Publications by authors named "Massimiliano Beghi"

52 Publications

Psychodynamic interpretation of linguistic findings in patients with epileptic and psychogenic non-epileptic seizures: the role of metaphors.

Riv Psichiatr 2021 Nov-Dec;56(6):340-348

Department of Mental Health, AUSL Romagna, Cesena, Italy.

This work points out the main differences in the semantic expressions used by patients with psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES). In reference to the body as a phenomenological entity, in ES the concept of the body-object prevails while in PNES the body, with all its life attributes, predominates. In description of seizures and in similitudes and metaphors used, ES patients focus on the description of the attack, trying to close the "gap" with a big effort, while patients with PNES concentrate on the context and on the presence of bystanders. Patients with PNES are unable to describe their own attack, since this it is not at the core of their distress, but rather the manifestation of something else, which is hiding the extreme anguish associated with experiences of the past that cannot be revealed (expressed). In the case of ES, instead, the ability to talk and the willingness to elaborate on the emotions become useful tools for facing the disease, an entity perhaps unsurmountable but at least manageable, to the benefit of everyone. In general, we can say that the experience of a disease (real or symbolic) deserves constant attention because it gives us the opportunity not only to probe the depth of the emotional experiences but also the psychic structure of the individual in front of us. A cure would not be a cure without considering such fundamental elements. It would become a sterile exercise of prescribing medications without paying attention to the person, which is the best way of preserving dignity in a state of illness.
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http://dx.doi.org/10.1708/3713.37049DOI Listing
December 2021

Differential diagnosis between epileptic and psychogenic nonepileptic seizures through conversational analysis: A blinded prospective study in the Russian language.

Epilepsy Behav 2021 12 24;125:108441. Epub 2021 Nov 24.

University of Milano Bicocca, GSD Research, Milan, Italy.

The current study examined the validity of conversational analysis (CA) in Russian patients with seizures, using a scoring table for the Simplified Linguistic Evaluation (SLE). The study sample was composed of 12 adult participants suffering either from epilepsy (ES) or psychogenic nonepileptic seizures (PNES) recruited in the Moscow Research and Clinical Center for Neuropsychiatry. Definitive diagnosis was established only after a habitual event was captured onvEEG. All participants with PNES or ES and at least one mental disorder underwent a 20-minute-long interview recorded on video. The interview then was evaluated by the external blinded physician already experienced in CA. Finally, that physician filled the SLE, consisting of 5 items analyzing the main characteristics of patient narrations. A score of ≥12 suggested a diagnosis of ES, while a score of <12 suggested a diagnosis of PNES. The blinded evaluator correctly identified 11 out of 12 cases. The concordance between the vEEG diagnosis and the CA diagnostic hypothesis was 91.67%. The sensitivity of the scoring table was 100%, while the specificity was 80%. The positive and the negative predictive values were, respectively, 87.5% and 100%. Our results suggested that the differences in seizure descriptions between patients with PNES and patients with ES are similar across Indo-European language family and are independent of psychiatric comorbidity.
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http://dx.doi.org/10.1016/j.yebeh.2021.108441DOI Listing
December 2021

Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from 4 centres in Italy.

Int J Psychiatry Clin Pract 2021 Sep 30:1-5. Epub 2021 Sep 30.

Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Italy.

An observation of the Emergency Room (ER) admissions during the lockdown. We monitored admissions to the ER requiring psychiatric evaluation during the 2020 lockdown (March 9-May 3, 2020) compared to the same period of 2019, in four sites of Northern Italy (ASST Lariana, AUSL Modena, ASU Friuli Centrale and AUSL Romagna). Number of admissions, baseline demographic and clinical variables were extracted from the clinical databases. A 20.0% reduction of psychiatric referrals was observed across the sites (24.2% in ASST Lariana, 30.5% in AUSL Modena, 12.0% in ASU Friuli Centrale and 14.5% in AUSL Romagna). This reduction peaked at 41.5% in the first month of the lockdown. Being homeless as well as with a dual diagnosis (OR 1,67, CI: 1.02-2.74), while living in a residential facility and admission for a depressive episode Being homeless (OR 2.50, CI: 1.36-4.61) and having a dual diagnosis (OR 1,67, CI: 1.02-2.74) were significantly associated with an increase in ER admission, while living in a residential facility (OR 0.48, CI: 0.31-0.74), having a depressive episode (OR 0.36, CI: 0.18-0.73) and a diagnosis of anxiety disorder (OR 0.60, CI: 0.36-0.99) were significantly associated with a decrease. During lockdown, a decrease in psychiatric referrals was observed.
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http://dx.doi.org/10.1080/13651501.2021.1980588DOI Listing
September 2021

Prosthesis rejection in individuals with limb amputation: a narrative review with respect to rehabilitation.

