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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.

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.

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.

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.

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.

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.

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.

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.

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.

Objective Psychogenic non-epileptic seizures (PNES), a common phenomenon in neurological settings, are regarded as a paroxysmal type of functional neurological disorder (FND). In a substantial proportion, PNES are disabling with poor long-term outcomes and high economic costs. Despite the clinical and financial consequences of PNES, there is still a lack of controlled clinical trials on the treatment of this challenging disorder. The study aims to evaluate the feasibility and collect first evidence of the efficacy of a group based-intervention in PNES-patients. Methods A pilot randomized controlled feasibility study with a parallel-group design was performed in adult outpatients with PNES to evaluate a new body-focused group therapy (CORDIS) versus guided self-help groups. Self-assessment of dissociation (Dissociation Experience Scale—DES-20) and seizure severity (Liverpool Seizure Severity Scale—LSSS) were assessed two weeks before and two weeks after the treatment intervention and also six months after treatment as primary outcome parameters. Results A total of 53 patients were recruited from a specialized outpatient clinic, and out of those, 29 patients completed either the body-focused group therapy program (n = 15) or a guided self-help group (SHG) therapy (n = 14). When analyzing the ITT sample (n = 22 CORDIS group, n = 20 SHG), both groups showed an effect on seizure severity and level of dissociation. In the per protocol sample (n = 13 CORDIS group, n = 12 SHG), CORDIS was superior to the self-help group for reducing seizure severity 6 months after the treatment. Significance CORDIS is a newly developed body-focused group therapy program for adults with PNES. Further studies should include a multicentric design with a higher number of participants.

Objective This study was undertaken to measure the incidence and prevalence of active psychogenic nonepileptic seizures (PNES) in a Norwegian county. Methods Using the Norwegian patient registry, we identified patients in More and Romsdal County in Norway diagnosed with F44.5 (conversion disorder with seizures or convulsions) or R56.8 (convulsions, not elsewhere classified) in the period January 2010 to January 2020. A review of the patients' medical records and an assessment of diagnostic validity were performed. PNES were diagnosed according to the recommendations by the International League Against Epilepsy Nonepileptic Seizures Task Force. Point prevalence of PNES on January 1, 2020 and incidence rates for the period 2010-2019 were determined. Results Based on PNES within the past 5 years, we found a PNES prevalence of 23.8/100 000 (95% confidence interval [CI] = 17.9-29.6), including all levels of diagnostic certainty. For the highest level of diagnostic certainty (video-electroencephalographically confirmed), the prevalence was 10.6/100 000 (95% CI = 6.7-14.5). The highest prevalence was found in the age group 15-19 years, at 59.5/100 000 (95% CI = 22.6-96.3). The mean annual incidence rate between 2010 and 2019 was 3.1/100 000/year (95% CI = 2.4-3.7). Significance We report for the first time a population-based estimate of the prevalence of PNES. Our findings suggest that the prevalence of PNES is within the range of estimates from non-population-based data. We found a strikingly high prevalence of PNES in the 15-19-year age group.

