18 research outputs found
Timing of Psychopharmacological and Nutritional Interventions in the Inpatient Treatment of Anorexia Nervosa: An Observational Study
No full textThis study aims to investigate possible different outcomes in the inpatient treatment of
anorexia nervosa (AN) related to different timings of psychopharmacological and nutritional interventions.
A retrospective observational study was conducted, involving young patients hospitalized
for AN, treated with naso-gastric tube feeding (NGT). Participants were divided into five groups
according to early (0–7 days) or late (8+ days) introduction of atypical antipsychotics (AAP) and NGT:
early AAP-early NGT (EE), early AAP-late NGT (EL), late AAP-early NGT (LE), late AAP-late NGT
(LL) and a control group treated with NGT only (NGT). Concurrent clinical and treatment variables
were analyzed. AN psychopathology was measured with the Eating Disorder Inventory-3 (EDI-3)
EDRC score. Outcomes were assessed as admission-discharge body-mass index (BMI) improvement
and length of hospital stay (LOS). Contributions of variables related to outcomes were assessed with
multifactorial-analyses of variance (MANOVA). Seventy-nine patients were enrolled in the study.
LOS was different among treatment groups (F (4, 75) = 5.993, p < 0.001), and EE patients showed
lower LOS than LE (p < 0.001) and LL (p = 0.025) patients. BMI improvement was not significantly
different among treatment groups but correlated negatively with age (F (1, 72) = 10.130, p = 0.002),
and admission BMI (F (1, 72) = 14.681, p < 0.001). In conclusion, patients treated with early AAP
and early NGT showed lower LOS than those treated with late AAP. Prognostic treatment variables
should be investigated in wider samples
Eating Disorders and the Internet: A Descriptive Cross-sectional Study Monitoring the Pro Ana Phenomenon in an Italian Sample
No full textBackground: The Internet is a significant source of information for adolescents, affecting their life and health.
The online Pro Anorexia (Pro Ana) phenomenon is a growing danger. The purpose of this study is to evaluate the
presence of the Pro Ana phenomenon in an Italian sample of patients affected by Eating Disorders.
Methods: This study is a descriptive cross-sectional analysis that examines two different samples of patients affected
by eating disorders at different points in time, in 2017 and 2020. This study was conducted by using a seven
item anonymous questionnaire specifically developed by the authors to collect data on knowledge and visitation of
websites and Social Networks Sites related to "pro-ana" and "thinspiration" content.
Results: More than 80% of the respondents in both samples use the Internet daily. From 2017 to 2020 we observed a
rise of the phenomenon among the adolescents of our sample. In 2020, 76% of the patients knew of sites emphasizing
a marked thinness as an ideal of beauty, 60% knew of Pro Ana sites and 22% visited them.
Conclusions: Our data confirm that in Italy too, Pro Ana is a diffused phenomenon, of which clinicians need to
be consistently aware especially when treating adolescents with ED. Patients with ED mainly visit diet and nutrition
sites, and it is important to acknowledge this practice in order to prevent and address ED in early adolescence.
Although few subjects claim to visit Pro Ana websites, the majority is aware of these sites and therefore they are
potential users. Many patients assert that they are familiar with websites promoting excessive thinness as ideal
beauty, which supports the bio-psycho-social etiopathogenetic model of Anorexia Nervosa. Information sharing and
prevention work are important forms of interventions for families, teachers and clinicians, who together care for
adolescent patients with ED
Refeeding syndrome and psychopharmacological interventions in children and adolescents with Anorexia Nervosa: a focus on olanzapine‐related modifications of electrolyte balance
No full textThis study aims to investigate the potential correlation between the use of olanzapine, a psychopharmacological intervention commonly
prescribed in Anorexia Nervosa treatment, and the occurrence of Refeeding Syndrome. Despite the acknowledged nutritional
and biochemical impacts of olanzapine, the literature lacks information regarding its specific association with Refeeding Syndrome
onset in individuals with Anorexia Nervosa. This is a naturalistic, retrospective, observational study, reporting the occurrence of
Refeeding Syndrome in children and adolescents with Anorexia Nervosa, treated or untreated with olanzapine. Dosages and serum
levels of olanzapine were assessed for potential associations with the occurrence of Refeeding Syndrome and specific variations
in Refeeding Syndrome–related electrolytes. Overall, 113 patients were enrolled, including 46 (41%) who developed a Refeeding
Syndrome. Mild (87%), moderate (6.5%), and severe (6.5%) Refeeding Syndrome was described, at a current average intake of
1378 ± 289 kcal/day (39 ± 7.7 kcal/kg/die), frequently associated with nasogastric tube (39%) or parenteral (2.2%) nutrition. Individuals
receiving olanzapine experienced a more positive phosphorus balance than those who did not (F(1,110) = 4.835, p = 0.030),
but no difference in the occurrence of Refeeding Syndrome was documented. The mean prescribed doses and serum concentrations
of olanzapine were comparable between Refeeding Syndrome and no-Refeeding Syndrome patients.