Riv Psichiatr 2021 Jul-Aug;56(4):175-181

School of Medicine and Surgery, University of Milano Bicocca, Italy.

Objective: To evaluate the refusal of the prosthesis in order to highlight elements in determining the acceptance/rejection of the prosthetic devices, and its role on rehabilitation program.

Methods: A literature review through a search of the database Medline for studies published between October 2007 and May 2020 using the key words "prosthesis", "limb", and "accept"*.

Results: Nine studies were included. Women appear to be more concerned about discomfort in using body-powered devices and about prosthesis cosmetic appearance. Level of limb amputation was considered relevant for prosthesis rejection only for the upper limb. Children fitted with prosthesis before two years old were less likely to abandon the prosthesis, preschool children have a lower drop-out prevalence compared to adults and school-age children.

Conclusions: Understating the factors for rejections is crucial for more favorable health outcomes; multiple psychological factors should be considered during the rehabilitation process of individuals with limb amputation. Rehabilitation should consider psychosocial assistance for acceptance and perception of body representation and its discrepancy with the real body.
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http://dx.doi.org/10.1708/3654.36344DOI Listing
October 2021

Is sexual trauma a risk factor for functional (psychogenic) seizures?

Neurosci Biobehav Rev 2021 09 11;128:58-63. Epub 2021 Jun 11.

Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:

The relationship between functional seizures (FS) and sexual trauma has received attention in many previous studies. However, the mechanisms underlying this relationship have not been elucidated yet. The purpose of this narrative review is to explore and speculate on the underpinning neurobiological mechanisms for the association and link between sexual trauma and functional seizures. While existence of a causal relationship between a history of sexual trauma and functional seizures is plausible, it should be viewed and treated as a hypothesis. In explaining this hypothesis, we can speculate that interactions between genetic factors and a history of sexual trauma may contribute to the risk of experiencing functional seizures. Childhood sexual trauma may lead to structural and functional connectivity changes in the brain and dysregulation of the biological stress systems, particularly in women. These neurobiological changes speculatively may predispose patients to functional seizures later in life. Importantly, a history of sexual trauma has many other implications beyond the predisposition towards FS.
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http://dx.doi.org/10.1016/j.neubiorev.2021.06.019DOI Listing
September 2021

Is sexual trauma a risk factor for functional (psychogenic) seizures?

Neurosci Biobehav Rev 2021 09 11;128:58-63. Epub 2021 Jun 11.

Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:

The relationship between functional seizures (FS) and sexual trauma has received attention in many previous studies. However, the mechanisms underlying this relationship have not been elucidated yet. The purpose of this narrative review is to explore and speculate on the underpinning neurobiological mechanisms for the association and link between sexual trauma and functional seizures. While existence of a causal relationship between a history of sexual trauma and functional seizures is plausible, it should be viewed and treated as a hypothesis. In explaining this hypothesis, we can speculate that interactions between genetic factors and a history of sexual trauma may contribute to the risk of experiencing functional seizures. Childhood sexual trauma may lead to structural and functional connectivity changes in the brain and dysregulation of the biological stress systems, particularly in women. These neurobiological changes speculatively may predispose patients to functional seizures later in life. Importantly, a history of sexual trauma has many other implications beyond the predisposition towards FS.
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http://dx.doi.org/10.1016/j.neubiorev.2021.06.019DOI Listing
September 2021

The impact of Covid-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy.

Health Policy Technol 2021 Mar 31;10(1):143-150. Epub 2020 Dec 31.

Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd Acton ACT 2601, Canberra, Australia.

Objectives: to assess the changes in prevalence, incidence and hospitalisation rates during the first four months of 2020, compared to the same period of 2019, in Friuli Venezia Giulia Mental Health Departments (MHDs); to analyse the features of MHDs patients tested for Sars-Cov-2, and to monitor whether MHDs applied and adhered to regional recommendations.

