Search

Transient loss of consciousness (TLOC) is a frequent cause of referral to an emergency room. In view of the impact on treatment and the patients’ daily life activities (e. g. profession, driving license), an accurate and timely diagnosis is of uttermost importance. This article provides key features and suggests a practical step-by-step approach of how to differentiate syncope, epileptic and psychogenic non-epileptic seizures as the commonest causes of nontraumatic TLOC.

Background The electroencephalogram (EEG) is a common diagnostic tool used to investigate patients for various indications including seizure disorders. In our study we investigate factors that predict the presence of epileptiform abnormalities on EEG and review the common indications for ordering an EEG. Methods We retrospectively reviewed all routine adult EEGs performed in a hospital over a six-month period. Data collated included patient demographics, clinical indication for EEG, setting in which EEG was performed, activation procedures utilised, history of epilepsy, and whether the patient was on antiepileptic medication. Our primary objective was to evaluate the factors that were predictive of an EEG with epileptiform abnormalities. Results 239 routine EEGs were included with indications including first seizure (25.9%), known epilepsy (25.1%), cognitive change (15.9%), syncope (15.0%), movement disorder (6.7%), psychogenic non-epileptic events (5.4%), unresponsiveness/ICU (4.6%), and psychiatric presentation (1.3%). Most EEGs were normal (48.1%). 8.9% of EEGs demonstrated epileptiform abnormalities. Using multivariate logistic regression, three variables proved significant in predicting an EEG with epileptiform abnormalities. Any seizure as an indication (first seizure or seizure in known epileptic), increasing patient age, and EEGs conducted in an inpatient setting and within 48 hours of seizure event were all statistically more likely to yield epileptiform abnormalities on EEG. Conclusions Our findings suggest that careful selection of patients based on appropriate indications for EEG referral would likely improve the yield of an EEG. Depending on the indication, a normal EEG result can be of similar usefulness to an abnormal EEG demonstrating epileptiform abnormalities. This article is protected by copyright. All rights reserved.

Functional dystonia represents a condition where psychological distress is being expressed as involuntary muscle contractions. In the foot and ankle, it most commonly presents as a sudden onset of a painful fixed ankle/hindfoot deformity in a female patient with a history of trivial trauma or surgery. The “fixed deformity” found on clinical examination is usually correctable under general anesthesia. Less commonly, it can present in the toes or may present as paroxysmal muscle movements rather than a fixed deformity. CRPS may occur concurrently with the dystonia. Failure to consider the diagnosis leads to a long delay in appropriate diagnosis, patient distress and unnecessary or even harmful surgery. A better approach to this clinical syndrome is to define it as fixed abnormal posturing that is most commonly psychogenic. Early referral to a movement disorder clinic is recommended. The prognosis is generally poor as less than a quarter of patients report subjective long-term improvement even when managed in a movement disorder clinic. Foot and ankle surgeons should, whenever possible, avoid operating on patients with functional dystonia in order to avoid symptomatic deterioration.

We previously established the head-tilt subjective visual vertical (HT-SVV) test to evaluate head-tilt perception gain (HTPG) in addition to the original head-upright SVV (HU-SVV) test (Wada-Y et al.: Laryngoscope Investig Otolaryngol, 2020). In this study, we aimed to investigate the HU-SVV and HT-SVV abnormality rates among patients with vertigo/dizziness.Between July 2014 and December 2020, 357 patients were hospitalized for examining the HU-SVV and HT-SVV at our vertigo/dizziness center. Among these patients, 120 had Meniere's disease (MD), 99 had unilateral vestibular disease (UVD), 76 had benign paroxysmal positional vertigo (BPPV), 14 had vestibular migraine (VM), 13 had orthostatic dysfunction (OD), 12 had bilateral vestibular disease (BVD), 12 had central dizziness (CD), 7 had vestibular schwannoma (VS), and 4 had psychogenic dizziness (PD). We determined the reference values of the absolute HU-SVV (2.5°) and HTPG (0.80-1.25) for the sitting position and used these for calculating the HU-SVV and HT-SVV abnormality rates in each type of vertigo/dizziness.Among the 357 patients, 111 had abnormal HU-SVV results (31.1%), 132 had abnormal HT-SVV results (37.0%), and 185 had abnormal HU-SVV and/or HT-SVV results (51.8%). The modified HT-SVV test in combination with the original HU-SVV test could detect gravity perception disturbance in patients with vertigo/dizziness significantly better than the original test alone (chi-square: p=0.00019). The HU-SVV, HT-SVV, and HU-SVV and/or HT-SVV abnormality rates were significantly higher in patients with peripheral vestibular diseases, i.e., MD, UVD, BPPV, and BVD than in those with other types of vertigo/dizziness, i.e., VM, OD, CD, VS, and PD (chi-square: p=0.010, p=0.020, and p=0.0025, respectively).These findings suggest that the combined HT-SVV and HU-SVV test could be a powerful neuro-otologic examination for detecting pathologies in the vestibular otolithic pathway.

Незадовільні результати лікування у пацієнтів старше 60 років з переломами дистального метаепіфіза променевої кістки зустрічаються в 44 % випадків (не вдається отримати задовільного зіставлення відламків після первинної репозиції або настає вторинне зміщення). Переважна більшість пацієнтів лікується консервативно за рядом об’єктивних причин. Великий відсоток поганих результатів обумовлює пошук оптимальної методики ведення таких пацієнтів. Мета: оптимізувати тактику надання амбулаторно-поліклінічної допомоги постраждалим із переломами дистального метаепіфіза променевої кістки шляхом мультимодального знеболення, малотравматичної репозиції за допомогою запропонованого пристрою і фіксації фрагментів адекватними засобами іммобілізації з використанням нових технологій, що дозволить поліпшити результати лікування. Матеріали та методи. При надходженні пацієнтам із переломом дистального метаепіфіза променевої кістки проводили щадну репозицію з застосуванням запропонованого пристрою пластирного витягнення, фіксації сучасними пластиковими фіксуючими пов’язками скотчкаст. У всіх 12 пацієнтів визначали компоненти болю. Проведення профілактичних заходів (психогенна підготовка постраждалих, мультимодальне знеболювання, медикаментозна профілактика та лікування, раннє фізіолікування і лікувальна фізкультура) призвело до зниження вираженості больового синдрому. Вже до 4-ї доби після травми постраждалі відзначали зниження інтенсивності болю з 7,42 ± 0,31 бала до 2,40 ± 0,12 бала на 7-му і 14-ту добу за даними візуально-аналогової шкали (задовільна переносимість болю — 2,1 ± 0,1 бала і 2,2 ± 0,3 бала, що є свідченням доброї переносимості болю). Такі ж показники збереглися і до кінця іммобілізаційного періоду. Результати лікування оцінювали через 90 днів після травми. Після відновного лікування 11 пацієнтів оцінювали біль як незначну і терпиму. У 1 постраждалого мала місце хронізація больового синдрому (5,2 ± 0,6 бала). Були контрактури пальців і променезап’ясткового суглоба. Зберігався нейропатичний виражений больовий синдром. У 2 пацієнтів мали місце виражені нейротрофічні та функціональні порушення, які в подальшому потребували тривалого консервативного лікування. При опитуванні хворих за шкалою DASH функцію пошкодженої руки визначили як задовільну (33,2 ± 0,4 бала). Отримані нами результати свідчать про ефективність запропонованого підходу до лікування пацієнтів із переломами дистального метаепіфіза променевої кістки.

In the article results of own researches concerning peculiarities of the course of asthenic syndrome in school-aged children with chronic hepatitis B, C and mixed forms are provided. It is established that chronic hepatitis C as well as a mixed hepatitis are accompanied by more evident symptoms of deadaptation and somatogenic asthenia than hepatitis B in which psychogenic manifestations prevailed. The degree of endogenous intoxication was also higher at hepatitis C.

Itch, or pruritus, is the uncomfortable sensation underlying the desire to scratch. Itch is a very common complaint in the general population that can result from dermatologic, systemic (eg, renal, hepatobiliary, endocrine), paraneoplastic, neuropathic, and psychogenic etiologies. Chronic itch is associated with significant sleep disturbances and profoundly reduces overall quality of life. Certain populations, including elderly and African Americans, are at increased risk of experiencing heightened burden of itch. Because of the variable clinical presentation and wide-ranging etiologies, itch presents a challenge for clinicians. The initial evaluation should include a complete blood count, with differential, hepatic, renal, and thyroid function testing along with diabetes screening. Further testing should be guided by history and physical examination findings. There should be a heightened concern for underlying malignancy in individuals older than 60 years of age who have a history of liver disease and diffuse itch less than 12 months of duration. For individuals with chronic pruritus of unknown origin, increased blood eosinophils may serve as a biomarker of T helper cell type 2 polarization and response to immunomodulator therapies. In this first part of a 2-part continuing medical education series, we describe the broader epidemiology and specific conditions associated with itch and the clinical presentation and diagnostic workup for patients with itch.

