Vol. 29 N. 2 Agosto 2009

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Studio pilota sull’imitazione motoria in bambini autistici
M. Saccani, B. Olivari, S. Borini, C. Lenti
Objective. Recent findings in literature demonstrate the presence of a deficit in “Executive functions” (FE) among ADHD patients, which explains “attention disorder” in terms of an alteration in information processing and response inhibition. The aim of our work was to investigate any possible improvement in FE functioning, in particular the “Working Memory” subclass, among a group of patients undergoing Atomoxetin therapy, through the evaluation of neurocognitive functions before and after pharmacological treatment. Methods. We evaluated 6 subjects, 5 males and 1 female, referred to the “U.O.C. of Developmental Neuropsichiatry” of Terni during a 12 month period, all diagnosed with a “Combined” type of Attention Deficit Hyperactivity Disorder. The diagnosis has been carried out in compliance with DSM-IV-TR criteria and each subject was treated pharmacologically with Atomoxetin HCl (1.2 mg/kg/die). During a one year observation period, each patient underwent neuropsychological testing (WISC-R subtests “Digit Span”, “Coding” and “Picture Completion”, Number Connection Test A and B, “Bell Test”) and specific evaluation scales were used to determine functional impairment levels (SDAG, CGI). Statistical analysis was carried out using both parameterised and nonparameterised tests such as the T-Student Test (life parameter), the “One-way Anova for repeated measures”(NCT-A e B) and the Wilcoxon Signed Rank Test (“Bell Test”, CGI, SDAG). Level of significance has been set to P = 0.05. Results. Data comparison at the end of month twelve shows improved performance in WISC-R subtests (“Digit Span”, “Coding” and “Picture Completion”), Number Connection Test (part A and B) and “Bell Test” (speed and accuracy). Also, a statistically relevant improvement was evidenced in behavioural patterns, measured through the Clinical Global Impression Scale and the SDAG Scale, with significant decrease of primary ADHD symptoms. Conclusion. Our preliminary findings, although limited to a small group of patients undergoing pharmacological treatment, prove a general improvement in “executive funcion” related cognitive processes. Furthermore our findings show a significant decrease of primary ADHD symptoms and consequent reduction of functional impairment.

Tethered Cord Sindrome nel mielomeningocele: follow up per un timing diagnostico-terapeutico
A. Traverso, P. Tomadini, M. Gatta, M. Calderone, R. Faggin, P. Drigo
Objective. Aim of the study is to evaluate what symptoms suggest Tethered Cord Syndrome (TCS) in children affected by myelomeningocele (MMC) and what are the diagnostic strategies for a correct surgical timing. Methods. The study consists in a retrospective evaluation of 22 MMC patients’ clinical history after surgical spinal detethering, performed between 1991 and 2008. Every patient was monitored according to a clinical-diagnostic protocol used in the Department of Pediatrics of the University of Padua. Results. Signs and symptoms suggesting TCS presented frequently in this population were: motor (77%), spinal curves variations such as scoliosis (63,6%), Chiari Malformation symptoms (45%), sphinteric (40,9%), urodynamical study changes (50%, in an half of them without clinical symptoms), sensitive (40,9%). Globally, after surgical detetherig, we observe a worsening in 2 children (9%), while 16 patients improve (73%). Only 4 children (18%) tend to be clinically stable.Conclusions. As in MMC patients life expectancy grows, TCS diagnosis becomes more important for the difficulty to detect the subtle and slow neurological and/or sphinterical worsening also in these so compromised patients. We confirm the fundamental role of a multidisciplinary follow up for the prevention and the precocious diagnosis of TCS.