Methods: Observational study using MHDs' administrative data and individual data on suspected and positive cases of Sars-Cov-2. Adherence to recommentations was assessed using 21 indicators. Changes in rates were calculated by Poisson regression analysis, while the Fisher exact test was used for assessing differences between suspected and positive cases.

Results: The decrease in voluntary admission rates on 100,000 inhabitants in hospital services was significantly larger from January to April 2020, compared to the same period of 2019 (<0.001), while no other data showed a significant decrease. Among the 82 cases tested for Sars-Cov-2, five were positive, and they significantly differ from suspected cases only in that they were at home or in supported housing facilities prior to the test. The MHDs mostly complied with the indicators in the month after the publication of recommendations.

Conclusions: Outpatient services continued to work normally during the emergency, while hospital services decreased their activities. A low number of positive cases was found among MHDs' users, which might be linked to a rapid reconversion of services, with an extensive use of home visits and telepsychiatry. These preliminary data should be interpreted with caution, due to the small size and the limited period of observation.
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http://dx.doi.org/10.1016/j.hlpt.2020.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833105PMC
March 2021

Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from the AUSL Romagna, Italy.

Int J Psychiatry Clin Pract 2021 Jun 21;25(2):135-139. Epub 2020 Dec 21.

Department of Biomedical Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy.

Objectives: An observation of the admissions to the emergency room (ER) requiring psychiatric evaluation during the lockdown and investigation of the demographic and clinical variables.

Methods: Retrospective longitudinal observational study of ER accesses for psychiatric evaluation was performed, comparing two periods (9 March-3 May 2020 vs. 9 March-3 May 2019). Data (number of admissions, key baseline demographic and clinical variables) were extracted from the ER databases of referral centres in a well-defined geographic area of North-Eastern Italy (Cesena, Ravenna, Forlì, and Rimini).

Results: A 15% reduction of psychiatric referrals was observed, together with a 17% reduction in the total number of patients referring to the ER. This reduction was most evident in the first month of the lockdown period (almost 25% reduction of both referrals and patients). Female gender (OR: 1.52: 95%, CI: 1.12-2.06) and being a local resident (OR: 1.54: 95%CI: 1.02-2.34) were factors associated with the decrease.

Conclusions: Lockdown changed dramatically health priorities in the local population, including people with mental health. We speculate that our observations do not only refer to the confinement due to the lockdown regime but also to fear of contagion and adoption of different coping strategies, especially in women.Key-pointsDuring lockdown 15% reduction of psychiatric visits and >17% reduction in the number of psychiatric patients referring to the ER was observed.in the first four weeks of the lockdown almost 25% reduction of both visits and patients was observedFemale gender and being a local resident were factors associated with the decrease.
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http://dx.doi.org/10.1080/13651501.2020.1859120DOI Listing
June 2021

ES/PNES differential diagnosis after a brief training of naive researchers using a linguistic Scoring Table.

Epilepsy Behav 2021 01 4;114(Pt A):107533. Epub 2020 Dec 4.

School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.

We asked a group of four researchers without experience in the field, to fill in the simplified Scoring Table based on Conversational Analysis principles. Researchers underwent a single-day training based on the linguistic differences in the event description by patients with epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES). Two raters reached 100% agreement with the gold standard and even in the worst case the error was only 25%. This tool could be used for first screening, because it is very easy to administer, both for the interview and for the Scoring Table completion, confirming the usefulness of Conversation Analysis in differential diagnosis between ES and PNES.
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http://dx.doi.org/10.1016/j.yebeh.2020.107533DOI Listing
January 2021

Late-life depression and its impact on rehabilitation after traumatic injuries.

Aging Clin Exp Res 2021 08 6;33(8):2313-2316. Epub 2020 Nov 6.

Unit of Epidemiological Research On Aging, National Institute of Gastroenterology 'Saverio de Bellis', Research Hospital, Castellana Grotte, Bari, Italy.

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http://dx.doi.org/10.1007/s40520-020-01744-4DOI Listing
August 2021

Late-life depression and its impact on rehabilitation after traumatic injuries.

Aging Clin Exp Res 2021 08 6;33(8):2313-2316. Epub 2020 Nov 6.

Unit of Epidemiological Research On Aging, National Institute of Gastroenterology 'Saverio de Bellis', Research Hospital, Castellana Grotte, Bari, Italy.