Background: Nonepileptic events misdiagnosed as epilepsy lead to a risk of iatrogenic morbidity, which increases health costs. Among the patients affected by nonepileptic events, 11-46% are psychogenic nonepileptic seizures (PNESs). Objective: To investigate the usefulness of the semiological classification of PNESs among patients diagnosed by means of video electroencephalograms (vEEGs). Methods: This was a retrospective review of the medical records of patients admitted to the adult vEEG unit between April 2007 and December 2016, who were diagnosed with PNES that was confirmed through vEEG. Analysis on demographic and clinical data and classification of PNESs according to the Magaudda classification were performed. Results: We identified 143 patients, among whom 31.5% had also epilepsy. According to the Magaudda classification, the events were: hypermotor (58%); subjective symptoms (21.7%); akinetic (14.7%) and focal motor (5.6%). Hypermotor predominated in both genders, followed by subjective symptoms in women (23.9%) and akinetic in men (19.2%). The mean number of antiepileptic drugs (AEDs) prescribed per patient was 2.3. Thirty-two patients (22.4%) required at least one hospitalization for PNESs. 48.3% of the patients had psychiatric comorbidities. Conclusion: The proposed semiological classification of PNESs is a relevant tool that general neurologists can use to characterize these events in their daily practice. Correct use of this classification, together with vEEG and appropriate clinical suspicion, makes it possible to reach an accurate early diagnosis, thus reducing morbidity and, possibly, the high costs associated with PNESs RESUMEN Introducción: Los eventos no epilépticos diagnosticados erróneamente como epilepsia conducen a un riesgo de morbilidad iatrogénica que aumenta los costes en salud. Entre los pacientes afectados por eventos no epilépticos, un 11-46% son de origen psicógeno (PNES). Objetivos: Evaluar la utilidad de la clasificación semiológica de PNES en pacientes diagnosticados por video electroencefalograma (vEEG). Métodos: Revisión retrospectiva de los registros médicos de pacientes ingresados en la unidad de adultos de vEEG entre 04-2007 y 12-2016, que fueron diagnosticados con PNES confirmado por vEEG. Se realizó un análisis de los datos demográficos y clínicos, y la clasificación de los PNES según la clasificación de Magaudda. Resultados: Identificamos 143 pacientes, el 31,5% de los cuales también tenía epilepsia. Según la clasificación de Magaudda, los eventos fueron: hipermotor 58%; síntomas subjetivos 21,7%; akinética 14,7% y motor focal 5,6%. El hipermotor predominó en ambos los sexos, seguido de síntomas subjetivos en las mujeres (23,9%) y akinéticos en los hombres (19,2%). La cantidad media de fármacos antiepilépticos (FAE) recetados por paciente fue 2.3. Un total de 32 pacientes (22.4%) requirieron al menos una hospitalización por PNES. El 48,3% de los pacientes tenía comorbilidad psiquiátrica. Conclusión: La clasificación semiológica de los PNES propuesta es una herramienta relevante que los neurólogos generales pueden usar para caracterizar esos eventos en su práctica diaria. El uso correcto de esta clasificación, vEEG y una sospecha clínica adecuada permite llegar a un diagnóstico preciso y temprano, reduciendo así la morbilidad y, posiblemente, los altos costes asociados con las PNES.

Hypoparathyroidism is a rare disorder of mineral metabolism, characterized by hypocalcemia as a result of the absence or deficiency of parathyroid hormone. The severity of the condition of patients with this disease is associated with both acute episodes of hypocalcemia due to cardiac arrhythmias, laryngo- or bronchospasm, generalized seizures, and manifestations of long-term complications of the disease, such as kidney pathology. In some cases, the normalization of phosphorus-calcium metabolism due to standard treatment with active metabolites / analogues of vitamin D and calcium salts does not lead to a reduction in clinical symptoms, which requires differential diagnosis with other conditions, including such neuropsychiatric disorders as epileptic seizures and their equivalents, syncope, and psychogenic nonepileptic seizures. We present a case report of a woman with convulsions, which developed due to dissociative (conversion motor) disorder, with chronic postoperative hypoparathyroidism, receiving standard treatment and having normo- and hypercalcemia.

Eng: We describe a collective episode of psychogenic illness in an indigenous group (Embera) of Colombia, geographically isolated from its native homeland and surrounded by non-indigenous settlers. The condition, which affected three young adult men and six adolescent women, was attributed by them to a spell (maleficio). It was designated as ataques de locura (madness attacks) according to their traditional medical system; and as a conversive disorder with dissociative features by psychiatrists. Different therapeutic approaches, including antipsychotic medication, religious healers and traditional herbal remedies were unsuccessful. Contact with shamans of the same ethnic origin, on the other hand, proved to be an effective way of dealing with the symptoms. We interpret the situation as an expression of psychosocial stress secondary to cultural change. This medical problem bears close resemblance to other specific culture-bound syndromes such as ataques de nervios or possession syndromes and gives clues to ways of dealing with psychogenic expressions of cultural stress. Spa: Describimos un episodio colectivo de enfermedad psicógena en un grupo indígena (embera) de Colombia, aislado geográficamente de su tierra natal y rodeado de colonos no indígenas. La enfermedad, que afectó a tres hombres adultos jóvenes y seis mujeres adolescentes, fue atribuida por ellos a un maleficio. Fue designado como ataques de locura según su sistema médico tradicional; y como trastorno conversivo con rasgos disociativos por los psiquiatras. Los diferentes enfoques terapéuticos, incluidos los medicamentos antipsicóticos, los curanderos religiosos y los remedios tradicionales a base de hierbas, no tuvieron éxito. El contacto con chamanes del mismo origen étnico, en cambio, resultó ser una forma eficaz de tratar los síntomas. Interpretamos la situación como una expresión del estrés psicosocial secundario al cambio cultural. Este problema médico se asemeja mucho a otros síndromes específicos ligados a la cultura, como los ataques de nervios o los síndromes de posesión, y da pistas sobre las formas de tratar las expresiones psicógenas del estrés cultural.

