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Rogantini C, Orlandi M, Provenzi L, Chiappedi M, Coci C, Criscuolo M, Castiglioni M, Zanna V, Borgatti R, Mensi M. Assessing Family Functioning Before and After an Integrated Multidisciplinary Family Treatment for Adolescents With Restrictive Eating Disorders. Eur Psychiatry 2022. [PMCID: PMC9568087 DOI: 10.1192/j.eurpsy.2022.1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Previous studies applying the Lausanne Trilogue Play (LTPc), a semi-structured method for observing family dynamics, highlighted dysfunctional interaction patterns in the families of individuals affected by restrictive eating disorders (REDs). Family-centered approaches are considered the first-line treatment for severe cases of REDs in adolescence.
Objectives
To investigate family functioning in the families of adolescents with severe REDs assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention and triadic or family-centered intervention.
Methods
Sixty-seven families of adolescent patients diagnosed with REDs were assessed for eligibility between July 2017 and October 2020. Family functioning was assessed using the clinical version of LTPc. Nutritional counseling and neuropsychiatric monitoring were also provided.
Results
We observed a significant change in the family functioning score for the LTPc phase 2, in which the father interacts with his daughter while the mother acts as a silent observer. This suggests that the fathers, when playing an active role, could improve dyadic family functioning. The treatment was not found to change triadic functioning: a 6-month treatment may not be long enough to modify interactions at the triadic level.
Conclusions
A brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, our study reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.
Disclosure
The authors declare that they do not have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstrac.
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Martinelli V, Cappa A, Zugnoni M, Cappello S, Masi S, Klersy C, Pellegrino E, Muggia C, Cavallotto C, Politi P, Bruno F, Mineo N, Peri A, Lobascio F, Chiappedi M, Dakanalis A, Pietrabissa A, Caccialanza R. Quality of life and psychopathology in candidates to bariatric surgery: relationship with BMI class. Eat Weight Disord 2021; 26:703-707. [PMID: 32146595 DOI: 10.1007/s40519-020-00881-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This cross-sectional study aimed at comparing the quality of life (Qol), the prevalence of psychiatric diagnosis and pharmacological treatment in 104 candidates to bariatric surgery according to the degree of obesity (class 2 vs. class ≥ 3 obesity). METHODS All surgical candidates underwent a detailed psychiatric interview based on DSM-5 criteria, including sociodemographic, clinical, psychological and psychiatric data. Participants completed the Binge Eating Scale (BES) and the 12-Item Short Form Health Survey (SF-12). RESULTS Overall, bariatric candidates reported a significant impairment in the physical (PCS 38.8 [95% CI 36.2-41.5]) and mental (MCS 42.2 [95% CI 40.4-43.9]) components of Qol compared to population norms (p < 0.001 for both). Subjects with class 2 obesity scored significantly lower in the MCS compared to those with class 3 (38.7 (8.1) vs. 43.6 (8.4), p = 0.008). No other statistically significant differences were found between the two groups in terms of sociodemographic and clinical variables. CONCLUSION These data support the usefulness of Qol assessment in bariatric candidates as a sensible screening parameter, especially in patients with lower BMI, in whom MCS could identify the need for early psychosocial intervention. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- V Martinelli
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - A Cappa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - M Zugnoni
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S Cappello
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S Masi
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - C Klersy
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Service of Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - E Pellegrino
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - C Muggia
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Internal Medicine, Clinica Medica 1, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - C Cavallotto
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - P Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - F Bruno
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - N Mineo
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - A Peri
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - F Lobascio
- Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Chiappedi
- Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - A Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - A Pietrabissa
- Bariatric Surgery Team, Unit of General Surgery 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - R Caccialanza
- Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Martinelli V, Gregorini M, Politi P, Erasmi F, Contardi A, Abelli M, Ticozzelli E, Canevari M, Pietrabissa A, Chiappedi M, Rampino T. Psychological Aspects and Psychopharmacologic Treatment in the Very Early Period After Kidney Transplantation: Role of a Multidisciplinary Approach. Transplant Proc 2019; 51:143-146. [DOI: 10.1016/j.transproceed.2018.02.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 12/13/2022]
