05; p=0.31) and emotional area (K=0.09; p=0.06). In SF-36 mothers, perceive a worse QoL for “role limitation” scale when they have only one child or more than three children, if timing since communication and HSCT was brief and if survivor was treated with allogenic related HSCT. Fathers perceive a worse mental health if they have one child or more than two children, and if they were married. Siblings who were closer to survivor appear to present a worse QoL according to parents. Conclusion. Pediatric HSCT survivors present psychological distress in many areas (internalizing, externalizing, attention and social areas), with a prevalence of somatic symptoms.As for QoL, parents report better emotional function and lower physical function of the survivor. The first sibling appears to perceive a worse QoL. Mother and father perceive different kind of distress, but having two children appears to be homogeneously protective. Studies are needed to explore discordant perception and finally to improve outcomes and care for pediatric HSCT patients and their families

The impact of the two-year COVID-19 pandemic on hospital admission and readmissions of children and adolescents because of mental health problems

PurposeThis study aimed to investigate the specific risk factors and psycho-social and clinical features of hospitalized neuropsychiatric patients during the COVID pandemic and to analyze the hospital readmission phenomenon, which, according to recent studies, increased in frequency during the first pandemic period.Patients and methodsThis observational retrospective cohort study examined 375 patients aged between 0 and 17 years who were hospitalized between 1 February 2018 and 31 March 2022 due to neuropsychiatric issues. The majority of the patients were girls: there were 265 girls compared to 110 boys (M = 13.9 years; SD 2.30 years). The total sample was divided into two groups: the pre-COVID-19 group (160 inpatients hospitalized between February 2018 and February 2020) and the COVID-19 group (215 inpatients hospitalized between March 2020 and March 2022). To explore the readmission phenomenon (second aim), we selected from the two groups of patients with at least one hospital readmission within 365 days after the first discharge. Multiple variables (sociodemographic, clinical, psychological, and related to hospitalization) were collected for each patient by reviewing their medical records.ResultsThe risk factors for mental health disorders were similar between the two groups, except for the significantly increased use of electronic devices in the COVID-19 group, increasing from 8.8% in the pre-COVID-19 group to 29.2% in the COVID-19 group. Patients suffering from eating disorders increased from 11.3% in the pre-COVID-19 group to 23.8% in the COVID-19 group. Hospital readmissions nearly increased from 16.7% in the 2-year pre-COVID-19 period to 26.2% in the 2-year COVID-19 period. A total of 75% of patients hospitalized three or more times in the last 2 years and 85.7% of the so-called “revolving door” patients (with relapse within 3 months after discharge) were identified in the COVID-19 group. However, the comparison between the two groups of patients readmitted before and during the COVID-19 pandemic did not show any differences in terms of sociodemographic and clinical characteristics.ConclusionIn conclusion, there was a significant increase in hospital readmissions, but these results suggest the need for better coordination between hospital and territorial services in managing the complexity of mental health problems related to situations arising from the COVID-19 pandemic and the necessity to implement prevention strategies and services

Studio sulle implicazioni psicoaffettive nel trapianto di cellule staminali emopoietiche (HSCT). Analisi retrospettiva in un campione di soggetti e famiglie dopo almeno 5 anni dal trapianto.