Conclusion: The present paper describes the occurrence of Refeeding Syndrome and its association with olanzapine prescriptions
in children and adolescents with Anorexia Nervosa. Olanzapine was associated with a more positive phosphorus
balance, but not with a different occurrence of Refeeding Syndrome. Further, longitudinal studies are required
Open prospective study on oxcarbazepine in epilepsy in children: A preliminary report
No full textSummaryPurposeTo evaluate the long-term efficacy, tolerability, and safety of oxcarbazepine (OXC) in children with epilepsy.MethodsWe enrolled 36 patients (median age 7.75) with new diagnosis of partial epilepsy in an open prospective study. All type of epilepsy were included: 25 patients were affected by idiopathic epilepsy, eight by symptomatic epilepsy and three by cryptogenic epilepsy. Patients were then scheduled to come back for controls at 3 months (T1), 12 months (T2) and 24 months (T3) after the beginning of OXC-monotherapy (T0). At each control we evaluated patients through their seizure diary, a questionnaire on side effects, their level of 10-monohydroxy (MHD) metabolite and laboratory analysis.ResultsAt T1, 21/36 patients (58.3%) were seizure-free, 3/36 patients (8.3%) showed an improvement higher than 50%, 3/36 (8.3%) lower than 50%, while 2/36 worsened (5.6%). In 7/36 (19.5%) patients, no improvement was reported. At T2 13/18 patients (72.2%) were seizure-free, 1/18 showed a response to therapy higher than 50% while 2/18 worsened (11%). In two patients no improvement was reported. A correspondence between MHD plasmatic levels and clinical response (r=0.49; p<0.05) was only registered at T1.An EEG normalization was observed in 25% of cases. Side effects were reported in 25% of cases, but symptoms progressively disappeared at follow-up.ConclusionsWe can therefore conclude that OXC can be considered, for its efficacy and safety, as a first line drug in children with epilepsy
Linguistic Markers of Anorexia Nervosa: Preliminary Data from a Prospective Observational Study
No full textRecent works indicated the potential relevance of Natural Language Processing techniques for the detection of clinical conditions. This
paper tries to address the issue in the Eating Disorder domain, by exploiting “linguistic biomarkers” for Anorexia Nervosa (AN) detection
in female teenagers. We hypothesize that (i) disturbances in self-perceived body image, black and white thinking and mood changes
strongly associated with AN disorder can result in altered linguistic patterns; and (ii) these subtle modifications can be identified by
means of NLP tools, acting as early proxy measures for the disorder. To this aim, we enrolled 51 participants (age range: 14-18): 17 girls
with a clinical diagnosis of Anorexia Nervosa and 34 normal weighted peers, matched by gender, age and educational level. Both the
groups were asked to produce three written texts (around 10-15 lines long), i.e. two autobiographical narratives and a short description
of a complex figure. A rich set of linguistic features was extracted from the text samples and the statistical significance in pinpointing
the pathological process was measured. Our preliminary results show that subtle language disruptions, mainly at the lexical and syntactic
level, can actually represent an early but reliable marker of the disease. However, an analysis on a bigger cohort with follow-up
information, still ongoing, is needed to consolidate this assumption
Short-term nonhormonal and nonsteroid treatment in West syndrome
No full textPurpose: West syndrome (WS) is considered an age-dependent epileptic encephalopathy and also a particular type of electrical epileptic status. Short-term hormonal or steroid treatment of WS with good efficacy is reported in the literature. The aim of this retrospective multiinstitutional study was to evaluate the early discontinuation of nonhormonal and nonsteroid treatment for WS. Methods: Twenty-two WS cases in which treatment was discontinued after a maximum of 6 months, were collected. Inclusion criteria were the presence of typical EEG hypsarrhythmia (HY) and video-EEG recorded epileptic spasms. Exclusion criteria were the presence of partial seizures or other seizure types before