Psychogenic Nonepileptic Seizures in Patients With Epilepsy: A Comparative Study With Patients With Pure Epilepsy

ABSTRACT

Psychogenic nonepileptic seizures (PNES) represent management challenges, especially if associated with epilepsy. We aimed to evaluate patients with mixed epilepsy (true and PNES) and compare them with pure epilepsy to identify predictors of psychogenic seizures. This study included 40 patients with pure epilepsy and 40 patients with mixed epilepsy matched in age and sex. Patients underwent neurological assessment, semistructured psychiatric clinical interview, and video electroencephalogram monitoring. We found that unemployment, divorce, and seizure frequency were higher in mixed epilepsy, as well as history of family dysfunction, child adversity, and depressive and dissociative disorders. Both groups were similar regarding family history for seizures and personality dysfunction scores. Family dysfunction, child adversity, and depressive disorders were predictors of PNES. We recommend early evaluation for social instability, family dysfunction, child adversity, and depressive disorders in epileptic patients with higher seizure frequency to avoid misdiagnosis of false drug-resistant epilepsy and enhance proper management.

Care providers' views on burden of psychosomatic symptoms of IS-traumatized female refugees participating in a Humanitarian Admission Program in Germany: A qualitative analysis

BACKGROUND

Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers.

METHODS

Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring.

RESULTS

The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible.

CONCLUSION

The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.

Psychogenic nonepileptic seizures that remit when the diagnosis is given: Just good luck?

OBJECTIVE

Some patients with psychogenic nonepileptic seizures (PNES) remit when given the diagnosis. It is not realistically possible to test this potential therapeutic effect in an Randomized Controlled Trial (RCT) so we aim to statistically demonstrate it using the temporal relationship between the communication of the diagnosis and the timing of remission.

METHOD

Re-analysis of data from a study of PNES, where diagnosis was communicated, and outcomes recorded in 54 patients. Making conservative assumptions and using the binomial distribution, the Poisson distribution and the chi-squared test distribution, we calculated likelihoods of the null hypothesis: that communication of the diagnosis and remission of seizures had occurred in random temporal relationship.

RESULTS

Remission occurred in the week following communication of the diagnosis in 15 out of 54 patients. The χ² test assigned this result a p value of <0.00001. Binomial and Poisson distribution calculations also indicated that remission was highly unlikely to have occurred by chance and that, in a dataset similar to ours, was unlikely to be due to chance if occurring in more than 9 patients (16.7%).

CONCLUSIONS

We showed that the observed remissions were highly unlikely to be due to chance. Where an intervention is 'short and sharp' and the outcome can be measured with reasonable temporal acuity, then this type of method may provide an alternative to RCT methodology when the latter is impracticable.

Role of Yoga and Meditation as Complimentary Therapeutic Regime for Stress-Related Neuropsychiatric Disorders: Utilization of Brain Waves Activity as Novel Tool

During recent decades, stress-related neuropsychiatric disorders such as anxiety, depression, chronic tension headache, and migraine have established their stronghold in the lives of a vast number of people worldwide. In order to address this global phenomenon, intensive studies have been carried out leading to the advancement of drugs like anti-depressants, anxiolytics, and analgesics which although help in combating the symptoms of such disorders but also create long-term side effects. Thus, as an alternative to such clinical practices, various complementary therapies such as yoga and meditation have been proved to be effective in alleviating the causes and symptoms of different neuropsychiatric disorders. The role of altered brain waves in this context has been recognized and needs to be pursued at the highest level. Thus, the current study provides a review focused on describing the effects of yoga and meditation on anxiety and depression as well as exploring brain waves as a tool for assessing the potential of these complementary therapies for such disorders.

[Perspectives for the Electroencephalogram in Psychiatry]

Perspectives for the Electroencephalogram in Psychiatry Abstract. The electroencephalogram (EEG) is a non-invasive and cost-effective method to monitor spontaneous neuronal activity over time. Pathologies in EEG recordings indicate with high sensitivity but low specificity abnormal functional brain states. The main psychiatric indications for EEG recordings include atypical clinical symptoms of a neuropsychiatric syndrome or atypical reactions to medication as well as a baseline diagnostic before starting treatment with specific drugs or stimulation modalities. In recent research the EEG continues to be a valuable tool not only in diagnostics but also for the prediction of treatment success. The following paper focuses on basic electrophysiological understanding of EEG recordings, the diagnostic value of EEG recordings in different clinical entities, and new research attempts in diagnostic and treatment prediction.