Vision loss with clinical findings that are incompatible with the symptoms and recognized neurological or ophthalmic conditions is a common presentation of patients to neurologists, ophthalmologists, and neuro-ophthalmologists. The accepted terminology to describe such patients has evolved over time, including functional visual disorder (FVD), non-organic vision loss, non-physiologic vision loss, functional vision loss, psychogenic, psychosomatic, and medically unexplained visual loss. Likewise, attitudes and recommended management options have changed over the years in the fields of psychiatry and neurology. FVD is a diagnosis of inclusion, and it is critical that the diagnosis be made and delivered efficiently and effectively to reduce patient and physician duress. We review the current Diagnostic and Statistical Manual (DSM V) terminology and the prior literature on FVD and describe how the approaches to diagnosis and management have changed. We provide recommendations on the appropriate techniques and diagnostic approach for patients with FVD. We also propose a protocol for consistent and standardized discussion with the patient of the diagnosis of FVD. We believe that the adoption of FVD as both a paradigm and nomenclature shift in ophthalmology will improve patient care.

AIM Psychogenic nonepileptic seizures (PNES) or functional seizures are universal phenomena. However, data on their epidemiology is limited. The aim of the current study was to review the literature on the epidemiology of PNES and to provide analytical estimates of its incidence and prevalence based on the direct data that are available from previous studies on PNES. METHODS The methods of this work had two parts: (1) MEDLINE, PsycINFO, and Scopus from inception to 19 October 2019 were systematically searched. (2) The analytical study of the incidence and prevalence of PNES was performed, based on the following data from previous studies: incidence of PNES, duration of PNES before making a diagnosis, outcome and mortality of PNES. RESULTS The search strategy yielded five articles; three were on the incidence and two on the prevalence. In the analytical part of the study, the incidence of PNES was calculated to be 3.1 (95% Confidence Interval: 1.1-5.1) per 100,000 population per year. The calculated prevalence rate of PNES in 2019 was 108.5 (95% Confidence Interval: 39.2-177.8) per 100,000 population, in the USA. CONCLUSION While, the generalizability of these calculated incidence and prevalence rates to other places in the world is limited, they give us a reasonable hint that PNES is a common condition and the prevalence is much more than that it was thought before.Supplemental data for this article is available online at https://doi.org/10.1080/00207454.2021.1942870.

When swallowing, a clicking in the throat may uncommonly occur, causing great discomfort and pain. This unpleasant event may lead health professionals to attribute the symptoms to psychogenic aetiology. The case of a 49-year-old female is presented, who reported an audible bilateral clicking in the throat, associated with neck and throat pain when swallowing or turning her neck. From the ENT examination and palpation of the neck during patient swallowing, we located the source of the clicking on the left. However, during palpation from side to side, the patient suffered bilateral pain. Laryngeal computed tomography with a 3D reconstruction showed a short distance between the hyoid bone and the superior part of the thyroid cornua, accompanied by posterior-medially displaced bilateral superior cornua in the thyrohyoid region. The bilateral sensation of throat pain during swallowing or palpation, in combination with our desire to maintain laryngeal symmetry, led us to a two-sided exeresis of the superior thyroid cornua. This resulted in immediate and complete relief of the symptoms. Although it is an uncommon complaint, clicking larynx syndrome should be considered as a differential diagnosis.

BACKGROUND Patients with psychogenic nonepileptic seizures (PNES) can be semiologically dichotomized into those with hyperkinetic and those with paucikinetic events. The objective of this study was to compare characteristics of patients with diverse phenomenology and their caregivers to evaluate for differences that could inform about disease nosology. METHODS Patients and caregivers monitored at the Epilepsy Monitoring Unit completed surveys about sociodemographic and disease characteristics, treatment and health care utilization, physical and psychosocial impact, and epilepsy knowledge. Patients were classified into hyperkinetic versus paucikinetic based on their recorded events. Comparison of the 2 populations was performed using Student t test for continuous variables and Fischer exact test for categorical variables. RESULTS Forty-three patients with Epilepsy Monitoring Unit confirmed PNES and 28 caregivers were enrolled. Patients with hyperkinetic events were more commonly non-White patients and necessitated greater caregiving time. Otherwise, no statistically significant differences were seen between the 2 semiologically diverse groups of patients and caregivers in their sociodemographic (age, sex, employment, income, marital, and education) and disease (age of onset, duration, seizures frequency) characteristics, treatment (number of antiseizure medications before diagnosis, side effects) and health care utilization (emergency room visits, hospitalizations, clinic visits), physical (injuries) and psychosocial (depression, anxiety, quality of life, stigma, burden) characteristics, nor in their knowledge about seizures. CONCLUSIONS Hyperkinetic events were more frequently encountered in non-White patients and required more caregiving time. Further research is required to elucidate if phenomenological dichotomy of PNES can inform about their nosological basis, and if it can guide treatment and define prognosis.

This work aimed to identify specific features of mental disorders associated with COVID-19. A comparative clinical psychopathological and psychodiagnostic study of 25 patients hospitalized at Shmeisani Hospital for the severe course of COVID-19 and 18 people without COVID-19 allowed a clearer gradation between psychogenic mental disorders associated with the pandemic situation as a stressor and mental disorders due to coronavirus disease. Statistical processing of the results was performed using online calculator medstatistic.ru. Anxiety about the cost of medical services turned out to be the main stressor and revealed feelings of insecurity and helplessness in front of the COVID-19 threat. [ABSTRACT FROM AUTHOR] Copyright of Social Work in Mental Health is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

В статье освещен инсульт как проблема мирового масштаба, его связь с тремя группами факторов риска (патогенетическими, психогенными и экологическими — загрязнение окружающей среды). В преддверии 35-й годовщины техногенной катастрофы в Чернобыле (26 апреля 1986 года) автор сравнил данные по инсульту в Украине и в Японии после аварии на АЭС «Фукусима-1» (11–12 марта 2011 года), которая привела к расплавлению активной зоны реакторов сразу на трех энергоблоках. Поднимаются вопросы оптимизации оказания специализированной медицинской помощи больным с мозговым инсультом, факторами риска инсульта. Необходимо минимизировать последствия, оптимизировать лечение, профилактику факторов риска, особенно в тех районах, где население подвергается опасности инкорпорированного радиационного поражения организма через пищевые продукты и воду. Также необходимо улучшение специализированной инсультной помощи, создание инсультных центров в областях Украины. Проведенные исследования свидетельствуют, что причин для возникновения мозговых инсультов много, и на сегодняшний день они недостаточно изучены. Особенностями клинического течения мозговых инсультов у участников ликвидации последствий аварии (УЛПА) на ЧАЭС являются развитие их в среднем в 40–49 лет и пожилом возрасте, длительный сосудистый анамнез, что характеризуется трансформацией в дебюте вегетососудистой дистонии в дисциркуляторную (пострадиационную) энцефалопатию, преобладание ишемического характера мозгового инсульта над геморрагическим, поражение преимущественно каротидного бассейна, относительная доброкачественность клинического течения, прогрессирующий характер психических расстройств, сопутствующая соматическая коморбидная патология, наличие устойчивого патоморфологического субстрата со стороны как сосудистой эндотелиальной дисфункции, так и мозговой ликворной системы. Полученная информация дополняет данные о патогенезе, клинике и диагностике мозгового инсульта у УЛПА и представляет практический интерес. Поднятые вопросы оптимизации оказания специализированной помощи в инсультных отделениях, центрах, достаточной их комплектации как кадрами, так и аппаратурой, а также вопросы последующей реабилитации становятся краеугольным камнем в преодолении эпидемии инсульта. Исходя из сказанного, сохраняется необходимость продолжения фундаментальных исследований в этой области и скорейшей разработки, внедрения научной концепции по профилактике, раннему выявлению основных модифицируемых факторов риска инсульта совместно с семейными терапевтами, специалистами узкого профиля. Надлежащее лечение инсульта, безусловно, улучшит качество жизни пациентов и их родственников.

