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Objective The aim of this study is to explore explanatory models (EM) about epilepsy in patients with drug-resistant epilepsy (DRE) in Buenos Aires, Argentina. Design A qualitative approach gathered data through semi-structured interviews, oriented to gain an in-depth and contextual understanding of EM about epilepsy of patients with DRE. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. Results 75 patients from two public hospitals participated. Emerging codes were grouped into three categories: Biomedical EM, Psychosocial EM, and Traditional EM. Also, factors that trigger or increase the frequency of seizures were reported. Conclusions Patients’ EM regarding epilepsy are complex, as biological, psychological, and supernatural aspects intertwine. EM represent a method of understanding the way people explain, recognize, and act in relation to a medical condition. Since patients’ beliefs regarding their illness are related to mental disorders, and quality of life, EM could shed light on the real impact of illness in the life of people, and, in turn, guide those intervention strategies to the patients’ subjectivity, in order to improve the treatment compliance, reduce distress, and improve health-related quality of life, among other aspects.

Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic events associated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and 30% of patients attending at epilepsy centers and constitute a serious mental health problem. PNES are often underdiagnosed, undertreated and mistaken with epilepsy. PNES are diagnosed after medical causes (epilepsy, syncope, stroke, etc.) have been ruled out, and psychological mechanisms are involved in their genesis and perpetuation. For psychiatry, there is not a single definition for PNES; the DSM-IV and ICD-10/11 describe the conversion and dissociative disorders, and the DSM-5 describes the functional neurological disorders. However, patients with PNES also have a high frequency of other comorbidities like depression, particularly trauma and post-traumatic stress disorder. It has been postulated that PNES are essentially dissociations that operate as a defensive psychological mechanism that use the mind as a defense to deal with traumas. With the advent of VEEG in the 90s, the recognition of PNES has significantly increased, and several psychological treatments have been developed. In this manuscript, we carried out a state-of-the-art review, with the aim to provide a critical approach to the extensive literature about PNES, focusing on diagnostic aspects, the primary management, and the available treatments that have been shown to be effective for the improvement of PNES. Fil: Lanzillotti, Alejandra Inés. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Sarudiansky, Mercedes. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Lombardi, Nicolás Robertino. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurologia "dr. Jose Maria Ramos Mejia".; Argentina Fil: Korman, Guido Pablo. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: D`alessio, Luciana. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurologia "dr. Jose Maria Ramos Mejia".; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; Argentina

Purpose To examine the effects of a three-session psychoeducational intervention on patients diagnosed with psychogenic non-epileptic seizures (PNES) in an Argentinian public hospital. It was hypothesized that patients would experience improvements in their understanding of PNES, illness perception and affective scores, but might not necessarily experience a significant change in post-traumatic and dissociative symptoms and in seizure frequency. Methods This study included 12 patients (10 women, 2 men) who were invited to participate in a psychoeducational group after receiving a V-EEG confirmed diagnosis of PNES. The group consisted of 3 sessions lasting 2 h each. Pre and post measures included Psychoeducational Intervention Questionnaire, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Brief Illness Perception Questionnaire, Posttraumatic Stress Disorder Diagnostic Scale 5, Dissociative Experiences Scale (DES-M). Results This psychoeducational intervention produced results that were similar to interventions reported in US and European studies with regard to changes on psychological measures. Moreover, many patients also reported (on the final day of the intervention) a decrease in seizure frequency. All patients reported that participating in the intervention was a positive experience. Also, all but one patient referred that the participation in the group would have a positive impact on their quality of life. Conclusions Psychoeducational interventions appear to have had positive results in Argentinian patients with PNES. This is initial step in the design of empirically based psychoeducational/supportive initiatives for patients in South America.