Studio pilota di alcune funzioni esecutive in minori con ADHD
E. Trinari, S. Mazzotta, R. D’Angelo, G. Mazzotta
Objectives. Several studies indicate a motor imitation deficit in children affected by Autism Spectrum Disorders and some theoretical statements attributed to imitation deficit a primary role in the development of social and communicative autistic symptoms. Imitation deficit can, therefore, be conceptualised as underlying social, communicative and affective disorders, deficit in symbolic play and that in the theory of the mind in these disorders. Our study intends to evaluate the features of motor imitation, in particular gesture imitation and the imitation of actions with objects, in children affected by Autism. Methods. The sample group examined consisted of 27 children: 16 affected by Autism and 11 with regular psycho-motor development. The age of the sample is from 21.5 to 53.5 months (average age of 43.4 months); the children affected by Autism are between 28 and 53.5 months while those with regular development between 21.5 and 40.7 months. The diagnosis protocol consists of a diagnostic framework according to the DSM-IV criteria, administration of ADOS-G to check the diagnosis of Autism, assessment of the level of development (Griffiths Mental Developmental Scales) and assessment of the motor imitation ability via the Motor Imitation Scale (Uzgiris e Hunt -MIS) and Imitation Battery (Rogers, Stackhouse e Wehner). The performance of imitation in patients with Autism was compared with that of the children of the control group, paired on the basis of the mental age. Results. The results showed worse performance in children with Autism compared to the control group. The performance of the children with Autism was worse not just compared to the average total points obtained in the MIS (p = 0.009), but also in the subscales relating to corporeal gesture imitation (p = 0.001) and manual imitation (p = 0.023). Conclusions. The results of the study, according whit literature, highlight a significant deficit in tests on motor imitation in children with Autism, evident at an early age. The discrepancy in the points obtained within the various subscales confirms the importance of considering the different types of imitation as separate dimensions.

Approccio psicoeducativo all’adolescente psichiatrico: l’esperienza di un servizio semiresidenziale
M. Gatta, E. Bertossi, L. Dal Zotto, L. Del Col, P. Testa, P.A. Battistella
Objectives. The aim of this research is to analyze the therapeutic approach to the psychiatric adolescent within a daily care centre. The experience is that of the Daily Service for Adolescents located into the Neuropsychiatric Unit for Children and Adolescent, ULSS 16 Padua. Matherial and methods. The sample, 60 adolescents, aged 12 to 19 years, was divided into 2 groups: who started and continued the clinical-pedagogical path in the daily service and who, after the location in the daily centre, received indications for the recovery in a community. All patients were evaluated at the beginning and during the clinical-pedagogical path (every 3-6 months) throughout the Youth Self Report questionnaire (YSR 11 – 18) of T. Achenbach and the Global Assessment Functioning scale (GAF). Moreover, information about the adolescent and his/her family and aspects concerning the clinical-pedagogic intervention (diagnosis, therapeutic targets, participation modality to the activities, therapeutic alliance with adolescents and family, therapeutic compliance, clinical outcome) were collected for each patient. Results. These variables were analyzed for each group and compared with the aim to verify possible meaningful differences in order to establish previous indicative elements for a residential rather than daily care approach. Conclusions. The study made evident some factors which can be referred to the opportunity of a recovery in a community: younger age (< 14 years), family’s low socio-cultural level, monoparental families (because of divorce and/or high parental conflict), medium-severe psychopatology (borderline or psychotic disorders with the presence of psychiatric comorbility), scholastic difficulties with interruption of the educational career.

Behavioral correlates of nonconvulsive status epilepticus in pediatric patients
R. Galimi, M.G. Palmieri
Lo stato di male epilettico non convulsivo (NCSE) rappresenta una difficile impresa diagnostica e terapeutica nel contesto della neurologia pediatrica moderna. Lo NCSE costituisce una condizione clinica fortemente eterogenea ed ancora poco studiata nella popolazione pediatrica. Molte funzioni mentali superiori possono essere coinvolte. Lo NCSE può insorgere nel caso di traumi cerebrali acuti, specifiche sindromi epilettiche dell’infanzia, difficoltà dell’apprendimento e altre condizioni neurologiche. Pazienti con NCSE possono presentare deficit “fruste” di memoria, comportamenti bizzarri, psicosi, disturbi dell’affettività, alterazioni del pensiero, alterazioni attitudinali o coma. Lo NCSE costituisce una patologia clinicamente eterogenea composta da diversi sottotipi. Come in tutte le condizioni cliniche “fruste”, un forte sospetto clinico risulta indispensabile per riconoscere lo NCSE. È richiesta una conferma EEG. La classificazione dello NCSE primariamente suddivisa per età di comparsa costituisce, a nostro avviso, la soluzione migliore. L’articolo evidenzia l’importanza dello NCSE nei pazienti pediatrici.