Psychogenic nonepileptic seizures resemble epileptic seizures but lack the physiological basis of epileptic seizures. We conducted a systematic review to explore whether childhood abuse is a risk factor for subsequent development of PNES. We reviewed only papers with an epilepsy control group, which employed strict criteria for diagnosis of epilepsy and well-validated tools for assessing abuse history. Odds ratios (ORs) for the different categories of childhood abuse and for childhood abuse as a whole were calculated where not previously available, and pooled ORs were calculated where suitable. In papers where OR could not be calculated data are presented as p values. Most Odds Ratios fell between 1.8 and 5.2 with relatively narrow confidence intervals. In 14 out of 18 calculations, 95% confidence intervals did not cross 1. This suggests that the chance of reporting abuse is higher in people with PNES than those with epilepsy and may be a causative factor in developing PNES. Several limitations of the data and directions for future study are discussed.

With a growing number of forcibly displaced people (FDP) globally, the focus on their medical needs has necessarily increased. Studies about the prevalence and incidence of epilepsy and psychogenic non-epileptic seizures (PNES) in this population are, though, sparse. This Review highlights the importance of exploring and managing both conditions in these vulnerable people to promote global health. We performed an exhaustive review of 10 databases, as well as a manual search of relevant websites related to global health and refugee-related organizations. We analyzed data related to the prevalence and incidence of epilepsy and PNES; health visits; costs of medical care and challenges faced by healthcare workers in relation to FDP with these conditions. Fifty six papers met our inclusion criteria. Of these, 53 reported directly or indirectly on the prevalence of epilepsy and its costs in FDP. Two articles reported on the prevalence of PNES in forcibly displaced people. The reported prevalence of epilepsy in FDP varied from 0.2% to 39.13%, being highest in people with pre-existing neurological or psychiatric comorbidities. Only one study reported on the incidence of epilepsy in internally displaced children. Data from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) have identified a tendency to higher incidence of epilepsy in children following wars. While within displaced women without a history of sexual violence the rate of PNES was 16.7%, in FDP women with such a history the rate of PNES was 43.7% (p=0.02). The healthcare costs for epilepsy can be high, with recurrent health visits related to seizures being the most common cause of health encounters in refugee camps. Increasing awareness and further studies of multicultural aspects to improve shared understanding of seizure phenomenon in vulnerable displaced populations would seem crucial.

Background: It has been reported that 10 to 30% of patients sent to epilepsy centers with a diagnosis of refractory epilepsy are diagnosed with psychogenic non-epileptic seizure (PNES). A wide variety of provocative methods are used to assist PNES diagnosis. Objective: To investigate the effect of seizure induction on the diagnosis and prognosis of PNES. Methods: We retrospectively examined 91 patients with PNES complaints in our video-EEG laboratory. Intravenous saline was administered to all patients for induction of seizures. Results: Saline injection was performed in 91 patients referred to our EEG lab with PNES initial diagnosis, 57 of whom were female and 34 male. Saline injection triggered an attack in 82 patients (90%). Conclusions: In this study we have concluded that provocative methods are practical, cheap and, most of all, effective for patient diagnosis. In clinical practice, explaining the diagnosis is the first and most important step of the treatment, and careful patient-doctor communication has a positive impact on patient prognosis. RESUMO Antecedentes: Há relatos de que 10 a 30% dos pacientes com epilepsia refratária enviados a centros de epilepsia são diagnosticados com crise não epiléptica psicogênica (CNEP). Uma ampla variedade de métodos provocativos é usada para auxiliar no diagnóstico de CNEP. Objetivo: Investigar o efeito da indução de convulsões no diagnóstico e no prognóstico de CNEP. Métodos: Examinamos 91 pacientes com queixas de CNEP em nosso laboratório de vídeo-EEG. Foi administrada solução salina intravenosa a todos os pacientes para indução de convulsões. Resultados: A injeção de solução salina foi realizada em 91 pacientes com diagnóstico inicial de CNEP encaminhados ao nosso laboratório de EEG, 57 dos quais eram mulheres e 34 homens. A injeção de solução salina desencadeou um ataque em 82 pacientes (90%). Conclusões: Neste estudo, concluímos que os métodos provocativos são práticos, baratos e, acima de tudo, eficazes para o diagnóstico de pacientes. Na prática clínica, a explicação do diagnóstico é a primeira e mais importante etapa do tratamento, e a comunicação cuidadosa entre médicos e pacientes tem um impacto positivo em seu prognóstico.

Psychiatric disorders are frequently found in both patients with PNES and DRE, making the differential diagnosis even more complex. The aim of this study was to analyze and compare psychiatric aspects and the quality of life in patients with psychogenic non-epileptic seizures (PNES) and drug resistant epilepsy (DRE).Patients admitted to video-electroencephalograpy (VEEG) unit with confirmed PNES and DRE were included. Demographical characteristics, psychiatric diagnosis according to SCID I and II of DSM IV, pharmacological treatment, general functioning measured with GAF (Global assessment of functionality), quality of life (QoL) using QlesQSF (Quality of Life Enjoyment and Satisfaction Questionnaire Short Form) and depression severity using BDI II (Beck depression inventory), were compared between the groups. Non-parametric tests, chi square test, and logistic regression were used for statistical analysis.148 patients consecutively admitted to VEEG were included (DRE n = 97; PNES n = 51). Somatization disorder (RR: 13.02, 95% CI: 1.23-137.39, p = 0.03) and a history of trauma (RR: 8.66, 95% CI: 3.21-23.31, p = 0.001) were associated with PNES. The QlesQ score and the GAF score were lower with a higher prevalence of suicide attempts in the PNES group (p 0.01). A negative correlation was observed between the severity of depression and the quality of life (DRE r = - 0.28, p = 0.013; PNES r = - 0.59, p = 0.001).Higher psychiatric comorbidity with poorer QoL were found in PNES patients compared to DRE. However, depression comorbidity negatively affected the QoL in both groups. Future studies based on illness perception will be orientated to complete this analysis.

To evaluate the diagnostic yield of the first 8 hours of video-EEG (vEEG) monitoring in detecting Psychogenic Non-Epileptic Seizures (PNES) during the Epilepsy Monitoring Unit (EMU) admission. We performed a retrospective chart review of patients ages ≥4 years who were admitted to the EMU between 2011 and 2018 (n = 616). We calculated the proportion of patients diagnosed with PNES within the first 8 hours of EEG recording and studied the associated risk factors for patients diagnosed with PNES and patients with epileptic seizures (ES). Out of the total 616 patients, 24% (149) patients had an EMU diagnosis of PNES. Of these, 44.3% had at least one typical event within the first 8 hours of vEEG monitoring. A higher incidence was seen within the pediatric subgroup (54.8% had an event within 8 hours). A diagnosis of chronic pain disorder was more common with PNES compared to ES (48.3% versus 16.5%, p < 0.001). A suspicion for PNES documented during an office visit was noted in a high proportion of patients (68.5%) who eventually had a PNES event during EMU. Our study suggests that in a well-selected group of patients (such as a high suspicion of PNES during a physician/neurology office visit), an outpatient 8-hour vEEG could open new avenues for a prompt diagnosis. This could especially be beneficial in hospital settings where there is either a lack of an EMU or a delay in admission to the EMU.

Non-organic vision loss can manifest in various ways, most commonly in the form of reduced vision and visual field defects. Colour vision disorders in the context of a conversion disorder have only rarely been reported.This review presents the case of a 9-year-old boy with a colour vision disorder as the isolated symptom of a conversion disorder. The challenging in this case was an additional somatic comorbidity - a congenital red-green deficiency. Consequently it was difficult to make a diagnosis and to convince the parents.It is important to rule out organic causes and establish the diagnosis of a conversion disorder. In these cases, multidisciplinary treatment is crucial for a successful outcome. The diagnosis may be especially challenging when the patients have both somatic and psychogenic complaints.Nichtorganische Sehstörungen können sich verschiedenartig manifestieren. Die häufigsten Symptome sind Visusminderungen und Gesichtsfelddefekte. Farbsinnstörungen im Rahmen einer Konversionsstörung sind selten.Dieser Artikel behandelt den Fall eines 9-jährigen Jungen mit einer Farbsinnstörung als alleiniges Symptom einer Konversionsstörung. Die diagnostische Herausforderung in diesem Fall war eine zusätzlich vorliegende somatische Komorbidität – eine kongenitale Rot-Grün-Schwäche, die eine Diagnosestellung und deren Akzeptanz erschwerte.Zunächst sollten umfassende zielorientierte Tests zum Ausschluss einer organischen Ursache erfolgen. Bei Vorliegen einer Konversionsstörung ist eine interdisziplinäre Zusammenarbeit von Ophthalmologen und Psychiatern/Psychologen wichtig. Gerade das zeitgleiche Vorliegen von somatischen und psychogenen Beschwerden kann diagnostisch herausfordernd sein.

