To the Editor Risks for mental health of children and adolescents in the era of the coronavirus disease 2019 (COVID-19) pandemic, owing to school closure and quarantine, have been delineated by Golberstein et al. 1 We further extend their implications of school closure for children and their families, an issue that undergoes a deafening silence in the public debate.Mental health of children and adolescents undergoes a sudden stress test during quarantine 1 that causes a complete, sudden, and unprepared loss of direct social relationships with peers, representing a significant human need and stimulus for well-being, socioemotional development, and self-identity in this age range. Direct social relationships are limited to family members, with increased risks of loneliness; especially in the absence of home outdoor spaces, school closure significantly increases the risks for (1) physical health; (2) addiction to video games and binge watching (clearly exceeding daily time limits of screen exposure indicated by pediatric guidelines); and (3) alteration of circadian rhythms. Moreover, compulsory coexistence with family members may increase the risk of direct or assisted verbal or physical domestic violence. Finally, school closure may have profound effect on academic achievement, especially in the youngest children and in children of families with low socioeconomic status. 2,3 If school closure will be confirmed for the remaining months and also summer camps will be impeded, the well-known summer learning gap will be amplified, 4 especially for children of families at low socioeconomic status and for children with preexisting neurodevelopmental or mental health conditions of vulnerability. Families with low socioeconomic status have less available possibilities in terms of suitable places to do homework, electronic devices, internet access, and owned books 2,3 ; parents themselves in the case of low socioeconomic status, exemplified by the immigrant parent-child acculturation gap, 5 may be less able to motivate and help them in this new experience of online schooling. Therefore, educational systems should plan and finance extraordinary ad hoc interventions to reduce long-lasting effects of prolonged school closures, especially for more disadvantaged children, focused but not limited to learning. Moreover, school closure is a serious and impeding problem also for working parents if they are allowed to return to work, considering that other family members who can provide resources, such as grandparents, are probably quarantined themselves. In conclusion, medical, educational, and economic competencies should implement strategic plans for a progressive restart of educational activities that may ensure a calculated trade-off between risk of COVID-19 infection, reduction of learning gap, and restart of working for parents.
<b><i>Background:</i></b> The majority of models on obsessive compulsive disorder (OCD) endorse a top-down perspective on the cognitive mechanisms underlying OCD functioning and maintenance, whereas a bottom-up perspective is rarely pursued. <b><i>Objectives:</i></b> The aim of the study was to review the empirical literature on sensory phenomena (SP) and neurodevelopmental antecedents of OCD, which could support the conceptualization of an alternative, bottom-up perspective integrating neurodevelopmental and phenomenological levels of analysis on OCD. <b><i>Methods:</i></b> A systematic review according to PRISMA guidelines was performed in PubMed/MEDLINE, PsycInfo, the Cochrane Library, and Excerpta Medica Database (EMBASE) and focused on SP and “neurodevelopmental antecedents” (operationalized in early risk factors, neuroimaging signs, neurological soft signs, and sensory responsivity). The time interval was from inception up to March 31, 2022. <b><i>Results:</i></b> From the search in electronic databases, 48 studies were retained and reviewed. SP are highly prevalent in OCD patients and overrepresented in comparison with healthy controls. Similarly, OCD patients also present a higher prevalence of early environmental adversities and sensorimotor alterations in terms of neurological soft signs and sensory over-responsivity in the tactile and acoustic domains; additional findings included hypogyrification signs at neuroimaging. Both sensorimotor alterations and SP are associated with tic-related manifestations and poorer insight in OCD patients. <b><i>Conclusions:</i></b> On the ground of established common subjective experience of SP and premorbid neurodevelopmental features, we hypothesized an explanatory model for OCD, which considers the possible pathophysiological role for altered corollary discharge and enhanced error detection in the neurodevelopment of SP and obsessions. SP may represent the subjective experiential resonance of an individual history of persistently inaccurate sensory predictions, whereas accompanying manifestations, such as the obsessive need for order and symmetry, may represent a compensatory attempt to mitigate SP. This neurodevelopmental-phenomenological bottom-up model, describing a dimensional gradient of sensorimotor alterations and related subjective experiences, may contribute to explain the dimensional affinity between OCD and schizophrenia spectrum disorders. Furthermore, this model could be useful for the early detection of subjects at higher risk of OCD.
For about one century the catalogue of books in phenomenological psychopathology has been tremendously rich in essays, but remarkably poor in handbooks. Even the cornerstone of our canon, Jaspers’ General Psychopathology, originally written as a textbook, can hardly be given to a student as a basic reading. This makes extremely difficult teaching the fundamentals of our discipline. Students ask for manualized knowledge expecting teachers to explain them what-exactly-must-be-done-in-a-given-circumstance. This Handbook is meant to fill these gaps. It includes a detailed, thorough and reader-friendly description of philosophical and clinical key-concepts and constructs, and of the contributions of leading figures of phenomenological psychopathology. It establishes clear connections between psychopathological knowledge and clinical practice. It liaise phenomenological psychopathology to contemporary debates in nosography, clinical epistemology, research and the neurosciences. It’s stronger benefit is that it brings together evidence-based with person-based knowledge. All learning is based on process of recognition. ‘Recognition’ means identification of someone or something from previous encounters or knowledge. In standard clinical training this process is called ‘diagnosis’ and evidence-based diagnostic skills are deemed fundamental. Students are spot-on when soliciting this kind of knowledge to be regimented and normalized. Yet ‘recognition’ has a second meaning: acknowledging the absolute singularity of what is out there. To recognize someone or something means to be able to tolerate its otherness. This kind of recognition is a practice in which epistemology is in touch with ethics. Whereas recognition qua identification or diagnosis is an act of recollection based on previously acquired knowledge, recognition qua acknowledgement is an ethical act of acceptance of the unique being-so of the other person or state of affairs. The Handbook of Phenomenological Psychopathology engages in bringing together these two kinds of ‘recognition’ and establish a solid as well as flexible framework for the clinic of mental disorders.
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