1,720,980 research outputs found
Psychopathological and Interactive-Relational Characteristics in Non-Suicidal Self-Injury Adolescent Outpatients
Full text linkNon-suicidal self-injury (NSSI) is described as behaviors that directly and intentionally inflict damage to body tissue without suicidal intent and for reasons not linked to cultural expectations or norms. Literature has confirmed several “specific risk factors” related to NSSI behaviors; emotional reactivity, internalizing problems, alexithymia traits, and maladaptive family functioning can predispose an individual to intrapersonal and interpersonal vulnerabilities related to difficulties in regulating one’s own cognitive-emotional experience. The present study aims to analyze and define the psychopathological and family interactive-relational characteristics of adolescents with NSSI through a case-control study. Thirty-one patients with NSSI and thirty-one patients without NSSI paired for sex, age, and psychiatric diagnosis (ICD-10) were recruited in Padua among two Child Neuropsychiatry Units before the COVID-19 pandemic. Results show a higher prevalence of internalizing problems, alexithymia trait related to “difficulty identifying feelings”, and lower quality of family functioning related to inclusion of partners, child involvement, and child self-regulation. These results carry significant implications for the clinical management and therapeutic care of non-suicidal self-injury patients and further confirm the need for an in-depth investigation of internalizing problems, alexithymia, and quality of family interactions
Non-suicidal self-injury in inpatient and outpatient adolescents: disentangling psychopathology and interactive family dynamics
Full text linkBackground: Non-suicidal self-injury (NSSI) is defined as a transdiagnostic phenomenon that has well increased in the latest years, especially in the adolescent population. It has been associated with suicidality, alexithymia, emotion dysregulation, and psychosocial impairment, as well as family issues. The choice of level of care (i.e., hospitalization versus outpatient visit) depends on a number of factors that relate not only to suicidal risk but also to severity of individual's psychosocial functioning, the ability of family environment to support treatment choices and to contain child, as well as the need for ongoing monitoring of the young patient. A scarcity of studies has compared outpatients with inpatients, both of them engaging in NSSI. Methods: the current study aimed to further expand knowledge regarding features that characterize young self-harmers who receive different levels of care, with particular attention on psychopathological, family, and NSSI-related characteristics, as well as suicidality. The current research included 56 inpatients and 56 outpatients with NSSI, paired for gender, age, and psychiatric diagnosis. Instruments investigating psychopathology, emotion dysregulation, alexithymia, psychosocial functioning, and interactive family dynamics were administered. Descriptive statistics, parametric and non-parametric inferential statistics were applied. Results: study findings highlighted that inpatients engaging in NSSI reported lifetime suicidality, clinical level of externalizing and internalizing problems, more severe alexithymia, emotion dysregulation, and impaired psychosocial functioning compared to outpatients engaging in self-harming. Furthermore, when compared to outpatients' families, inpatients' families were more capable of adhering to rules and time of the family play situation (the Lausanne Trilogue Play procedure) and fixing interactive mistakes through activities. On the contrary, in the inpatient group, global performance, role implication, parental scaffolding, child's involvement and self regulation tend to decline, while parental conflicts tend to rise over the four part scenario of the family play. Conclusion: these findings confirmed a more severe global picture of young inpatients engaging in self-harming, suggesting that NSSI may be the expression of this larger psychopathological picture. In addition, the study highlighted the need for a multi-informant and multimethod clinical assessment, which should include evaluation of family context and co-parenting system, especially for hospitalized young patients engaging in self-harm
The Role of Alexithymia in Social Withdrawal during Adolescence: A Case–Control Study