spasm onset. The patients were treated with vigabatrin (VGB) in 19 cases and nitrazepam (NTZ) in three. The dose range was 70-130 mg/kg/day for VGB and 0.7-1.5 mg/kg/day for NTZ. The drug was discontinued if spasms stopped and HY disappeared after a mean treatment period of 5.1 months (range, 3-6 months). All patients underwent repeated and prolonged awake and sleep video-EEG, both before and after drug discontinuation. Results: Cryptogenic (15) and symptomatic (seven) WS patients were included. All the symptomatic cases had neonatal hypoxic-ischemic encephalopathy. The mean age at spasm onset was 5.5 months (range, 3-7 months; median, 6). The interval between spasm onset and drug administration ranged from 7 to 90 days (mean, 23 days; median, 20). The interval between drug administration and spasm disappearance ranged from 2 to 11 days (mean, 6 days; median, 6 days). The interval between drug administration and HY disappearance ranged from 3 to 30 days (mean, 9 days; median, 10 days). Drugs were stopped progressively over a 30- to 60-day period. Follow-up ranged from 13 to 50 months (mean, 26 months; median, 22 months). None of our cases showed spasm recurrence. Conclusions: Our data show that successful nonhormonal and nonsteroid treatment can be shortened to a few months without spasm recurrence in patients with cryptogenic or postanoxic WS
VNS in drug resistant epilepsy: preliminary report on a small group of patients
No full textAbstract Background In 1997 Vagus Nerve Stimulation (VNS) received approval from the US Food and Drug Administration (FDA) as an adjunctive therapy in the treatment of medically intractable partial epilepsy in people aged 12 years and older who are ineligible for resective epilepsy surgery. Although the exact mechanisms of action are unknown, the use of VNS with children has increased, including those younger than 12 years of age, or those with generalized epilepsy. Methods We describe the outcome for the first group of nine patients, aged 8-28 years, who had pharmaco-resistant epilepsy and were treated with VNS. During the follow up, we gradually and slowly increased the parameters of the stimulation in order to assess the efficacy of VNS even at parameters which would usually be considered "non-therapeutic", along with possible side effects and changes in quality of life. Results At the last follow, up 1 patient was "seizures free", 3 were "very good responders", 3 were "good responders" and 2 were "non responders". We obtained an initial seizure reduction with low stimulation parameters, the highest current reached being 2.00 mA. This observation supports the possibility that, for younger patients, lower stimulation intensities than those commonly used in clinical practice for adults can be therapeutic. We also wanted to underline the reduction in seizure frequency (~91,7%) and the reduction in seizure duration (> 50%) in the patients affected by drug-resistant absence epilepsy. Adverse effects were mild, tolerable and, in most of cases, easily resolved by adjusting the stimulation parameters. Hoarseness of voice was the most frequent side effect. The improvements in the quality of life are relevant and seem to be independent of the VNS effect in controlling seizures. Conclusions Our small experience seems to confirm the efficacy and safety of VNS in drug resistant partial and generalized epilepsy in developing age groups.</p
Feeding and eating disorders in children and adolescents during the COVID-19 pandemic: real-word data from an observational, naturalistic study
No full textBACKGROUND: The COVID-19 pandemic had a substantial impact on the mental health of children and adolescents. The literature lacks large-scale research evaluating its consequences on teenagers with feeding and eating disorders (FED). This study aims to assess the impact of the COVID-19 pandemic on a population of patients of developmental age.
METHODS: This single-center observational study compares two historical cohorts of children and adolescents diagnosed with FED, with a first consultation before (1st March 2018 to 31st October 2019) and during (1st March 2020 to 31st October 2021) pandemic. Demographic, clinical, nutritional, and treatment variables were assessed.
