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Kustov G, Zhuravlev D, Zinchuk M, Popova S, Tikhonova O, Yakovlev A, Rider F, Guekht A. Maladaptive personality traits in patients with epilepsy and psychogenic non-epileptic seizures. Seizure 2024; 117:77-82. [PMID: 38342044 DOI: 10.1016/j.seizure.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE We aimed to evaluate the sociodemographic, clinical, and psychological characteristics associated with psychogenic non-epileptic seizures (PNES) in patients with epilepsy, with particular emphasis on the personality profile assessed from a dimensional perspective. METHODS The cohort study included 77 consecutive inpatients with active epilepsy aged 36-55 years; 52 (67.5%) were female. The presence of PNES was confirmed by video-EEG monitoring. All patients underwent the Mini-International Neuropsychiatric Interview to diagnose psychiatric disorders. All participants completed the Neurological Disorders Depression Inventory in Epilepsy, the Epilepsy Anxiety Survey Instrument - brief version, and the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus Modified. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Brunner-Munzel test was used for quantitative variables. RESULTS Twenty-four patients (31.2%) had both epilepsy and PNES. There were no significant differences in social, demographic or clinical characteristics, psychiatric diagnoses or depression severity. Compared to patients with epilepsy alone, patients with epilepsy and PNES had higher anxiety scores and more pronounced maladaptive personality traits such as disinhibition and psychoticism. SIGNIFICANCE The main novelty of our study is that using the recently proposed dimensional approach to personality disorders and an appropriate instrument we assessed all personality domains listed in two of the most widely used classifications of mental disorders (DSM-5 and ICD-11) in PWE with and without PNES. To our knowledge, this is the first study to demonstrate the association of the maladaptive traits of psychoticism and disinhibition with the development of PNES in PWE.
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Affiliation(s)
- G Kustov
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - D Zhuravlev
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - M Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation.
| | - S Popova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - O Tikhonova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - A Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - F Rider
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - A Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Wei D, Garlinghouse M, Li W, Swingle N, Samson KK, Taraschenko O. Association between kinetic semiology of psychogenic nonepileptic spells and seizure type in dual disorder. Epilepsy Behav 2021; 114:107597. [PMID: 33246895 DOI: 10.1016/j.yebeh.2020.107597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Epilepsy is diagnosed in 20% of patients with psychogenic nonepileptic spells (PNES). The semiology of PNES and epileptic seizures (ES) overlaps in some patients. It is unclear whether the motor phenotype of PNES predicts the type of ES. METHODS Video segments of EEGs in patients with PNES and ES treated in the Epilepsy Monitoring Unit at the University of Nebraska Medical Center were reviewed. Videos were categorized according to the validated motor-based classification of PNES. Ratings of kinetic PNES events were analyzed to determine if there was an association with focal or generalized ES. If available, the video segments of ES were categorized as hypokinetic or hyperkinetic based on the constellation of focal or generalized movements and other semiological features. RESULTS Among 43 patients with documented PNES-ES (median age 34, interquartile range (IQR) 26-45), 27.9% were male. The largest proportion of patients (39.5%) had focal temporal epilepsy (TE). Other diagnostic groups included focal frontal (FE, 25.6%), generalized (GE, 25.6%), or other (9.3%) epilepsies. Thirty-three PNES patients (82.5%) were rated as having a hypokinetic phenotype. On average, hypokinetic PNES patients were receiving a median of 3 (IQR 2-4) anticonvulsants, compared to a median of 2 (IQR 2-3) in hyperkinetic PNES patients (p = 0.06). While the group with coexisting FE had a higher prevalence of hyperkinetic semiology (45.4%) than either the TE (11.7%) or GE (18.1%) patients, there was no significant association between the ES type and kinetic status of PNES. Among 20 patients who had video recordings of both PNES and ES, 40% displayed the concordant hypokinetic phenotypes for PNES and seizures while 15% had hyperkinetic presentation of both event types. Among additional 16 patients with scalp EEG-negative suspected nonepileptic events and documented ES, 6 had the recordings of seizures and 3 have presented with concordant hypokinetic PNES and ES. CONCLUSION In patients with PNES and ES, the hypokinetic semiology of PNES prevails over hyperkinetic semiology in TE and GE syndromes. The motor status of PNES does not predict the phenotype of coexisting ES. The concordant kinetic semiology is present in more than half of the patients with dual diagnosis and available video data.
