Stefano Vicari

Background: Neuropeptide Y is a highly conserved neuropeptide involved in several physiological processes, including stress regulation, appetite control, and cognitive functioning. Emerging evidence suggests that alterations in neuropeptide Y signaling may contribute to neurodevelopmental and behavioural phenotypes. This study describes a family carrying a microduplication involving the neuropeptide Y gene on chromosome 7p15.3, with the aim of exploring its potential association with attention deficit/hyperactivity disorder and specific cognitive vulnerabilities, particularly in the memory domain. Methods: Five individuals across three generations of one family carrying the duplication underwent comprehensive clinical and neuropsychological assessment, including standardized measures of intellectual functioning, attention, memory, adaptive skills, and psychopathology. Results: A consistent pattern of attentional difficulties was observed across affected individuals, accompanied by internalizing features such as anxiety. Cognitive evaluation revealed selective vulnerabilities in memory domains, involving both verbal and spatial components, across short- and long-term processes. Intellectual functioning ranged from borderline to average levels. In addition, increased body weight and hormonal imbalances were recurrently observed, indicating a possible contribution of neuropeptide Y dysregulation to metabolic phenotype in association with behavioural features. Conclusions: These findings support the hypothesis that duplication of the neuropeptide Y gene may be associated with a distinct neurobehavioural profile characterized by attentional difficulties, internalizing symptoms, and selective memory vulnerabilities. The co-occurrence of obesity further highlights the potential role of neuropeptide Y in linking metabolic and neurodevelopmental processes. Although based on a small familial sample, this study contributes to the characterization of genotype–phenotype correlations involving neuropeptide Y and underscores the need for further investigation in larger cohorts.

Background: Sex differences in adolescent mental disorders are well documented, but less is known about how these differences evolve during the transition to adulthood, particularly during the shift from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS), a critical period marked by vulnerability to discontinuity of care. Objective: To examine sex-specific differences in psychiatric symptom profiles and clinical trajectories during the CAMHS–AMHS transition using data from the European MILESTONE project, a 2-year longitudinal study. Methods: A cohort of 1004 adolescents (aged 17–19) in CAMHS was assessed at baseline (T1), 9 months (T2), 15 months (T3) and 24 months (T4). Measures included the Child Behavior Checklist/Adult Behavior Checklist, Health of the Nation Outcome Scales for Children and Adolescents, and the Specific Level of Functioning Scale. Multilevel modelling included sex, diagnosis and time point as covariates, testing three-way interactions for differential trajectories. Findings: Males showed higher symptom severity and impairment across measures, particularly in anxiety/somatic/trauma, eating disorder/obsessive-compulsive disorder (ED/OCD) and schizophrenia. Females exhibited better functioning. Significant sex differences emerged in internalising symptoms (eg, anxiety/somatic/trauma, autism spectrum disorder (ASD)), externalising symptoms (eg, attention deficit hyperactivity disorder (ADHD)), overall psychopathology (eg, ADHD, personality disorder/conduct disorder/substance use disorder) and functioning (eg, ED/OCD, schizophrenia spectrum disorder). Conclusions: Sex-related differences in symptom severity, diagnosis and functioning persist across the CAMHS–AMHS transition, with males generally more impaired and females showing better adaptive outcomes. Clinical implications: Identifying sex-specific trajectories can enhance personalised transitional care, reduce misdiagnosis and guide targeted interventions—especially for under-recognised presentations such as ADHD/ASD in females and ED in males. Trial registration number: ISRCTN83240263 .

Purpose: The prefrontal cortex [PFC] is crucial in controlling food-related impulses. Functional near-infrared spectroscopy [fNIRS] represents a wearable functional neuroimaging technology for measuring PFC activation in real life. Aims of the study were to examine PFC activation in fasting conditions and after an oral glucose tolerance test [OGTT] in resting- state [R], cognitive tasks [Ts] conditions and explore the PFC activation relationship with insulin sensitivity index [ISI] in youths with obesity. Methods: 28 patients’ cross-sectional study [age 7—15 y]. ISI was quantified by Matsuda’s Index and PFC activation as oxygenated [O ₂ Hb, mol/L] and total [tHb, mol/L] hemoglobin concentration changes, in fasting and during the first 60 min of the OGTT; in resting-state condition and during cognitive tasks [Ts: Verbal Fluency, Digit Span, Non-Verbal Stroop] administered before [Fasting-Ts], and 15 min after OGTT [OGTT-Ts]. 15 min OGTT-R was divided into 5 time periods [P1-P2-P3-P4-P5], and cognitive tasks [OGTT-Ts] were then administered again. Results: Dorsolateral PFC [DLPFC] and right frontal pole were over-activated in OGTT compared to the fasting state. Significant differences [p < 0.005, false discovery rate corrected] were observed: P2 [O ₂ Hb Left DLPFC Fasting-R: 1.47 _* 10 ^–6 vs OGTT-R: 4.13 _* 10 ^–6 mol/L], P3 [tHb Right DLPFC Fasting-R: 1.15 _* 10 ^–6 vs OGTT-R: 3.36 _* 10 ^–6 mol/L], and P5 [ O ₂ Hb Left DLPFC Fasting-R: 1.47 _* 10 ^–6 vs OGTT-R: 4.34 _* 10 ^–6 mol/L, tHb Right DLPFC Fasting-R: 1.15 _* 10 ^–6 vs OGTT-R: 3.07 _* 10 ^–6 mol/L]. The change of left DLPFC activity correlated significantly with ISI [r = 0.61, p < 0.001]. Conclusion: fNIRS enabled the non-invasive examination of the PFC hemodynamic response associated with participants’ insulin sensitivity in an ecological context. Bilateral DLPFC activation following OGTT in youths with obesity was associated with peripheral ISI. This association suggests that peripheral insulin sensitivity might reflect the PFC’s ability to control food-related behaviours.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties in social communication and restricted and repetitive behavi