The Brain-Gut Axis Contributes to Neuroprogression in Stress-Related Disorders

There is a growing emphasis on the relationship between the complexity and diversity of the microorganisms that inhabit our gut (human gastrointestinal microbiota) and brain health. The microbiota-gut-brain axis is a dynamic matrix of tissues and organs including the brain, glands, gut, immune cells, and gastrointestinal microbiota that communicate in a complex multidirectional manner to maintain homeostasis. Changes in this environment may contribute to the neuroprogression of stress-related disorders by altering physiological processes including hypothalamic-pituitary-adrenal axis activation, neurotransmitter systems, immune function, and inflammatory responses. While appropriate, coordinated physiological responses, such as immune or stress responses, are necessary for survival, the contribution of repeated or chronic exposure to stress may predispose individuals to a more vulnerable state leaving them more susceptible to stress-related disorders. In this chapter, the involvement of the gastrointestinal microbiota in stress- and immune-mediated modulation of neuroendocrine, immune, and neurotransmitter systems and the consequential behavior is considered. We also focus on the mechanisms by which commensal gut microbiota can regulate neuroinflammation and further aim to exploit our understanding of their role in the effects of the microbiota-gut-brain axis on the neuroprogression of stress-related disorders as a consequence of neuroinflammatory processes.

Paroxysmal nonepileptic events in children with epilepsy

OBJECTIVE

The aim of this study was to clarify the characteristics of paroxysmal nonepileptic events (PNEs) suspected as being epileptic seizures by families of children with epilepsy.

METHODS

The video-EEG (vEEG) recordings of habitual paroxysmal events in children with epilepsy at Nagoya University Hospital between October 2006 and January 2016 were reviewed. Based on the doctor's suspicion before the vEEG, the PNEs were divided into two groups that included PNEs suspected as epileptic seizures and PNEs suspected as PNEs. PNEs in the former group were classified based on the suspected seizure type.

RESULTS

Of 886 habitual paroxysmal events, vEEG confirmed that 83 events (68 children) were PNEs. The median age of the 68 children was 3.2 years. Concurrent epilepsies included focal epilepsies (n=33), infantile spasms (n=16), and other types (n=19). The most common types of PNEs were sleep myoclonus (n=11), followed by stereotypies (n=9), awake myoclonus (n=8), paroxysmal ocular deviations (PODs, n=8), and tonic posturing (n=8). Even after direct observation or video viewing, the doctors suspected epileptic seizures in all three of the PODs and two of the tonic posturing children. Before the vEEG, however, the accurate visual information led to the speculation that the four psychogenic and two sleep myoclonus events were all PNEs. Myoclonus, stereotypies, and head drops were often misdiagnosed as epileptic spasms, while PODs and tonic posturing were often misdiagnosed as focal seizures with motor components. Additionally, staring and motion arrest during a drowsy state were often misdiagnosed as focal dyscognitive seizures. Seven of eight patients with PODs had epileptic spasms that were concurrent with epileptic seizures. A diffuse cerebral lesion or reduced visual acuity was seen in seven patients with PODs.

CONCLUSION

We re-emphasize that vEEG is essential for accurate diagnosis and provides evidence for listing POD in the differential diagnosis of oculomotor paroxysmal events.

Comparative Analysis of the Clinical Significance of Oscillatory Components in the Rhythmic Structure of Pulse Signal in the Diagnostics of Psychosomatic Disorders in School Age Children

We performed a comparative analysis of the types of spectral density typical of various parameters of pulse signal. The experimental material was obtained during the examination of school age children with various psychosomatic disorders. We also performed a typological analysis of the spectral density functions corresponding to the time series of different parameters of a single oscillation of pulse signals; the results of their comparative analysis are presented. We determined the most significant spectral components for two disordersin children: arterial hypertension and mitral valve prolapse.

[Relaxation treatments and biofeedback for anxiety and somatic stress-related disorders]

INTRODUCTION

Relaxation techniques (TR) and biofeedback (BFB) are widely used in psychiatric and psychological practice for the treatment for anxiety and stress-related disorders.

METHODS

An examination of studies focusing on the correlates of psychophysiology of relaxation and biofeedback has been done, in addiction to controlled therapeutic studies that describes clinical aspects, efficacy and limits.

RESULTS

There are different TR and BFB procedures, but they have the same goal and same physiological modifications, resulting in stress and anxiety reduction. There is a proven action to musculoskeletal, neuroendocrine and autonomic nervous system, showing similar results. Very few data on immune changes are available. Meta-Analysis show superior efficacy to no treatment or placebo in anxiety disorders, tension headache, bruxism, temporomandibular pain syndrome, rehabilitation and prevention of ischemic heart disease. Moderate efficacy is shown for chronic low back pain, cancer-related pain, rheumatoid arthritis and gastrointestinal disorders; data for essential hypertension are controversial. Variability of techniques, procedures, sampling problems, non-systematic make definitive conclusions difficult. TR and BFB are often used in combination with cognitive-behavioral and educational techniques. The association of the active relaxation technique facilitates generalization and self-control during stress situation and outside the training session.

CONCLUSIONS

TR and BFB are effective for anxiety and somatic stress-related disorders, associated with coping and quality of life improvement and affordable costs; they are minimally invasive but needing an active participation in the treatment process. Some limits are responders' prediction, continuity of practice and limited effectiveness for depression disorders. Finally, it is shown that they are real psychosomatic therapies that are able to produce somatic peripheral changes (neuroendocrine, neurovegetative and muscular systems) generated by the mind and secondary to the involvement of central neurotransmitter circuits.