Psychogenic erectile dysfunction (ED) is a very common condition in men. About 40% of ED cases are psychogenic. Many of the psychogenic ED patients are young men. The causes of psychogenic ED can be generalized as well as situational. Psychogenic management approaches are different from organic ED. In patients with psychogenic ED, an intersystemic approach is needed for both the patient and his partner. This intersystemic approach will inspect the real cause of the problem. Intersystemic approach: The intersystemic approach not only focuses on the patient side but also on his partner. This approach provides space for partners to explore and understand their sexual life. In this article, we focus to explore a research that conducts intersystemic principle in ED management. We conclude that in psychogenic ED, an intersystematic approach is important for determining the root cause of the problem. Finding the right core cause will determine the right treatment. This therapy can combine with pharmacologic treatments. These therapies can give a better outcome for psychogenic ED.

The realization that autoantibodies can contribute to dysfunction of the brain has brought about a paradigm shift in neurological diseases over the past decade, offering up important novel diagnostic and therapeutic opportunities. Detection of specific autoantibodies to neuronal or glial targets has resulted in a better understanding of central nervous system autoimmunity and in the reclassification of some diseases previously thought to result from infectious, ‘idiopathic’ or psychogenic causes. The most prominent examples, such as aquaporin 4 autoantibodies in neuromyelitis optica or NMDAR autoantibodies in encephalitis, have stimulated an entire field of clinical and experimental studies on disease mechanisms and immunological abnormalities. Also, these findings inspired the search for additional autoantibodies, which has been very successful to date and has not yet reached its peak. This Review summarizes this rapid development at a point in time where preclinical studies have started delivering fundamental new data for mechanistic understanding, where new technologies are being introduced into this field, and — most importantly — where the first specifically tailored immunotherapeutic approaches are emerging., Here, Harald Prüss discusses how autoantibodies can contribute to neurological diseases. The identification of specific autoantibodies to neuronal and glial targets has increased our understanding of autoimmunity in the central nervous system and led to the reclassification of some diseases previously thought to result from infection or ‘idiopathic’ causes.

We sought to determine whether skin conductance level could warn of outbursts of combative behavior in dementia patients by using a wristband device. Two outbursts were captured and are reported here. Although no physiologic parameter measured by the wristband gave advance warning, there is a common pattern of parasympathetic withdrawal (increased heart rate) followed approximately 30 seconds later by sympathetic activation (increased skin conductance). In the literature, a similar pattern occurs in psychogenic non-epileptic seizures. We hypothesize that similar autonomic responses reflect similarities in pathophysiology and that physical activity may partially account for the time course of skin conductance.

Introduction : Mechanically ventilated patients admitted to the intensive care unit (ICU) for generalized convulsive status epilepticus (GCSE) are a heterogeneous population. Our objective was to evaluate the number of patients who fulfilled the diagnostic criteria for refractory GCSE and describe their initial management and prognosis. Methods : This multicenter retrospective study was conducted in four French ICUs in Pitie-Salpetriere University Hospital in Paris and in the Hospital of Jossigny. Mechanically ventilated patients admitted to the ICU for GCSE between, January 1, 2014, and, December 31, 2016, were included. Patients with anoxia and traumatic brain injury were excluded. Their pre-hospital and ICU medical records were reviewed. The collected data included pre-hospital clinical status, pre-hospital antiepileptic treatment, reason for mechanical ventilation, duration of general anesthesia, and prognosis in the ICU. A retrospective initial diagnosis based on the findings of the analysis of the clinical records was attributed to each patient. Results : Among the 98 patients included, 88.8% (n = 87/98) fulfilled the diagnostic criteria for GCSE; of these cases, 16.1% (n = 14/87) were refractory. Eleven percent of the patients did not fulfill the criteria for GCSE at the time of initial management (retrospective diagnosis of single convulsive seizure, repetitive convulsive seizures, or psychogenic non-epileptic seizures). Most patients were intubated for coma (58.9%, n = 56/95, missing data: n = 3). In the ICU, the median [Q1–Q3] duration of general anesthesia before weaning was 12.3 h (5.0–18.0 h); 7% of the patients had a relapse of status epilepticus, and 2% died in the ICU. Conclusion : Among the cases of confirmed GCSE in the mechanically ventilated patients admitted to the ICU, 16.1% were refractory, with an overall good prognosis. A significant proportion of patients did not fulfill the diagnostic criteria for refractory GCSE.