Resumen La perspectiva del paciente se presenta como algo importante a tener en cuenta para la comprensión del padecimiento y para lograr un tratamiento efectivo. El objetivo de la presente investigación es indagar las trayectorias terapéuticas y las experiencias durante el recorrido terapéutico de pacientes con Crisis No Epilépticas Psicógenas (CNEP) pertenecientes a un Hospital General de la Ciudad Autónoma de Buenos Aires. Se realizaron entrevistas semiestructuradas a diez pacientes diagnosticados con CNEP. Para el análisis de los datos se utilizó una metodología cualitativa basada en los principios del análisis temático. Se ha identificado una categoría central: Itinerarios terapéuticos dentro del sistema etnomédico y tres subcategorías: (1) Diagnósticos Recibidos; (2) Recursos del sistema etnomédico y (3) Evaluaciones de los recursos utilizados. La dificultad de arribar a un diagnóstico y un tratamiento que permitiera mejorar las CNEP, así como el uso de distintas medicinas, fue destacada por la totalidad de los pacientes. Resumo A perspectiva do paciente se apresenta como algo importante a levar em conta para a compreensão do sofrimento e para se alcançar um tratamento eficaz. O objetivo desta pesquisa é investigar as trajetórias terapêuticas e as experiências durante a jornada terapêutica de pacientes com crise não epilética psicogênica (CNEP) de um Hospital Geral da Cidade Autônoma de Buenos Aires. Entrevistas semiestruturadas foram realizadas com dez pacientes com diagnóstico de CNEP. Para a análise dos dados, utilizou-se metodologia qualitativa baseada nos princípios da análise temática. Uma categoria central foi identificada: Itinerários terapêuticos dentro do sistema etnomédico; e três subcategorias: (1) Diagnósticos recebidos; (2) Recursos do sistema etnomédico; e (3) Avaliações dos recursos utilizados. A dificuldade de se chegar a um diagnóstico e a um tratamento que permitisse melhorar a CNEP, bem como o uso de diferentes medicamentos, foi destacada por todos os pacientes. Abstract The patient’s perspective is essential to understand their condition and to achieve an effective treatment. The objective of this paper is to investigate the therapeutic trajectories and experiences of patients with Psychogenic Non-Epileptic Crisis (PNES) under treatment in a General Hospital of the Autonomous City of Buenos Aires. Semi-structured interviews were conducted with ten patients diagnosed with PNES. For data analysis, a qualitative methodology based on thematic analysis was adopted. A central category has been identified: Therapeutic Itineraries within the Ethnomedical System, and three subcategories: (1) Diagnoses received; (2) Resources of the ethnomedical system; and (3) Evaluation of the resources used. The difficulty of finding a diagnosis, a treatment to improve PNES, and proper medicine were highlighted by all the patients. Résumé Le point de vue du patient est présenté comme quelque chose d’important à prendre en compte afin de comprendre la maladie et d’obtenir un traitement efficace. L’objectif de cette recherche est d’analyser les trajectoires thérapeutiques et les expériences au cours du parcours thérapeutique des patients atteints de Crise Psychogénique Non Épileptique (CPNE) dans un hôpital général de la ville de Buenos Aires. Des entretiens semi-structurés ont été menés auprès de 10 patients diagnostiqués avec une CPNE. Pour l’analyse des données, une méthodologie qualitative basée sur les principes de l’analyse thématique a été utilisée. Une catégorie centrale a été identifiée : Les itinéraires thérapeutiques au sein du système ethno-médical et trois sous-catégories : (1) Diagnostics reçus ; (2) Ressources du système ethno-médical ; et (3) Évaluations des ressources utilisées. La difficulté d’arriver à un diagnostic et à un traitement permettant d’améliorer la CPNE, ainsi que l’utilisation de médicaments différents, a été soulignée par l’ensemble des patients.