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http://dx.doi.org/10.1007/s40520-020-01744-4DOI Listing
August 2021

Driving a motor vehicle and psychogenic nonepileptic seizures: ILAE Report by the Task Force on Psychogenic Nonepileptic Seizures.

Epilepsia Open 2020 Sep 9;5(3):371-385. Epub 2020 Jun 9.

Academic Department of Neurosciences University of Sheffield Royal Hallamshire Hospital Sheffield UK.

Objectives: This International League Against Epilepsy (ILAE) Report: (a) summarizes the literature about "driving and psychogenic nonepileptic seizures (PNES)"; (b) presents the views of international experts; and (c) proposes an approach to assessing the ability of persons with PNES (PwPNES) to drive.

Methods: Phase 1: Systematic literature review. Phase 2: Collection of international expert opinion using SurveyMonkey®. Experts included the members of the ILAE PNES Task Force and individuals with relevant publications since 2000. Phase 3: Joint analysis of the findings and refinement of conclusions by all participants using email. As an ILAE Report, the resulting text was reviewed by the Psychiatry Commission, the ILAE Task Force on Driving Guidelines, and Executive Committee.

Results: Eight studies identified by the systematic review process failed to provide a firm evidence base for PNES-related driving regulations, but suggest that most health professionals think restrictions are appropriate. Twenty-six experts responded to the survey. Most held the view that decisions about driving privileges should consider individual patient and PNES characteristics and take account of whether permits are sought for private or commercial driving. Most felt that those with active PNES should not be allowed to drive unless certain criteria were met and that PNES should be thought of as "active" if the last psychogenic seizure had occurred within 6 months.

Significance: Recommendations on whether PwPNES can drive should be made at the individual patient level. Until future research has determined the risk of accidents in PwPNES a proposed algorithm may guide decisions about driving advice.
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http://dx.doi.org/10.1002/epi4.12408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469780PMC
September 2020

History of violence/maltreatment and psychogenic non-epileptic seizures.

Seizure 2020 Oct 14;81:8-12. Epub 2020 Jul 14.

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Purpose: To study the association of earlier violence/maltreatment with the occurrence of PNES in a nationwide population sample.

Methods: This is a nested case-control study performed using Swedish nationwide registers. Cases were all individuals born in Sweden between 1941 and 2009 with incident PNES between 2001 and 2013 while resident in Sweden according to the Swedish Patient Register. For each case, 10 controls, alive and PNES-free at time of PNES diagnosis of the matched case, were randomly selected from the Swedish Total Population Register, matched on age and sex. To test the specificity of the association, we conducted two similar analyses for epilepsy and dissociative disorder with motor symptoms or deficit, as comparators to PNES. Registers were examined in search of all coded diagnoses of child maltreatment or violence episodes before the index date among the cases and controls.

Results: 885 patients received a first diagnosis of PNES. 7.6 % of cases had a history of violence/maltreatment, compared to 1.1 % of controls, giving a crude OR of 7.9 (95 % CI: 3.7-11.0). The ORs decreased but remained significant after adjustment for socio-economic factors (OR = 6.3, 95 % CI: 4.4-9.0) and psychiatric comorbidities (OR = 5.2, 95 % CI: 3.5-7.9). The association was also evident for epilepsy and dissociative disorder, although of lower magnitude.

Conclusion: Patients with PNES have a history of violence/maltreatment more frequently than the rest of the population. This association can be influenced by socio-economic factors and the presence of concurrent psychiatric disturbances.
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http://dx.doi.org/10.1016/j.seizure.2020.07.012DOI Listing
October 2020

Reply to: We need a functioning name for PNES: Considering dissociative seizures.

Epilepsy Behav 2020 08 18;109:107084. Epub 2020 Apr 18.

School of Medicine and Surgery, University of Milano Bicocca, Italy.

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http://dx.doi.org/10.1016/j.yebeh.2020.107084DOI Listing
August 2020

The Challenge of Antidepressant Therapeutics in Alzheimer's Disease.

Adv Exp Med Biol 2020 ;1260:267-281

Unit of Epidemiological Research on Aging, National Institute of Gastroenterology 'Saverio de Bellis', Research Hospital, Castellana Grotte, Bari, Italy.

