Galvanic Skin Response—Extinction Biofeedback Training for Psychogenic Abdominal Pain: A Validation Protocol

Abdominal and pelvic pain of psychogenic origin is a widespread, disabling, difficult to identify, and often inadequately treated medical condition. This condition is often associated with poor quality of life due to high pain interference with daily activities. Cognitive behavioral psychological therapy and neuromodulation with biofeedback are validated therapies for the treatment of this condition. Aim of the present research work is the validation of a therapeutic protocol that involves the use of both techniques in combination. 20 patients diagnosed with psychogenic abdominal pain, of both sexes, aged between 18 and 60 years who had not benefited from pharmacological therapies were enrolled. 10 patients were randomly assigned to the control group (psychological treatment only), another 10 patients were assigned to the study group (neuromodulation with biofeedback-Galvanic skin response-extinction in combination with psychological therapy). For both groups, the pain score, interference of pain with daily living activities, pain relief, and the share of anxiety associated with the pain condition were evaluated (pre- and post-treatment). The patients who underwent the combined treatment achieved statistically significant better scores than patients in the control group, respectively −4.9 ± 0.9 vs −1.0 ± 0.4 for Pain;−5.1 ± 1.1 vs −0.9 ± 0.3 for Interference with life;−7.2 ± 3.7 vs −2.2 ± 2.1 for HAMA;4.6 ± 1.2 vs 1.1 ± 0.6 for Relief.

Association between Epilepsy and Psychogenic Non-Epileptic Seizures: A Case Report

Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic Seizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal events have the same clinical evidences of epilepsy, such as an impairment of the self-control and a range of sensory, motor and mental manifestations, without the typical related electroencephalogram (EEG) because of the absence of an organic cause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related to psychological factors like dissociation. This is a defense mechanism used to cope stressful events or emotional conflicts. Psychological or psychiatric disorders, like Post Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic Non-Epileptic Seizures. In this article, we present a case report of epilepsy combined with Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance in this occurrence. The subject received a psychological assessment including psychometric and projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test and graphic tests. A psychological disorder related to defense mechanisms was identified. The subject presents a tendency to convert his fears and emotive pains in rational and more socially acceptable problems, using his body to express his discomfort. Patient with epileptic seizures should receive a psychological assessment to exclude Psychogenic Non-Epileptic Seizures. Further studies should propose guidelines to integrate neurological, psychiatric and psychological intervention.

Psychogenic Nonepileptic Seizures in Men: Comparison of Clinical and Psychosocial Features between Afro-American and Caucasian Patients

PNES represents an alternative diagnosis for refractory epilepsy in the EMU, however it is less frequent in males. The impact of ethnicity on PNES was evaluated retrospectively in 54 males with confirmed diagnosis of PNES. We evaluated and compared the demographic, clinical and psycho-social characteristics of both AAMs and WMs. In both AAMs and CMS, over half of all patients were <50 years of age, had a shorter history of spells, and took between 1 to 3 AEDS. However, the spells were more frequent in AAM (2.25) compared to CM, but the CMs had more frequent limp/unresponsive events. Also there was higher incidence of head injury report, alcohol and substance abuse, unemployment and disability benefits in AAMs compared to CMs. These differences may provide insight into the causative factors in PNES.

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and specialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves discontinuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.

Erectile Dysfunction in Male with Glans Penis Apocrine Hydrocystoma: Organic or Psychogenic?

The location of the apocrine hydrocystoma in the penis region is rare. We present a case where we evaluated the erectile function of a patient presenting such an asymptomatic formation. We assessed the psychogenic component of the erectile dysfunction based on the association of the somatic component of the cyst with the patient’s inability to focus on sexual intercourse. The fear of traumatization of the cyst during sexual intercourse was considered as a triggering factor of the chain of insufficient or unsuccessful erections, and the sexual performance anxiety as a factor in maintaining this erectile dysfunction. Apparently, an organic cause induced an erectile dysfunction, through non-organic (predisposition, triggering and maintenance) mechanisms.

Resolution of erectile dysfunction after an andrological visit in a selected population of patients affected by psychogenic erectile dysfunction

The aim of this study was to ascertain whether some patients with psychogenic erectile dysfunction （PED） who chose psychotherapy spontaneously improved their sexual function immediately after diagnosis. Two hundred eighty-five patients with PED were retrospectively studied. Complete resolution of PED was analyzed regarding age, primary or secondary PED, marital status, domestic status, prevailing attitude of the female partner to the dysfunction, duration of their partnership, social status, duration of PED, International Index of Erectile Function score, and prevailing attitude of the patient after a diagnosis of PED. The data were analyzed using post-hoc tests. PED was resolved in 32.3% of the patients immediately after diagnosis. These patients were older, more frequently affected by secondary ED, more frequently living with their partner, and more frequently resigned or happy with the diagnosis of PED than the patients who did not resolve their PED. A nonchalant or cooperative female attitude to PED improved the possibility of PED resolution. The other variables did not influence PED resolution. Our data showed that a clear-cut diagnosis of psychogenic erectile deficiency and some psychosocial factors were critical for the management of some patients with PED.

