Background Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood a... more Background Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators. Methods 73 female participants affected with AN were assessed at intake (T0), and at 6 (T1) and 12 (T2) months after treatment into an outpatient multimodal treatment program, 19 participants were also assessed 15 years after demission (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with GLM ANOVA for repeated measures, and using t-test or Wilcoxon test as post-hoc. T0 features of dropout, stable and healed participants were compared with ANOVA. Healed and unhealed long-term follow-up groups were compared using Mann-Whitney U test. Treatment changes were co...
Purpose Rising levels of psychopathology in the adolescent population have been evidenced in the ... more Purpose Rising levels of psychopathology in the adolescent population have been evidenced in the last few years throughout the Western world. We aim to examine how contemporary neuropsychiatry is changing in Northwestern Italy and how this impacts inpatient services. Methods The present research considered the 1177 admissions to a public neuropsychiatric inpatient service in the 2007–2017 decade. The annual percentual change (APC) was analysed for the total admissions, the number of the neurological vs psychiatric admissions, the length of inpatient stay, and the mean age at admission, also accounting for sex differences. The annual trend was also calculated for each diagnosis. Results The overall number of inpatient admissions decreased significantly (APC = − 5.91), in particular for children under 12 years of age (APC = − 7.23). The rate of neurologic diagnoses significantly decreased (APC = − 26.44), while the length of the inpatient stay (APC = 6.98) and the mean age at admissio...
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
Purpose Obsessive–compulsive symptoms (OC) are associated with greater morbidity and worse progno... more Purpose Obsessive–compulsive symptoms (OC) are associated with greater morbidity and worse prognosis in anorexia nervosa (AN). We assessed the presence of non-eating OC in participants with AN and related them with their psychopathology, personality, and attachment style features. Methods Young women with AN (N = 41, 30 restrictor and 11 binge-purging type) were assessed on the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS). These participants with AN and 82 healthy controls (HC) completed the Temperament and Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90 (SCL-90), Toronto Alexithymia Scale (TAS-20), and Attachment Style Questionnaire (ASQ). The association between Y-BOCS scores and indexes of psychopathology, personality, and attachment were examined. Results AN had significantly higher scores than HC on the EDI-2, SCL-90, TAS-20, ASQ-Need for Approval, and TCI-Harm Avoidance and Self-directedness. The Y-BOCS scores were significantly correlate...
Purpose: Despite its severity and increasing prevalence, Anorexia nervosa (AN) has no completely ... more Purpose: Despite its severity and increasing prevalence, Anorexia nervosa (AN) has no completely satisfactory evidence-based treatments. Follow-up studies may enlighten outcome predictors and process indicators.Methods: 73 female AN participants were assessed at intake (T0), and at 6 (T1) and 12 (T2) months after an outpatient multimodal treatment, 19 were followed-up for 15 years (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with ANOVA for repeated measures. T0 features were compared among dropout, stable and healed participants. Healed and unhealed at follow-up were compared using Mann-Whitney-U test. Treatment changes were correlated with multivariate regression.Results: complete remission at T2 was reached in 64.4% participants and in 73.7% at T3. At T2 22% participants maintained a full diagnosis, and only 15.8% at T3. BMI significantly increased at each time point since T0. Among per...
AimEmotional dysregulation (ED), defined by deficits in the ability to monitor and modulate the v... more AimEmotional dysregulation (ED), defined by deficits in the ability to monitor and modulate the valence, intensity, and expression of emotions, is typically expressed with irritability, tantrums, mood fluctuations, and self-harm in young children with autism spectrum disorder (ASD). Although ED does not represent a diagnostic feature of ASD, its manifestations are an important contributor to functional impairment and clinical referral. This study aims to examine the relationship between ED and adaptive functioning in preschoolers clinically referred for ASD or other neurodevelopmental disorders.MethodsA sample of 100 children (74% males, mean age 39.4 ± 12.3 months), consecutively referred to a university clinic for neurodevelopmental disorders, received clinical assessments of psychopathology with the CBCL and the Autism Diagnostic Interview-Revised, of ED- with the CBCL-Attention, Anxious/Depressed, and Aggression index (CBCL-AAA), of autism symptom severity with the ADOS-2 Calibr...
Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder... more Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder in children, with genetic factors accounting for 75–80% of the phenotypic variance. Recent studies have suggested that ADHD patients might present with atypical central myelination that can persist into adulthood. Given the essential role of sphingolipids in myelin formation and maintenance, we explored genetic variation in sphingolipid metabolism genes for association with ADHD risk. Whole-exome genotyping was performed in three independent cohorts from disparate regions of the world, for a total of 1520 genotyped subjects. Cohort 1 (MTA (Multimodal Treatment study of children with ADHD) sample, 371 subjects) was analyzed as the discovery cohort, while cohorts 2 (Paisa sample, 298 subjects) and 3 (US sample, 851 subjects) were used for replication. A set of 58 genes was manually curated based on their roles in sphingolipid metabolism. A targeted exploration for association between ADHD...