Diagnosis and Treatment of Nonepileptic Seizures

PURPOSE OF REVIEW

This article details the evaluation process involved in the diagnosis of psychogenic nonepileptic seizures (PNES). The psychological underpinnings, prognostic factors, and recent treatment advances of PNES are also reviewed.

RECENT FINDINGS

The diagnosis of PNES is determined based on concordance of the composite evidence available, including historical and physical examination findings, seizure symptoms and signs, and ictal/interictal EEG. No single clinical data point is definitively diagnostic of PNES. The diagnosis of PNES can be challenging at times, such as when seizure documentation on video-EEG cannot be readily obtained. Yet, delayed diagnosis of PNES portends poor outcome. A multicomponent approach to the diagnosis of PNES, with use of an aggregate of available evidence, may facilitate diagnosis and then care of patients with PNES. Emerging evidence supports the effectiveness of cognitive-behavioral-based therapy in the treatment of these patients.

SUMMARY

The diagnosis of PNES can be made reliably, and evidence-based treatment now exists. Continued efforts remain necessary to enhance prompt recognition and interdisciplinary management for patients with PNES.

Correspondence in Stakeholder Assessment of Health, Work Capacity and Sick Leave in Workers with Comorbid Subjective Health Complaints? A Video Vignette Study

Purpose The purpose of this study is to test if there is correspondence in stakeholders' assessments of health, work capacity and sickness certification in four workers with comorbid subjective health complaints based on video vignettes. Methods A cross sectional survey among stakeholders (N = 514) in Norway in 2009/2010. Logistic regression and multinomial logistic regression was used to obtain the estimated probability of stakeholders choosing 100 % sick leave, partial sick leave or work and the estimation of odds ratio of stakeholder assessment compared to the other stakeholders for the individual worker. Results The supervisors were less likely to assess poor health and reduced work capacity, and more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. The public was less likely to assess comorbidity and reduced work capacity, and 6 and 12 times more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. Stakeholders generally agreed in their assessments of workers 2 and 3. The public was more likely to assess poor health, comorbidity and reduced work capacity, and the supervisors more likely to assess comorbidity and reduced work capacity, compared to the GPs for worker 4. Compared to the GPs, all other stakeholders were less likely to suggest full time work for this worker. Conclusions Our results seem to suggest that stakeholders have divergent assessments of complaints, health, work capacity, and sickness certification in workers with comorbid subjective health complaints.

[Peculiarities of the psychic state and quality of life in patients with duodenal ulcer in the context of chronomedicine]

Most clinicians consider duodenum ulcer as a psychosomatic disease. Objective: To show the interdependence of this condition and mental disorders and their relation to disturbances of melatonin production . Materials and Methods: 15 patients with seasonal DU and 15 healthy subjects of the control group were examined during 3 years using laboratory, endoscopic, and standard psychodiagnostic methods. Results. It was found that all patients with exacerbation of DU experienced enhanced anxiety, reduced background mood, and impaired quality of life based on general health and mental health scoring scales. The circadian rhythm of melatonin production was markedly distorted throughout the observation period but especially during exacerbations of the disease. Conclusions. The results indicate a high degree of correlation between DU and mental disorders caused by impaired production of melatonin. It suggests common etiological mechanisms of DU and psychosomatic symptom complex.

[PSYCHODERMATOLOGY]

Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. Correlation between psychiatric and dermatological disorders is a highly complex relation considering etiology, diagnostic procedures and treatment. There are three major groups of psychodermatological disorders: psychosomatic (psychophysiologic) disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychosomatic disorders are dermatological diseases which can be exacerbated or worsened by emotional stress, but are not caused directly by stress. Emotional stress can exacerbate many chronic dermatoses like urticaria, eczema, psoriasis, acne, seborrheic dermatitis, atopic dermatitis, alopecia areata, psychogenic purpura, rosacea, atypical pain syndromes and hyperhidrosis. The treatment of patients with the resistant chronic dermatosis can be difficult when stress is not recognized as a provoking factor. Primary psychiatric disorders are psychiatric conditions which induce development of various skin changes, e.g trichotillomania, factitial dermatitis, neurotic excoriations, delusions of parasitosis and dysmorphophobia. They include psychiatric disorders with anxiety, compulsive- opsessive and depressive symptoms and pathologic delusional ideas or hallucinations regarding the skin. Secondary psychiatric disorders appear as a result of a certain disfiguring skin disease that induces psychologic suffering such as loss of self-confidence, anxiety and social phobia. This category includes diseases like psoriasis, chronic eczema, various ichthyosiform syndromes, rhinophyma, multiple neurofibromas, severe acne, and other cosmetically disfiguring cutaneous lesions. The therapeutic approach of psychodermatological disorders should be multidisciplinary including primary care physicians, dermatologist, psychiatrist and psychologist. It is very important to educate dermatologists in the diagnostic procedures and therapy of psychiatric disorders which sometimes coexist with the skin disease. Majority of psychodermatological disorders can be treated with cognitive-bihevioral psychotherapy, psychotherapeutic stress-and-anxiety-management techniques and psychotropic drugs. Psychopharmacologic treatment includes anxiolytics, antidepressants, antipsychotics and mood stabilizer.