Full text linkAlthough social withdrawal is becoming increasingly common among adolescents, there is still no consensus on its definition from the diagnostic and psychopathological standpoints. So far, research has focused mainly on social withdrawal as a symptom of specific diagnostic categories, such as depression, social phobia, or anxiety disorders, or in the setting of dependence or personality disorders. Few studies have dealt with social withdrawal in terms of its syndromic significance, also considering aspects of emotion control, such as alexithymia. The present case-control study aimed to further investigate the issue of social withdrawal, and try to clarify the part played by alexithymia in a sample of Italian adolescents diagnosed with psychological disorders (n = 80; Average Ageg = 15.2 years, SD = 1.49). Our patients with social withdrawal (cases) scored significantly higher than those without this type of behavior (controls) in every domain of alexithymia investigated, using the Toronto Alexithymia Scale (TAS-20) and with the scales in the Youth Self-Report (YSR) regarding internalizing problems, anxiety–depression, social problems, and total problems. Internalizing problems and total levels of alexithymia also emerged as predictors of social withdrawal. These variables may therefore precede and predispose adolescents to social withdrawal, while social problems may develop as a consequence of the latter
Pediatric epilepsy and psychiatric comorbidity: Preliminary observational data from a prospective study
No full textThe Impact of The Covid-19 Pandemic on Adolescent Neuropsychiatric Admissions for Anorexic Eating Disorders Throughout the 2013-2022 Decade
Full text linkObjective: The purpose of this study is to evaluate the impact that Covid-19 pandemic and the related restrictive measures have had on minors diagnosed with eating disorders (EDs), in particular Anorexia nervosa (AN) and restrictive unspecified EDs, both on an epidemiological and on a clinical level.Methods: We considered AN and restrictive unspecified EDs cases treated in the years 2013-2022 in Padua Hospital’s Child Neuropsychiatry ward, the 97 patients were then divided into two groups, one dated before the pandemic’s start and one dated after. We then analyzed the differences using data collected from medical records and from the Youth Self Report (YSR) tests performed.Results:Our study confirms a large increase in the number of cases of AN and restrictive EDs during the pandemic/post-pandemic period, the clinical characteristics of these cases instead seem substantially unchanged compared to the pre-pandemic ones.Conclusions:The pandemic has led to a large increase in the number of these EDs, underlining the need for attention to the topic and for new measures aimed at primary and secondary prevention
Psycho-Behavioral Profiles of Pediatric Inpatients with Past and Recent Onset of Nonsuicidal Self-Injury: A Cluster Analysis Approach
Full text linkFew studies have focused on the persistence of nonsuicidal self-injury (NSSI) over time in developmental age. This study aimed to define the psycho-behavioral profiles of young inpatients according to past or recent NSSI onset (i.e., NSSI for more or less than one year, respectively), and identify possible risk factors for maintaining NSSI over time. A total of 118 Italian NSSI inpatients aged 9–17 were involved. The Youth Self-Report (YSR) was administered. K-means cluster analyses were conducted using the YSR affective disorders, social competencies, and social problems scales as clustering variables. A binomial logistic regression was run to clarify which of these variables discriminate between the past and recent NSSI onset groups. Chi-square tests were performed to pinpoint the variables associated with long-standing NSSI. The final cluster solution displayed four psycho-behavioral profiles; a greater number of inpatients with recent NSSI onset was found in the clusters characterized by scarce social competencies. Affective disorders and social competencies were significant predictors, and higher scores on both scales were more likely in the past NSSI onset group. School problems and alcohol/substance use were related to long-standing NSSI. Therefore, a lack of social skills may be involved in recent NSSI onset, while affective disorders and other problem behaviors may dictate the continuation of NSSI over time
Self-harm in developmental age: epidemiological-clinical study of patients hospitalized in Child Neuropsychiatry
Full text linkopenLa finalità principale dello studio è di aggiungere conoscenze sul tema dell'autolesionismo in età evolutiva, rispetto gli elementi che caratterizzano i comportamenti suicidari (ideazione anticonservativa e tentato suicidio) e non suicidari. A tale scopo viene analizzato un campione di adolescenti estrapolato dai ricoverati presso la U.O.C. di Neuropsichiatria Infantile del Dipartimento di Salute della Donna e del Bambino dell'Azienda Ospedale-Università di Padova
Autism Spectrum Disorder between Clinical Heterogeneity and Genetic Insights: Struggles of Precision Medicine
No full textreservedIntroduzione:
Il Disturbo dello Spettro Autistico (ASD) è un disturbo del neurosviluppo a insorgenza infantile e ad alta prevalenza, caratterizzato da difficoltà nell’interazione sociale e dalla presenza di comportamenti o interessi ristretti e ripetitivi. Nonostante i criteri diagnostici categoriali internazionalmente adottati, la patologia presenta un’elevata variabilità interindividuale e può manifestarsi con profili differenti per comportamento, eziologia, traiettorie di sviluppo, comorbidità e risposta agli interventi. L’obiettivo principale del nostro studio è stato valutare l’esistenza di possibili correlazioni lineari tra domini clinici, comportamentali o neuropsicologici e le alterazioni genetiche identificate.