Journal of child psychology and psychiatry, and allied disciplines, Jan 8, 2018
Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed wi... more Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly fa...
Journal of child psychology and psychiatry, and allied disciplines, Jan 10, 2017
The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral ... more The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup dif...
Journal of child and adolescent psychopharmacology, Dec 11, 2016
Risperidone is approved for the treatment of serious behavioral problems in children with autism ... more Risperidone is approved for the treatment of serious behavioral problems in children with autism spectrum disorder (ASD). This study examined the effects of risperidone on cardiac conduction in children with ASD. Data were collected from an 8-week, five-site trial conducted by the Research Units on Pediatric Psychopharmacology Autism Network. Children (age 5-17 years) were randomly assigned to risperidone (n = 49) or placebo (n = 52) under double-blind conditions. Risperidone was superior to placebo in reducing serious behavioral problems. A standard 12-lead, electrocardiogram (ECG) was obtained in most subjects at screening and week 8. A pediatric electrophysiologist blind to treatment assignment reviewed all available ECGs for readability, abnormalities, and cardiac conduction parameters, including QTc. The electrophysiologist measurements were compared to machine readings. A second blinded electrophysiologist examined all available ECGs for abnormalities and a 20% random sample f...
Child and Adolescent Psychopharmacology News, 2002
Obsessive-Compulsive Disorder (OCD) is defined by the presence of obsessions and/or compulsions t... more Obsessive-Compulsive Disorder (OCD) is defined by the presence of obsessions and/or compulsions that cause marked distress and/or interference. OCD was once thought to be uncommon, but since 1980, epidemiologic studies have revealed lifetime prevalence rates ranging from 1.9% to 4% in community samples, both in adults and adolescents. Moreover, studies examining case series of patients with OCD have found that the majority have an age of onset before 18 years. Described as a “hidden epidemic” in the past, OCD is the fourth most common psychiatric disorder and is receiving more public recognition (consider Hollywood’s portrayal of a man with OCD in the movie “As Good As It Gets”). The increased public visibility of OCD has paralleled the emergence of effective treatments—both psychotherapeutic: for the most part the use of a cognitive-behavioral approach and also a pharmacologic one, primarily utilizing SSRI agents. We will review current pharmacologic agents available for OCD in children and adolescents. First-line agents, such as selective serotonin reuptake inhibitors (SSRI) and serotonin reuptake inhibitors (SRI)—as well as augmenting and alternative agents—will be discussed.
Background Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood a... more Background Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators. Methods 73 female participants affected with AN were assessed at intake (T0), and at 6 (T1) and 12 (T2) months after treatment into an outpatient multimodal treatment program, 19 participants were also assessed 15 years after demission (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with GLM ANOVA for repeated measures, and using t-test or Wilcoxon test as post-hoc. T0 features of dropout, stable and healed participants were compared with ANOVA. Healed and unhealed long-term follow-up groups were compared using Mann-Whitney U test. Treatment changes were co...
Purpose Rising levels of psychopathology in the adolescent population have been evidenced in the ... more Purpose Rising levels of psychopathology in the adolescent population have been evidenced in the last few years throughout the Western world. We aim to examine how contemporary neuropsychiatry is changing in Northwestern Italy and how this impacts inpatient services. Methods The present research considered the 1177 admissions to a public neuropsychiatric inpatient service in the 2007–2017 decade. The annual percentual change (APC) was analysed for the total admissions, the number of the neurological vs psychiatric admissions, the length of inpatient stay, and the mean age at admission, also accounting for sex differences. The annual trend was also calculated for each diagnosis. Results The overall number of inpatient admissions decreased significantly (APC = − 5.91), in particular for children under 12 years of age (APC = − 7.23). The rate of neurologic diagnoses significantly decreased (APC = − 26.44), while the length of the inpatient stay (APC = 6.98) and the mean age at admissio...
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
Purpose Obsessive–compulsive symptoms (OC) are associated with greater morbidity and worse progno... more Purpose Obsessive–compulsive symptoms (OC) are associated with greater morbidity and worse prognosis in anorexia nervosa (AN). We assessed the presence of non-eating OC in participants with AN and related them with their psychopathology, personality, and attachment style features. Methods Young women with AN (N = 41, 30 restrictor and 11 binge-purging type) were assessed on the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS). These participants with AN and 82 healthy controls (HC) completed the Temperament and Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90 (SCL-90), Toronto Alexithymia Scale (TAS-20), and Attachment Style Questionnaire (ASQ). The association between Y-BOCS scores and indexes of psychopathology, personality, and attachment were examined. Results AN had significantly higher scores than HC on the EDI-2, SCL-90, TAS-20, ASQ-Need for Approval, and TCI-Harm Avoidance and Self-directedness. The Y-BOCS scores were significantly correlate...
