DDX3X Syndrome Behavioral Manifestations with Particular Emphasis on Psycho-Pathological Symptoms-A Review

(1) Background: Identification of typical behavioral manifestations in patients with DEAD-Box Helicase 3 X-linked gene (DDX3X) variants plays a crucial role in accurately diagnosing and managing the syndrome. The objective of this paper was to carry out a review of medical and public databases and assess the behavioral features of the DDX3X syndrome (DDX3X), with a particular focus on psycho-pathological symptoms. (2) Methods: An extensive computerized search was conducted in various databases, including PubMed, Medline Complete, Science Direct, Scopus, and Web of Science. Specific keywords and Medical Subject Headings were used to ensure the inclusion of relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to assess the methodological quality of the manuscripts. (3) Results: Only nine papers out of the 272 assessed met the inclusion criteria. These articles revealed various psycho-pathological manifestations in patients with the DDX3X syndrome. Intellectual disability (ID) or developmental disability (DD), speech delay, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), self-injurious behaviors (SIBs), sensory symptoms and sleep disturbance were demonstrated to be the most common psycho-pathological behavior manifestations. (4) Conclusions: Patients with the DDX3X syndrome manifest a wide spectrum of psycho-pathological symptoms. A comprehensive investigation of these symptoms in patients is essential for early diagnosis and effective therapy.

Developmental pathways from preschool temper tantrums to later psychopathology

Temper tantrums are sudden, overt negative emotional displays that are disproportionate to the eliciting event. Research supports that severe temper tantrums during the preschool period are associated with preschool psychopathology, but few studies have identified which characteristics of preschool tantrums are predictive of distal psychopathological outcomes in later childhood and adolescence. To examine this question, we used a prospective, longitudinal dataset enriched for early psychopathology. Participants (N = 299) included 3-to 6-year-old children (47.8% female) assessed for tantrums and early childhood psychopathology using diagnostic interviews and then continually assessed using diagnostic interviews over 10 subsequent time points throughout childhood and adolescence. We identified two unique groupings of tantrum behaviors: aggression towards others/objects (e.g., hitting others) and aggression towards self (e.g., hitting self). While both types of tantrum behaviors were associated with early childhood psychopathology severity, tantrum behaviors characterized by aggression towards self were more predictive of later psychopathology. Children displaying high levels of both types of tantrum behaviors had more severe externalizing problems during early childhood and more severe depression and oppositional defiant disorder across childhood and adolescence. Findings suggest that tantrum behaviors characterized by aggression towards self are particularly predictive of later psychopathology.

Developmental Regression Followed by Epilepsy and Aggression: A New Syndrome in Autism Spectrum Disorder?

Autism spectrum disorder (ASD) with regression (ASD-R) involves the loss of previously attained developmental milestones, typically during the first or second year of life. As children age, it is not uncommon for them to develop comorbid conditions such as aggressive behaviors or epilepsy, which can inhibit habilitation in language and social function. In this paper, we hypothesize that aggressive behaviors and epilepsy more commonly develop in patients with ASD-R than in those without a history of regression (ASD-NR). We conducted a retrospective review of non-syndromic patients with ASD over 12 years of age and compared the rates of epilepsy and aggression between ASD-R and ASD-NR patients. Patients with ASD-R, as compared to ASD-NR patients, demonstrated non-significantly higher rates of epilepsy (51.8% vs. 38.1%, p = 0.1335) and aggressive behaviors (73.2% vs. 57.1%, p = 0.0673) when evaluated separately. The rates for combined epilepsy and aggression, however, were statistically significant when comparing ASD-R versus ASD patients (44.5% vs. 23.8%, p = 0.0163). These results suggest that epilepsy with aggression is more common in ASD-R as compared to ASD-NR patients. When considering the impact of epilepsy and aggression on quality of life, these co-morbidities effectively cause a second regression in patients who experienced an earlier regression as toddlers. A larger, prospective trial is recommended to confirm these associations and further define the timeline in which these characteristics develop from early childhood to adolescence.

