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Much has been written about sexual dysfunction in men with epilepsy. We wanted to determine the frequency and nature of sexual disorders in our highly selected population of male veterans. Charts of the 184 men with epilepsy followed in the Neurodiagnostic Clinic, Veterans Affairs Medical Center, Durham, NC were reviewed to determine reports of sexual dysfunction. Demographics, type of epilepsy, localization, and antiepileptic drugs (AEDs) at the time of complaints were noted. These patients were compared to 20 men with epilepsy without reported sexual dysfunction (control group). Forty-one (22%) patients complained of sexual dysfunction (impotence 56%, decreased libido 37%, difficulty maintaining erection 22%, and other disorders 15%). Mean age at evaluation was 48.3 years for patients and 44.8 years for controls. Mean age of onset of seizures was 34.0 and 29.3 years for patients and controls, respectively. 93% of patients and 95% of controls had partial seizures. The AEDs (phenytoin, carbamazepine, valproate, phenobarbital, and primadone) were used with approximately equal frequency in both groups. Fifty-nine percent of patients and 65% of controls were on monotherapy, 34% and 25% on dual therapy, 5% each on triple therapy, and 2% and 5% on no medication. Sexual dysfunction is a common problem in our population of veteran men with epilepsy. Age of onset and type of seizures and the medications used were comparable in patients and controls.

This paper describes the assessment and treatment of a family of 4 prepubescent children following the experience of a traumatic attack of the 6-year-old girl by a dog. The two eldest children received diagnoses of posttraumatic stress disorder (PTSD), and in addition, the 6-year-old victim developed a simple phobia of medical procedures. The younger children also developed posttraumatic reactions specific to their developmental level. Because the traumatic experience was witnessed by all of the children in the same family, their comprehensive data provide a cross-sectional illustration of the developmental expression of posttraumatic reactions in very young children. Established behavioral treatment approaches for PTSD were adapted to be developmentally appropriate and involved individual hierarchical, imaginal, and in-vivo exposure, coupled with joint sessions utilizing the older sibling as a behavioral model for his sister's simple phobia. This family case study illustrates the use of behavioral assessment and treatment methods in a clinic setting.

The present study evaluated the efficacy of three tasks in inducing depersonalization (DP) and derealization (DR) in three different groups: (a) panic disorder patients who report these symptoms while panicking (PD + DD; n = 10); (b) panic disorder patients never experiencing these symptoms during panic attacks (PD; n = 10); and (c) nonanxious controls (NC; n = 10). Clinical features of the PD+DD and PD Ss were compared as well. Relative to PD Ss, PD + DD Ss evidenced higher levels of depression, trait anxiety, more fear of panic, and had a briefer duration of their disorder. A substantial proportion of NC Ss reported past DP and DR experiences. DP and DR induction procedures were the following: staring at a dot on the wall, staring in a mirror, and silent repetition of one's name. Results indicated two tasks (mirror and dot) successfully elicited these sensations above baseline levels with DP reported more frequently and intensely than DR for all Ss. The PD + DD Ss evidenced greater baseline-to-task increases in DP and DR relative to the other two groups and exhibited a differential fear response, particularly on the dot task, with 30% of these Ss intentionally distracting themselves or terminating the induction.

Interview data from 162 subjects assigned a diagnosis of panic disorder with or without agoraphobia were analyzed regarding descriptive features of initial panic attacks. The extent to which groups of minimal and extensive avoiders were differentiated by such features was examined. Overall, initial panic attacks were likely to occur at any time of year, and were associated with reported Stressors in 72% of the cases. The most frequently reported Stressors were somatic in nature. Approximately half of the subjects reported experiencing similar although milder experiences prior to the first panic attack. No differences were found between minimal and extensive avoiders in terms of the presence of others, behavioral response, or location of the first panic attack. Nor did the groups differ with respect to the presence of other anxiety disorders prior to the first panic. However, extensive avoiders tended subsequently to develop additional anxiety disorders moreso than minimal avoiders. Initial panic attack locations were also judged to be more capable of blocking escape action tendencies associated with the fear/panic response in the extensive avoidance group.