Teaching a neuromedical-contextual approach to psychosomatic medicine

The practice of psychosomatic medicine in the general hospital setting can be challenging, particularly for the inexperienced trainee. Guidance for how to approach a psychiatric consultation can be nonspecific or lacking altogether. In response, we offer a pedagogical model that emphasizes patient-specific neurological, medical, and contextual variables. A stepwise, "ABC" approach to psychiatric consultation is elaborated, beginning with collection of critical history ("Admission, Background, Consultation Question"), followed by both patient encounter ("Appearance, Behavior, Context") and actual patient examination ("Arousal, Brain/Body, Cognitive Assessment"), ultimately informing any given case formulation. Multiple clinical vignettes illustrate this approach and are offered for educational purposes in dissemination to trainees.

Effects of adolescent online gaming time and motives on depressive, musculoskeletal, and psychosomatic symptoms

AIM

To investigate whether adolescent online gaming time and the additive effect of gaming motives were associated with depressive, musculoskeletal, and psychosomatic symptoms. The hypothesis was that adolescents who engage in online gaming with escape motives and increased online gaming time have higher probability for depressive, musculoskeletal, and psychosomatic symptoms compared to adolescents with other online gaming motives and/or less online gaming time.

METHOD

An anonymous and voluntary questionnaire was completed during class hours by 7,757 Swedish adolescents aged 13-18 years. The questionnaire included demographic background, gaming habits, and depressive, musculoskeletal, and psychosomatic symptoms.

RESULTS

It was found that increased online gaming time during weekdays increased the probability of having depressive, musculoskeletal, and psychosomatic symptoms. However, these relations with time spent gaming were further explained by online gaming motives. Weekday online gaming for more than five hours a day, in combination with escape motives, was associated with an increased probability of depressive symptoms (odds ratio (OR) 4.614, 95% CI 3.230-6.590), musculoskeletal symptoms (OR 2.494, 95% CI 1.598-3.892), and psychosomatic symptoms (OR 4.437, 95% CI 2.966-6.637). The probability of ill health decreased when gaming was for fun or had social motives.

CONCLUSION

Excessive gaming time and escape motives were found to be associated with increased probability of ill health among adolescents. Gaming motives may identify gamers in need of support to reduce unhealthy gaming behaviour as well as identify individuals at risk for ill health.

[Features of oxygen utilization by the body of patients with arterial hypertension in the days of magnetic storms depending on the psychosomatic status and treatment options]

During magnetic storms the observed increase in γ-background environment and the reduction of the rate of oxygen utilization by the tissues, but the increase in the number of angina attacks per day to magnetic storms the choleric, in the days of magnetic storms in sanguine, for 3-4 days at a phlegmatic, and 4-5 days in the melancholic especially in groups high anxiety phlegmatic and melancholic. Last-risk group severe arterial hypertension and ischemic heart disease. Antihypertensive therapy based on the blockade of the features of the psychosomatic status, significantly reduced the number of attacks and brought the values of the utilization of oxygen and coefficient of oxygen utilization bu the tissues of all the days to those in healthy individual relevant anxiety and temperament.

[Comorbidity -- mind and body interconnection based on the new findings]

Comorbidity is a multicausal, multidimensional, multifaced phenomenon in medicine. There are many different definitions of the co-occurrence of two or more disorders, but Feinstein's is the most acceptable. Although epidemiological data show a high prevalence of comorbidity of somatic and psychiatric disorders, it is still underrecognized and undertreated. There are many unanswered questions related to comorbidity, including whether comorbidity is a valid phenomenon; whether the epidemiological results have validity; what is the linkage between somatic and psychological processes; which factors take part in the bidirectional manifestation; how do we treat the involved disorders; what is the right organization to manage the patients. The aim of the author was to review different aspects of comorbidity with the help of new knowledge. The starting point of the interpretation was the concept of identical biological substrates (pathophysiological endpoint) that generate the development of somatic and psychiatric disorders. The formation of these substrates is influenced by risk factors, which depend or not on the person (stressors vs genes). The effects of risk factors and biological substrates are parallel to each other, but one of them is a dominant agent. The author's concept ("dominance theory") is based on new discoveries of the biological mechanisms of psychiatric processes to help to understand the phenomenon of comorbidity and develop new therapies. It is very important to recognize, to diagnose and treat comorbidity because of the prevalence of excess mortality is high and the morbidity burden influences the patient' quality of life.

[Evaluating psychophysiologic adaptation state in operators of Bilibino nuclear power station]

The study revealed that 60% operators of Bilibino nuclear power station suffer from psychosomatic diseases, 41.7% of them are assigned to occupational group of workers, and major part of the examinees with psychosomatic diseases (45.82%) are aged 41-50, high integral level ofpsychophysiologic adaptation is revealed in 5 examinees (12.5%), medium integral level--in 12 examinees (30%). Lower integral level of psychophysiologic adaptation manifested in decrease in psychophysiologic and physiologic levels.