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Bejor M, Mandrini S, Caspani P, Comelli M, Chiappedi M. Quantification of upper limb skills in elderly rehabilitative inpatients: a controlled study. Eur J Phys Rehabil Med 2015; 51:399-404. [PMID: 25384513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Aging has a recognized degenerative effect on the functionality of the hand in terms of strength and dexterity. Despite this, there are few studies in literature that quantify the upper limb skills in the elderly. AIM The aim was to present quantitative data regarding upper limb functionality in the elderly and to quantify the effect of aging on them, considering the influence of the comorbidities, of the global level of autonomy, of the cognitive status and of the mood, which are typically compromised in the elderly. DESIGN It was a controlled study. SETTING It was settled in the Rehabilitation Unit of the "Santa Maria alle Fonti" Medical Center, part of the Don Carlo Gnocchi ONLUS Foundation. POPULATION Thirty-five elderly inpatients (aged 78.6±7.5 years) compared to 30 healthy young adults (aged 30±3.9 years). METHODS A task consisting in 12 trials of grasping of rulers was administered to each subject and studied with a video analysis software. To assess the comorbidities, the global level of autonomy, the cognitive status and the mood, we respectively used the Cumulative Illness Rating Scale (CIRS), the Functional Independence Measure (FIM™), the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale in the 15-items version (GDS-15). The scores obtained in these scales were correlated to the mean times of trials execution. RESULTS The motor performance was significantly worse in the inpatients group compared to the control group in terms of time to complete single tasks (which was on average three times higher in the inpatients group) and of respect of the starting sound stimulus, with more subjects from the inpatients group anticipating the starting signal. This worsening of the motor performance was significantly correlated to the severity of comorbidities and to the global level of autonomy. No significant differences emerged for the correctness of the performance and significant differences were not correlated with depression or cognitive impairment. CONCLUSION This study provides quantifiable data regarding upper limb skills in the elderly inpatient, allowing comparisons with other future studies of the rehabilitative environment. CLINICAL REHABILITATION IMPACT It suggests the relevance of considering the severity of comorbidities and the global level of autonomy in the assessment of upper limb skills in the elderly.
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Affiliation(s)
- M Bejor
- Physical Medicine and Rehabilitation Section University of Pavia, Pavia, Italy -
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Braida D, Guerini FR, Ponzoni L, Corradini I, De Astis S, Pattini L, Bolognesi E, Benfante R, Fornasari D, Chiappedi M, Ghezzo A, Clerici M, Matteoli M, Sala M. Association between SNAP-25 gene polymorphisms and cognition in autism: functional consequences and potential therapeutic strategies. Transl Psychiatry 2015; 5:e500. [PMID: 25629685 PMCID: PMC4312830 DOI: 10.1038/tp.2014.136] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/19/2014] [Indexed: 12/27/2022] Open
Abstract
Synaptosomal-associated protein of 25 kDa (SNAP-25) is involved in different neuropsychiatric disorders, including schizophrenia and attention-deficit/hyperactivity disorder. Consistently, SNAP-25 polymorphisms in humans are associated with hyperactivity and/or with low cognitive scores. We analysed five SNAP-25 gene polymorphisms (rs363050, rs363039, rs363043, rs3746544 and rs1051312) in 46 autistic children trying to correlate them with Childhood Autism Rating Scale and electroencephalogram (EEG) abnormalities. The functional effects of rs363050 single-nucleotide polymorphism (SNP) on the gene transcriptional activity, by means of the luciferase reporter gene, were evaluated. To investigate the functional consequences that SNAP-25 reduction may have in children, the behaviour and EEG of SNAP-25(+/-) adolescent mice (SNAP-25(+/+)) were studied. Significant association of SNAP-25 polymorphism with decreasing cognitive scores was observed. Analysis of transcriptional activity revealed that SNP rs363050 encompasses a regulatory element, leading to protein expression decrease. Reduction of SNAP-25 levels in adolescent mice was associated with hyperactivity, cognitive and social impairment and an abnormal EEG, characterized by the occurrence of frequent spikes. Both EEG abnormalities and behavioural deficits were rescued by repeated exposure for 21 days to sodium salt valproate (VLP). A partial recovery of SNAP-25 expression content in SNAP-25(+/-) hippocampi was also observed by means of western blotting. A reduced expression of SNAP-25 is responsible for the cognitive deficits in children affected by autism spectrum disorders, as presumably occurring in the presence of rs363050(G) allele, and for behavioural and EEG alterations in adolescent mice. VLP treatment could result in novel therapeutic strategies.