Purpose: Despite its severity and increasing prevalence, Anorexia nervosa (AN) has no completely ... more Purpose: Despite its severity and increasing prevalence, Anorexia nervosa (AN) has no completely satisfactory evidence-based treatments. Follow-up studies may enlighten outcome predictors and process indicators.Methods: 73 female AN participants were assessed at intake (T0), and at 6 (T1) and 12 (T2) months after an outpatient multimodal treatment, 19 were followed-up for 15 years (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with ANOVA for repeated measures. T0 features were compared among dropout, stable and healed participants. Healed and unhealed at follow-up were compared using Mann-Whitney-U test. Treatment changes were correlated with multivariate regression.Results: complete remission at T2 was reached in 64.4% participants and in 73.7% at T3. At T2 22% participants maintained a full diagnosis, and only 15.8% at T3. BMI significantly increased at each time point since T0. Among per...
AimEmotional dysregulation (ED), defined by deficits in the ability to monitor and modulate the v... more AimEmotional dysregulation (ED), defined by deficits in the ability to monitor and modulate the valence, intensity, and expression of emotions, is typically expressed with irritability, tantrums, mood fluctuations, and self-harm in young children with autism spectrum disorder (ASD). Although ED does not represent a diagnostic feature of ASD, its manifestations are an important contributor to functional impairment and clinical referral. This study aims to examine the relationship between ED and adaptive functioning in preschoolers clinically referred for ASD or other neurodevelopmental disorders.MethodsA sample of 100 children (74% males, mean age 39.4 ± 12.3 months), consecutively referred to a university clinic for neurodevelopmental disorders, received clinical assessments of psychopathology with the CBCL and the Autism Diagnostic Interview-Revised, of ED- with the CBCL-Attention, Anxious/Depressed, and Aggression index (CBCL-AAA), of autism symptom severity with the ADOS-2 Calibr...
Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder... more Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder in children, with genetic factors accounting for 75–80% of the phenotypic variance. Recent studies have suggested that ADHD patients might present with atypical central myelination that can persist into adulthood. Given the essential role of sphingolipids in myelin formation and maintenance, we explored genetic variation in sphingolipid metabolism genes for association with ADHD risk. Whole-exome genotyping was performed in three independent cohorts from disparate regions of the world, for a total of 1520 genotyped subjects. Cohort 1 (MTA (Multimodal Treatment study of children with ADHD) sample, 371 subjects) was analyzed as the discovery cohort, while cohorts 2 (Paisa sample, 298 subjects) and 3 (US sample, 851 subjects) were used for replication. A set of 58 genes was manually curated based on their roles in sphingolipid metabolism. A targeted exploration for association between ADHD...
Journal of child psychology and psychiatry, and allied disciplines, Jan 8, 2018
Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed wi... more Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly fa...
Journal of child psychology and psychiatry, and allied disciplines, Jan 10, 2017
The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral ... more The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup dif...
Journal of child and adolescent psychopharmacology, Dec 11, 2016
Risperidone is approved for the treatment of serious behavioral problems in children with autism ... more Risperidone is approved for the treatment of serious behavioral problems in children with autism spectrum disorder (ASD). This study examined the effects of risperidone on cardiac conduction in children with ASD. Data were collected from an 8-week, five-site trial conducted by the Research Units on Pediatric Psychopharmacology Autism Network. Children (age 5-17 years) were randomly assigned to risperidone (n = 49) or placebo (n = 52) under double-blind conditions. Risperidone was superior to placebo in reducing serious behavioral problems. A standard 12-lead, electrocardiogram (ECG) was obtained in most subjects at screening and week 8. A pediatric electrophysiologist blind to treatment assignment reviewed all available ECGs for readability, abnormalities, and cardiac conduction parameters, including QTc. The electrophysiologist measurements were compared to machine readings. A second blinded electrophysiologist examined all available ECGs for abnormalities and a 20% random sample f...
Child and Adolescent Psychopharmacology News, 2002
Obsessive-Compulsive Disorder (OCD) is defined by the presence of obsessions and/or compulsions t... more Obsessive-Compulsive Disorder (OCD) is defined by the presence of obsessions and/or compulsions that cause marked distress and/or interference. OCD was once thought to be uncommon, but since 1980, epidemiologic studies have revealed lifetime prevalence rates ranging from 1.9% to 4% in community samples, both in adults and adolescents. Moreover, studies examining case series of patients with OCD have found that the majority have an age of onset before 18 years. Described as a “hidden epidemic” in the past, OCD is the fourth most common psychiatric disorder and is receiving more public recognition (consider Hollywood’s portrayal of a man with OCD in the movie “As Good As It Gets”). The increased public visibility of OCD has paralleled the emergence of effective treatments—both psychotherapeutic: for the most part the use of a cognitive-behavioral approach and also a pharmacologic one, primarily utilizing SSRI agents. We will review current pharmacologic agents available for OCD in children and adolescents. First-line agents, such as selective serotonin reuptake inhibitors (SSRI) and serotonin reuptake inhibitors (SRI)—as well as augmenting and alternative agents—will be discussed.
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Papers by Benedetto Vitiello