Compared to schizophrenia in adults, Early Onset Schizophrenia (EOS) features diagnostic, clinical, and therapeutic peculiarities that are the subject of ongoing discussion among psychiatrists and neuropsychiatrists. This article presents the outcomes of a meeting and a series of virtual roundtable discussions among specialists who validated practical recommendations for the diagnosis and management of EOS in light of recent literature. The identification of risk factors and prodromal symptoms, as well as the differentiation of EOS from other psychiatric conditions, is crucial for early detection. Timely identification enables the implementation of appropriate psycho-behavioural and pharmacological interventions and supports close monitoring of the developmental trajectories associated with EOS. The collaboration between the different professionals who deal with EOS patients and a therapeutic approach that allows a normal cognitive, sexual, and psychophysical development makes it possible to ensure the therapeutic alliance necessary for the optimal management of the disease over time. In a scenario that is complicated by negative prognostic factors, such as the late recognition of the disease, comorbid and latent psychiatric conditions, the increasingly widespread use of substances among adolescents, and a poor therapeutic adherence often due to antipsychotics side effects, a growing body of literature emphasizes the advantages of lurasidone in the treatment of EOS. Compared to other pharmacological agents commonly used in schizophrenia, lurasidone has been shown to intervene comprehensively and effectively against the positive and negative symptoms of EOS, with manageable side effects and the preservation of a good QoL.

Background: It is well documented in the scientific literature that obsessive–compulsive disorder (OCD) and various eating disorders may present overlapping psychopathological traits. Exploring these aspects could help to identify underlying features that connect different diagnostic categories. However, evidence is lacking regarding certain less-studied eating disorders, such as avoidant/restrictive food intake disorder (ARFID). The aim of this review is to investigate the presence of comorbidity between OCD and ARFID and, consequently, the psychopathological similarities between these disorders. Methods: A systematic review of the PubMed/MEDLINE, Scopus and PsycInfo databases was conducted. To ensure methodological rigor, the review process followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Results: After removing duplicates and applying the exclusion criteria, nine studies were included. Results indicated that although ARFID presents with primarily food-related symptomatology, the two disorders demonstrate both overlapping and distinct psychopathological characteristics. A tendency toward comorbidity is evident; however, symptom presentation appears to be influenced by age. Specifically, lower obsessive–compulsive comorbidity is observed during childhood and adolescence. Nevertheless, OCD in younger populations is more frequently associated with a fear-driven ARFID profile compared to older individuals. The co-occurrence of these conditions complicates treatment; OCD-related symptoms often show limited responsiveness to conventional approaches used for eating disorders. Conclusions: ARFID and OCD share partially overlapping psychopathological features, with comorbidity patterns varying by age. Recognizing these shared and disorder-specific traits—and investigating them through longitudinal studies—may guide more targeted, personalized interventions and improve treatment outcomes.

Background: Emotional dysregulation (ED) is a transdiagnostic construct implicated in a broad range of psychiatric conditions. However, the influence of gender on ED remains understudied, particularly among adolescents with severe mood and behavioral disorders. Furthermore, few studies have controlled for confounding effects of specific psychiatric diagnoses. Methods: We assessed 182 adolescents (80.8% female; mean age 15.7 years) referred to our clinical institution. Participants completed the Cyclothymic–Hypersensitive Temperament Questionnaire (CHTQ), the Reactivity, Intensity, Polarity, and Stability Questionnaire (RIPoSt-Y), and the K-SADS-PL interview. Results: Females reported significantly higher levels of CHTQ mood lability (7.53 vs. 5.94, p = 0.012), RIPoSt-Y affective instability (62.33 vs. 53.31, p = 0.023), and interpersonal sensitivity (30.80 vs. 24.97, p < 0.001). They also exhibited higher rates of cyclothymic–hypersensitive temperament (46.6% vs. 14.7%, p = 0.001). Regression analysis revealed that gender and specific psychiatric diagnoses exerted significant independent effects on ED dimensions. Mood lability/hypersensitivity was significantly predicted by bipolar disorder (p = 0.001), depressive disorder (p = 0.002), and female sex (p = 0.025). Affective instability was independently predicted by bulimia nervosa (p = 0.019), depressive disorder (p = 0.004), and female sex (p = 0.033). Significant predictors for interpersonal sensitivity included female sex (p = 0.002), depressive disorder (p = 0.008), bulimia nervosa (p = 0.044), and the absence of conduct disorder (p = 0.048). Conclusions: Female adolescents with severe psychiatric presentations exhibited higher levels of ED, specifically regarding mood lability, affective instability, and interpersonal sensitivity. These associations persisted independently of current mood disorder diagnoses or comorbidities. While findings from this clinical cohort may not be fully generalizable to the general population, they highlight the need for gender-informed clinical interventions for adolescents characterized by severe ED.