Botulinum Neurotoxin Injections in Children with Self-Injurious Behaviors

Self-injurious behaviors are repetitive, persistent actions directed toward one's body that threaten or cause physical harm. These behaviors are seen within a broad spectrum of neurodevelopmental and neuropsychiatric conditions, often associated with intellectual disability. Injuries can be severe and distressing to patients and caregivers. Furthermore, injuries can be life-threatening. Often, these behaviors are challenging to treat and require a tiered, multimodal approach which may include mechanical/physical restraints, behavioral therapy, pharmacotherapy, or in some cases, surgical management, such as tooth extraction or deep brain stimulation. Here, we describe a series of 17 children who presented to our institution with self-injurious behaviors in whom botulinum neurotoxin injections were found helpful in preventing or lessening self-injury.

Expanding Clozapine Use in State Prisons: A Review of the North Carolina Experience

The prevalence of serious mental illnesses in prisons is estimated to be significantly higher than in the community. The antipsychotic medication clozapine is very effective in managing treatment-resistant psychosis and may also reduce suicidal and self-injurious behaviors but is underused due to several logistic challenges. A partnership between the North Carolina prison system and University of North Carolina School of Medicine established a consultative system for clozapine initiations that has led to a 390% increase in the number of incarcerated people using clozapine over a 5-year period. This article reviews the benefits and challenges of clozapine use in corrections based on the North Carolina experience and practical strategies on how to expand use in a prison system.

Diminished body trust uniquely predicts suicidal ideation and nonsuicidal self-injury among people with recent self-injurious thoughts and behaviors

INTRODUCTION

Self-injurious thoughts and behaviors (SITBs) are difficult to predict, and novel risk factors must be identified. While diminished interoception is associated with SITBs cross-sectionally, the current study assesses whether multiple measures of interoception predict future SITBs.

METHODS

Adults (N = 43) with recent SITBs completed assessments of interoception during a baseline visit. Participants then completed biweekly assessments for 6 months in which they reported the presence and severity/frequency of suicidal ideation and nonsuicidal self-injury (NSSI).

RESULTS

Multilevel models were performed, where baseline interoceptive measures predicted presence and severity/frequency of suicidal ideation and NSSI at follow-up. The Multidimensional Assessment of Interoceptive Awareness (MAIA) Trusting subscale was the only significant predictor of the presence/severity of suicidal ideation. The MAIA Trusting, Emotional Awareness, and Body Listening subscales significantly predicted the presence of NSSI. The MAIA Emotional Awareness subscale and the Body Perception Questionnaire significantly predicted NSSI frequency.

DISCUSSION

Diminished body trust predicted both suicidal ideation and NSSI, indicating a potential shared risk pathway. However, two interoception measures (Body Listening subscale and Body Perception Questionnaire) were associated with NSSI only, indicating potentially unique risk pathways. Given the differential associations between interoception measures and SITBs, results highlight the importance of clearly defining how interoception is measured.

Online Sexual Abuse and Symptomatology in Chilean Adolescents: The Role of Peer Support

Several authors are studying sexual abuse via the Internet and its consequences. However, the available studies have not sufficiently detected factors that could help reduce the symptoms that victims may experience. Given the importance of peers during adolescence, especially in the online world, the objective of this study was to evaluate the relationship between online sexual abuse, perceived peer support, and internalizing and externalizing symptomatology. Three hundred and eighty Chilean adolescents (M = 16.12 years, SD = .52, 49.7% girls, 50.3% boys) responded to a set of self-report instruments. The results showed a relationship between online sexual abuse and depressive symptomatology, as well as self-injurious and antisocial behaviors. In turn, peer support was inversely associated with internalizing symptomatology. Results of the study highlight the relevance of peers as factors in intervention programs for adolescents dealing with online sexual abuse.

Big Data Approach to Characterize Restricted and Repetitive Behaviors in Autism

OBJECTIVE

Despite being a core diagnostic feature of autism spectrum disorder (ASD), demographic, developmental and clinical correlates of restricted and repetitive behaviors and interests (RRB) remain poorly characterized. This study aimed to utilize the largest available RRB data set to date to provide a comprehensive characterization of how distinct RRB domains vary according to a range of individual characteristics.