Metodi:
È stato condotto uno studio osservazionale retrospettivo su una coorte di 253 bambini e adolescenti con diagnosi di Disturbo dello Spettro Autistico (ASD), valutati presso l’Unità Operativa di Neuropsichiatria dell’Infanzia e dell’Adolescenza dell’Azienda Ospedaliera Università di Padova tra il 2018 e il 2024. La diagnosi clinica è stata formulata secondo i criteri del DSM-5 e supportata da strumenti standardizzati quali l’Autism Diagnostic Observation Schedule (ADOS). I dati, estratti dalle cartelle cliniche, comprendevano variabili demografiche, anamnestiche e di comorbidità, risultati di indagini EEG e RM, e analisi genetiche (aCGH, FMR1, pannelli NGS). Le analisi statistiche sono state eseguite con IBM SPSS Statistics 29.0.1.0. Sono state utilizzate statistiche descrittive per la caratterizzazione del campione e analisi inferenziali (ANOVA, chi-quadro, correlazioni di Pearson) per esplorare le associazioni tra risultati genetici e variabili cliniche, cognitive e comportamentali. È stata adottata una soglia di significatività di p < 0,05 per tutti i test.
Risultati:
Tra i 188 soggetti con dati genetici disponibili, il 42% presentava alterazioni positive, per lo più copy number variants (CNV) di dimensioni e significato clinico variabile. Il gruppo con genetica positiva mostrava una maggiore compromissione nei comportamenti socio-comunicativi, inclusa una riduzione dell’attenzione condivisa, del sorriso sociale e della qualità dello sguardo. Inoltre, presentava una più alta prevalenza di epilessia e anomalie EEG (in particolare alterazioni a onde lente) e punteggi WISC con le maggiori differenze nel QI totale e nella Comprensione Verbale. Le scale di competenza del CBCL (Attività, Sociale e Scolastica) risultavano significativamente più basse nei soggetti con genetica positiva, indicando un ridotto funzionamento adattivo, mentre le scale dei problemi broadband non differivano tra i gruppi.
Conclusioni:
I nostri risultati supportano l’ipotesi che i soggetti con ASD e alterazioni genetiche identificabili rappresentino un sottogruppo clinicamente distinto, caratterizzato da una più ampia vulnerabilità neuroevolutiva. Questi dati rafforzano l’importanza di integrare la caratterizzazione genetica, cognitiva e comportamentale all’interno di un approccio di medicina di precisione, al fine di migliorare la valutazione individualizzata e la pianificazione degli interventi terapeutici nei disturbi dello spettro autisticoBackground: Autism Spectrum Disorder (ASD) is a highly prevalent, childhood-onset neurodevelopmental disorder characterized by deficits in social interaction and the presence of restrictive and repetitive behaviors or interests. Despite the internationally used categorical diagnostic criteria, the disease presents a high variability among patients and may manifest differentially in terms of behaviors, etiology, developmental trajectories, presence of comorbid diagnoses, and response to interventions. The main aim of our study was to evaluate possible linear correlations between clinical, behavioral or neuropsychological domains and genetic alterations.
Methods: We conducted a retrospective observational study on a cohort of 253 children and adolescents diagnosed with Autism Spectrum Disorder (ASD) and evaluated at the Child and Adolescent Neuropsychiatry Unit of Padua University Hospital between 2018 and 2024. Clinical diagnosis was established according to DSM-5 criteria, supported by standardized tools such as the Autism Diagnostic Observation Schedule (ADOS). Data were extracted from medical records and included demographic, anamnestic, and comorbidity variables, results from EEG and MRI investigations, and genetic analyses (aCGH, FMR1, NGS panels). Statistical analyses were performed using IBM SPSS Statistics 29.0.1.0. Descriptive statistics were used to characterize the sample, and inferential analyses (ANOVA, chi-square, Pearson’s correlations) were applied to explore associations between genetic findings and clinical, cognitive, and behavioral variables. A significance threshold of p < 0.05 was adopted for all tests.