Psychogenic non-epileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with abnormal electrical activity in the brain. PNES are a heterogeneous entity and while there is increasing interest in the characterisation of PNES sub-groups, little is known about individuals with PNES who have an intellectual disability (ID). ID is a lifelong condition characterised by significant limitations in cognitive, social and practical skills. ID (commonly with comorbid epilepsy) has been identified as a risk factor for developing PNES. However, people with ID are often excluded from research in PNES. This has unfortunately resulted in a lack of evidence to help inform practice and policy for this population. This narrative review synthesises the currently available evidence in terms of the epidemiology, demographic and clinical profile of adults with PNES and ID. There is a particular focus on demographics, aetiological factors, PNES characteristics, diagnosis and treatment of the condition in this population. Throughout this article, we critique the existing evidence, discuss implications for clinical practice and highlight the need for further research and enquiry. What emerges from the evidence is that, even within the sub-group of those with ID, PNES are a heterogeneous condition. Individuals with ID and PNES are likely to present with diverse and complex needs requiring multidisciplinary care. This review is aimed at the broad range of healthcare professionals who may encounter this group. We hope that it will stimulate further discussion and research initiatives.

Manifestation of abnormal excessive synchronous cortical activity, which is what defines epileptic seizures, is typically absent in seizures with psychological etiology, a heterogeneous set of factors that have been identified. Distinguishing psychogenic nonepileptic seizures (PNES) from epileptic seizures may be difficult at the bedside. We report a case series of PNES which presented with diagnostic dilemma. Diagnostic delay of years with PNES is common. The exact choice of treatment is often difficult and should be based on individual differences in the underlying factors. Outcome can be measured in terms of seizure occurrence (frequency, severity), but other measures might be of greater importance for the patient. Prognosis is varied but studies consistently report that 1/3rd to 1/4th of these cases become chronic.

Objective Psychogenic nonepileptic seizures (PNES) are associated with high alexithymia, social cognition problems and low quality of life (QoL). Theory of Mind (ToM) has been studied in several conditions as a significant predictor of QoL. We aimed to assess the relationship between ToM abilities, alexithymia and subjective QoL in PNES patients and compare with generalised epilepsy (ES) patients and healthy controls. Method Patients with PNES (n = 28), ES (n = 28) and healthy volunteers (n = 28) were evaluated for alexithymia and quality of life (QoL) with Toronto Alexithymia Scale-20 (TAS-20) and Short Form-36 (SF-36). Reading the Mind in the Eyes test was used for assessment of affective ToM and Hinting Task and Strange Stories tests for cognitive ToM abilities. Results Analyses revealed lower SF-36 scores and poorer ToM performance in the PNES group compared to healthy group and poorer cognitive ToM performance than ES group. Cognitive ToM performance was inversely correlated with TAS-20 “difficulty identifying feelings” subscale and “physical functioning” subscale of SF-36 in the PNES group. Conclusion These results are consistent with previous research on PNES and other somatoform disorders and suggest that PNES is associated with impaired ToM task performance. ToM task performance might be related to specific aspects of alexithymia and QoL.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria for conversion disorder have replaced the criterion of evidence of a "psychogenic" etiology with a criterion that patients must be "positively" diagnosed on the basis of their neurological assessment. We retrospectively studied referrals to a specialist functional neurology clinic to see how commonly the new criteria were met since DSM-5's introduction. Positive signs were reported in a quarter of referrals (26.5%), which was associated with diagnosticians' confidence (p = 0.001) and with the clinic confirming the diagnosis (p = 0.01). Our clinic found positive signs in 28.6% of the referrals. In 13 (13.3%) patients, the new criterion was not met. In conclusion, positive signs are diagnostically helpful but are only reported in a minority of assessments. A significant group of those currently believed to have conversion disorder would not meet the revised diagnostic criteria based on this.

Біль у животі — частий привід для звернення пацієнтів різного віку до лікаря, одна з найбільш частих скарг, що пред’являються дітьми та їх батьками. Больовий абдомінальний синдром у дітей — це сукупність симптомів, що супроводжують різні хірургічні та нехірургічні захворювання, одним із проявів яких є біль у животі. Розрізняють гострий і хронічний (рецидивуючий) біль. Гострий біль у животі може бути проявом хірургічної патології, травми або гострого інфекційного захворювання. Біль у животі в більшості випадків обумовлений хронічними захворюваннями органів травлення або функціональними розладами. Педіатри, лікарі загальної практики та гастроентерологи частіше зустрічаються з рецидивуючим болем у животі (довготривалий переривчастий або постійний біль). Рецидивуючий біль у животі у дітей визначається як три епізоди болю, що відбуваються протягом трьох місяців і впливають на нормальну активність дитини. Погоджувальний документ Американської педіатричної асоціації та Північноамериканської асоціації дитячої гастроентерології, гепатології та харчування в 2005 році запропонував використовувати замість терміну «рецидивуючий біль у животі» термін «хронічний абдомінальний біль». Хронічний абдомінальний біль найчастіше (90–95 % випадків) вважається функціональним (неорганічним) болем у животі без об’єктивних ознак основного органічного розладу і характеризується різноманіттям проявів. За механізмом виникнення виокремлюють вісцеральний, парієтальний (соматичний), іррадиюючий та психогенний біль. При болі в животі необхідно оцінити: час появи, інтенсивність, характер, тривалість, локалізацію. На першому етапі діагностики необхідно виключити гостру хірургічну патологію. Про високу ймовірність хірургічної патології свідчать «симптоми тривоги». На наступному етапі проводиться диференційна діагностика органічних та функціональних причин абдомінального болю. При всіх видах функціонального болю відзначають порушення вісцеральної моторики і розвиток спазмів. Скорочувальна активність гладких м’язів ініціюється парасимпатичною нервовою системою. Лікування рецидивуючого болю в животі направлено на усунення його причин: зняття спазму, нормалізацію моторики шлунково-кишкового тракту. На даний час серед різних груп спазмолітиків при лікуванні функціональних розладів травного тракту віддають перевагу селективним міотропним спазмолітикам. Серед них мебеверин є оптимальним за ефективністю та безпекою. Мебеверин блокує швидкі натрієві канали, розташовані на клітинній мембрані міоцитів, перешкоджаючи надходженню іонів натрію в клітину. Цей механізм призводить до послаблення скорочувальної функції гладком’язового волокна і сприяє усуненню спазму, але не викликає гіпотонії. На відміну від антихолінергічних препаратів мебеверин справляє селективну дію на гладкі м’язи травного тракту. У клінічній практиці заслуговує на увагу мебеверину гідрохлорид — Спарк® (ПАТ «Фармак»), при прийомі якого відзначається збереження нормального тонусу і перистальтики після купірування м’язового спазму. Препарат Спарк® випускається в капсулах, одна капсула містить 200 мг мебеверину гідрохлориду. Згідно з інструкцією мебеверин (Спарк®) призначається дорослим і дітям від 10 років по 1 капсулі два рази на добу. Препарат не має системної дії. Застосування мебеверину (Спарк®) патогенетично обґрунтовано для лікування захворювань, що перебігають з абдомінальним больовим синдромом у дорослих і дітей старше 10 років.