METHOD

Data were obtained from 17,581 children and adolescents with ASD (mean_age= 8.24 years, SD_age= 4.06) from the Simons Foundation Powering Autism Research for Knowledge cohort. Caregivers completed the Repetitive Behavior Scale-Revised questionnaire as a measure of repetitive motor behaviors, self-injurious behaviors, compulsions, insistence on sameness, and circumscribed interests RRB domains. Caregivers also provided information on children's cognitive functioning, language ability, and social and communication impairments.

RESULTS

Male sex was associated with higher severity of repetitive motor behaviors and restricted interests and with lower severity of compulsions and self-injurious behaviors; no sex differences were found for the insistence on sameness domain. Although repetitive motor behaviors showed a mostly linear (negative) association with age, other RRB domains showed more complex and nonlinear pattern of associations. Higher severity of social and communication impairments provided significant independent contribution in predicting higher severity of all RRB domains at the p < .001 level; however, these effects were small (d < 0.25). The strongest of these effects was observed for insistence on sameness (d = 0.24), followed by repetitive motor behaviors (d = 0.21), compulsions (d = 0.17), restricted interests (d = 0.14), and self-injurious behaviors (d = 0.12).

CONCLUSION

Findings reported here provide further evidence that RRB subdomains show a somewhat distinct pattern of associations with demographic, developmental, and clinical variables, with a key implication that separate consideration of these domains can help to facilitate efforts to understand diverse ASD etiology and to inform the design of effective interventions.

Autistic adults' subjective experiences of hoarding and self-injurious behaviors

LAY ABSTRACT

Hoarding and self-injurious behaviors are relatively common in autism, but knowledge about their expressions in adulthood is scarce. Through interviews collecting subjective experiences of autistic adults, these behaviors were explored, and categorized to their underlying purposes. Findings portray the occurrence of these behaviors in the lives of autistic adults, their self-regulatory purposes, and their relationship to other behaviors in the domain of Restrictive and Repetitive Behaviors and Interests.

Problematic shopping and self-injurious behaviors in adolescents

BACKGROUND AND AIMS

Self-injurious behaviors (SIBs) and problematic shopping (PS) are both prevalent in adolescents. These behaviors have been proposed as behavioral addictions and linked to impulsivity (Imp) and sensation-seeking (SS). They are also associated with negative mental health and psychosocial measures. This study examined relationships between PS and SIB in adolescents. It also examined how PS and SIB relate to Imp and SS, and interactions between PS and SIB in relation to health/functioning measures.

METHODS

Survey data from 2,624 Connecticut high-school students were evaluated using chi-square analyses. Next, logistic regression models were used to assess relationships between PS and measures of SIB. T-tests compared Imp and SS in adolescents with and without PS and SIB. Interaction analyses assessed effects of PS on relationships between SIB and health/functioning measures.

RESULTS

Adolescents with PS had 3.43-fold higher odds of endorsing lifetime SIB than those without PS, and were more likely to exhibit severe SIB and disruption due to SIB. PS and SIB were associated with elevated Imp and SS. Interaction analyses revealed that in adolescents with PS, the relationships between SIB and substance use was weaker than in adolescents without PS. This suggests PS accounts for variance in relationships between SIB and substance use.

DISCUSSION AND CONCLUSIONS

PS is strongly related to SIB prevalence, severity, and impairment in adolescents, and weakens associations between SIB and substance use. PS should therefore be considered for prevention efforts for SIB. Further research should investigate mechanisms connecting PS and SIB and explore possible interventions targeting associated features like Imp and SS.

Mental Disorders in Peyronie's Disease: A Swedish Cohort Study of 3.5 Million Men

PURPOSE

Studies have shown that men with Peyronie's disease often suffer from psychological problems, but the psychiatric burden of this disorder remains largely unknown. We assessed risks of a range of psychiatric outcomes in a population based Swedish cohort comprising 3.5 million men.

MATERIALS AND METHODS

We conducted a longitudinal cohort study based on Swedish national registers. A total of 8,105 men diagnosed with Peyronie's disease and 3.5 million comparison subjects from the general Swedish population were selected, and followed up with for diagnosed psychiatric outcomes including substance use disorder, alcohol misuse, anxiety disorder, depression, and self-injurious behaviors. Risks of psychiatric outcomes were estimated with Cox regressions and additionally adjusted for birth year.