Objective To determine whether patients who experienced their first psychogenic non-epileptic seizure (PNES) at 50 years or older differed from those who developed PNES at a younger age, in terms of demographic, social/clinical as well as psychological measures. Background The typical age for PNES onset is roughly between 20 and 40 years of age. Only a handful of studies have examined samples with PNES onset at an older age and therefore information about these individuals is limited. Methods This is a retrospective study of 75 consecutive individuals who developed (video EEG-confirmed diagnosis) PNES before age 50 years and 55 consecutive individuals who developed PNES at 50 years or more. Patients were examined on demographics (age, education, working and relationship status), clinical (seizure frequency, trauma type: sexual, multiple trauma, and health-related traumatic experiences), and self-report measures(Coping Inventory for Stressful Situations, Toronto Alexithymia Scale, and the Quality of Life Inventory in Epilepsy-31). Results Patients who had experienced sexual trauma were likelier to develop PNES at an earlier age. Those who experienced “health problems pre-PNES onset” were likelier to develop PNES at an older age. On psychological measures, it was noted that after adjusting for the covariate effects, those with elevations in Avoidance (CISS) were likelier to develop PNES at an earlier age. and those with elevations in QOLIE31 cognitive complaints were likelier to be in the older cohort. Conclusions No matter at what age PNES presented, patients reported markedly high rates of exposure to psychological trauma (single and multiple), similarly elevated unemployment rates and low quality of life. The groups with different age of onset differed in the type of trauma experienced prior to the development of PNES. In addition, the younger onset group demonstrated a significantly higher use of avoidance as a stress-coping strategy.

Background Psychogenic nonepileptic seizures (PNES) are still poorly understood and difficult to treat. Attachment theory could add new aspects to the understanding of the multifactorial genesis and maintenance of PNES and the therapeutic needs of this patient group. Objective The aim of the present study is to systematically assess attachment in adult patients with PNES with a focus on the role of unresolved/disorganized attachment. Methods A cross-sectional design was chosen to compare patients with confirmed PNES (n = 44) and healthy controls (n = 44) matched for gender, age, and education. Attachment was assessed using the Adult Attachment Projective Picture System. Psychometric questionnaires included the Childhood Trauma Questionnaire; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis II disorders, Patient Questionnaire; the Somatoform Dissociation Questionnaire; and the Patient Health Questionnaire. Results We found significantly less secure (P = 0.006) and more unresolved/disorganized (P = 0.041) attachment classifications in the PNES group. Among patients with PNES, 7% were classified secure and 43% were classified unresolved/disorganized. Patients with an unresolved attachment representation were significantly more likely to be screened positive for personality pathology in the Structured Clinical Interview for DSM-IV axis II disorders, Patient Questionnaire (P = 0.03) and to report more emotional abuse in the Childhood Trauma Questionnaire (P = 0.007) than patients with other attachment classifications. Conclusions Our findings suggest that unresolved/disorganized attachment might be the predominant attachment style in patients with PNES and might be associated with more severe personality pathology. This could be of therapeutic relevance. The present study is the first to assess adult attachment in patients with PNES using a semi-structured interview in comparison to matched healthy controls.