[Current views of psychosomatic diseases]

This review is designed to analyse current views of physicians representing different fields of medicine (psychoanalysis, pathological anatomy, psychiatry, etc.) on the problem of psychosomatic diseases with reference to its history, past and present concepts, etiopathogenetic mechanisms of these conditions. The authors propose to use the results of analysis as a basis for considering psychosomatic diseases as a singular etiopathogenetic entity resulting from dysregulation of rhythm-organizing structures.

[Anxiety-depressive disorders in elderly migrants of the far north in the period of re-adaptation to new climatic conditions]

The article presents the results of studies of the anxious and depressed characteristics in elderly migrants of the Far North with arterial hypertension in the period of their stay in new climatic conditions with regard to their North experience, gender, age and timing of rehabilitation. There was a high frequency of disturbing-depressive symptomatology of the surveyed migrants in the Far North, the frequency and severity of which increases with age; women migrants of Far North are prone to depression 1,8 times, anxiety--3,2 times more often than men. With the increase of the period of stay in the new climate and geographical conditions, the severity and frequency of occurrence of anxiety and depression increase. The obtained results should be taken into account when building rehabilitation program and forecasting its effectiveness, while conducting psychotherapy and psychological prevention in this group of patients.

[Parallel pharmacological correction of myocardial dysfunction, cognitive and psychopathological disordres in patients with congestive heart failure]

Was examined 92 patients with congestive heart failure III-IV FC with fraction of emission left ventricle < 45% against coronary artery disease. Patients of control group received basic therapy (according to recommendations of the Ukrainian society of cardiology), the 1 group--in addition received a preparation of Vazonat within 15 days intravenously in a dose of 1000 mg a day further are out-patient within 1 month on 250 mg 3 times per os; the 2 group--under the same scheme a preparation of Vazonat and a day tranquilizer of Adapto in a dose of 500 mg twice a day throughout all term of supervision. It is established that addition of Vazonat to basic treatment leads to additional effect concerning improvement of indicators cardio-hemodynamic, to improvement congestive functions. Joint appointment of preparations of Vazonat and Adaptol against basic treatment leads to more expressed improvement congestive functions, to progressive reduction of degree of trouble, depression.

[Complex estimation of the state of health, quality of life, level of psychological adaptation and rates of senescence of war veterans, suffering from arterial hypertension]

The article presents some aspects of the health status of the veterans of the Samara region. Intercommunication is marked between the level of social adaptation, quality of life and rate aging combatants. The study shows the effect of chronic posttraumatic stress disorder on the occurrence of psychosomatic pathology and development of senescence combat veterans suffering from arterial hypertension.

Juvenile and adult-onset psychogenic non-epileptic seizures

PURPOSE

Psychogenic non-epileptic seizures (PNES) tend to begin in adolescence and young adulthood, although the seizures can occur in a wide range of ages. In the current study, we investigated the age of onset in patients with PNES and tried to determine the correlation between the age of onset and the demographic and clinical characteristics and factors potentially predisposing to PNES.

METHODS

In this cross-sectional study, all patients with a clinical diagnosis of PNES were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 to 2012. We dichotomized the patients into two groups; those with age of onset below 18 years (juvenile), and those with age of onset at 18-55 years (adult-onset). We studied the demographic and clinical characteristics and factors potentially predisposing to PNES between these two groups. Statistical analyses were performed using Chi square and Fisher's Exact tests and Mann-Whitney U test.

RESULTS

Fifty-seven patients with juvenile and 129 people with adult-onset PNES were studied. Demographic characteristics of these two groups were not different significantly. Seizure characteristics and semiology in these two groups were not significantly different either. However, factors potentially predisposing to PNES were significantly different between these two groups. History of being abused, academic failure, epilepsy or family history of epilepsy were more frequently observed in juvenile PNES, while medical comorbidities were more frequent among patients with adult-onset PNES.

CONCLUSION

Age of onset of PNES is not correlated with the clinical manifestations; however, factors potentially predisposing to PNES are significantly different in patients with juvenile compared to those with adult-onset PNES.

[Functional imaging of pain: from the somatic response to emotions]

Functional brain imaging in subjects experiencing pain (real, observed or imagined) has led to considerable progress in our understanding of the role of the brain andpsyche in pain integration and control, as well as some forms of somatoform pain with no anatomical basis. This research is challenging not only the dichotomy between the soma and psyche, but also the concept of psychosomatic pain.

Prevalence of vasomotor, psychological, psychosomatic and sexual symptoms in perimenopausal and recently postmenopausal Greek women: association with demographic, life-style and hormonal factors

AIM

To assess the prevalence of climacteric symptoms and their association with demographic, life-style and hormonal parameters in Greek peri- and recently postmenopausal women.

METHODS

1025 Greek women who were either perimenopausal or within their first 5 postmenopausal years participated in this cross-sectional observational study. Menopausal symptoms were assessed by the Greene Climacteric Scale and were tested for associations with demographic, anthropometric, life-style and hormonal parameters.