RESULTS

Men with Peyronie's disease had increased risks of being diagnosed with substance use disorder (HR 1.4, 95% CI 1.1-1.9), no excess risk of alcohol misuse (HR 0.9, CI 0.8-1.1), but elevated risks of anxiety disorder (HR 1.9, CI 1.6-2.2), depression (HR 1.7, CI 1.5-2.0), self-injurious behaviors (HR 2.0, 95% CI 1.7-2.3) as well as any psychiatric outcomes (HR 1.4, 95% CI 1.2-1.5). The risk estimates were slightly decreased when adjusted for birth year. A limitation of the study was that we had no information about Peyronie's disease diagnoses assigned before year 1997.

CONCLUSIONS

Men with Peyronie's disease are at increased risk of being diagnosed with adverse psychiatric outcomes. Health care providers should ensure that men with Peyronie's disease have a documented mental health status assessment.

Self-Injurious Behaviors and Adult Attachment: A Review of the Literature

Self-injurious behaviors (SIB) continue to afflict a significant segment of the clinical and general population, sometimes with fatal consequences. The development of SIB seems to share developmental pathways and mechanisms similar to attachment insecurity. To date, no reviews have explored their relationship. A search of publication databases PubMed and PsychInfo from 1969 through April 2018 was conducted and 17 papers met inclusion criteria. Of the 17 articles identified, 13 reported a positive relationship and 1 reported a negative relationship between attachment insecurity and SIB. Both attachment anxiety and avoidance seem to play a role in the risk for SIB, possibly through different mechanisms and likely with different impacts on the choice for either self-harm or suicide attempts.

Management of Self-injurious Behaviors in Children with Neurodevelopmental Disorders: A Pharmacotherapy Overview

Neurodevelopmental disorders (NDDs), a group of disorders affecting ~1-2% of the general population, are caused by changes in brain development that result in behavioral and cognitive alterations, sensory and motor changes, and speech and language deficits. Neurodevelopmental disorders encompass a heterogeneous group of disorders including, but not limited to, Smith-Magenis syndrome, Lesch-Nyhan disease, cri du chat syndrome, Prader-Willi syndrome, pervasive developmental disorders, fragile X syndrome, Rett syndrome, Cornelia de Lange syndrome, and Down syndrome. Self-injurious behaviors (SIBs) are common in children with NDDs; depending on the specific NDD, the incidence of SIBs is nearly 100%. The management of SIBs in this population is complex, and little high-quality data exist to guide a consistent approach to therapy. However, managing SIBs is of the utmost importance for the child as well as the family and caregivers. Behavior therapies must be implemented as first-line therapy. If behavioral interventions alone fail, pharmacotherapy becomes an essential part of management plans. The limited available evidence for the use of common pharmacologic agents, such as second-generation antipsychotics, and less common agents, such as clonidine, n-acetylcysteine, riluzole, naltrexone, and topical anesthetics, is reviewed. Additional data from well-designed studies in children with NDDs are needed to gain a better understanding of this common and troublesome problem including efficacy and safety implications associated with pharmacotherapy. Until then, clinicians must rely on the limited available data, clinical expertise, and ongoing systematic monitoring when managing SIBs in children with NDDs.

Behavior and sleep disturbance in Smith-Magenis syndrome

PURPOSE OF REVIEW

To provide an update of the most recent studies on Smith-Magenis syndrome (SMS) with a focus on the unique pattern of behavioral and sleep disturbances associated with the condition.

RECENT FINDINGS

The recent literature on SMS has focused on the characteristic severe behavioral and sleep disturbances. A better understanding of the underlying pathophysiological mechanisms and common clinical course has helped further characterize SMS, while much is left to be discovered in regard to effective treatment/management.

SUMMARY

SMS is a difficult to manage genetic condition defined by pervasive and progressive behavioral and sleep disturbances with a unique pattern that can often be easily discerned from other neurodevelopmental disorders. Common behavioral features include maladaptive/self-injurious, aggressive, stereotypic, and the newly appreciated food seeking behaviors associated with SMS. In addition, there is a sleep disturbance defined by an altered circadian rhythm with frequent nighttime waking and daytime sleepiness, causing patients and families significant distress. Small studies have suggested some treatment/management approaches to the behavioral and sleep disturbances, however, much remains to be discovered.