The link between depression and Alzheimer's disease (AD) is controversial, because it is not clear if depression is an independent risk factor for the disease or a prodromal symptom in the older population. Cerebral amyloid-β (Aβ) peptide deposition is associated with both cognitive symptoms and neuropsychiatric symptoms (NPS), which may be a biological mechanism of compensation. Despite the widespread use of antidepressant therapeutics (30-50% of patients with AD/dementia are on antidepressants), there is mixed evidence regarding the benefits from their use in AD depression. Monoaminergic antidepressant drugs have shown only modest or no clinical benefits. Therefore, it is important to understand the reason of this drug-resistance and the relationship between antidepressant drugs and the Aβ peptide. The goal of the present review is to highlight the etiology of depression in patients affected by AD in comparison to depressive disorders without AD, and to speculate on more appropriate and alternative therapeutics.
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http://dx.doi.org/10.1007/978-3-030-42667-5_10DOI Listing
June 2020

Epilepsy, antiepileptic drugs and dementia.

Curr Opin Neurol 2020 04;33(2):191-197

Department of Mental Health, AUSL Romagna, Ravenna, Italy.

Purpose Of Review: To illustrate the frequency and trends of the comorbidity of epilepsy and dementia and the effects of antiepileptic drugs (AEDs) on cognitive functions.

Recent Findings: Although the mortality and incidence of epilepsy are decreasing overall, they are increasing in the elderly as a result of population growth and increased life expectancy. Alzheimer's disease and other dementias are among the commonest causes of seizures and epilepsy. Epilepsy can be also complicated by cognitive impairment, suggesting a bidirectional association. Although epilepsy with onset in the elderly can be the manifestation of a CNS disease/injury, the cause of cognitive impairment is multifactorial and includes static (genetic background, age at seizure onset, developmental and acquired cerebral lesions) and dynamic factors [recurrent seizures, epileptiform discharges, type and number of AEDs and psychiatric comorbidities]. Most AEDs, with special reference to first-generation drugs, have negative effects on cognitive functions; however, none was found to increase the risk of dementia.

Summary: A net increase in the burden of epilepsy, dementia and epilepsy-dementia comorbidity is expected. The growing use of second-generation AEDs might help reducing adverse cognitive effects. However, the fairly high cost of these drugs might delay their widespread use in resource-poor countries. VIDEO ABSTRACT: http://links.lww.com/CONR/A49.
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http://dx.doi.org/10.1097/WCO.0000000000000802DOI Listing
April 2020

Is post-traumatic stress disorder a too underestimated factor in the early rehabilitation of cerebro-vascular events?

Neurol Sci 2020 May 3;41(5):1287-1288. Epub 2019 Dec 3.

Department of Mental Health, AUSL Romagna, Ravenna, Italy.

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http://dx.doi.org/10.1007/s10072-019-04166-xDOI Listing
May 2020

Is drug treatment of psychogenic nonepileptic seizures effective?

Epilepsy Behav 2019 09 12;98(Pt A):288-289. Epub 2019 Jul 12.

Alpert Medical School, Brown University, Director of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, United States of America.

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http://dx.doi.org/10.1016/j.yebeh.2019.06.025DOI Listing
September 2019

Linguistic analysis in the differential diagnosis between cognitive impairment and functional cognitive impairment (depression): a pilot study.

Riv Psichiatr 2018 Jul-Aug;53(4):192-198

Department of Mental Health, AUSL Romagna, Ravenna, Italy.

The differential diagnosis between cognitive impairment and functional cognitive impairment (depression) is complex and difficult, especially in the early stages of the disease. The aim of our study was to test linguistic analysis as a diagnostic tool to support clinical, and test-based diagnoses for this differential diagnosis. We enrolled 13 patients, requesting a diagnostic consultation in a Alzheimer Evaluation Unit. A provisional diagnosis through a neuropsychological evaluation (interview and neuropsychological tests) was made at baseline, while a definitive diagnosis was provided after six months, or, if not possible, after 12 months. The linguistic analysis was performed at T0 in blind by a linguist. Patients' language was studied at linguistic (morphological, syntactical, lexical literal and textual) and conversational (verbiage and humor) level. The correspondence rate between the linguistic analysis at T0 and the definitive diagnosis was 76.9%, compared to 58.4% between the neuropsychological équipe analyses at T0 and definitive diagnosis. There is no single patognomonic phenomenon for cognitive impairment or depression, but rather a linguistic cluster can lead to a diagnosis with a fairly good reliability.
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http://dx.doi.org/10.1708/2954.29695DOI Listing
February 2019

A Novel Mutation Identified in an Autistic Proband Affects the Single Channel Properties of Kir2.1.