Results: Out of 188 subjects with available genetic data, 42% presented positive findings, most frequently CNVs of variable size and clinical significance. The genetic-positive group clinical observation revealed greater impairment in social-communicative behaviors, including diminished joint attention, social smiling, and gaze quality. Moreover, they showed higher rates of epilepsy and EEG anomalies (particularly slow-wave abnormalities) and lower mean IQ scores across all WISC indices, with the largest differences in Full-Scale IQ and Verbal Comprehension. CBCL competence scales (Activities, Social, and School domains) were significantly lower among genetically positive patients, indicating reduced adaptive functioning, while broadband problem scales did not differ between groups.
Conclusions: Our findings support the hypothesis that ASD with identifiable genetic alterations represents a clinically distinct subgroup characterized by broader neurodevelopmental vulnerability. These results reinforce the importance of integrating genetic, cognitive, and behavioral profiling within a precision-medicine framework to improve individualized assessment and intervention planning in ASD
Psychotic-like experiences in adolescents with eating disorders
No full textopenBackground: Le esperienze psicotiche sono fenomeni molto frequenti nella popolazione generale e clinica, e il loro significato è passato da sintomi precursori di schizofrenia a marker transdiagnostici di gravità e alterato funzionamento. La loro prevalenza è ancora maggiore in adolescenza, così come lo è quella dei disturbi della nutrizione e dell’alimentazione (DNA). La letteratura riguardante le esperienze psicotiche in bambini e adolescenti con diagnosi di DNA è ad oggi scarsa, per quanto l’intreccio fenomenologico tra psicosi e DNA sia stato varie volte rilevato in precedenza, e sia stato formulato un tentativo di spiegazione tramite la teorizzazione di core psicotico nei disturbi del comportamento alimentare.
Obiettivi e metodi: Abbiamo selezionato un campione di 100 pazienti al primo ricovero per DNA nella U.O.C. di Neuropsichiatria Infantile dell’Azienda Ospedale-Università di Padova, nel periodo di tempo dal 2018 al 2023 compresi. Abbiamo utilizzato i tre item 34 (sentirsi perseguitati), 40 (allucinazioni uditive) e 70 (allucinazioni visive) di Youth Self Report, compilato dal paziente, e di Child Behavior Checklist, compilata dai genitori, per la ricerca di esperienze psicotiche. Abbiamo individuato tre criteri di positività allo screening, utilizzati poi per operare un confronto tra le caratteristiche cliniche dei pazienti con e senza esperienze psicotiche, nonché tra self-report e parent-report.
Risultati: La prevalenza di esperienze psicotiche nel nostro campione è risultata elevata; il 64% dei pazienti sono risultati positivi a YSR, CBCL o entrambi. Il criterio 1, riferito a positività agli item di YSR, è risultato quello maggiormente associato a gravità clinica più accentuata; ciò non si è verificato per il criterio 2 (costituito dalla positività agli item in CBCL). Abbiamo constatato la plausibilità di un core psicotico nei DNA, riconducibile ad una dimensione di disembodiment, a sua volta concretizzato in manifestazioni tipiche dei disturbi del comportamento alimentare, quali dismorfofobia e voce anoressizzante. Inoltre, una dimensione di disregolazione emotiva potrebbe accomunare ulteriormente queste sfere di patologia, in quanto entrambe condividono elevata comorbidità per disturbi affettivi.