Objective: The objective of the present study was to perform a long-term follow-up of economicallydisadvantaged Latin American patients diagnosed as having psychogenic nonepileptic seizures (PNES) andcontribute to the field´s understanding of outcome in this population.Background: A handful of studies have examined outcome of patients once the diagnosis of PNES has beencommunicated. However, the vast majority of these have been conducted in the first world countries withsamples that were predominantly Caucasian. There is limited knowledge about outcome in economicallydisadvantaged Latin American patients diagnosed as having PNES.Methods: This is a study of 23 patients (20women, 3men)with PNES inwhich demographic data (age, education,nationality, presence of psychological trauma, age of onset) were retrospectively retrieved from medical files.Follow-up was done through a telephonic questionnaire in which investigators collected clinical information(seizure characteristics at follow-up, and treatments employed) and changes in demographic data.Results: Patients fromthis Argentinian PNES sample demonstrated havingmany similar demographic and clinicalcharacteristics to samples from US and European studies. Long-term follow-up revealed, however, decreasedseizure frequency and intensity as well as a substantial improvement in occupational status. A majority hadengaged in psychotherapy aswell as alternative and complementary approaches. Amajority had also developedwhat are suspected to be other functional symptoms.Conclusions: Argentinian patients from economically disadvantaged backgrounds, diagnosed as having PNESreported improvements in seizure frequency and occupational status during long-termfollow-up. Future studieswill need to focus on what (e.g., communication of diagnosis, psychotherapy, alternative treatments) may havecontributed to these changes. Fil: Korman, Guido Pablo. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Sarudiansky, Mercedes. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro Argentino de Etnología Americana; Argentina Fil: Lanzillotti, Alejandra Inés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Centro Argentino de Etnología Americana; Argentina Fil: Areco Pico, Maria Marta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Centro Argentino de Etnología Americana; Argentina Fil: Tenreyro, Cristina. Universidad de Buenos Aires. Facultad de Psicología; Argentina Fil: Valdez Paolasini, Gabriela. Universidad de Buenos Aires. Facultad de Psicología; Argentina Fil: D`alessio, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Scévola, Maria Laura. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Myers, Lorna. No especifíca

Purpose: To analyse the methods of reasoning with regard to patients’ experiences of living with psychogenic nonepileptic seizures (PNES) in Buenos Aires, Argentina. Method: A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of five patients with PNES. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. Results: Explanatory models and prototypes were identified from the patients’ narratives. Four patients related their suffering regarding psychosocial causes –family conflicts, sexual harassment, and life changes, among others-. Hereditary and organic hypotheses appeared to be unspecific. Folk explanations were common to all participants (magic, witchcraft, energetic causes). Four patients used the term epilepsy as an illness prototype, focusing on seizures and the use of antiepileptic drugs. Three of them also compared their illness to other people’s “attacks” (heart attacks, panic attacks, nervous breakdown). Only one of them referred to someone who was suspected of having epilepsy. Conclusion: Patients’ psychosocial explanatory models are different from the results of previous studies because these studies indicate that most patients support somatic explanations. Patients also use folk explanations related to traditional medicine, which highlights the interpersonal aspects of the disease. Doctor-patient communication is essential for a correct understanding of PNES, resulting in better outcomes. It could also help to reduce the cultural distance between professionals and patients, leading to narrowing inequalities present in multicultural healthcare services. Fil: Sarudiansky, Mercedes. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Lanzillotti, Alejandra Inés. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Areco Pico, Maria Marta. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Tenreyro, Cristina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Scévola, Maria Laura. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: D`Alessio, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Korman, Guido Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Universidad de Buenos Aires. Facultad de Psicología; Argentina