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Affiliation(s)
- Danmeng Wei
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew Garlinghouse
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Wenyang Li
- Department of Neurology, University of Kentucky, Lexington, KY, United States
| | - Nicholas Swingle
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States.
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Hansen AS, Rask CU, Rodrigo-Domingo M, Pristed SG, Christensen J, Nielsen RE. Incidence rates and characteristics of pediatric onset psychogenic nonepileptic seizures. Pediatr Res 2020; 88:796-803. [PMID: 32392575 DOI: 10.1038/s41390-020-0945-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pediatric onset psychogenic nonepileptic seizures (PNES) is a highly disabling disorder and potentially misdiagnosed as epilepsy. Still, knowledge regarding PNES in children and adolescents is limited and data on both incidence and characteristics are scarce. This study investigated the incidence rate (IR) and clinical characteristics of pediatric onset PNES, including possible differences when having comorbid epilepsy. METHODS A population-based study of children and adolescents aged 5-17 years with an incident diagnosis of PNES in the Danish healthcare registries between 1996 and 2014. In total, 386 children and adolescents were included after assessment of diagnostic validity using medical record data. RESULTS The IR increased during the study period with the maximum IR observed in 2014 (7.4 per 100,000 person-years). A history of both neurologic and psychiatric problems as well as negative life events was identified. Comorbid epilepsy was confirmed for 55 cases (14.2%) and was associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. CONCLUSIONS PNES are increasingly diagnosed in children and adolescents, and the clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. These findings provide important information for future healthcare planning in this area. IMPACT This nationwide study is the first to report population-based incidence rates of pediatric onset PNES documenting markedly increasing incidence rates between 1996 and 2014. A history of both neurologic and psychiatric problems as well as negative life events was identified for pediatric onset PNES. Comorbid epileptic seizures were associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. The clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. The increasing number of children and adolescents diagnosed with PNES is important information for future healthcare planning in this area.
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Affiliation(s)
- Anne S Hansen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Charlotte U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Rodrigo-Domingo
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Sofie G Pristed
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - René E Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes. Epilepsy Behav 2018; 89:70-78. [PMID: 30384103 DOI: 10.1016/j.yebeh.2018.10.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/06/2018] [Accepted: 10/07/2018] [Indexed: 11/21/2022]
Abstract
Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) represent a serious challenge for the clinicians. However, the frequency, associations, and outcomes of dual diagnosis of epilepsy and PNES are unclear. The aim of the review was to determine the frequency, correlates, and outcomes of a dual diagnosis. A systematic review of all published observational studies (from inception to Dec. 2016) was conducted to determine the frequency, correlates, and outcomes of dual diagnosis. We included studies of individuals of any age reporting a dual diagnosis of epilepsy and PNES. All observational study designs were included with the exception of case reports and case series with fewer than 10 participants. The mean frequency of epilepsy in patients with PNES across all studies was 22% (95% confidence intervals [CI] 20 to 25%, range: 0% to 90%) while the mean frequency of PNES in patients with epilepsy was 12% (95% CI 10 to 14%, range: 1% to 62%). High heterogeneity means that these pooled estimates should be viewed with caution. A number of correlates of dual diagnosis were reported. Some studies delineated differences in semiology of seizures in patients with dual diagnosis vs. PNES or epilepsy only. However, most of the correlates were inconclusive. Only a few studies examined outcome in patients with dual diagnosis. Dual diagnosis is common in clinical practice, especially among patients referred to specialized services, and requires careful diagnosis and management.