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Affiliation(s)
- D Braida
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,Fondazione IRCCS Don Gnocchi, Milan, Italy
| | | | - L Ponzoni
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,Fondazione Fratelli Confalonieri, Milan, Italy
| | | | - S De Astis
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy
| | - L Pattini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - R Benfante
- CNR—Neuroscience Institute, Milan, Italy
| | - D Fornasari
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,CNR—Neuroscience Institute, Milan, Italy
| | - M Chiappedi
- Child Neuropsychiatry Unit, National Neurological Institute C. Mondino, Pavia, Italy
| | - A Ghezzo
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy,Associazione Nazionale Famiglie di Persone con Disabilitá Affettiva e/o Relazionale (ANFFAS), Macerata, Italy
| | - M Clerici
- Fondazione IRCCS Don Gnocchi, Milan, Italy,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - M Matteoli
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,Humanitas Clinical and Research Center, Rozzano, Italy
| | - M Sala
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,CNR—Neuroscience Institute, Milan, Italy,Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Via Vanvitelli 32, Milan 20129, Italy. E-mail:
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Piazza F, Chiappedi M, Maffioletti E, Galli F, Spada G, Nappi G, Balottin U. A clinical study on medication overuse headache in childhood and adolescence. J Headache Pain 2013. [PMCID: PMC3620085 DOI: 10.1186/1129-2377-14-s1-p27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chiappedi M, Baschenis IMC, Dolci R, Bejor M. Importance of a critical reading of neuropsychological testing. Minerva Pediatr 2011; 63:239-245. [PMID: 21654605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Neuropsychological testing has become an important part of the diagnostic tools available to assess children's functioning. Tests are routinely use to establish diagnosis, measure patient's impairment and drive rehabilitation. The authors present the clinical case of a eight-year-old girl, sent to our Child Neuropsychiatry and Rehabilitation Unit for a suspected Specific Learning Disorder. Peculiar findings regarding attention and reading ability became evident during the initial evaluation; a mistaken diagnosis of dyslexia was avoided by carefully examining her global functioning (in particular sight, as she suffered from hyperopia but more importantly she had an insufficient control of vertical saccadic movements) and the strategies she used during testing. This constitutes a good example of the need to take into consideration the patient as a whole during any assessment, including neuropsychological testing.
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Bejor M, Pezzoli A, Dalla Toffola E, Chiappedi M. Main diagnosis, comorbidity and functional impairment at admission in the rehabilitative wards of Lombardy region. A survey on 6,671 patients. Eur J Phys Rehabil Med 2010; 46:609-611. [PMID: 20827256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Chiappedi M, Maltagliati S, Amoruso A, Dolci R, Carniglia C, Bejor M. Child rehabilitation refusal: why it happens and possible strategies to avoid it. Eur J Phys Rehabil Med 2009; 45:487-492. [PMID: 20032906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM Despite an obvious need for rehabilitative treatment, some parents deny consent and some others withdraw their children from a previously accepted program. There is limited literature concerning how to prevent this, serving the child's best interest, and the existing is mainly focused on legal implications. METHODS This was a naturalistic study, carried out using data obtained during the diagnostic evaluation of 166 children (all those seen in the Child Neuropsychiatry Unit). For 25 children (15.1%), parents refused or interrupted suggested treatment. RESULTS Statistical analysis showed that there is a significant difference in terms of impairment in children of parents accepting or refusing the rehabilitative treatment. Treatment discontinuation is related to the diagnosis (higher percentage in severe language disorders or complex developmental disorders), higher reduction in global functioning, higher disability burden, need for integrated treatment, lower age. CONCLUSIONS Findings of this study could be useful in order to better plan rehabilitative options and goals. It is possible that an attempt to increase parental involvement in the rehabilitative program could lead to a decrease in treatment discontinuation. Anyway, more research is needed because we are still far from having a good predictive model to anticipate and, if possible, avoid treatment discontinuation.
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Affiliation(s)
- M Chiappedi
- Department of Rehabilitation, Santa Maria alle Fonti Medical Center, Don Carlo Gnocchi ONLUS Foundation, Salice Terme, Pavia, Italy.
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Rossi G, Balottin U, Rossi M, Chiappedi M, Fazzi E, Lanzi G. Pharmacological treatment of anorexia nervosa: a retrospective study in preadolescents and adolescents. Clin Pediatr (Phila) 2007; 46:806-11. [PMID: 17641118 DOI: 10.1177/0009922807303929] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To date, studies addressing the role of pharmacotherapy in the treatment of anorexia nervosa are limited, especially in childhood and adolescence. The aim of this retrospective naturalistic study was to evaluate the efficacy and safety of pharmacotherapy in 19 anorexic preadolescents and adolescents referred, for the first time, to a specialist psychiatry unit. Almost all the patients showed an improvement both in their eating behaviors, and in their mood and obsessive symptoms. No evidence was found of dangerous adverse events. Combined with a multidisciplinary approach that includes nutritional rehabilitation and psychotherapy, adjunctive pharmacotherapy may be useful in addressing both eating disorder psychopathology and comorbid psychiatric disorders.