Background.Hematopoietic stem cell transplantation (HSCT) is now the therapeutic treatment for malignant and nonmalignant hematologic diseases and could represent a challenge to pediatric patients and their families. Advances in HSCT procedure have significantly increased the number of HSCT performed each year and have improved long term survival rates, so studies have shifted their focus from survival time to Quality of Life (QoL). Childhood HSCT survivors have been shown to be prone to develop psychological, cognitive, social and familiar, as well as medical, adverse outcomes. (Khera et al., 2012; Syrjala et al., 2012). The aim of the present study is to evaluate psychosocial and behavioral features and QoL of childhood HSCT survivors and their families (including siblings). Secondary aims are to evaluate the level of agreement between survivor-parents reports as for psychopathological areas and QoL; to evaluate parental stress and finally to identify risk and protective factors for mental health. Methods. Paediatric HSCT survivors (at least 5 years post transplantation) and their parent each completed a questionnaire package that included Achenbach test (Child Behaviour Checklist-CBCL; Youth Self Report-YSR), Pediatric Quality of Life Inventory 4.0 (PedsQL) and a brief unstructured text. Parents were also asked to complete an anamnestic interview and two other test: Short Form-36 (SF-36) and Parenting Stress Index scale (PSI). Siblings were asked to complete YSR and a brief unstructured text. Data were analysed using SPSS software. Results From 2012, 37 pediatric HSCT survivors (62% male) were enrolled in the study. The age at HSCT was 10 yrs on average (range 0,7-11,2 yrs). Fifty four percent of survivors were treated with allogenic unrelated HSCT. Seventy-four parent and 38 siblings were also tested. YSR scores exceeded the normative cut off for total competences (22%), social competences (13%) and somatic complains (8%), while CBCL scores were mainly pathological for total competences (49%), activities (22%) and somatic symptoms (11%). Symptoms reported to CBCL were more if: the survivor is female, there were a allogenic related HSCT, there were medical toxicities and if timing since communication of therapeutic choice and HSCT were longer. CBCL and YSR present a good level of agreement only for total competences scale (K=0.06, p= 0.002), somatic symptoms (K=0.21, p= 0.003) and attention problems (k=0.13; p=0.02). As for PedsQL, there was a poor level of agreement between survivors and parents only for physical area (K=0.05; p=0.31) and emotional area (K=0.09; p=0.06). In SF-36 mothers, perceive a worse QoL for “role limitation” scale when they have only one child or more than three children, if timing since communication and HSCT was brief and if survivor was treated with allogenic related HSCT. Fathers perceive a worse mental health if they have one child or more than two children, and if they were married. Siblings who were closer to survivor appear to present a worse QoL according to parents. Conclusion. Pediatric HSCT survivors present psychological distress in many areas (internalizing, externalizing, attention and social areas), with a prevalence of somatic symptoms.As for QoL, parents report better emotional function and lower physical function of the survivor. The first sibling appears to perceive a worse QoL. Mother and father perceive different kind of distress, but having two children appears to be homogeneously protective. Studies are needed to explore discordant perception and finally to improve outcomes and care for pediatric HSCT patients and their families.Premesse. Il trapianto di cellule staminali ematopoietiche (HSCT) rappresenta ad oggi la terapia per alcune patologie ematologiche maligne e non maligne e costituisce una sfida per iI paziente in età pediatrica e per la sua famiglia. Il progresso medico relativo alla procedura di HSCT ha significativamente aumentato il numero di trapianti eseguiti ogni anno ed ha migliorato le percentuali di sopravvivenza a lungo termine, pertanto gli studi scientifici hanno spostato il loro focus dalla valutazione dei tassi di sopravvivenza all’esplorazione della Qualità di Vita (QoL). I sopravvissuti a HSCT avvenuto in età pediatrica sono stati dimostrati essere una popolazione più suscettibile allo sviluppo di sequele psicologiche, cognitive, sociali e familiari, oltre che mediche (Khera et al., 2012; Syrjala et al., 2012). L’obiettivo dello studio è la valutazione degli aspetti psicosociali e comportamentali oltre che della QoL dei soggetti pediatrici sopravvissuti ad HSCT e delle loro famiglie (includendo i fratelli). Obiettivi secondari sono: la valutazione del livello di accordo tra survivor e genitori relativamente agli aspetti psicopatologici ed alla QoL, la valutazione dello stress genitoriale e infine l’identificazione di fattori di rischio e fattori protettivi per la salute mentale di questi soggetti. Metodo. Sono stati testati soggetti pediatrici sopravvissuti ad HSCT (almeno 5 anni dopo il trapianto) e i loro genitori. Ad ognuno è stato richiesto di completare una batteria di test che includeva i questionari di Achenbach (Child BehaviourChecklist-CBCL; Youth Self Report-YSR) e il PediatricQuality of Life Inventory 4.0 (PedsQL) e di produrre un breve testo libero. Ai genitori è stata richiesto inoltre di completare una intervista anamnestica ed ulteriori due test: il Short Form-36 (SF-36) e il Parenting Stress Index (PSI). Ai fratelli del sopravvissuto è stato chiesto di completare la YSR e di produrre un breve testo libero. I dati sono stati elaborati con l’utilizzo del software SPSS. Risultati. Dal 2012 sono stati reclutati 37 soggetti sopravvissuti ad HSCT (62% maschi). L’età media al momento dell’HSCT era 10 anni (range 0,7-11,2 anni). Cinquantaquattro percento dei sopravvissuti era stato sottoposto a trapianto allogenico non familiare. Sono stati inoltre testati 74 genitori e 38 fratelli. I punteggi dello YSR superano i cut off per competenze totali (22%), competenze sociali (13%) e lamentele somatiche (8%), mentre i punteggi alle CBCL risultano patologici principalmente nelle aree di competenze totali (49%), attività (22%) e sintomi somatici (11%). I sintomi riportati alla CBCL appaiono più significativi se: il sopravvissuto è femmina, in caso di trapianto allogenico familiare, presenza di tossicità mediche e se il tempo intercorso tra la comunicazione della scelta terapeutica e l’HSCT era più lungo. CBCL e YSR presentano un buon grado di accordo solo relativamente alle scale competenze totali (K=0.06, p= 0.002), sintomi somatici (K=0.21, p= 0.003) e problemi di attenzione (k=0.13; p=0.02). Rispetto alla PedsQL genitori e survivor non appaiono in accordo per l’area fisica (K=0.05; p=0.31) ed emotiva (K=0.09; p=0.06). Nella SF-36 le madri percepiscono una peggiore QoL nella scala relativa alla “limitazione del ruolo” quando hanno un solo figlio o più di tre figli, se il tempo intercorso tra la comunicazione della scelta terapeutica e l’HSCT è breve e in caso di trapianto allogenico familiare. I padri percepiscono una salute mentale peggiore se hanno un unico figlio o più di due e se sono sposati. I fratelli più vicini al sopravvissuto per ordine di genitura sembrano presentare una peggiore QoL secondo i genitori. Conclusioni.I soggetti sopravvissuti a HSCT in età pediatrica presentano livelli di stress psicologico in diverse aree (internalizzante, esternalizzante, dell’attenzione e della socializzazione), con una prevalenza di sintomi somatici. Rispetto alla QoL, i genitori riportano un funzionamento emotivo del sopravvissuto migliore a fronte di un peggiore funzionamento fisico. Il primo fratello sembra percepire una QoL peggiore. Madri e padri percepiscono diversamente il proprio distress, ma il fatto di avere due figli appare rappresentare in modo omogeneo un fattore protettivo. Saranno necessari ulteriori studi per approfondire la discordanza tra le percezioni e infine migliorare l’outcome e la cura dei pazienti pediatrici sottoposti ad HSCT e delle loro famiglie