Front Cell Neurosci 2018 20;12:76. Epub 2018 Mar 20.

School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

Inwardly rectifying potassium channels (Kir) have been historically associated to several cardiovascular disorders. In particular, loss-of-function mutations in the Kir2.1 channel have been reported in cases affected by Andersen-Tawil syndrome while gain-of-function mutations in the same channel cause the short QT3 syndrome. Recently, a missense mutation in Kir2.1, as well as mutations in the Kir4.1, were reported to be involved in autism spectrum disorders (ASDs) suggesting a role of potassium channels in these diseases and introducing the idea of the existence of K channel ASDs. Here, we report the identification in an Italian affected family of a novel missense mutation (p.Phe58Ser) in the gene detected in heterozygosity in a proband affected by autism and borderline for short QT syndrome type 3. The mutation is located in the N-terminal region of the gene coding for the Kir2.1 channel and in particular in a very conserved domain. assays demonstrated that this mutation results in an increase of the channel conductance and in its open probability. This gain-of-function of the protein is consistent with the autistic phenotype, which is normally associated to an altered neuronal excitability.
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http://dx.doi.org/10.3389/fncel.2018.00076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869910PMC
March 2018

Engaging psychiatrists in the diagnosis of psychogenic nonepileptic seizures. What can they contribute?

Seizure 2017 Nov 16;52:182-187. Epub 2017 Oct 16.

Laboratory of Neurological Disorders, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. Electronic address:

Purpose: To investigate if psychiatrists could predict the diagnosis of psychogenic nonepileptic seizures (PNES) by reviewing videos of seizures of various types and to compare the accuracy and the criteria leading to the diagnosis used by psychiatrists with those used by epileptologists.

Methods: Four board-certified psychiatrists were asked to review 23 videos capturing representative events of 21 unselected consecutive patients admitted to an epilepsy center for long-term video-EEG monitoring. All raters were blind to EEG and clinical information. They were requested to (1) rate the videos for quality and content; (2) choose among four diagnoses: (a) epileptic seizures; (b) PNES; (c) Other nonepileptic seizures (syncope, movement disorder, migraine, etc.); (d) "Cannot Say"; and (3) explain in their own words the main reasons leading to the diagnosis of choice. The results were compared to those of four blind epileptologists who independently reviewed the same cases. The inter-rater reliability was tested with the Kappa statistic.

Results: All psychiatrists were concordant and correct in 3/23 video-events, compared to 8/23 among epileptologists. Despite widespread disagreement among themselves and frequent failures as a group, individual psychiatrists scored a comparable number of correct diagnoses as did individual epileptologists. The comments provided to justify the diagnosis of choice differed from neurologists, varied among raters, and reflected considerable attention to body movements and body language.

Conclusion: Psychiatrists, as a group, are less reliable than neurologists in differentiating seizure types on video but, as individuals, can be quite accurate in making the correct diagnosis because they are more attuned to capture the subtleties of human behaviour, of subjective experiences, as the effects of hidden internal conflicts and can contribute a new lexicon in defining PNES.
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http://dx.doi.org/10.1016/j.seizure.2017.10.014DOI Listing
November 2017

Why talking about psychiatric comorbidity in PNES?

Epilepsy Behav 2017 10 26;75:276. Epub 2017 Aug 26.

Department of Neurosciences, IRCSS Mario Negri Institute, Milan, Italy.

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http://dx.doi.org/10.1016/j.yebeh.2017.07.010DOI Listing
October 2017

Late onset clozapine-induced sierositis: the case of ms C.

Riv Psichiatr 2017 May-Jun;52(3):126-128

Department of Mental Health, ASST Rhodense, Rho, Milan, Italy.

Introduction: Polisierositis is a rare but not negligible adverse event of a therapy with clozapine, that occurs usually during the titration phase of clozapine or just after the reachment of the plateau, and politherapy increases the incidence rate.

Case Report: Ms. C. is a 42 years old smoker woman who suffers from a schizophrenia associated to a borderline personality disorder. In 2007 a therapy with clozapine was introduced with good tolerance and efficacy on her symptoms for a long period. In August 2015, after a period characterized by many psychiatric ward admissions an augmentation with valproic acid and sertraline was done, with partial symptoms improvement. In June 2016, she developed pleuritis and pericarditis and underwent pleural and pericardial drainage. After clozapine interruption (andzuclopentixol titration) the symptoms progressively decreased and in August 2016 she had a complete remission.