RESULTS

29.8% Of the women reported moderate to severe menopausal symptoms. More specifically, 39.2% reported vasomotor, 21.3% psychological, 6.3% psychosomatic and 34.5% sexual symptoms. Years since menopause (r = 0.13, p < 0.01), waist circumference (r = 0.11, p < 0.05) as well as serum FSH, LH and estradiol (r = 0.15, r = 0.118, r = -0.157; p < 0.01) correlated with the intensity of menopausal symptoms. In the multivariate analysis years since menopause and serum estradiol were the only significant predictors of menopausal symptoms (b = -0.158 and b = -0.198, p < 0.001, respectively), explaining though only 4.8% of the variance.

CONCLUSION

One out of three Greek women has moderate to severe climacteric symptoms during the menopause transition or the first postmenopausal years. This frequency is comparable to other White populations. Menopausal age and endogenous estrogens are significant predictors of climacteric symptoms.

[Mental pathology in general pediatric practice: a problem of psychovegetative diathesis]

An examination of patients of a pediatric inpatient clinic revealed a variety of psychopathological disorders concomitant to functional autonomic/somatic pathology in children and adolescents as well as the variants of personality deviations and features of the patient's family. Based on this study, we suggest a concept of psychoautonomic diathesis and describe features of its symptoms and course as well as its relation to psychopathological diathesis. Main problems that should be solved to treat effectively functional autonomic/somatic disorders in the frames of psychoautonomic syndrome are presented.

[Psychosomatic relationships in postmenopausal women]

AIM

To study the prevalence of depressive and anxiety disorders in postmenopausal disorders and their relationship with the manifestations of climacteric syndrome.

SUBJECTS AND METHODS

The study enrolled 203 women, including 142 patients with surgical menopause and 61 with natural menopause. Psychometric testing using the Hamilton depression rating scale and the Spielberger test anxiety inventory, and 24-hour blood pressure (BP) monitoring with assessment of the 24-hour BP profile were performed.

RESULTS

Depressive disorders (DD) were found in 82.5% of the postmenopausal women; all the patients had higher levels of situational and personality anxiety. The women with natural menopause developed moderate and severe DD and those who had undergone ovariectomy had mild DD. The prevalence of DD was higher in patients with essential hypertension (EH) than in those with normal BP (88.6 and 78.3%, respectively; p < 0.01); DD was more marked in these patients. The severity of DD also depended on the type of diurnal BP variations; the highest level of depression was recorded in patients without nocturnal BP reduction. The same group was found to have the highest level of personality and situational anxiety.

CONCLUSION

The magnitude of DD depends on the type of menopause, the presence of EH, and the specific features of diurnal BP variations. The findings necessitate a detail examination of postmenopausal women for identification of affective disorders and their further correction.

[Pain disorders in traumatized individuals - neurophysiology and clinical presentation]

This overview portrays the salient physiological mechanisms being involved in the clinical manifestation of chronic pain in traumatized patients. A «hypermnesia-hyperarousal-model» is purported to support the neurophysiologic plausibility of the trauma-pain-relationship. We discuss seven characteristic clinical pain entities which alone or in combination can be found in patients with a previous psychological trauma.

[Psycho-physiological peculiarities of stomatologists aged 50-65 with essential hypertension]

The article presents the results of studying of psycho-physiological peculiarities in stomatologists in the age before 65, that is actual in modern medicine. Certain specificity of psycho-physiological indices in stomatologists with essential hypertension is shown. The proposition is justified that alexithimia and susceptibility to illnesses of psychosomatic origin (particularly, essential hypertension) in stomatologists are essentially influenced by withdrawal, absence of inclination to partnership, cooperation, compromise at solution of problems and in conflict situations, and irresponsible attitude to other people, reduced empathy and sympathy to other people.

[Depression as a systemic disease]

Depression has traditionally been considered as a mental illness, because basic biological methods previously failed to reveal any associated somatic changes. New more sensitive methods have, however, revealed many kinds of biological changes associated with depression. Scientific research has shown that the categorical division into mind and body is not justified. Instead, depression can be considered a systemic illness due to the manifold associated biological changes predisposing to somatic diseases and worsening their prognosis.

[Successful hypnotherapy in an intellectually disabled patient with drug treatment resistant epilepsy]

The possibility of psychogenic non-epileptic seizures (PNES) should be considered in patients with treatment-resistant epilepsy for whom hypnotherapeutic approach may be tried as one treatment option. Multimodal epileptic seizures as well as various behavioral and dyskinetic disorders are commonly associated with intellectual disabilities. Differentiation of brain derived epileptic seizures from other non-epileptic seizures requires an extensive anamnesis, clinical follow-up of the patient and video-EEG recording of seizures. We describe a patient with mild intellectual disability whose almost daily, drug-resistant epileptic attacks were found to be psychogenic. Hypnotherapeutic relaxation initiated upon mother's suggestion turned out to be useful.