Emotional Pain Mediates the Link Between Preoccupied Attachment and Non-suicidal Self-Injury in High Suicide Risk Psychiatric Inpatients

Background: Non-suicidal self-injury (NSSI) is a risk factor for suicide attempts (SA). Both attachment disturbances and cognitive and emotional problems (e.g., emotional pain) have been associated with SA history. This study sought to determine differential contributions of attachment styles and cognitive and emotional states associated with SA to lifetime NSSI occurrence among adults hospitalized for suicide risk.

Sampling and Methods: Adult psychiatric inpatients (n = 200) were assessed for attachment style, cognitive and emotional states, and lifetime NSSI within 72 h of hospitalization. Binary logistic regression and mediation analyses were performed.

Results: Preoccupied attachment and emotional pain at admission were independently associated with lifetime NSSI. Emotional pain partially mediated the relationship between preoccupied attachment and lifetime NSSI.

Limitations: The cross-sectional nature of the study and the use of a dichotomous (yes/no) measure of NSSI, not specifically designed for its assessment.

Conclusions: Preoccupied attachment and emotional pain are associated with NSSI and may be useful targets for assessing risk of NSSI.

[Reduction of dysfunctional self-injurious and self-stimulatory behaviors in autism disorders spectrum through occupational therapy]

Self-stimulatory and self-injurious behaviors are very frequent in neurodevelopmental disorders, being a source of anxiety and suffering for persons who have that behavior and their families. Sometimes these behaviors are so intense and frequent that it becomes a selfintegrity risk. A bibliographic review was conducted on the different approaches that have been developed until today; in addition, this article explains the methodology applied in our clinic, with a data collection on the effect of therapy on self-injurious and self-stimulatory behaviors in 20 cases, as a starting point for future research. The sensory integration model that complements pharmacological and behavioral cognitive treatment is highlighted, since it considers sensory needs relevant and trains the capacity for functional self-regulation.

Self-injurious behaviors in children with autism spectrum disorder enrolled in the Study to Explore Early Development

We assessed potential factors associated with "current" or "ever" self-injurious behaviors, reported in the Autism Diagnostic Interview-Revised, among children with autism spectrum disorder (n = 692) from the Study to Explore Early Development. Data on factors examined were obtained from questionnaires, standardized clinical instruments, and birth certificates. We employed a log-binomial regression to assess these associations. Although most associations were quite similar for currently and ever exhibiting self-injurious behaviors, a few differences were noted. We documented previously unreported associations of current self-injurious behaviors with maternal age and cesarean delivery, and ever self-injurious behaviors with maternal age, child sex, gestational age, and maternal race. We also confirmed previously reported associations with adaptive skills, somatic conditions (sleep, gastrointestinal, and sensory abnormalities), and other behavioral problems. These findings are informative for clinical practice and future research.

Typical Skin Injuries in Children With Autism Spectrum Disorder

Pediatric skin injuries have primarily been described in typically developing children. Our objectives were to describe the prevalence and pattern of skin injuries of children with autism spectrum disorder (ASD), to describe how this compared with previously demonstrated skin injury locations in typically developing children, and to identify differences in skin injury frequency and locations between autistic children with and without self-injurious behaviors (SIBs). Children with ASD were recruited between September of 2011 and September of 2014. Demographic information was obtained from the caregiver. All skin injuries and their locations were documented. Of the 41 children enrolled, half were reported to have SIBs. The most identified skin injury locations were the legs, knees, and back. Children with autism (1) obtain skin injuries frequently and in similar locations as typically developing children and (2) rarely obtain skin injuries to locations that are considered uncommon for accidental injuries despite reports of SIBs.

Self-Injurious Behavior in Prison: A Case Study

The practice of self-injurious behaviors (SIBs) within corrections disproportionately consumes resources and negatively impacts staff. To date, the majority of empirical studies on the topic have relied upon quantitative methodologies that fail to include the perspective of the actual offender who is engaging in self-injury, thus reinforcing mischaracterizations and confusion. In response, this manuscript features a case study of an offender currently housed in a maximum security prison who routinely engages in self-injury. Findings are presented along the tripartite themes of family background, suicidality, and SIB. Policy implications include supporting a systematic reorientation toward therapeutic responses in lieu of the current punitive responses that may in fact be iatrogenic.