Conclusions: Even if uncommon, sierositis should be taken into consideration also in long term clozapine treatment, especially when associated with other drugs, as valproate or sertraline, although the role of the latter is less clear. Moreover, patients life habits (smoke), allergic or rheumatological disorders or temporary intake of other drugs (like antifungins) should be recorded carefully for their possible effects on cytochrome P450 substrates.
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http://dx.doi.org/10.1708/2722.27765DOI Listing
May 2018

Conversation analysis in the differentiation of psychogenic nonepileptic and epileptic seizures in pediatric and adolescent settings.

Epilepsy Behav 2016 09 3;62:231-8. Epub 2016 Aug 3.

Department of Mental Health, ASST Rhodense, Rho, Milan, Italy. Electronic address:

The differential diagnosis of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) is often difficult, especially in pediatric and adolescent settings. Conversation analysis (CA) can be a worthwhile diagnostic tool in adults. The aim of this study was to assess the diagnostic value of CA in Italian children and adolescents. Ten patients (seven females and three males), diagnosed using video-EEG as having either ES or PNES, underwent a video-recorded interview by a physician from outside the center specifically trained for this purpose. An external linguistic rater then examined the video recordings and transcripts using CA. Diagnoses formulated on the basis of interactional and linguistic features of the patients' speech were compared with diagnoses made by seizure experts on the basis of all available clinical information including the video-EEG findings. Conversation analysis diagnoses corresponded to the video-EEG diagnoses in 8 out of 10 cases. In conclusion, while some conversational adaptation is necessary to enable children and adolescents to share their seizure experiences with an adult health professional, this study indicates the differential diagnostic potential of a CA approach in these young people with PNES or epilepsy. Larger samples are obviously needed to confirm these findings.
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http://dx.doi.org/10.1016/j.yebeh.2016.07.006DOI Listing
September 2016

Psychotropic Drug Consumption and Employment Status in Time of Economic Crisis (2007-2011).

Psychiatr Q 2017 06;88(2):371-384

Department of Economy and Statistics, University of Milano-Bicocca, via Bicocca degli Arcimboldi 8, 20126, Milan, Italy.

Psychiatric disorders and in particular depression have increased during the "Great Recession". The aim of this study was to investigate the consumption of psychotropic drugs in people who lost their permanent employment, using administrative data. The study considered all of the subjects domiciled in Lombardy, Northern Italy, who lost a permanent employment between 2008 and 2010, not assuming psychotropic drugs and who did not find a new job within the following 12 months. The control group included people who did not lose permanent job in the study period, matched to the cases for gender, age, nationality, skill level, education and economic sector, using propensity score matching. The subjects who lost their permanent employment were 17 % more likely to receive one or more drug prescriptions than the controls, but the difference was significant only for males. Females, subjects aged >50 years, low skill level workers and Italians were more likely to have received a prescription for psychotropic drugs than respectively males, subjects aged 20-29 years or aged 30-39 years, low skill level workers and non-Italians. The average number of drugs prescribed for those who lost their job and those who continued working was respectively 2.9 and 3.1. In conclusion, losing a permanent job increases significantly psychotropic drugs consumption in males but not in females.
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http://dx.doi.org/10.1007/s11126-016-9448-9DOI Listing
June 2017

Validation of a novel classification model of psychogenic nonepileptic seizures by video-EEG analysis and a machine learning approach.

Epilepsy Behav 2016 07 20;60:197-201. Epub 2016 May 20.

Department of Human Pathology of Adult and Child, Unit of Infantile Neuropsychiatry, University of Messina, Italy.

