The outbreak of COVID-19 is severely affecting mental health worldwide, although individual response may vary. This study aims to investigate the psychological distress perceived by the Italian general population during the early phase of the COVID-19 pandemic, and to analyze affective temperament and adult attachment styles as potential mediators. Through an online survey, we collected sociodemographic and lockdown-related information and evaluated distress, temperament, and attachment using the Kessler 10 Psychological Distress Scale (K10), the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire short version (TEMPS-A) andthe Attachment Style Questionnaire (ASQ).In our sample (n=500), 62% of the individuals reported no likelihood of psychological distress, whereas 19.4% and 18.6% displayed mild and moderate-to-severe likelihood. Cyclothymic (OR:1.24; p<0.001), depressive (OR: 1.52; p<0.001) and anxious (OR: 1.58; p=0.002) temperaments, and the ASQ "Need for approval" (OR: 1.08; p=0.01) were risk factors for moderate-to-severe psychological distress compared to no distress, while the ASQ "Confidence" (OR: 0.89; p=0.002) and "Discomfort with closeness" were protective (OR: 0.92; p=0.001). Cyclothymic (OR: 1.17; p=0.008) and depressive (OR: 1.32; p=0.003) temperaments resulted as risk factors in subjects with moderate-to-severe psychological distress compared to mild distress, while the ASQ "Confidence" (OR: 0.92; p=0.039) and "Discomfort with closeness" (OR: 0.94; p=0.023) were protective.Our data indicated that a relevant rate of individuals may have experienced psychological distress following the COVID-19 outbreak. Specific affective temperament and attachment features predict the extent of mental health burden. To the best of our knowledge, these are the first data available on the psychological impact of the early phase of the COVID-19 pandemic on a sizeable sample of the Italian population. Moreover, our study is the first to investigate temperament and attachment characteristics in the psychological response to the ongoing pandemic. Our results provide further insight into developing targeted intervention strategies.

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Summary:Purpose: Mechanisms inducing continuous spikewave during slow sleep (CSWS) in encephalopathy with electrical status epilepticus during sleep are still unclear. Recently, some sporadic cases with early thalamic injury associated with CSWS have been reported. The aim of the study was to investigate in a population of patients with an early thalamic injury the presence of an activation of paroxysmal activities during sleep, their characteristics, and possible relations to neuroimaging and neuropsychological features.Methods: Thirty-two patients with prenatal or perinatal thalamic injuries, mostly due to a vascular mechanisms, were fully examined, including neuroimaging, EEG monitoring, and cognitive follow-up.Results and Conclusions: Twenty-nine of 32 patients showed major sleep EEG activation. Among these 29 patients, two different groups were distinguished: the first included the more or less typical CSWS (12 cases), generally with symmetry of spike and waves (SWs) and often with no spindle at all. The other cases had an usual asymmetry of SWs and presence or reduction of spindles, plus other atypical features concerning synchronism and morphology of SWs. Behavioral disorders were significantly more present in patients with a true CSWS; their improvement (and in one case of the three thoroughly followed the improvement of cognitive competence) paralleled the disappearance of CSWS. The generally predominant injury of the lateral aspect of the thalamus included reticular nucleus and ventral nuclei. An imbalance of γ -aminobutyric acid (GABA) B -versus GABA Amediated receptors may be evoked as a cofactor predisposing to CSWS.Epilepsy with continuous spike-waves (SWs) during slow sleep (CSWS) is an acknowledged epileptic syndrome characterized by a combination of focal epilepsy, neuropsychological impairment, and typical EEG findings with a pattern of diffuse SWs occurring in ≤85% of slow sleep (1). Recently, the possible role of primary early thalamic injury in generating CSWS has been suggested (2), and sporadic cases with similar lesions have been reported (3-8). Morphologic and metabolic thalamic abnormalities have been described in CSWS as well (9). Our study aimed at clarifying (a) the possible presence and eventually the characteristics of an activation of paroxysmal activities during sleep in a population of patients with an early thalamic injury; and (b) their relation to findings from neuroimaging, with thalamic injuries, and with neuropsychological features.Accepted January 23, 2005. Address correspondence and reprint requests to Dr. F. Guzzetta at Division of Child Neurology and Psychiatry, School of Medicine, Catholic University, Largo Gemelli I-00168 Rome, Italy. E-mail: fguzzetta@rm.unicatt.it PATIENTS AND METHODSAll the patients aged between 4 and 12 years (when CSWS usually develops), showing at magnetic resonance imaging (MRI) an early acquired thalamic lesion and consequently admitted to our hospital between 1999 and 2003, were enrolled in the study. Indication for MRI resulted from the cli...

Summary Purpose:  To clarify the role of epilepsy and genetic background in determining the cognitive outcome of patients with Dravet syndrome. Methods:  In this retrospective study, we reviewed the clinical history and cognitive development of 26 patients who had been followed with standardized evaluations since seizure onset. The cognitive outcome was quantified as differential general quotient (dGQ) between ages 12 and 60 months. Statistical analysis correlated the dGQ with genotype and epilepsy course. Key Findings:  Epilepsy started at the mean age of 5.6 months. All patients experienced prolonged convulsive seizures, whereas absences and myoclonus were reported in 17. Cognitive outcome was poor in almost all patients; the mean dGQ was 33 points, varying from 6–77 points. The analysis of individual cognitive profiles identified seven patients in whom the dGQ was <20 points; the main clinical characteristic in this subset of patients was lack of early absences and myoclonus. The statistical analysis of the whole series failed to reveal significant differences in cognitive outcome with regard to the presence of SCN1A mutations and their type. In particular, mutation‐carrier patients with the best cognitive outcome harbored either missense or truncating mutations. Significance:  Dravet syndrome encompasses different epileptic and cognitive phenotypes that probably result from both genetic and epigenetic factors. In this series, early appearance of myoclonus and absences was associated with the worst cognitive outcome.