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Labudda K, Frauenheim M, Illies D, Miller I, Schrecke M, Vietmeier N, Brandt C, Bien CG. Psychiatric disorders and trauma history in patients with pure PNES and patients with PNES and coexisting epilepsy. Epilepsy Behav 2018; 88:41-48. [PMID: 30241052 DOI: 10.1016/j.yebeh.2018.08.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 01/06/2023]
Abstract
Several studies found high prevalence rates of psychiatric disorders in patients with pure psychogenic nonepileptic seizures (PNES). Traumatic experiences were also reported to be elevated in patients with PNES and were discussed as a crucial risk factor for the development of PNES. Much less is known about psychiatric comorbidities and specifically, about trauma history in patients with PNES and coexisting epilepsy. Here, we aimed at directly comparing psychiatric disorders and traumatic life experiences in patients with pure PNES and in patients with PNES and coexisting epilepsy. We assessed the presence of current axes I and II disorders in 109 patients with either pure PNES (n = 67) or with PNES + epilepsy (n = 42) by using structured clinical interviews. We also compared the trauma histories by using the posttraumatic diagnostic scale (PDS) as an interview and the extent of physical, sexual, and emotional childhood maltreatment measured with the Childhood Trauma Questionnaire (CTQ). Patients of both groups had very high rates of psychiatric disorders: 79.1% of the patients with pure PNES and 76.2% of the patients with PNES + epilepsy had at least one psychiatric disorder. The frequencies of psychiatric disorders did not differ between groups. However, there was a trend towards higher rates of posttraumatic stress disorder (PTSD) in patients with PNES (32.9%) compared with patients with PNES + epilepsy (16.7%). In both groups, the proportion of patients who recalled traumatic events in the PDS was high (72.6% in the patients with pure PNES, 64.3% in the patients with PNES + epilepsy) and did not differ significantly between groups. The age at first traumatization, the types of trauma events experienced, the number of patients with single traumatization, and those with repeated traumatic experiences also did not differ between groups. We found high frequencies of childhood maltreatment in both groups. Our findings show that patients with PNES and patients with PNES and coexisting epilepsy could neither be differentiated by the amount of psychiatric additional disorders nor by the nature and extent of trauma and maltreatment experiences. Our results suggest that patients with PNES + epilepsy rather resemble patients with pure PNES than patients with epilepsy in respect to psychopathological characteristics and adverse life experiences. Trauma and maltreatment history are therefore assumed to be predisposing factors to PNES in both patients with pure PNES and patients with PNES and coexisting epilepsy.
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Affiliation(s)
- Kirsten Labudda
- Bielefeld University, Department of Psychology, Bielefeld, Germany.
| | | | - Dominik Illies
- Bielefeld University, Department of Psychology, Bielefeld, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
| | - Inga Miller
- Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
| | - Mario Schrecke
- Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
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Wissel BD, Dwivedi AK, Gaston TE, Rodriguez-Porcel FJ, Aljaafari D, Hopp JL, Krumholz A, van der Salm SMA, Andrade DM, Borlot F, Moseley BD, Cavitt JL, Williams S, Stone J, LaFrance WC, Szaflarski JP, Espay AJ. Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case-control study. Epilepsy Behav 2016; 61:180-184. [PMID: 27362440 DOI: 10.1016/j.yebeh.2016.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/11/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to examine the clinical and electrographic differences between patients with combined epileptic (ES) and psychogenic nonepileptic seizures (PNES) and age- and gender-matched patients with ES-only and PNES-only. METHODS Data from 138 patients (105 women [77%]), including 46 with PNES/ES (39±12years), 46 with PNES-only (39±11years), and 46 with ES-only (39±11years), were compared using logistic regression analysis after adjusting for clustering effect. RESULTS In the cohort with PNES/ES, ES antedated PNES in 28 patients (70%) and occurred simultaneously in 11 (27.5%), while PNES were the initial presentation in only 1 case (2.5%); disease duration was undetermined in 6. Compared with those with ES-only, patients with PNES/ES had higher depression and anxiety scores, shorter-duration electrographic seizures, less ES absence/staring semiology (all p≤0.01), and more ES arising in the right hemisphere, both in isolation and in combination with contralateral brain regions (61% vs. 41%; p=0.024, adjusted for anxiety and depression) and tended to have less ES arising in the left temporal lobe (13% vs. 28%; p=0.054). Compared with those with PNES-only, patients with PNES/ES tended to show fewer right-hemibody PNES events (7% vs. 23%; p=0.054) and more myoclonic semiology (10% vs. 2%; p=0.073). CONCLUSIONS Right-hemispheric electrographic seizures may be more common among patients with ES who develop comorbid PNES, in agreement with prior neurobiological studies on functional neurological disorders.