We examined 109 children with autonomic dysfunction syndrome aged 6–16 years, which were divided into 2 groups. The basic group enrolled 87 children with autonomic dysfunction syndrome and impaired motor function of the upper alimentary canal; the comparison group included 22 children with autonomic dysfunction syndrome without the impaired motor function of the upper alimentary tract. The examination scheme developed by us for children observed included the collection of complaints, anamnesis of life and illness, an objective examination using clinical, instrumental, and laboratory research methods. The following information was studied: age, sex, course of pregnancy and childbirth in the mother, diseases in early childhood, the presence of chronic and functional diseases of the digestive system in parents, the presence of autonomic dysfunction in the child’s parents, the nature of nutrition in infancy and school age, the presence of food allergies and the influence of psychogenic factors, duration of complaints, frequency of exacerbations, concomitant pathology. To assess the clinical course of autonomic dysfunction and motor disorders of the upper gastrointestinal tract, the symptoms of diseases were studied taking into account the results of physical examination, general clinical study of blood and urine, a biochemical blood test, a study of feces for helminth eggs, electrocardiography, consultations of specialists (otorhinolaryngologist, neurologist, ophthalmologist), ultrasound examination of the abdominal organs. The state of the mucous membrane of the stomach, duodenum and the presence of motor-evacuation disorders in the form of reflux were assessed according to the data of fibroesophagogastroduodenoscopy, which was carried out using Richard Wolf 2163 (Germany) and Olympus CLE 10 (Japan) fiberscopes, followed by a biopsy according to the generally accepted method., Было обследовано 109 детей с синдромом вегетативной дисфункции в возрасте 6–16 лет, которые были распределены на 2 группы. Основная группа — 87 детей с синдромом вегетативной дисфункции и нарушениями моторной функции верхнего отдела пищеварительного канала и группа сравнения — 22 ребенка с синдромом вегетативной дисфункции без нарушений моторной функции верхнего отдела пищеварительного тракта. По разработанной нами схеме обследования у детей, находившихся под наблюдением, нами был проведен анализ жалоб, анамнеза жизни и болезни, объективное обследование с использованием клинических, инструментальных и лабораторных методов исследования. Была изучена следующая информация: возраст, пол, течение беременности и родов у матери, заболевания в раннем детском возрасте, наличие хронических и функциональных заболеваний органов пищеварения у родителей, наличие у родителей ребенка вегетативной дисфункции, характер питания в грудном и школьном возрасте, наличие пищевой аллергии и влияния психогенных факторов, продолжительность жалоб, частота обострений, сопутствующая патология. Для оценки клинического течения вегетативной дисфункции и моторных нарушений верхнего отдела пищеварительного тракта была изучена симптоматика заболеваний с учетом физикальных данных, результатов общего клинического исследования крови и мочи, биохимического исследования крови, исследование кала на яйца гельминтов, данных электрокардиографии, консультаций врачей-специалистов (лор, невролог, офтальмолог), ультразвукового исследования органов брюшной полости. Состояние слизистой оболочки желудка, двенадцатиперстной кишки и наличие моторно-эвакуаторной нарушений в виде рефлюкса нами оценивались по данным фиброэзофагогастродуоденоскопии, которую проводили с помощью фиброскопов Richard Wolf 2163 (Германия) и Оlympus CLE 10 (Япония) с последующим взятием биопсии по общепринятой методике., Було обстежено 109 дітей із синдромом вегетативної дисфункції віком 6–16 років, які були розподілені на 2 групи. Основна група — 87 дітей із синдромом вегетативної дисфункції і порушеннями моторної функції верхнього відділу травного каналу та група порівняння — 22 дитини із синдромом вегетативної дисфункції без порушень моторної функції верхнього відділу травного каналу. За розробленою нами схемою обстеження у дітей, які перебували під спостереженням, нами було проведено аналіз скарг, анамнезу життя та хвороби, об’єктивне обстеження із застосуванням клінічних, інструментальних і лабораторних методів дослідження. Було вивчено таку інформацію: вік, стать, перебіг вагітності та пологів у матері, захворювання в ранньому дитячому віці, наявність хронічних і функціональних захворювань органів травлення у батьків, наявність у батьків дитини вегетативної дисфункції, характер харчування в грудному та шкільному віці, наявність харчової алергії та впливу психогенних чинників, тривалість скарг, частота загострень, супутня патологія. Для оцінки клінічного перебігу вегетативної дисфункції та моторних порушень верхнього відділу травного каналу було вивчено симптоматику захворювань з урахуванням фізикальних даних, результатів загального клінічного дослідження крові та сечі, біохімічного дослідження крові, дослідження калу на яйця гельмінтів, даних електрокардіографії, консультацій лікарів-спеціалістів (лор, невролог, офтальмолог), ультразвукового дослідження органів черевної порожнини. Стан слизової оболонки шлунка та дванадцятипалої кишки й наявність моторно-евакуаторних порушень у вигляді рефлюксу нами оцінювалася за даними фіброезофагогастродуоденоскопії, яку проводили за допомогою фіброскопів Richard Wolf 2163 (Німеччина) та Оlympus CLE 10 (Японія) з наступним взяттям біопсій за загальноприйнятою методикою.

Nowadays, due to the rapid increase in the number of stress factors, it is especially important to use psychotherapy and psychopharmacotherapy in the combination treatment of patients with diseases of the gastrointestinal tract. Psychogenic overlaying plays a leading role in the clinical picture of the disease and determines the decreased performance in patients. Objective. To evaluate the effectiveness of therapy with psychocorrective agents in patients with gastroesophageal reflux disease (GERD) associated with dysfunction of the biliary system, if they have depressive and anxiety symptoms. Materials and methods. All patients were divided into 2 groups: group I consisted of 27 patients, who received only basic combination treatment, group II — of 25 patients, who in addition to the basic treatment received thioridazine, which is a piperidine derivative of phenothiazine and belongs to the group of neuroleptics. Both groups were representative by the age, duration and course of the disease. All patients demonstrate anxiety and depressive symptoms on the HADS scale. Questionnaire SF‑36 was used to analyze the quality of life. Treatment efficacy was assessed 14 days after. Results. As a result of the treatment, an improvement in overall well-being was observed in both groups against the background of reduction in the pain and dyspeptic syndromes. Additional prescription of psychocorrectives (thioridazine) to the basic therapy results in greater positive changes in the intensity of anxiety and depressive symptoms. The distribution of patients by the level of anxiety and depression after treatment showed that these indicators were absent more often in group II (by 2.6 and 1.5 times, respectively). However, cases of clinically significant anxiety and depression were 4.6 and 3.7 times more often in patients, who did not receive thioridazine. The difference in points between the level of anxiety and depression before and after the treatment was 4 times higher in patients, who additionally received psychocorrection. Also, comparing scores before and after the treatment, we have found significant improvement in the quality of life in group II. Conclusion. The inclusion of thioridazine into the basic therapy in the presence of depressive and anxiety disorders in patients with GERD associated with dysfunction of the biliary system improves the clinical effectiveness of pharmacotherapy of this comorbid pathology.

Objectives Acute movement disorders (AMD) are frequent in neurological and pediatric emergencies. Few studies analyzed AMD in children, none in Tunisia or other African country. The purpose of this study was to describe the peculiarities of AMD in a Tunisian pediatric population with a literature review. Methods We conducted a retrospective descriptive study over 8 years including 80 children (sex ratio, 1.05; mean age of onset, 4.8 years) with AMD, followed in tertiary referral Child Neurology Department in North Tunisia. Results Acute movement disorders were mainly hyperkinetic (n = 67 with dystonia (n = 33; mostly due to inherited metabolic diseases (IMD) in 11; with status epilepticus in 10 children), chorea (n = 14; with Sydenham chorea in 5); myoclonus (n = 14; mostly with opsoclonus-myoclonus syndrome in 10) and tremor (n = 6; of posttraumatic origin in half). Hypokinetic movement disorder (MD) included acute parkinsonism in 5 children of infectious (n = 3), postinfectious (n = 1, malaria) and posttraumatic origin (n = 1). Mixed MD, found in 8 children, were mainly due to IMD in half of them, and to familial lupus in two. Paroxysmal MDs were seen in 2 children, one with multiple sclerosis and one of idiopathic origin. Psychogenic MDs were found in 7 patients mainly of dystonic type. Management of AMD comprised symptomatic treatment according to the phenomenology of the MD and causative treatment depending on its etiology. Conclusions Our study illustrated the broad range of AMD in children and the wide spectrum of their etiologies. In our series, we described some exceptional findings and etiologies of AMD in children. These findings may denote a specific profile in of AMD in our country with predominant infectious, postinfectious, and IMD.