RESULTS: We enrolled 479 patients (F=398, 83.1%), including 205 (F=161, 78.5% mean age 14.5±2.5, range 7.9-17.9 years) belonging to the first historical cohort and 274 (F=237, 86.5%; 14.4±2.1, range 6.5-17.9) to the second one (+33.7%). Increased mean new accesses/month (P=0.042) and a greater percentage of females (P=0.042) during the pandemic compared to the pre-pandemic period emerged. Physical hyperactivity (P=0.022) and suicidal behaviors (P=0.030) increased, while fewer patients required hospitalization (P=0.013).
CONCLUSIONS: An increase in first visits for FED after the COVID-19 pandemic emerged, with females being the most affected. Physical hyperactivity and self-harming behaviors were intensified, while patients in need of hospitalization were reduced. Longitudinal studies are required
Efficacy and safety of topiramate in refractory epilepsy of childhood: long-term follow-up study
No full textThis study aimed to evaluate the long-term efficacy and safety of topiramate in treating children with drug-resistant epilepsy. A multicentric, retrospective, open-label, add-on study was undertaken of 277 children (mean age 8.4 years; range 12 months to 16 years) affected by drug-resistant epilepsy. The efficacy was rated according to the seizure types and epilepsy syndrome. After a mean period of 27.5 months of treatment (range 24-61 months), 11 patients (4%) were seizure free and 56 (20%) had more than 50% reduction in seizure frequency. The efficacy of topiramate treatment was noted in localization-related epilepsy and in generalized epilepsy. In addition, in a group of 114 patients, we compared the initial efficacy (evaluated after a mean of 9 months of follow-up) and the retention at a mean of 30 months of topiramate with regard to loss of efficacy (defined as the return to the baseline seizure frequency). Fifty-five (48%) of 114 patients were initial responders. The retention at a mean of 30 months was 23 of 114 patients (20%), 4 of whom (3.5%) were still seizure free. A loss of efficacy occurred in 32 of the 55 initial responders (58%). It was prominent in patients with generalized epilepsy, such as symptomatic infantile spasms and Lennox-Gastaut syndrome, as well as in those with Dravet syndrome. By contrast, a well-sustained topiramate efficacy was noted among patients with localization-related epilepsy. Globally, adverse events were observed in 161 patients (58%) and were mainly represented by weight loss, hyperthermia, sedation, and nervousness, which, in most cases, disappeared after slowing titration or reducing the dosage of the drug. In conclusion, the present long-term study confirms that topiramate represents a useful drug effective in a wide range of seizures and epilepsy syndromes. Moreover, preliminary data seem to suggest that the efficacy of topiramate, when evaluated in the long-term perspective, is more sustained in localization-related epilepsy than in generalized epilepsy
An observational study of fixed-dose Tanacetum parthenium nutraceutical preparation for prophylaxis of pediatric headache
No full textAbstract Background Migraine is one of the most prevalent chronic pain manifestations of childhood. Despite the multitude of available treatments, parents are often concerned about chronic therapies and pediatricians have insufficient confidence in prescribing prophylactic drugs. Therefore, there is now growing interest for natural supplements used to control recurrent migraine headaches. Such approach may increase acceptance and adherence to long-term prophylaxis therapy in children. Methods This is an observational multicenter study performed in children (n = 91) with migraine, with (MO) or without aura (MA), or tension-type headache (TTH). A fixed-dose Andrographis paniculata, CoQ10, riboflavin, and magnesium, was administered for 16 weeks. Patients were evaluated at baseline (T0), at week 8 (T1) and at the end of treatment at week 16 (T2). A follow-up period occurred at week 20 (T3) and week 32 (T4). Results The herbal supplement significantly reduced the frequency of headaches in TTH patients during treatment period (T0: 11.97 + 1.92 vs T2: 5.13 + 1.93; p 0.05 vs T0). TTH patients did not report significant improvement of pain intensity. A significant effect was observed in the MO group during treatment (T0: 3.06 + 0.11 vs T2: 2.14 + 0.19; p < 0.001) and after treatment withdrawal (T4: 2.20 + 0.21; p < 0.001 vs T0). Likewise, MA group showed a significant treatment effect (T0: 2.57 + 0.20 vs T2: 0.86 + 0.45; p < 0.001) and the efficacy persisted at the end of the study (T4: 1.00 + 0.58; p < 0.001 vs T0). Conclusion This fixed-dose Tanacetum parthenium preparation improved headache frequency and pain intensity in children affected by TTH. Despite the main limits, this study supports the use of nutraceutical in pediatric headache/migraine