HOSPITALISATION IN CHILD NEUROPSYCHIATRY: A CASE STUDY ALONG A FIVE-YEAR EPIDEMIOLOGICAL-CLINICAL TREND

Objective: In Italy, the number of patients admitted to child and adolescent neuropsychiatry services has almost doubled in the last 10 years. Despite this significant increase in demand, there is still a paucity of literature on mental disorders in the paediatric population. Therefore, we investigated and described the clinical and socio-demographic characteristics of a sample of young Italian inpatients with psychiatric disorders. The aim was to contribute to the jet scarce literature on this topic, while also providing useful information for the clinical-care organisation of mental health services dedicated to children and adolescents. Method: In this retrospective cohort study, data were collected from 361 hospitalised patients aged̀ 1 to 18 who had been admitted to a Child Neuropsychiatry Unit in Northern Italy, from January 2016 to December 2020. Descriptive analyses, Univariate Analysis of Variance (ANOVA), and Chi-square tests were applied. Results: During a five-year timeline, a higher admission rate for females was recorded, and the average age of inpatients was 13.4 years (SD = 3.01). Most of the admissions occurred through the Paediatric Emergency Department, and suicidal behaviour was the most frequent reason for admission. At discharge, affective disorders were the main diagnoses, which were also found to be the most frequent in patients with self-injurious behaviours. Non-suicidal self-injury, which was mainly reported as occurring in order to obtain relief from suffering, regarded 40.8% of the total sample. Almost half of the subjects reported suicidal ideation, and 21.1% attempted suicide. The mean hospitalisation length significantly decreased from 2016–2018 to 2019–2020. In general, patients with psychotic disorders had the longest stays. Conclusions: Ad hoc diagnostic–therapeutic protocols should be developed for psychiatric emergencies, and health personnel should be adequately trained to manage acute psychiatric conditions in developmental age. Primary and secondary prevention programs should be implemented to promptly recognise and treat mental health issues in this age group