Comorbidità psicopatologica nel Disturbo di Sviluppo della Coordinazione Motoria
M. Poletti
The DSM-IV-TR diagnostic label of Developmental Coordination Disorder (DCD) describes children with difficulties in motor coordination. Children with DCD often present a minor neurological dysfunction, characterized by one or more clusters of neurological soft signs. This clinical condition, that will develop in a DCD, is common in children that suffered of perinatal problems, like preterm birth and low birth weight: the majority of these children present a damaged white matter of interhemispheric fibers, specially of the Corpus Callosum. This damage persists along development and is detectable by neuroimaging also in adolescence; the degree of white matter impairment is directly related to the severity of motor and cognitive impairments of these children. Longitudinal studies permit to describe developmental trajectories of children with DCD. In infancy they present a delay in the acquisition of developmental motor milestones, difficulties in motor coordination and often inattention. During school years the DCD is complicated by externalizing behaviours (inattention, hyperactivity, impulsivity), directly related to motor impairment, and difficulties in learning (specially in writing), and social functioning. In adolescence externalizing behaviours decrease, while internalizing behaviours (anxiety, depression) increase, probably due to the low perceived self-worth of these children. Psychopathological comorbidity in DCD is discussed reviewing recent papers identified in electronic databases MedLine and PsychInfo.

Le convulsioni associate a gastroenterite nel lattante: una entità clinica benigna
E. Franzoni, D. Brunetto, V. Valenti, V. Gentile, D.M. Cordelli, L. Iero, I. Cecconi
Convulsions with mild gastroenteritis could be defined as seizures accompanying symptoms of gastroenteritis not linked to fever, electrolyte imbalance and dehydration, in children without meningitis, encephalitis, encephalopathy or apparent history of epilepsy. Seizures are mostly brief and often repetitive, occurring in clusters. Cerebrospinal fluid studies, electroencephalogram and neuroimaging are normal. Convulsions with mild gastroenteritis constitute a benign condition: anticonvulsant therapy not always warranted and the prognosis is excellent. We describe a case of Convulsions with mild gastroenteritis hospitalized at the Child Neuropsychiatric Unit of S.Orsola-Malpighi Hospital, University of Bologna (Italy) in March 2009.

Il teatro nei Disturbi del Comportamento Alimentare: presentazione di un progetto attivato nel Centro per i DCA in età evolutiva di Bologna
A. Pellicciari, F. Rossi, P. Gualandi, C. Muratore, L. Iero, S. Gualandi, V. gentile, E. Franzoni
We present a new project, activated in the Eating Disorder Center for children and adolescents of Bologna, that is called “Metamorphosis: the theater at the hospital”. The theoretical basis of the use of theater in psychiatry will be shown through the points of view of several authors, including Freud, Winnicott, M. Klein and Moreno. Three clinical cases will be discussed as an example of our methods. Finally a pilot study will be introduced, where we have administered at the beginning and at the end of the cycle of laboratories SAFA, TAS20 and EDI-2: we found statistically significant improvements in the TAS20, SAFA D and SAFA O scores (p < 0.05); the overall satisfaction rate was 93%. Our experience suggests that theater can be more than a recreational activity. Decreasing the defense mechanisms it can allow a more focused therapeutic plan, in order to mitigate determined symptoms and to improve the quality of life during the stay in hospital.