[The variability of the basic speech tone frequency in the patients presenting with functional voice disorders]

The objective of this study was to elucidate changes in tone sigma (σ) before and after the treatment of the patients with mutational falsetto (n=10) and functional dysphonia (n=10). The control group was comprised of 30 healthy subjects. A personal computer was used to determine the values of SF0 (the mean frequency of the basic speech tone) and sigma (the standard deviation of the frequency values comprising SF0). It was shown that the treatment of the patients presenting with mutational falsetto (MF) and functional dysphonia (FD) resulted in identical quantitative changes of SF0, namely its lowering after the treatment compared with the elevated level before it. At the same time, the measurement of sigma revealed the qualitative difference between these characteristics. Specifically, sigma decreased in the patients with MF and increased in FD. It is concluded that variability in the constituent frequencies of SF0, besides its quantitative changes, should be taken into consideration, when estimating the results of the correction of functional voice disorders.

Movement disorder emergencies in childhood

The literature on paediatric acute-onset movement disorders is scattered. In a prospective cohort of 52 children (21 male; age range 2mo-15y), the commonest were chorea, dystonia, tremor, myoclonus, and Parkinsonism in descending order of frequency. In this series of mainly previously well children with cryptogenic acute movement disorders, three groups were recognised: (1) Psychogenic disorders (n = 12), typically >10 years of age, more likely to be female and to have tremor and myoclonus (2) Inflammatory or autoimmune disorders (n = 22), including N-methyl-d-aspartate receptor encephalitis, opsoclonus-myoclonus, Sydenham chorea, systemic lupus erythematosus, acute necrotizing encephalopathy (which may be autosomal dominant), and other encephalitides and (3) Non-inflammatory disorders (n = 18), including drug-induced movement disorder, post-pump chorea, metabolic, e.g. glutaric aciduria, and vascular disease, e.g. moyamoya. Other important non-inflammatory movement disorders, typically seen in symptomatic children with underlying aetiologies such as trauma, severe cerebral palsy, epileptic encephalopathy, Down syndrome and Rett syndrome, include dystonic posturing secondary to gastro-oesophageal reflux (Sandifer syndrome) and Paroxysmal Autonomic Instability with Dystonia (PAID) or autonomic 'storming'. Status dystonicus may present in children with known extrapyramidal disorders, such as cerebral palsy or during changes in management e.g. introduction or withdrawal of neuroleptic drugs or failure of intrathecal baclofen infusion; the main risk in terms of mortality is renal failure from rhabdomyolysis. Although the evidence base is weak, as many of the inflammatory/autoimmune conditions are treatable with steroids, immunoglobulin, plasmapheresis, or cyclophosphamide, it is important to make an early diagnosis where possible. Outcome in survivors is variable. Using illustrative case histories, this review draws attention to the practical difficulties in diagnosis and management of this important group of patients.

[Sex steroids and monoamines in the system of neuroendocrine regulation of amygdala functions]

The aim of this review is a review of literature data, which characterize participation of monoamines brain systems and sex steroids in regulation (modulation) of the amygdalas' functions. Shown were characteristic noradrenergic, dopaminergic and serotoninergic systems and their representation in amygdala. Effect ofnoradrenaline, dopamine and serotonine on neurons of Amygdala was shown realized from appropriate cell receptors under modulated influence of sex steroids. Combined participation of monoamines and sex steroids occur in regulation of activity in cyclic centre of secretion and releasing of gonadotropins, constituted a base of forming adaptive (sexual, food and aggressive-defensive) behaviour, including stress reaction. The presented data could be used for understanding influence of gender factor on personality characteristics of humans, cognitive abilities and behavioural reactions, and also in application to development of optimal medicinal treatment of psychoneurological diseases.

[Psychogenic non-epileptic seizures in an epilepsy surgery unit]

INTRODUCTION

The psychogenic non-epileptic seizures (PNES) represent a significant percentage of patients in different units of epilepsy surgery. AIMS. To analyze the characteristics of patients with PNES and compared with epileptic patients, to analyze the early response to the application of placebo and to discuss the multidisciplinary approach to these patients.

PATIENTS AND METHODS

408 patients, candidates for epilepsy surgery in the last nine years, were retrospectively evaluated. All patients were studied with scalp electroencephalography, magnetic resonance imaging, interictal single photon emission computed tomography and video-EEG.

RESULTS

Patients were ascribed to the following diagnostic groups: epileptics (90.2%), patients with PNES and/or without seizures or signs of epilepsy (6.4%) and patients for whom no seizures were recorded, but showed signs of epilepsy (3.4%). There were no differences between patients with PNES and epileptic respect to age, average frequency, distribution of seizures or drug treatment, but the time of onset was earlier in PNES. Patients with PNES (n = 15) revealed the presence of epilepsy or irritative manifestations in 10 cases. Most (n = 13) were women and only five had a history of mild psychiatric disorders that were not present in the group of patients exclusively with PNES. In four cases was carried out an induction with placebo, which was positive.

CONCLUSION

A multidisciplinary approach is required for the proper evaluation and treatment of patients with PNES.

A systematic review of neurobiological and clinical features of mindfulness meditations

BACKGROUND

Mindfulness meditation (MM) practices constitute an important group of meditative practices that have received growing attention. The aim of the present paper was to systematically review current evidence on the neurobiological changes and clinical benefits related to MM practice in psychiatric disorders, in physical illnesses and in healthy subjects.

METHOD

A literature search was undertaken using Medline, ISI Web of Knowledge, the Cochrane collaboration database and references of retrieved articles. Controlled and cross-sectional studies with controls published in English up to November 2008 were included.