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Affiliation(s)
- G Rossi
- Department of Child Neurology and Psychiatry, IRCCS C. Mondino Foundation, University of Pavia, Pavia, Italy.
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Chiappedi M, Zoppello M, Rossi R, Scarabello EM, Piazza F. [Specific learning disabilities and psychopathological aspects: the importance of early diagnosis]. Minerva Pediatr 2007; 59:281-7. [PMID: 17519874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The case of a couple of monozygotic twins, for whom the diagnosis of Specific Learning Disabilities was made when they were 14.5 years old, even if reading and writing difficulties had been present since the beginning of primary school, is described. The consultation had been required due to difficulties in relating with same age boys, with social withdrawal and depressive traits, leaving in second place school difficulties; clinical suspect has led to extend the evaluation to include the neuropsychological aspects and so to reach the diagnosis. The differences in terms of adaptive modalities facing the discomfort, probably based on temperament differences, and neuropsychological disorder (low grade dyslexia for one twin, dis-orthography and low-to-medium grade dyslexia for the other one) are discussed. The acquired awareness of being intelligent has permitted the boys to look back in a new way to the school failures they had collected through years; namely, understanding that their difficulties reflected a specific neuropsychological deficit has permitted to reconsider their own past history with a consequent modification of the ''beliefs'' about their abilities. This all has led as a consequence to an increase of life quality (with an improved school and relational adaptation), without cancelling but instead supporting the research of on individuality based on temperament differences. This was possible in spite of the evident delay in reaching the diagnosis and the consequent accumulation of frustration and inadequacy experiences for many years; it's therefore demonstrated the importance of a global evaluation of patients with anamnesis of difficulties in learning to read and write, also in order to treat the possible psychopathological aspects of the clinical picture, which can be the result of a sense of helplessness.
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Affiliation(s)
- M Chiappedi
- Fondazione don Carlo Gnocchi ONLUS, Servizio di Neuropsichiatria e Riabilitazione per l'Età Evolutiva, Centro Medico Santa Maria alle Fonti, di Salice Terme, Pavia.
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Piazza F, Maccabruni A, Rossi G, Chiappedi M, Caselli D, Bonforte F, Lanzi G. [Neurological and psychological evolution of adolescents with vertical transmission HIV infection]. Minerva Pediatr 2004; 56:411-7. [PMID: 15457138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM Personal experience in a sample group of children with AIDS vertically transmitted followed from birth to adolescence (out of 56 cases with documented HIV infection, 9 who have reached the age of 13 have been studied) is presented. METHODS The evaluation protocol includes: hematochemical, serological and virological tests to monitor the infectious status, as well as annual EEG, CT/MRI scan to detect anatomical alteration of CNS, neurological examination, intelligence test (WISC-R), interview and projective test (Blacky Pictures) to investigate emotional situation. RESULTS As to the status of the disease, according to the CDC classification, 2 patients are asymptomatic, 2 paucisymptomatic, 2 with moderate symptoms, 2 severely symptomatic; 1 patient died due to progressive encephalopathy. Of the 2 severely symptomatic cases, 1 presents cortical atrophy and the other basal nuclei calcifications. No one of them has clinical signs of encephalopathy. All patients receive anti-retroviral medications. From tests and interviews emotional problem-emerge, future is seen as menacing and insidious, and defensive mechanisms are fragile and inconstant; denial can lead to a refusal of the pharmacological therapy; families themselves often refuse medical staff the consent to communicate the diagnosis fearing that this could induce unbearable anguish. CONCLUSIONS It seems important that patients are informed, considering their capacity to make front to the communication, even if one must bear in mind that understanding and accepting the diagnosis may be a long and painful process requiring a long time.
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Affiliation(s)
- F Piazza
- Cattedra di Neuropsichiatria Infantile, Università degli Studi di Pavia, Pavia
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Severi F, Verri AP, Chiappedi M, Bozzola M, Ferro P, Colombo A. [Obesity in the developmental age. Psychogenic aspects]. Minerva Pediatr 1977; 29:1453-61. [PMID: 895686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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