Objective To examine the validity of head roll-tilt subjective visual vertical (HT-SVV) in diagnosing persistent postural-perceptual dizziness (PPPD). Study design Retrospective review. Setting Tertiary referral center. Patients Sixty-one patients with PPPD, 10 with unilateral vestibular hypofunction (UVH), and 11 with psychogenic dizziness (PD), showing chronic vestibular symptoms for >3 months. Interventions Head-tilt perception gain (HTPG, i.e., mean perceptual gain [perceived/actual tilt angle]) during right or left head tilt of approximately 30° (HT-SVV) and conventional head-upright SVV (UP-SVV) were measured. Bithermal caloric testing, cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), and posturography were conducted. Main outcome measures Multiple comparisons were performed for the HT-SVV and other vestibular tests among the disease groups. A receiver operating characteristic curve was created to predict PPPD using HTPG. Results HTPG was significantly greater in the PPPD group than in the UVH and PD groups. There were no significant differences in UP-SVV, cVEMP, oVEMP, and posturography (foam ratio and Romberg ratio on foam) among the disease groups, while the UVH group had the highest canal paresis compared to the other two groups. The area under the curve of the receiver operating characteristic curve for predicting PPPD was 0.764, and the HTPG value of 1.202 had a specificity of 95.2% for diagnosing PPPD. Conclusions While conventional vestibular tests including UP-SVV, VEMPs, and posturography did not show abnormalities in PPPD, high HTPG in the HT-SVV test, an excessive perception of head tilt, can be a specific marker for discriminating PPPD from other chronic vestibular diseases.

Introduction The diagnosis of psychogenic nonepileptic seizures (PNES) is a common clinical dilemma. We sought to assess the diagnostic value of four ictal signs commonly used in differentiating PNES from epileptic seizures (ES). Methods We retrospectively reviewed consecutive adult video-electroencephalogram (VEM) studies conducted at a single tertiary epilepsy center between May 2009 and August 2016. Each event was assessed by a blinded rater for the presence of four signs: fluctuating course, head shaking, hip thrusting, and back arching. The final diagnosis of PNES or ES was established for each event based on clinical and VEM characteristics. All ES were pooled regardless of focal or generalized onset. We analyzed the odds ratio of each sign in PNES in comparison to ES with adjustment for repeated measures using logistic regression. Additionally, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of each sign to diagnose PNES. Results A total of 742 events from 140 VEM studies were assessed. Fluctuating course (odds ratio (OR) 37.37, 95% confidence interval (CI) 13.56–102.96, P

Epilepsy is a risk factor for the development of psychogenic non-epileptic seizures (PNES) and comorbid epilepsy is recognized as a comorbidity in about 10–30% of patients with PNES. The combination of epileptic and nonepileptic seizures poses a particular diagnostic challenge. In patients with epilepsy, additional PNES may be suspected on the basis of their typical semiology. The possibility of additional PNES should also be considered if seizures fail to respond to antiepileptic drug treatment, in patients with frequent emergency admissions with seizures and in those who develop new types of seizures. The description of semiological details by patients and witnesses can suggest additional PNES. Home video recordings can support an initial diagnosis, however, especially in patients with mixed seizure disorders it is advisable to seek further diagnostic confirmation by capturing all habitual seizure types with video-EEG. The clinical features of PNES associated with epilepsy are similar to those in isolated PNES disorders and include longer duration, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, persistently closed eyes and mouth, ictal crying, recall of ictal experiences and absence of postictal confusion. PNES can also present as syncope-like episodes with unresponsiveness and reduced muscle tone. There is no unique epileptological or brain pathology profile putting patients with epilepsy at risk of additional PNES. However, patients with epilepsy and PNES typically have lower educational achievements and higher levels of psychiatric comorbidities than patients with epilepsy alone. Psychological trauma, including sexual abuse, appears to be a less relevant aetiological factor in patients with mixed seizure disorders than those with isolated PNES, and the gender imbalance (i.e. the greater prevalence in women) is less marked in patients with PNES and additional epilepsy than those with PNES alone. PNES sometimes develop after epilepsy surgery. A diagnosis of ‘known epilepsy’ should never be accepted without (at least brief) critical review. This narrative review summarises clinical, electrophysiological and historical features that can help identify patients with epilepsy and additional PNES.

Paroxysmal kinesigenic dyskinesia (PKD) is a rare condition characterized by abnormal involuntary movements that are precipitated by a sudden movement. PKD is often misdiagnosed with psychogenic movement disorders. Carbamazepine is usually the first choice of medication due to its well-established evidence but could induce Stevens-Johnson syndrome. We report a 21-year-old male patient with PKD referred to our movement disorders clinic after being misdiagnosed with conversion syndrome. PRRT2 gene testing using next-generation sequencing revealed a mutation in c.649dupC p. (Arg217fs). The patient responded well to carbamazepine but had to withdraw the treatment due to carbamazepine-induced Stevens-Johnson syndrome after 3 weeks of medication. Our patient did not respond to trials of levetiracetam and phenytoin but finally responded well to oxcarbazepine. The patient was followed up for 4 years, during which he had no attacks and no side effects. Here, we present a PKD case with carbamazepine-induced Stevens-Johnson syndrome successfully treated with oxcarbazepine despite the risk of cross-reactive skin eruption between these antiepileptics. Careful history taking and examining patient’s attacks are crucial to accurate diagnosis and treatment in PKD patients.

Based on theoretical analysis of the literature and experimental research, the relationship between the types of accentuations of personality and its possible behavior in a conflict situation. Adolescents participated in this study. Thirty people were interviewed. To obtain the actual data of persons were interviewed by two methods: the first method – a questionnaire of character accentuations G. Shmishek, K. Leonhard; the second is a test to determine the style of behavior in a conflict situation K. Thomas. Character accentuations can be considered borderline variants of the norm, in which certain character traits are excessively enhanced, resulting in a selective vulnerability to a certain kind of psychogenic actions with good and even increased resistance to others. The style of behavior in a particular conflict is determined by how a person seeks to satisfy their own interests (acting passively or actively) and the interests of the other party (acting jointly or individually). Differences in the manifestations of the studied traits between men and women were revealed. There is a difference in dysthymic, cyclothymic, emotional, anxious, exalted and exciting type of character accentuation. Emotional and anxious types of character accentuation are more common among women. Dysthymic type of accentuation is more pronounced among men. It was also found that there is a gender difference in the following styles of behavior in conflict situations: rivalry and cooperation. The analysis showed that rivalry is inherent in men, while women are more likely to use a style of cooperation. A correlation analysis of the obtained research results was performed. Correlation analysis of the results of the study revealed some correlations between character accentuations and behavioral styles in conflict. There is a difference in correlations by gender. It has been established that the style of behavior in a conflict situation is a rivalry, more characteristic of a meticulously accentuated personality, which indicates a desire to adhere to certain strict rules of behavior and not to give in to one's own position. It was found that people with a predominance of emotional accentuation of character more often use the style of cooperation to resolve the conflict, which indicates a more tolerant attitude towards others. Recommendations are given to psychologists to work with people with different accentuations of character in a conflict situation.

Patients with functional neurological symptom disorder (FND) have many diverse symptoms including psychogenic nonepileptic seizures (PNES), positive movements such as tremor, dystonia, or gait abnormalities, loss of motor function such as leg or arm paresis, and loss of sensory functions, such as blindness, deafness, or loss of feeling in the limbs. Eye movement desensitization and reprocessing (EMDR) is a therapy method that includes some techniques arising from psychodynamic, cognitive, and behavioral approaches. EMDR is known as a proven psychotherapeutic approach in post-traumatic stress disorder, but there are also numerous studies reporting its efficacy in other psychiatric disorders and trauma-associated symptoms, in patients with comorbid psychiatric disorders. This article presents the outcome of EMDR treatment of two patients’ cases, a 13-year-old female and a 16-year-old male, who were diagnosed as FND with PNES, according to the DSM-5 diagnostic criteria. In both cases, there was a significant decrease in Adolescent Dissociative Experiences Scale scores and no pseudo seizures were found, even at the sixth-month follow-up visits. These case studies suggest that EMDR can be an effective method in the long-term treatment of FND with PNES and a useful alternative to other treatment methods.