Background:. The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM. Methods:. We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated. Results:. In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. The duration of T2DM also significantly associated with the prevalence of “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. Subsequently, the prevalence of “disturbances of pigmentation” was higher in males than females in NGT (P

Objective Interictal dysphoric disorder (IDD) has been regarded as an affective disorder occurring only in people with epilepsy (PWE). Data showing similar characteristics and similar prevalence of IDD in patients with migraine and with psychogenic nonepileptic seizures question the epilepsy-specific nature of IDD. The aim of the study was to investigate the nature of IDD in people with prevalent epilepsy with mood disorders and people with mood disorders who are free of neurological disease. Methods This is a case-control study, with 142 patients with a confirmed diagnosis of epilepsy and major depressive disorder (MDD; cases) and 222 patients with MDD only (controls). MDD diagnosis was confirmed by a structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID-I-RV). We used the Beck Depression Inventory and the Beck Anxiety Inventory to estimate anxiety and depression levels and the Interictal Dysphoric Disorder Inventory (IDDI) to confirm the presence of IDD. Mann-Whitney U test, Pearson chi-squared, Spearman correlation, and logistic regression were used. Results No differences were found in the prevalence of IDD between PWE with MDD and people with MDD alone (88.73% vs. 85.13%, χ2 = .96, p = .32). There were no differences between the groups overall or for any IDDI subscales (all p > .05). In both groups, IDD symptoms were grouped with the same incidence and had the same duration and periodicity. IDD was not associated with epilepsy (odds ratio = .84, 95% confidence interval = .40-1.98, p = .72). No significant correlation was found between epilepsy, demographic characteristics, and all IDDI subscales (all p > .05). Notably, patients with IDD suffered from affective disorders longer (6.68 ± 6.82 years vs. 3.7 ± 3.97 years, p = .001) and also received higher scores on all psychometric scales (all p Significance This study does not confirm the specificity of IDD for epilepsy. The presence of IDD symptoms may be associated with a more severe course of MDD and significant anxiety distress.

STUDY OBJECTIVES: To update the literature on the diagnostic category of sleep-related dissociative disorders (SRDDs), involving psychogenic dissociation, since the time of their inclusion in the parasomnias section of the International Classification of Sleep Disorders, second edition, in 2005; to summarize the most salient clinical and video-polysomnographic (vPSG) findings and typical clinical profile from all reported cases; and to provide the rationale for the re-inclusion of the group of SRDDs in future editions of the International Classification of Sleep Disorders. METHODS: A systematic computerized literature search was conducted searching for SRDDs, nocturnal dissociative disorders, and nocturnal dissociation. RESULTS: Nine additional cases were identified, with sufficient clinical history and vPSG findings to justify the diagnosis of SRDDs, supplementing the 11 cases cited in the International Classification of Sleep Disorders, second edition, for a total of 20 cases. Twenty-six other cases with vPSG testing were found, with 18 cases reported in abstracts and 8 cases reported in a publication with compelling histories of SRDDs and 2 consecutive vPSG studies, but without the vPSG findings explicitly reported for any case. In more than half of all reported cases, there was objective diagnostic confirmation for SRDDs consisting of the hallmark finding of abnormal nocturnal behaviors arising from sustained electroencephalography wakefulness, or during wake–sleep transitions, without epileptiform activity. These nocturnal behaviors often replicated daytime psychogenic dissociative behaviors. A history of trauma (physical, sexual, emotional) was an almost universal finding, along with major psychopathology. All patients, except for one, had prominent histories of daytime dissociative disorders. Many of the patients were referred on account of a presumed parasomnia. CONCLUSIONS: Cases of SRDDs continue to be reported, often as a “parasomnia mimic,” with psychogenic dissociation being clearly distinguished from physiologic sleep–wake dissociation as found in primary sleep disorders such as narcolepsy, rapid eye movement sleep behavior disorder, etc. Eleven reasons are provided for why the category of SRDDs should be re-included in future editions of the International Classification of Sleep Disorders, and in the parasomnias section. CITATION: Schenck CH, Cramer Bornemann M, Kaplish N, Eiser AS. Sleep-related (psychogenic) dissociative disorders as parasomnias associated with a psychiatric disorder: update on reported cases. J Clin Sleep Med. 2021;17(4):803–810.