The aim of this study was to validate a novel classification for the diagnosis of PNESs. Fifty-five PNES video-EEG recordings were retrospectively analyzed by four epileptologists and one psychiatrist in a blind manner and classified into four distinct groups: Hypermotor (H), Akinetic (A), Focal Motor (FM), and with Subjective Symptoms (SS). Eleven signs and symptoms, which are frequently found in PNESs, were chosen for statistical validation of our classification. An artificial neural network (ANN) analyzed PNES video recordings based on the signs and symptoms mentioned above. By comparing results produced by the ANN with classifications given by examiners, we were able to understand whether such classification was objective and generalizable. Through accordance metrics based on signs and symptoms (range: 0-100%), we found that most of the seizures belonging to class A showed a high degree of accordance (mean±SD=73%±5%); a similar pattern was found for class SS (80% slightly lower accordance was reported for class H (58%±18%)), with a minimum of 30% in some cases. Low agreement arose from the FM group. Seizures were univocally assigned to a given class in 83.6% of seizures. The ANN classified PNESs in the same way as visual examination in 86.7%. Agreement between ANN classification and visual classification reached 83.3% (SD=17.8%) accordance for class H, 100% (SD=22%) for class A, 83.3% (SD=21.2%) for class SS, and 50% (SD=19.52%) for class FM. This is the first study in which the validity of a new PNES classification was established and reached in two different ways. Video-EEG evaluation needs to be performed by an experienced clinician, but later on, it may be fed into ANN analysis, whose feedback will provide guidance for differential diagnosis. Our analysis, supported by the ML approach, showed that this model of classification could be objectively performed by video-EEG examination.
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http://dx.doi.org/10.1016/j.yebeh.2016.03.031DOI Listing
July 2016

Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense mechanisms.

Neuropsychiatr Dis Treat 2015 30;11:2519-27. Epub 2015 Sep 30.

Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy ; Rehabilitation Medicine, Istituti Clinici Zucchi, Carate Brianza, Monza and Brianza, Italy.

In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES) do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline) personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of "neurotic" type; their goal is to lead to a "split", either vertical (dissociation) or horizontal (repression). The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial). PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES) and need usually a different treatment (pharmacological or psychological). Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of specific psychiatric disorders.
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http://dx.doi.org/10.2147/NDT.S82079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599147PMC
October 2015

Childhood trauma and psychogenic nonepileptic seizures: A review of findings with speculations on the underlying mechanisms.

Epilepsy Behav 2015 Nov 30;52(Pt A):169-73. Epub 2015 Sep 30.

Department of Surgery and Translational Medicine, University of Milano Bicocca, Monza, Italy.

Objective: The objective of this review was to examine the possible link between psychological trauma in a patient's medical history and the onset of psychogenic nonepileptic seizures (PNES).

Methodology: An electronic search of published reports was made using the search engines PubMed-MedLine, EBSCO, PsycINFO, SFX, and Embase and the keywords "PNES", "psychogenic seizures", "sexual abuse", and "trauma".

Results: A correlation emerged between history of childhood trauma and the presence of PNES. Antecedent trauma was more frequent in females than in males and in patients exhibiting psychiatric disorders but was inversely correlated with cognitive impairment.

Conclusions: In the presence of PNES, it is important to accurately investigate the patient's medical history in search of psychological trauma, particularly in women and in patients with psychiatric disorders.
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http://dx.doi.org/10.1016/j.yebeh.2015.09.007DOI Listing
November 2015

Experience of group conversations in rehabilitation medicine: methodological approach and pilot study.

J Med Person 2015;13(2):96-104. Epub 2015 May 7.

Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20052 Monza, Italy ; Cognitive Neurorehabilitation, "Zucchi" Clinical Institute, P.Za Madonnina 1, Carate Brianza, Italy.

The restoring of equilibrium after a traumatic event makes it possible to give a new significance to patients' existence, and healthcare professionals simultaneously find themselves very close to questions of pain and disability. For these reasons, we introduced weekly group meetings of healthcare professionals and patients suffering from vascular, traumatic or neurological accidents, and meetings of professionals only at the Neurocognitive Rehabilitation Day Hospital of the University of Milan Bicocca. The aim of this paper is to identify possible indicators of changes in patients' existence through a conversational analysis, describing the experience at the light of methodological approach and reporting the results of a pilot observational study. The patient meetings began in October 2011 and led to a process of greater closeness and trust that was expressed by means of words, gestures, emotional participation, and non-verbal communication. The pilot considers the evolution of indicators in a sample of 14 patients for a period of 9 months and a timeframe of 3 months. Supportive interventions decreased while elements of sharing progressively increased, leading to progressive increased consciousness of both self and the disease. The group of professionals found that being together allowed them to distinguish performance as the use of their technical skills from understanding the other and his/her experience as part of their own, and not only linked to the disease. The professionals' reflections on their experiences led to the emergence of two possible ways of looking at a patient: as somebody other than me or somebody other like me.
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http://dx.doi.org/10.1007/s12682-015-0208-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522023PMC
May 2015
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