Introduction The diagnosis of psychogenic non-epileptic seizures (PNES) can often be challenging. When video-electroencephalography (EEG) is not conclusive, single-photon emission computed tomography (SPECT) can be useful by quantifying changes in regional cerebral blood flow (rCBF). Methods We conducted a retrospective case-control study in adult patients with pharmacoresistant temporal lobe epilepsy (TLE). Those patients with an ictal SPECT obtained during an event finally diagnosed as PNES were included as cases (PNES+). The control group consisted of patients with TLE without PNES (PNES-). Clinical episodes were analysed and classified according to PNES subtypes. Subtraction ictal SPECT coregistered to MRI (SISCOM) analysis was performed for the detection of areas with significant changes in perfusion compared to individual interictal studies. Group comparisons in SPM12 included paired t-tests of ictal vs. interictal studies in each group of temporal lobe seizures and PNES events. Results Ten patients with TLE and PNES were included. We found no patterns of regional hyperperfusion typical of TLE seizures during the PNES events. In two of these cases, an ictal SPECT during a confirmed epileptic seizure was also obtained, showing antero-mesial temporal lobe hyperperfusion. Group comparisons between ictal and interictal SPECTs showed increased rCBF in the temporal lobe with reduced perfusion in the default mode network areas and cerebellum during temporal lobe seizures in PNES- patients and decreased perfusion restricted to the posterior parietal cortex without significant rCBF increases in PNES events. Conclusions Ictal SPECT can be a helpful tool to characterize rCBF changes in PNES and for differential diagnosis with seizures in TLE patients.

ObjectiveTo determine the epidemiology of prolonged psychogenic non-epileptic seizures (pPNES) misdiagnosed as status epilepticus, as well as the risks associated with non-indicated treatment.MethodsWe performed an individual patient data analysis from the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) and the Established Status Epilepticus Treatment Trial (ESETT) to assess incidence, patient characteristics and clinical course of misdiagnosed pPNES.ResultsAmong 980 patients aged 8 years or older diagnosed and treated for status epilepticus in RAMPART and ESETT, 79 (8.1%) were discharged with a final diagnosis of pPNES. The relative incidence was highest in adolescents and young adults (20.1%). The typical female preponderance seen in that age bracket was not evident in children and older adults. Adverse effects, including respiratory depression and intubation, were documented in 26% of patients with pPNES receiving benzodiazepines in RAMPART and 33% of patients receiving additional second-line medication in ESETT. In ESETT, patients who were treated with benzodiazepines before hospital admission had higher rates of unresponsiveness and severe adverse effects than those treated after admission, suggesting cumulative effects of accelerated treatment momentum. Across trials, one in five patients with pPNES were admitted to an intensive care unit.ConclusionsMisdiagnosis and treatment of pPNES as status epilepticus are a common and widespread problem with deleterious consequences. Mitigating it will require training of emergency staff in semiological diagnosis. Status epilepticus response protocols should incorporate appropriate diagnostic re-evaluations at each step of treatment escalation, especially in clinical trials.

Background and Objectives: There are many causes of erectile dysfunction (ED) like congenital anomalies, neurological, endocrinal, pharmacological, psychological, pathological or hemodynamic. Penile doppler ultrasound provides real-time evaluation of cavernosal vascular flow dynamics. Purpose of our study was to evaluate and compare the baseline penile ultrasound and color doppler vascular parameters in patients of ED to see if there was any significant difference between patients of psychogenic and vasculogenic ED (diagnosed on post Papaverine injection color doppler) without the use of intracavernosal Papaverine injection. To best of our knowledge such detailed comparison of baseline penile ultrasound and doppler parameters have not been published in literature. Methods: We have prospectively studied 32 patients of ED who underwent ultrasound, and color doppler pre-and post-papaverine intracavernosal injection. Baseline pre papaverine diameters of right and left cavernosal arteries were measured on grey scale ultrasound. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of right and left cavernosal arteries were measured on color doppler before and after injecting intracavernosal papaverine injection. Patients were divided into normal study group (psychogenic ED), arterial insufficiency and venous leakage groups (vasculogenic ED) on the basis of post papaverine color doppler findings. Results: Eighteen patients showed normal study, 11 showed arterial insufficiency and 3 patients had venous leakage on post Papaverine injection color doppler. When base line prepapaverine vascular diameters and color doppler parameters were compared statistically, no significant difference was detected between and within these study groups. We have also compared Ed duration and IIEF scores among various study groups and found statistically significant difference between and within the groups. Conclusion: Use of a vasoactive agent like Papaverine with color Doppler is must to diagnose the vasculogenic ED.

Intractable hiccups (singultus) are continuous involuntary spasmodic contraction of diaphragm resulting in inspiration followed by closure of glottis. However, it is naturally occurring common phenomenon but intractable hiccups are a continuous form of hiccups which persist for more than 2 months. This can be tough task for physician to found out the organic cause of hiccups. We report a case of 40-year-old female who had hiccups since more than 2 months and she is known case of anxiety neurosis, for which ongoing treatment with anti-depressants and anti-anxiety is going on. Evaluating a psychogenic origin hiccup is the main consequence here.

Anxiety and depression can be comorbid diseases, or they can also be psychogenic complications for information about your condition. Therefore, it is essential to know how the patient's personality reacts to the awareness of his illness. The study aims to conduct a comparative analysis of indicators of anxiety and depression in patients of the occupational health clinic with various diseases, including COVID-19. Based on the screening results, we studied the need to change the tactics of organizing psychological and psychiatric care for the treatment of anxiety and depression in the Occupational Diseases Clinic after its conversion to treat patients with COVID-19. © 2021, Izmerov Research Institute of Occupational Medicine. All rights reserved.

As overreporting of symptoms threatens the integrity and utility of the neuropsychological evaluation, symptom validity test (SVT) usage has become a standard of practice. The Miller Forensic Assessment of Symptoms Test (M-FAST) SVT has been validated in various forensic contexts, though its utility in specific medical settings remains under-explored. The current study examined the validity and diagnostic utility of the M-FAST among 123 inpatient veterans on a long-term video electroencephalogram (V-EEG) epilepsy monitoring unit (EMU). Select scores from the Structured Inventory of Malingered Symptomatology and the Minnesota Multiphasic Personality Inventory-2-Restructured Form were combined into an SVT composite used as a criterion for validating the M-FAST with receiver operating characteristic (ROC) curves. A Student’s t-test revealed significantly higher total M-FAST scores among the symptom invalidity group compared to individuals with valid symptom reports (Cohen’s d = 1.24). An optimal M-FAST cut score of ≥ 5 was identified to detect symptom overreporting, with .65 sensitivity and .85 specificity (AUC = .82). However, ROC curve analysis indicated that the M-FAST had poor diagnostic classification accuracy for V-EEG-confirmed epilepsy (ES; n = 21) versus V-EEG-confirmed psychogenic non-epileptic events (PNEE; n = 46; AUC = .56). Although diagnostic utility of the M-FAST for PNEE versus ES was not supported within our sample, results demonstrate the validity of the M-FAST as an effective SVT in an EMU. Findings highlight that various cut scores may be considered to optimize detection of symptom overreporting in settings where comorbid physiological and psychological conditions may influence response validity.

Objective : The differential diagnosis between epileptic and psychogenic nonepileptic seizures (PNES) is challenging, yet suspicion of PNES is crucial to rethink treatment strategies and select patients for diagnostic confirmation through video EEG (VEEG). We developed a novel scale to prospectively suspect PNES. Methods : First, we developed a 51-item scale in two steps, based upon literature review and panel expert opinion. A pilot study verified the applicability of the instrument, followed by a prospective evaluation of 158 patients (66.5% women, mean age 33 years) who were diagnosed for prolonged VEEG. Only epileptic seizures were recorded in 103 patients, and the other 55 had either isolated PNES or both types of seizures. Statistical procedures identified 15 items scored between 0 and 3 that best discriminated patients with and without PNES, with a high degree of consistency. Results : Internal consistency reliability of the scale for suspicion of PNES was 0.77 with Cronbach's Alpha Coefficient and 0.95 with Rasch Item Reliability Index, and performance did not differ according to the patient's gender. For a cut-off score of 20 (of 45) points, area under the curve was 0.92 (95% IC: 0.87–0.96), with an accuracy of 87%, sensitivity of 89%, specificity of 85%, positive predictive value of 77%, and negative predictive value of 94% (95% IC) for a diagnosis of PNES. Conclusions : The scale for suspicion of PNES (SS-PNES) has high accuracy to a reliable suspicion of PNES, helping with the interpretation of apparent seizure refractoriness, reframing treatment strategies, and streamlining referral for prolonged VEEG.