Las Crisis No Epilépticas Psicógenas (CNEP) representan un desafío clínico, debido a la complejidad de sus manifestaciones, etiología y comorbilidad. El objetivo de este artículo es presentar los tratamientos psicológicos disponibles para abordar y tratar las CNEP. Se ha llevado a cabo una búsqueda bibliográfica en las bases de datos Medline, Latindex, Redalyc, Cochrane Collaboration EBSCO y Lilacs. Dentro de los abordajes diseñados para el tratamiento de las CNEP, se destacan tres modelos de intervención psicoterapéutica que han obtenido resultados favorables en la puesta a prueba de sus intervenciones: dos modelos cognitivo conductuales y el tratamiento aumentado de Terapia Interpersonal. Se discuten estos hallazgos en función de las limitaciones, tanto metodológicas como provenientes de los distintos estudios clínicos encontrados. Psychogenic Nonepileptic Seizures (PNES) pose a clinical challenge because of the diagnostic difficulty due to the complexity of their manifestations, etiology and comorbility. The aim of this paper is to outline the available psychological treatments developed to deal with PNES. To fulfill this purpose a literature search was carried out across the databases Medline, Latindex, Redalyc, Cochrane Collaboration EBSCO and Lilacs. Within the designs intended to deal with PNES, three models of psychotherapeutic approach stand out, due to the positive outcome measurements of their interventions: two cognitive-behavioral based interventions and the augmented model of Interpersonal Therapy. These findings are analyzed taking into account their methodological and clinical limitations. Fil: Korman, Guido Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: Sarudiansky, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: Lanzillotti, Alejandra Inés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: Areco Pico, Maria Marta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: Tenrreyro, Maria Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: Scévola, Maria Laura. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: D`Alessio, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina

Depression is the most frequent psychiatric co-morbidity in patients with epilepsy. Lifetime prevalence of depression is reported more frequently in temporal lobe epilepsy and is estimated at 35%. This comorbidity appears to be related with various mechanisms. The aim of this study was to determine the qualityof life (QoL) of patients with pharmacoresistant epilepsy with and without co-morbid depression in an Argentinean population.Methods: Patients admitted to the video-EEG monitoring unit during the period 2010 ?2013 went through a standardized psychiatric assessment using SCID-I (Structured Clinical Interview for Axis I diagnoses of DSM-IV), BDI II(Beck Depression Inventory) GAF (Global assessment of functioning), and Q LES Q-SF (for quality of life). Patientswere divided in two groups: with and without depression (according to DSM-IV). Sociodemographic data, BDI IIscores, GAF, and quality of life (QoL) were compared between the two groups. Comparisons were made usingStudent´s t-test and Mann ?Whitney U test. Frequency distributions were compared by Chi-square test. Spearmancorrelation coefficients were determined.Results: Seventy-seven patients with pharmacoresistant epilepsy were eligible for this study, 41 patients wereincluded in the group with depression (mean BDI II 15.93), and 36 in the group without depression (mean BDIII 3.36) (p = 0.001). The overall QoL was signi ficantly lower in the group with depression compared tothe group without depression (p b 0.01). The most affected areas were: physical health (p = 0.013), mood(p = 0.006), course activities (referring to school as well as to hobbies or classes outside of school) (p =0.003), leisure time activities (p = 0.011), social activities (p = 0.047), general activities (p = 0.042), andmedication (p = 0.022). Severity of depression according to BDI II had a negative correlation with overall QoL(r - 0.339, p b 0.01). No correlations were found between seizure frequency, QoL and BDI II.Conclusion: Patients with pharmacoresistant epilepsy and co-morbid depression reported worst QoL. Depressiondisrupts daily functioning (leisure, social functioning) and is a negative influence for subjective perception of healthand medication. Interdisciplinary treatment should be considered (neurology?psychiatry?psychotherapy). Fil: Scévola, Maria Laura. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad En Red El Cruce Dr. Nestor Carlos Kirchner Samic. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos.; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos ; Argentina Fil: Sarudiansky, Mercedes. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad En Red El Cruce Dr. Nestor Carlos Kirchner Samic. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos.; Argentina Fil: Lanzillotti, Alejandra Inés. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad En Red El Cruce Dr. Nestor Carlos Kirchner Samic. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos.; Argentina Fil: Oddo, Silvia Andrea. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad En Red El Cruce Dr. Nestor Carlos Kirchner Samic. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia ; Argentina Fil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia ; Argentina. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad En Red El Cruce Dr. Nestor Carlos Kirchner Samic. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos.; Argentina Fil: D`Alessio, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia ; Argentina. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad En Red El Cruce Dr. Nestor Carlos Kirchner Samic. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Unidad Ejecutora de Estudios En Neurociencias y Sistemas Complejos.; Argentina