RESULTS

Electroencephalographic (EEG) studies have revealed a significant increase in alpha and theta activity during meditation. Neuroimaging studies showed that MM practice activates the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC) and that long-term meditation practice is associated with an enhancement of cerebral areas related to attention. From a clinical viewpoint, Mindfulness-Based Stress Reduction (MBSR) has shown efficacy for many psychiatric and physical conditions and also for healthy subjects, Mindfulness-Based Cognitive Therapy (MBCT) is mainly efficacious in reducing relapses of depression in patients with three or more episodes, Zen meditation significantly reduces blood pressure and Vipassana meditation shows efficacy in reducing alcohol and substance abuse in prisoners. However, given the low-quality designs of current studies it is difficult to establish whether clinical outcomes are due to specific or non-specific effects of MM.

DISCUSSION

Despite encouraging findings, several limitations affect current studies. Suggestions are given for future research based on better designed methodology and for future directions of investigation.

[Psychosomatic aspects of cardiac arrhythmias]

Emotional stress facilitates the occurrence of cardiac arrhythmias including sudden cardiac death. The prevalence of anxiety and depression is increased in cardiac patients as compared to the normal population. The risk of cardiovascular mortality is enhanced in patients suffering from depression. Comorbid anxiety disorders worsen the course of cardiac arrhythmias. Disturbance of neurocardiac regulation with predominance of the sympathetic tone is hypothesized to be causative for this. The emotional reaction to cardiac arrhythmias is differing to a large extent between individuals. Emotional stress may result from coping with treatment of cardiac arrhythmias. Emotional stress and cardiac arrhythmias may influence each other in the sense of a vicious circle. Somatoform cardiac arrhythmias are predominantly of psychogenic origin. Instrumental measures and frequent contacts between physicians and patients may facilitate disease chronification. The present review is dealing with the multifaceted relationships between cardiac arrhythmias and emotional stress. The underlying mechanisms and corresponding treatment modalities are discussed.

Post-ictal alpha activity in supplementary motor seizures mimics nonepileptic seizures

Supplementary motor area seizures may present with bilateral tonic-clonic movements with no loss of consciousness and no postictal confusion, and patients may be erroneously thought to have psychogenic nonepileptic seizures. We describe the rapid emergence of alpha activity in the immediate postictal period in patients with supplementary motor area seizures as an additional confounding factor that may lead to the erroneous diagnosis of nonepileptic seizures in these patients. We present two cases of patients with intractable supplementary motor area seizures investigated with video/EEG monitoring. Their postictal EEG records revealed an immediate postictal recovery of alpha activity, mimicking the pattern seen with psychogenic nonepileptic seizures. Prolonged video/EEG monitoring is mandatory in establishing the diagnosis of supplementary motor area seizures and in distinguishing this condition from nonepileptic seizures.

Comorbidity, multimorbidity and personalized psychosomatic medicine: epigenetics rolling on the horizon

This review focuses first on conceptual chaos and different connotations in psychosomatic medicine, then on new perspectives on comorbidity and multimorbidity, especially from epigenetics perspective. Comorbidity is one of the greatest research and clinical challenges to contemporary psychiatry and psychosomatic medicine. Recently altered gene expression due to epigenetic regulation has been implicated in the development of multifarious mental disorders and somatic diseases. The potential relevance of epigenetics for better understanding and more successful treatment of comorbidity and multimorbidity is described.

Psychophysiological indicators of acute stress disorder

AIM

The aim of the current study was to compare basal psychophysiology and startle reflexes in acute stress disorder (ASD) patients and controls. Stress reactions to traumatic event include acute and chronic reactions like ASD and posttraumatic stress disorder (PTSD). They are characterized by prominent psychophysiological symptoms that can give insight into the pathogenesis of PTSD.

METHODS

We measured heart-rate (HR), respiratory sinus arrhythmia (RSA), electrodermal activity (EDA) and electromyography (EMG) of musculus orbicularis occuli during an acclimation period and during the presentation of startle stimuli in 29 ASD patients with different traumatic experiences and in 33 healthy controls.

RESULTS

ASD subjects had similar habituation to the startle probe as healthy controls. EDA for individuals with ASD after traffic accident was higher then for healthy controls. There were no differences for heart-rate in two compared groups.

CONCLUSION

EDA appears to offer the most reliable psychophysiological indices in the ASD following traffic accident.

[Hyperkinetic symptoms in children and adolescents with psychosomatic disorders]

Authors studied 151 patients with psychosomatic diseases with attention deficit of different severity and hyperkinetic disorders. Based on the results obtained in the study, it was suggested an affective- disontogenetic conception of hyperkinetic disorders in children and adolescents. A significant role of both biological and psychosocial factors as well as gender and age differences in the development and formation of activity and attention disorders is emphasized. The frequency of these factors was correlated with clinical specifics of hyperkinetic disorders. The correlation between specifics of hyperkinetic disorders and affective disorders (subdepression) was confirmed by the high effectiveness of differential psychopharmacotherapy with antidepressants.