Conclusioni: La prevalenza di esperienza psicotica in pazienti adolescenti con DNA sembra essere particolarmente elevata, ed indicativa di maggiore gravità psicopatologica. Lo YSR è un utile strumento per implementare uno screening di primo livello, ma ad esso devono seguire indagini con strumenti ad hoc che rilevino in modo più accurato le caratteristiche delle PE (quali tipologia, distress causato, frequenza). Studi successivi sono necessari per seguire i pazienti a lungo termine, e per condurre ricerche specifiche per ciascuna diagnosi di DNA. È verosimile considerare le PLEs (Psychotic-Like Experiences) come elementi costitutivi dei disturbi del comportamento alimentare, e come tali da ricercare in questi pazienti. Abbiamo inoltre ipotizzato l’esistenza di un legame tra DNA, psicosi e disturbi affettivi, che potrebbe trovare le proprie origini in alterazioni del neurosviluppo.Background: Psychotic-like experiences (PLEs) are very common phenomena in both general and clinical populations. These experiences were viewed as precursor symptoms of schizophrenia, but they are now often considered transdiagnostic markers of severity and impaired functioning. Their prevalence is particularly high in adolescence, as is the case for eating disorders (EDs). However, the literature on psychotic experiences in children and adolescents with EDs remains scarce, despite previous recognition of the phenomenological overlap between psychosis and EDs. There is also an explanatory hypothesis that suggests a "psychotic core" in eating disorders.
Objectives and methods: We selected a sample of 100 patients, each hospitalized for the first time due to an eating disorder, in the U.O.C. of Neuropsichiatria Infantile of the Azienda Ospedale-Università of Padova (AOUPD) between 2018 and 2023. We used three items from the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL) to investigate psychotic experiences. The items assessed were: item 34 (feeling persecuted), item 40 (auditory hallucinations), and item 70 (visual hallucinations). These were completed by both the patients (YSR) and their parents (CBCL). We identified three criteria for positive screening and compared the clinical characteristics of patients with and without psychotic experiences, as well as self-reports versus parent reports.
Results: The prevalence of psychotic experiences in our sample was high, with 64% of patients testing positive on either the YSR, the CBCL, or both. Criterion 1, referring to positive responses in the YSR, was the most strongly associated with greater clinical severity. This was not the case for Criterion 2 (positive responses in the CBCL). We found support for the plausibility of a psychotic core in EDs, potentially related to a disembodiment dimension, which is reflected in typical EDs manifestations such as body dysmorphia and the anorexic voice. Additionally, emotional dysregulation may further connect these two domains of pathology, as both share a high comorbidity with affective disorders.
Conclusions: The prevalence of psychotic experiences in adolescents with EDs appears to be particularly high and indicative of greater psychopathological severity. The YSR is a useful tool for first-level screening, but further investigations with specialized tools are necessary to accurately assess the characteristics of psychotic experiences (such as type, frequency, and distress caused). Future studies should follow patients long-term and conduct research specific to each ED diagnosis. It is plausible to consider Psychotic-Like Experiences (PLEs) as constitutive elements of EDs, and as such, they should be specifically sought in these patients. We also hypothesize a link between EDs, psychosis, and affective disorders, which may originate from neurodevelopmental alterations
Self-harm in adolescence and predictive indicators of recurrence: retrospective clinical study
No full textopenBackground:
L’autolesionismo, definito come un comportamento finalizzato a infliggere volontariamente un danno a sé stessi, è un fenomeno in costante aumento in età evolutiva. Esso rappresenta un importante indice di sofferenza psicologica e si associa frequentemente ad altri quadri clinici, come: disturbi dell’umore, d’ansia e di personalità. Tra le dimensioni meno approfondite in letteratura si evidenzia quella delle recidive, definite come la ricomparsa della sintomatologia a seguito di un periodo di remissione. Le recidive sono spesso associate a maggiore gravità e complessità psicopatologica, costituendo un fattore di rischio per la cronicizzazione della condotta autolesiva e della psicopatologia comorbida, nonché per una possibile evoluzione verso forme suicidarie.
Obiettivi e metodi:
Il presente studio osservazionale retrospettivo ha analizzato un campione di 289 adolescenti ricoverati presso l’U.O.C. di Neuropsichiatria Infantile dell’Azienda Ospedale-Università di Padova tra gennaio 2015 e maggio 2025 a seguito di condotte autolesive. Sono state raccolte e analizzate variabili sociodemografiche, cliniche e psicopatologiche, tramite revisione delle cartelle cliniche e dei protocolli psicodiagnostici. Gli obiettivi principali hanno riguardato: la descrizione del campione al primo ricovero; il confronto tra soggetti recidivanti e non recidivanti, al fine di individuare eventuali fattori associati al rischio di recidiva; l’analisi comparativa, all’interno del sottogruppo recidivante, tra il primo ricovero e quelli successivi.