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Affiliation(s)
- Benjamin D Wissel
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Alok K Dwivedi
- Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Tyler E Gaston
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Danah Aljaafari
- Division of Neurology, University of Toronto, Toronto, ON, Canada; Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Jennifer L Hopp
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allan Krumholz
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sandra M A van der Salm
- Department of Neurology, Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, Netherlands
| | | | - Felippe Borlot
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Brian D Moseley
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer L Cavitt
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stevie Williams
- Department of Clinical Neurosciences, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Jon Stone
- Department of Clinical Neurosciences, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - W Curt LaFrance
- Department of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alberto J Espay
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA.
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Variables associated with co-existing epileptic and psychogenic nonepileptic seizures: a systematic review. Seizure 2016; 37:35-40. [PMID: 26987033 DOI: 10.1016/j.seizure.2016.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Epileptic seizures (ES) have many mimickers, perhaps the most relevant being psychogenic nonepileptic seizures (PNES). The picture is even more challenging when PNES are associated with ES in a given patient. The aim of this research paper was to delineate the demographic, epileptological and psychiatric profile of that specific population. METHODS A systematic review was carried out from 2000 to 2015 for articles in English, French, Italian, Spanish and Portuguese in PUBMED and EMBASE. Cohort or case-control studies reporting prospective or retrospective original data comparing patients with co-existing ES and PNES with those who had PNES only and ES only have been included. In retained studies, the presence of PNES was confirmed by video-electroencephalography (V-EEG). Forty-eight abstracts were identified. RESULTS Nine studies were retained. Most showed that female gender predominated in both groups with PNES. Patients with co-existing ES and PNES take higher number of antiepileptic drugs (AEDs) than PNES alone. Two studies showed association of concomitant ES and PNES with earlier age of seizure onset. Localizing EEG features and ES type were evaluated in only two studies and their association with either group was inconclusive. Somatoform, conversion or cluster B personality disorders were more frequent in subjects with PNES than with ES. DISCUSSION Patients with concomitant ES and PNES are highly heterogeneous, challenging differentiation on clinical grounds. A diagnosis of conversion or somatoform, anxiety disorders, and the use of a higher number of AEDs than psychiatric medications may have an association with co-existing ES and PNES. Further studies are warranted to differentiate patients who only have PNES from those with co-existing ES and PNES.
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Lafrance WC, Ranieri R, Blum AS. Nonepileptic seizures - objective phenomena. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:297-304. [PMID: 27719849 DOI: 10.1016/b978-0-12-801772-2.00026-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This chapter describes the evaluation process for the diagnosis of psychogenic nonepileptic seizures (PNES), which is determined based on concordance of the composite evidence available, including historic and physical exam findings, seizure semiology, and ictal/interictal electroencephalogram (EEG). No single clinical feature is pathognomonic of PNES. The diagnosis of PNES can be at times challenging, such as when seizure documentation on video-EEG cannot be readily achieved. A multicomponent approach to the diagnosis of PNES, with use of all available evidence, may facilitate diagnosis and then care of patients with PNES. Emerging evidence supports the use of symptom identification by the patient as part of the treatment of these patients. With advances in diagnostic methods and criteria, the diagnosis of PNES can be made reliably.
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Affiliation(s)
- W Curt Lafrance
- Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, RI, USA.
| | - R Ranieri
- Department of Psychiatry, Università degli Studi di Milano, Ospedale San Paolo, Milan, Italy
| | - A S Blum
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
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Freudenreich O, Huffman JC, Sharpe M, Beach SR, Celano CM, Chwastiak LA, Cohen MA, Dickerman A, Fitz-Gerald MJ, Kontos N, Mittal L, Nejad SH, Niazi S, Novak M, Philbrick K, Rasimas JJ, Shim J, Simpson SA, Walker A, Walker J, Wichman CL, Zimbrean P, Söllner W, Stern TA. Updates in Psychosomatic Medicine: 2014. PSYCHOSOMATICS 2015; 56:445-59. [DOI: 10.1016/j.psym.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/21/2023]
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