Background Erectile dysfunction (ED) is common among ageing men because of associated underlying risk factors which are peculiar to this category of patients. Endothelial dysfunction and replacement of cavernosal smooth muscles by collagen fibres are common in older men, making them prone to ED. It is either vasogenic, neurogenic, hormonal, cavernosal or psychogenic in origin, but vasogenic causes are the commonest. This study was aimed at establishing vasogenic causes among patients being evaluated for ED using Doppler ultrasound as this category of ED is amenable to either medical and/or surgical treatment. Methods The study was conducted from July 2015 to January, 2017 at Federal Medical Centre Abuja. Nineteen consecutive patients with clinical diagnosis of erectile dysfunction were evaluated with Doppler ultrasound scan using a high-frequency linear array transducer. The penile scan was done before and after intracavernosal injection of 20 µg of Prostaglandin E1 (PGE1). B-mode scan of the penis was done prior to intracavernosal injection of PGE1, and the spectral waveforms as well as peak systolic velocity (PSV) of the CA were recorded at 5 min interval, from 5 to 50 min post-intracavernosal injection of PGE1, using angle of insoation ≤ 60°. Results The age range of the patients was fifty to sixty-six years (mean: 57.4 ± 4.3 years), while the PSV of CA varied between 21.4 and 104.4 cm/s (mean: 46.2 ± 19.2) among the entire patients, between 21.4 and 22.3 cm/s (mean: 21.9 ± 0.7) among patients with arteriogenic ED, and between 25.0 and 74.9 cm/s (mean: 45.0 ± 15.5) among those with venogenic ED. Arteriogenic ED was found in two patients (10.6%), while venogenic ED was observed in seven patients, which constituted 36.8% of the entire research participants. None had Peyronie’s disease, penile fracture, penile tumour or mixed arteriogenic and venogenic ED. Conclusion 47.4% of the patients had vasogenic ED and venogenic ED was more common than arterioegenic ED in the age range considered. This categorization of ED with Doppler study is imperative before initiating therapy as treatment protocol for vasogenic ED is aetiologic specific.

Introduction. Differentiation of epileptic seizures from psychogenic nonepileptic seizures (PNES) is problematic and leads to wrong diagnosis. It is estimated that among patients diagnosed with epilepsy, as many as 20–40% suffered from pseudo-epileptic seizures. Misdiagnosis is associated with a delay in the implementation of appropriate treatment, complications following unnecessary treatment, worse functioning of the patient, high costs of care and unemployment. Aim. The aim of the study was to familiarise neuroscience nurses with the causes, symptoms, treatment and nursing care for a patient with PNES on the basis of the described case. Case Report. Case study of a female patient with psychogenic non-epileptic seizures repeatedly treated in a psychiatric ward. Based on an interview with the patient, analysis of the medical documentation, direct and indirect observation of the patient, problems with nursing were identified and a care plan was established. Results. The depicted patient was admitted to a psychiatric ward due to suicidal intentions, decreased mood and epileptic attacks of unknown aetiology. The patient was struggling with numerous psychosocial problems, which required high professional and ethical competences. The patient has been diagnosed with the following care problems: reluctance to undergo video EEG examination, abdominal pain, isolation of the patient in the ward, risk of suicide, risk of injury. Conclusions. The nursing interventions undertaken with respect to the patient turned out to be effective. Improvement in psychosocial functioning was achieved and the patient did not attempt suicide during the crisis. Thanks to the interdisciplinary cooperation, it was possible to confirm the non-epileptic nature of the seizures, and the patient was discharged with therapeutic recommendations (pharmacotherapy, psychotherapy, visits to a mental health clinic). (JNNN 2021;10(1):35–41)

Personal anxiety in adolescence is largely determined by psychological factors (personal, adaptive, motivational), and the correction of personal anxiety in adolescents is possible by combining two areas of work: reducing the effects of psychological factors on its occurrence; development of constructive forms of behavior in psychogenic situations, in conditions of increased anxiety through the use of music therapy. The aim of the study is to study the state of anxiety in adolescence after psychocorrection by music therapy. A set of methods was used to study the psychological features of anxiety in adolescents, ways to overcome and level before and after the psychocorrection program. There are a number of positive changes in the indicators of personal and motivational factors of anxiety: an increase in self-esteem and responsibility, increased self-esteem, which, in turn, led to a decrease in the difference between this indicator and the level of claims, a change in attitude realistic type, changing the distribution of affiliation motives and achieving in favor of the motive of the desire to accept and the desire to succeed, respectively. The effectiveness of the corrective effect was manifested in the change in the distribution of subjects by levels of anxiety. A high level of personal anxiety was recorded, after the implementation of the program it halved. During the study, a number of positive changes in the indicators of personal and motivational factors of anxiety were recorded. The results show, however, that psychocorrectional work with music therapy is effective in the work of a psychologist. The obtained results can be used both during the training of future psychologists, the development of a psycho-correctional program and during family counseling.