Risultati:
Il campione analizzato risulta composto principalmente da ragazze (80%), con un’età media di 14 anni e 10 mesi. La maggior parte dei soggetti presentava una diagnosi appartenente alle categorie dei disturbi dell’umore e d’ansia, oltre a difficoltà relazionali sia in ambito familiare che con il gruppo dei pari. Il gruppo dei soggetti recidivanti ha evidenziato livelli più elevati di problematiche esternalizzanti e internalizzanti, con particolare riferimento ad ansia e depressione. Inoltre, ha riportato una maggiore disregolazione emotiva, una frequenza più alta di disturbi del sonno e un livello di funzionamento della personalità più basso, secondo il modello teorico proposto da Kernberg.
Sono emerse, infine, relazioni più problematiche con il gruppo dei pari, frequentemente caratterizzate da ritiro sociale. Per quanto riguarda l’analisi intragruppo condotta all’interno del sottogruppo recidivante, dal confronto fra il primo e i successivi ricoveri è emerso un quadro nel complesso stabile, sebbene siano state riscontrate differenze statisticamente significative in alcune delle variabili cliniche considerate, che suggeriscono una diminuzione della sintomatologia psicopatologica nei ricoveri successivi al primo.
Conclusioni:
I risultati dello studio suggeriscono che la disregolazione emotiva, un funzionamento di personalità compromesso e la presenza di problemi esternalizzanti costituiscono potenziali indicatori predittivi di recidiva nei comportamenti autolesivi in adolescenza. L’intercettazione di questi elementi al primo ricovero potrebbe contribuire all’identificazione precoce dei soggetti maggiormente a rischio di reiterazione delle condotte autolesive.Background:
Self-harm, understood as the deliberate behavior of inflicting harm on oneself, has been increasingly observed during adolescence. It serves as a key indicator of psychological distress and is frequently linked to other clinical conditions, including mood, anxiety, and personality disorders. One dimension that remains relatively underexplored in the literature concerns recurrences, defined as the return of symptoms after a period of remission. These recurrences are often associated with greater clinical severity and psychopathological complexity, representing a risk factor for the chronic course of self-injurious behavior and comorbid psychopathology, as well as for a possible transition toward suicidal behaviors.
Objectives and Methods:
This retrospective observational study examined a sample of 289 adolescents admitted to the Child and Adolescent Neuropsychiatry Unit of the Padua University Hospital between January 2015 and May 2025 following self-injurious behaviors. Sociodemographic, clinical, and psychopathological variables were collected and analyzed through a review of medical records and psychodiagnostic protocols. The study pursued three main objectives: to describe the sample at the time of the first hospitalization; to compare adolescents with and without recurrences in order to identify potential risk factors associated with relapse; and, within the subgroup of recurrent cases, to conduct a comparative analysis between the first and subsequent hospitalizations.
Results:
The sample consisted predominantly of female adolescents (80%), with a mean age of 14 years and 10 months. Most participants received diagnoses within the categories of mood and anxiety disorders, in addition to relational difficulties both within the family and with peers. The subgroup of recurrent patients showed higher levels of both externalizing and internalizing problems, particularly anxiety and depression. They also reported greater emotional dysregulation, a higher frequency of sleep disorders, and lower levels of personality functioning, as described within Kernberg’s theoretical framework.
Furthermore, more problematic peer relationships emerged in this group, often marked by social withdrawal. With regard to the intragroup analysis conducted among recurrent cases, the comparison between the first and subsequent hospitalizations revealed an overall stable clinical picture. Nonetheless, statistically significant differences were observed in some clinical variables, suggesting a decrease in psychopathological symptomatology in hospitalizations following the first.
Conclusions:
The findings of this study suggest that emotional dysregulation, impaired personality functioning, and the presence of externalizing problems may serve as potential predictors of recurrence in adolescent self-injurious behaviors. Identifying these factors during the first hospitalization could support the early recognition of individuals at greater risk of repeating self-injurious acts
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