Introduction The process of ejaculation has important meanings not only for its association with orgasm but also for the timing to ejaculate in the context of sexual activity. Spontaneous (involuntary) ejaculation (SE) without any sexual stimulation is a distressing symptom. Our understanding of SE is limited. Unfortunately, many physicians are not aware of these cases. Objectives The objective of this study is to describe the etiopathogenesis, clinical features, diagnosis, and treatment options for SE. Methods We searched the literature for publications on “SE,” “spontaneous emission” or “involuntary ejaculation,” and factors influencing SE in the PUBMED/MEDLINE, Scopus, Cochrane Library, EMBASE, PsycINFO, ProQuest, Academic Search Complete database, Google Scholar, and CINAHL databases from inception to August 2020. Results The literature search yielded 36 relevant publications reporting on 43 patients with SE. Attempts to explain the cause of pathologic SE have included 4 etiological groups (spinal cord lesions, psychological causes, rabies, and drug-induced). The underlying mechanisms responsible for induction of SE may include increased adrenergic activity, overactivity in dopaminergic system, decreased serotonergic activity, damage of descending inhibitory pathway, or penile hyperexcitability. SE may occur in the absence of an identifiable trigger or may be triggered by non-sexual circumstances (micturition, defecation, glans touch, anxiety, panic attack, or school examinations). Treatment options include psychoanalytic treatment, paroxetine, citalopram, sertraline, silodosin, and anxiolytics. In drug-induced SE, dose reduction and drug withdrawal with or without switching to another drug may relief SE. Conclusions SE is one of the least reported ejaculatory dysfunction. The key feature shared in common by these men is SE without any sexual thoughts or fantasies, may be triggered by non-sexual contexts, rarely associated with orgasm or erection. Treatment by psychoanalytic treatment and pharmacotherapy may be helpful. Further research might explore the definite underlying mechanisms. Abdel-Hamid IA, Ali OI. Spontaneous Ejaculation: A Focused Review for the Clinicians. Sex Med Rev 2021;9:406–422.

Hysteria is one of the oldest and best known clinical terms. Its history reveals the extent to which pathological entities, some more than others, are the fruit of successive conceptions of experts, themselves undoubtedly influenced by the prevailing currents of thought of their time. From its uterine origin to its psychogenic etiology, here is the history of hysteria and its controversies. A history that belongs to that of medicine, neurology, psychiatry, psychology and psychoanalysis.

Establishing misdiagnosis “epilepsy” is a common event comprising 25% total cases of “pharmacoresistant” forms. Eventually, the majority of cases resulted in diagnosing psychogenic nonepileptic seizures, or functional seizures, conversion seizures, and dissociative seizures. Here we review publications assessing psychogenic non-epileptic seizures. The scientific resources for analysis were selected in Russian (eLibrary) and international (Pubmed/MEDLINE, Google Scholar) databases, as well as in open access resources. We also present a clinical case of a patient diagnosed with epilepsy. In particular, the patient was admitted to the hospital with complains of paroxysmal conditions starting as headache, nausea proceeding with speech arrest and decreased mindfulness of what happens in personal life. He also informed about at least two episodes of disorientation described as “missed public transport stop” and “finding himself in unfamiliar place”. The patient underwent examination (electroencephalography, brain magnetic resonance imaging) and dynamic follow-up to verify origin of such conditions. As a result, he was diagnosed with psychogenic non-epileptic seizures. Administering proper therapy allowed to achieve stabilized condition and arrest seizures. The criteria provided in the review as well as clinical case report may help clinical practitioners to timely conduct differential diagnostics and deliver specialized medical aid.

Chronic pruritus (itch lasting ≥6 weeks) is a bothersome chief complaint that may present in a broad variety of diseases. Most itch-causing diagnoses fit into 1 of 5 categories (inflammatory, secondary to systemic disease, neuropathic, chronic pruritus of undetermined origin, and psychogenic itch) and this broad differential can be narrowed using key findings in the history and physical. In this article, we discuss which key findings are most pertinent for narrowing this differential and guiding further workup and treatment, as well as how to treat many itchy conditions.

BACKGROUND: Diabetes mellitus (DM) is a chronic metabolic syndrome marked by hyperglycemia due to absolute or relative deficiency of insulin hormone. Diabetic neuropathy is a complication of both type 1 and type 2 diabetes. Although pain is one of the most dominant symptoms of diabetic neuropathy, its pathophysiological mechanisms yet unknown. Toxic effects of high glucose levels play an important role in the development of this complication. METHODOLOGY: Data was collected through the questionnaire regarding Clinical findings, medical records, weight, age, family history, different habits, and psychogenic behavior. All the patients with the mentioned diseases are included in this study, excluding the mentally ill patients and the pregnant women. RESULT: The result of the present study showed that diabetic neuropathy is the most common complication of diabetes mellitus. It has been observed that most of the patients due to lack of awareness are suspected to the elevated or extreme blood sugar level which leads to neuropathy. Due to the Diabetic Peripheral Neuropathy (DPN) most of the patients suffering from foot problems, foot ulcers and then amputations. Lack of awareness, lack of health management, obesity, blood pressure changes, less care plays a key role in increasing the chances of diabetic neuropathy. COCLUSION: Diabetic neuropathy had very bad influence on a person’s health and daily activities. The Patient education programs need to emphasize on large scale. The ultimate aim of this study is the foot care education for people with the diabetes and to prevent foot ulcers and amputation.

A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease—2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score > 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score > 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the “time of meals” (mean score 65) following by the “sleep” (mean score 66) and “eating desire” (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology.

Background Functional movement disorders (FMD) are associated with considerable morbidity and impairment of quality of life. Specialized treatment is scarce and data on efficacy of different therapies are limited. Objective To evaluate a multi‐modal inpatient treatment program for patients with FMD. Methods Thirty‐one patients with FMD were analyzed before (t1) and after multi‐modal inpatient treatment (t2) by a blinded video rating using the Psychogenic Movement Disorder Rating Scale (PMDRS), the simplified Functional Movement Disorder Rating Scale (S‐FMDRS), and the Clinical Global Impression Scale of Severity (CGI‐S), as well as patients' self‐rating. In 23 out of 31 patients a 5 months follow‐up investigation was performed (t3). Wilcoxon signed‐rank test and Friedman test were used for rating scale and self‐rating comparisons over time. Spearman correlation was used for correlation of symptom improvement and clinical characteristics. Results Video rating revealed significant reduction of scores after therapy (median PMDRS t1 = 24, t2 = 8, P = 0.0006; S‐FMDRS t1 = 11, t2 = 4, P = 0.008; CGI‐S t1 = 4, t2 = 3, P = 0.000136) with sustained score decrease in follow‐up evaluations (PMDRS t1 = 31, t2 = 8, t3 = 7, P = 0.000032; S‐FMDRS t1 = 12, t2 = 4, t3 = 3, P = 0.000888; CGI‐S t1 = 4, t2 = 3, t3 = 3, P = 0.000032). Patients reported a stable reduction of symptoms in the self‐rating (CGI‐S t1 = 5, t2 = 4, t3 = 4, P = 0.016). Age correlated with treatment response with older patients showing better improvement, but disease duration did not correlate with outcome. Patients who suffered from physical trauma, sexual or physical abuse had smaller score reductions. Conclusion Blinded video and self‐rating assessment showed significant score reduction in patients with FMD after an individualized interdisciplinary inpatient intervention.

BACKGROUND Psychogenic non-epileptic seizure-status (PNES-status), defined by psychogenic non-epileptic seizures (PNES) over 30 min, are often misdiagnosed as status epilepticus. We aimed to describe the features of patients who experienced PNES-status, admitted to an intensive care unit (ICU). METHODS We screened the patients hospitalized in our epilepsy unit during a 4-year period, with a diagnosis of PNES-status and ICU admission. RESULTS Among 171 patients with PNES, we identified 25 patients (15%) who presented 39 episodes of PNES-status leading to ICU admission. Some 76% of the patients were women. The median age at the time of the PNES-status episode was 35 years. Half (48%) alleged a history of epilepsy, but epilepsy was confirmed in only 12%. A history of psychiatric disease was found in 68%. PNES were present in 85% of patients before PNES-status, and semiology of PNES and PNES-status was similar for 79% of the patients, including hyperkinetic movements in 95% of the episodes and suspected loss of consciousness in 87%. Benzodiazepines were administrated in 77% of the episodes, antiepileptic drugs in 87%, and antibiotherapy for a ICU-related infection in 15% of the episodes. Oral intubation was performed in 41% of the episodes. Blood tests showed normal levels of creatine phosphokinase and leucocytes in 90% and 95% of the episodes, respectively. No epileptic activity was found during per-event electroencephalography but interictal epileptic activity was found in 10% of the episodes. CONCLUSION Hyperkinetic PNES-status should always be considered as a differential diagnosis of status epilepticus, with a high risk of iatrogenic consequences.