Boy Crisis? Sex Differences in Self-Injurious Behaviors and the Effects of Gender Role Conflicts Among College Students in China

In Western research, self-injurious behaviors are commonly viewed as "feminine" behavior. In this present study, using the data from a survey administered to 960 first- and second-year students in Xi'an Jiaotong University in China, the self-injurious behaviors among college students are analyzed by sex. The results reported that the average prevalence of self-injurious behaviors among male students is 35.2%, higher than the 20.4% observed among female students (p < .1), and the average frequency of severe self-injurious behaviors among male students is 0.4, higher than the 0.18 reported among female students (p < .05). Gender role conflicts and verbal violence are strongly associated with male students' self-injurious behaviors, whereas gender role conflicts and verbal, visual, and sexual violence are strongly associated with female students' self-injurious behaviors. This suggests that self-injurious behaviors among college students in China constitute, to some extent, a boy crisis that can be well explained by gender role conflicts. In addition, verbal violence leads to self-injurious behaviors among both male and female students, whereas visual and sexual violence lead to self-injurious behaviors only among female students.

Psychological Distress in Chimpanzees Rescued From Laboratories

The United States is one of the last countries allowing invasive research on chimpanzees. Biomedical research on chimpanzees commonly involves maternal deprivation, social isolation, intensive confinement, and repetitive invasive procedures. These physically harmful and psychologically traumatic experiences cause many chimpanzees to develop symptoms of psychopathology that persist even after relocation from laboratories to sanctuaries. Through semistructured interviews with chimpanzee caregivers, direct behavioral observations, and consultation of laboratory records, we were interested in qualitatively analyzing symptoms of psychological distress in a sample of 253 chimpanzees rescued from biomedical research now residing at an accredited chimpanzee sanctuary. We present the results of this analysis and include an illustrative case study of one rescued chimpanzee who engages in self-injurious behaviors and meets modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for posttraumatic stress disorder. We discuss our results in light of recent policy changes regarding the use of chimpanzees in biomedical research in the United States and their implications for those involved in the rescue and rehabilitation of chimpanzees from biomedical research.

The role of dissociation in self-injurious behavior among female adolescents who were sexually abused

The study aimed to examine the role of dissociation (persistent versus peritraumatic) in self-injurious behavior among at-risk Israeli female adolescents. In addition, the relationship between childhood sexual abuse, depression, dissociation, and potency was investigated. A convenience sample of 93 female adolescents aged 12 years to 18 years were recruited from institutions for at-risk adolescent girls in Israel. Participants were administered an anonymous self-report questionnaire that included six measures: Demographics, Dissociative Experiences Scale, Center for Epidemiologic Studies Depression Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Traumatic Events Questionnaire, and the Potency Scale. Results indicated that childhood sexual abuse increases the risk for self-injurious behavior more than threefold. Higher levels of persistent dissociation were found among girls who reported child sexual abuse compared to those who did not. Self-injurious behavior was predicted by persistent dissociation. Girls who engaged in self-injurious behavior had lower potency and higher depression levels, regardless of childhood sexual abuse history.

[Report of a case of penile self-amputation]

INTRODUCTION

Motivated by a clinic case, this report introduces some issues related with genital self-amputation in terms of descriptions, epidemiological and clinical issues.

METHODOLOGY

Case report describing a clinic case of genital self-amputation. The description is followed by a discussion based on the information available in the scientific literature. A man, 32 years old, with no history of mental disorder, who amputates his penis with a cutting object after quarreling with his mate for infidelity reasons.

RESULTS

Several characteristics imply risk factors for genital self-mutilation, such as gender identity disorders, rejection to male genitals, guilt feelings related to sexual activity and a history of previous self-injuries. More common diagnoses include schizophrenia and affective disorders followed by disorders induced by psychoactive substances.

CONCLUSION

Genital self-amputation is not a frequent situation and has been under-recorded; however, bearing in mind the high association with psychopathology and recurrence reported in worldwide literature, it is necessary to carry out a proper study and following up of patients exhibiting this conduct.