Diagnostic and Therapeutic Challenges of Catatonia in an Adolescent With High Functioning Autism Spectrum Disorder: A Case Report

Catatonia is a psychomotor syndrome with specific clusters of speech, behavioral and motor features. Although potentially life-threatening, especially in its malignant form accompanied with autonomic dysregulation and medical complications, it is a treatable condition, when promptly identified. For a long time catatonia was considered a marker of schizophrenia, thus limiting the possibility of diagnosis and treatment. Due to growing awareness and studies on the subject, it is now known that catatonia can occur in the context of a number of diseases, including psychotic, affective and neurodevelopmental disorders. In recent years, there's been a renewed interest in the recognition and definition of catatonia in neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD), where the differential diagnosis poses great challenges, given the considerable overlapping of signs and symptoms between the conditions. We present the case of a 15 year old boy with High Functioning ASD with a sudden onset of severe catatonic symptoms and the co-existence of psychotic symptoms, whose complex clinical course raises many questions on the differentiation and relation of said disorders

Urgency and emergency in developmental psychopathology: analysys of cases\u2019 report attending a Child and Adolescent Neuropsychiatric Service

Psychiatric emergencies have steadily increased in recent years, but they are still poorly defined and studied, especially in developmental age and outside the Emergency Department context. This retrospective cross-sectional study aims to analyse characteristics of a clinical sample under the light of psychiatric urgency and emergency concepts. Both the \u201curgency\u201d and \u201cemergency\u201d concepts and the Rosenn & Gail\u2019s severity classification were applied to 399 first inspection forms to describe different conditions at the arrival. About half of the cases corresponded to urgency/ emergency conditions, with a male gender prevalence and an average age of 10 y. Emergency was associated to Behavioural Disorders mainly, while urgency conditions were associated to Somatic sphere Disorders, Selfinjured Behaviours, Anxious -Affective Disorders. This research, operating a differentiation between urgency and emergency, allows a clearer identification and a tailored therapeutic plan about cases that are similar on a symptomatic side but different by a psychopathological perspective

A Retrospective Study on the Factors Associated with Long-Stay Hospitalization in a Child Neuropsychiatry Unit

none7noThe past twenty years have seen a rapid increase in acute psychiatric symptoms in children and adolescents, with a subsequent rise in the number of psychiatric hospitalizations. This paper aims to: (a) describe the epidemiology of hospitalizations and some of the clinical and sociodemographic characteristics of pediatric patients admitted to a regional referral Complex Operative Child Neuropsychiatry Hospital Unit in Northeast Italy and (b) identify potential factors correlated with the length of hospital stay. Methods: 318 (M = 12.8 years; SD = 3.11; 72% Female) patients hospitalized for mental health disorders from 2013 to 2019. Results: Around 60% of hospital admissions occurred via the emergency room, mostly due to suicidal ideation and/or suicide attempts (24%). Affective disorders were the most frequent discharge diagnosis (40%). As for factors correlated with length of hospital stay, we found significant links with chronological age, way of hospital admission, cause of admission, discharge diagnosis, presence of psychiatric comorbidity, family conflict, and psychiatric family history. Conclusions: These results provide information about global characteristics associated with the length of psychiatric hospital stays in pediatric patients and provide a basis on which specific precautions can be hypothesized with the aim of developing more focused treatments.openSilvia Zanato, Marina Miscioscia, Annalisa Traverso, Miriam Gatto, Mikael Poli, Alessia Raffagnato, Michela GattaZanato, Silvia; Miscioscia, Marina; Traverso, Annalisa; Gatto, Miriam; Poli, Mikael; Raffagnato, Alessia; Gatta, Michel

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