Objective: The main aim of the research is to study the early behavioral development in autistic children through home movies. Methods: fifteen home movies, regarding the first 2 years of life of autistic children are compared with the home movies of 15 normal children. The films of the two groups were mixed and rated by blind ratings with the Grid for the Assessment of Normal Behavior in Infants and Toddlers. The grid is composed of 17 items grouped into three developmental areas: social competence, intersubjectivity and symbolic activity. For every area, we have identified specific children’s behaviors. Results: Significant differences between the two groups are found both in the range of age 0–6 for intersubjectivity, and in the ranges of age 6–12 and 18–24 for symbolic activity. Conclusions: The authors pose some hypotheses about an early-appearing impairment of intersubjectivity, the ability to represent other’s state of mind, in subjects with autistic disorder.

Objective: To evaluate the psychopathological status and denial of symptoms in a sample of 38 consecutively admitted adolescents with anorexia nervosa (AN). Method: The Schedule for Affective Disorders and Schizophrenia for School-Aged Children was used to determine the categorical diagnosis of eating disorder. The anorexic adolescents completed the EAT-40 (Eating Attitude Test) and, on the basis of its score, the sample was dichotomized in a false-negative group (FNG) scoring under 30 and a positive group (PG) scoring over 30. We compared these two subgroups in terms of clinical variables (age of onset and admission, duration of illness prior to admission, diagnosis, BMI) and psychopathology assessed by the CBCL (Child Behaviour Checklist) and the YSR (Youth Self-Report). In order to evaluate the possible role of diagnosis and BMI on the EAT score we also dichotomized the sample with respect to the diagnosis (full vs. partial AN) and to the mean female BMI (≤15 vs. >15). Results: A significant difference was found in terms of duration of illness prior to admission, which was briefer in the FNG. Higher CBCL and YSR values were found in the PG with significant differences in terms of YSR internalizing symptoms. A large amount of significantly positive Pearson’s correlations were found between the CBCL and YSR values in the FNG. No significant Pearson’s correlations were found between EAT, BMI and diagnosis. Conclusions: The lower CBCL and YSR values in the FNG seem to point out a tendency of this group to deny anxiety and depression as well as an eating pathology; the longer duration of illness prior to admission in the PG seems to support the hypothesis that the PG may be considered to be not so much more disturbed as more aware of its eating attitudes and psychopathology. The nature of denial in anorexic adolescents is discussed.

Children who develop first episode psychosis during adolescence differ from children with normal development. The premorbid internalizing state is common to AG but social competencies and school problems are the most affected areas in EOS when compared to the AG. It is hypothesized that both EOS and AG can be considered as the expression of a previous vulnerability.

A massive asymptomatic creatine kinase elevation (MACKE) has been described during antipsychotic exposure in adult psychotic patients without signs of neuroleptic malignant syndrome (NMS), or other most frequent reasons for high creatine kinase (CK) serum level (intramuscular injections, restraints, intense physical activity, dystonic reactions). In this article, we review this clinical condition, and report three cases of MACKE in nonpsychotic, drug-naïve youth during treatment with second generation antipsychotics. The diagnosis of MACKE should be considered after ruling out other possible common reasons of CK increase. The finding of MACKE should indicate a need for weekly monitoring of the CK level only when there are reasons to believe elevated CK is toxic or harmful. Further investigations are recommended when signs and symptoms raise a suspicion of NMS or rhabdomyolysis, including flu-like syndrome, fever, weakness, alteration of consciousness, muscle rigidity, tachycardia, hyper-/hypotension, and dark urine. A drug discontinuation should be considered when possible signs of NMS or rhabdomyolysis are suspected, or in cases of very high and persisting CK levels. Empirical evidence indicates that there is not a "safe" antipsychotic medication; therefore, a switch to another antipsychotic with a different profile is not necessarily a safe option. The spontaneously remitting or intermittent course suggests that the "true" MACKE should be kept distinct from both rhabdomyolysis and NMS. Raising awareness with MACKE may reduce the need for unnecessary diagnosis of NMS or rhabdomyolysis, which may otherwise lead to an unnecessary discontinuation of an effective therapeutic agent.

Background: Bipolar Disorders (BD) in youth are a heterogeneous condition with different phenomenology, patterns of comorbidity and outcomes. Our aim was to explore the effects of gender; age at onset (prepubertal- vs. adolescent-onset) of BD; and elements associated with attention deficit hyperactivity disorder (ADHD) and Substance Use Disorder (SUD) comorbidities, severe suicidal ideation or attempts, and poorer response to pharmacological treatments. Method: 117 youth (69 males and 57 females, age range 7 to 18 years, mean age 14.5 ± 2.6 years) consecutively referred for (hypo)manic episodes according to the Diagnostic and Statistical Manual of Mental Disorders, 54th ed (DSM 5) were included. Results: Gender differences were not evident for any of the selected features. Prepubertal-onset BD was associated with higher rates of ADHD and externalizing disorders. SUD was higher in adolescent-onset BD and was associated with externalizing comorbidities and lower response to treatments. None of the selected measures differentiated patients with or without suicidality. At a 6-month follow up, 51.3% of the patients were responders to treatments, without difference between those receiving and not receiving a psychotherapy. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response. Logistic regression indicated that baseline severity and number of externalizing disorders were associated with a poorer outcome. Conclusions: Disentangling broader clinical conditions in more specific phenotypes can help timely and focused preventative and therapeutic interventions.

Although childhood-onset psychiatric disorders are often considered as distinct and separate from each other, they frequently co-occur, with partial overlapping symptomatology. Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur with each other and with other mental disorders, particularly disruptive behavior disorders, oppositional defiant disorder/conduct disorder (ODD/CD). Whether these associated comorbidities represent a spectrum of distinct clinical phenotypes is matter of research. The aim of our study was to describe the clinical phenotypes of youths with ADHD with and without ASD and/or ODD/CD, based on neuropsychological and psychopathological variables. One-hundred fifty-one participants with ADHD were prospectively recruited and assigned to four clinical groups, and assessed by means of parent-reported questionnaires, the child behavior checklist and the behavior rating inventory of executive functions. The ADHD alone group presented a greater impairment in metacognitive executive functions, ADHD+ASD patients presented higher internalizing problems and deficits in Shifting tasks, and ADHD+ODD/CD subjects presented emotional-behavioral dysregulation. Moreover, ADHD+ASD+ODD/CD individuals exhibited greater internalizing and externalizing problems, and specific neuropsychological impairments in the domains of emotional regulation. Our study supports the need to implement the evaluation of the psychopathological and neuropsychological functioning profiles, and to characterize specific endophenotypes for a finely customized establishment of treatment strategies.

Objective: To identify the prevalence of internalizing and externalizing conditions in referred anorexic adolescents. Method: Child Behavior CheckList (CBCL) and Youth Self Report (YSR) were used to assess psychopathology: (a) in the global sample (43 adolescents); (b) in different subtypes of anorexia; (c) considering the timing of admission after the onset of the disease. Results: A high percentage of patients were found in the internalizing clinical range both at CBCL and YSR. Higher mean values were found in full syndromes both at CBCL and YSR, and in the binge-eating subtype only at the YSR. Subjects arrived within the first year of illness showed a less severe psychopathology. Conclusions: Adolescents with anorexia have high rates of internalizing psychopathology. The less severe psychopathology in adolescents arrived within the first year of illness shed light on discontinuity between anorexia and internalizing condition. On the basis of the psychopathological severity, three types of adolescent anorexia are proposed which could be of interest for therapeutic decisions.

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