The first-line management of psychogenic non-epileptic seizures(PNES)in adults in the emergency:a practical approach

Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic challenge.Misdiagnoses are frequent,especially when video-EEG recording,the gold-standard for PNES confirmation,cannot be completed.The issue is further complicated in cases of combined PNES with ES.In emergency units,a misdiagnosis can lead to extreme antiepileptic drug escalade,unnecessary resuscitation measures(intubation,catheterization,etc.),as well as needless biologic and imaging investigations.Outside of the acute window,an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy.Early recognition is thus desirable to initiate adequate treatment and improve prognosis.Considering experience-based strategies and a thorough review of the literature,we aimed to present the main clinical clues for physicians facing PNES in non-specialized units,before management is transferred to epileptologists and neuropsychiatrists.In such conditions,patient recall or witness-report provide the first orientation for the diagnosis,recognizing that collected information may be inaccurate.Thorough analysis of an event(live or based on home-video)may lead to a clinical diagnosis of PNES with a high confidence level.Indeed,a fluctuating course,crying with gestures of frustration,pelvic thrusting,eye closure during the episode,and the absence of postictal confusion and/or amnesia are highly suggestive of PNES.Moreover,induction and/or inhibition tests of PNES have a good diagnostic value when positive.Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures,especially following bilateral tonic-clonic seizures.Finally,regardless the level of certainty in the diagnosis of the PNES,it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.

Differential diagnosis between epileptic seizures and psychogenic nonepileptic seizures based on semiology

Psychogenic nonepileptic seizures present as paroxysmal symptoms and signs mimicking epileptic seizures.The gold standard test is the synchronous recording by video,electrocardiogram and electroencephalogram.However,video electroencephalogram is not available at many centers and not entirely independent of semiology.Recent studies have focused on semiological characteristics distinguishing these two circumstances.Clinical signs and symptoms provide important clues when making differential diagnosis.The purpose of this review is to help physicians differentiating psychogenic nonepileptic seizures better from epileptic seizures based on semiology,and improve care for those patients.

An Unusual Case of Functional Neurological Disorders and Psychogenic Coma following Physical Assault:Clinical and Medico-Legal Considerations

Functional neurological disorders can have different clinical manifestations,including coma,in the setting of an unknown etiology.In this article,we present a case of a young man affected by intellectual disabilities who,after a physical assault reported serious neurological alterations and a functional coma.This case shows how a stressful psychophysical event can bring acute and variable neurological manifestations of functional significance to a victim with previous intellectual disabilities.Despite the growing interest in this field,research is still very limited and studies in this field could better explain the nature of the psychogenic coma.From a medico-legal point of view,problems of evaluation may emerge for these disorders emerge as a result of acute psycho-physical stress and without any detectable structural alterations.

The Molecularly Fielding Psychophysical Nature of the Brain Mental Activity

The brain is a unique organization in nature, having the psychic activity, which is expressed in subjective states: thoughts, feelings, emotions. Knowledge of the nature of mental activity of the brain is the most urgent and the most challenging task of physiology. Historically the neurophysiology developed on the basis of physical and chemical laws discovered in an inanimate nature. Our investigation is devoted towards the origin of a human subjective state, and presents a new methodology for studying of the nature psychic brain activity. We have established the existence of physical phenomena unique for the living brain so-called “psychogenic field”, which reflects the expressed psychic state of human brain. The subjective state of a human being was shown to affect remotely the physicochemical properties of the blood. An original schematic diagram is presented to describe the formation of the brain psychic activity. This approach is based on the feedback influence of a psychogenic field on neuronal molecular processes (self-induction in the brain). We propose a paradigm for the origin of psychic state and possible existence of the fields, which are unique for the brain. The presented scheme and paradigm of systemic organization of psychic activity of the brain are a prerequisite for the subsequent development of the theory consciousness.

To Knowledge of the Origin of the Brain Mental Activity

This paper is devoted towards the origin of a human subjective state, and we present a methodology for studying the origin of brain activity. We were first to reveal that the subjective states of a human being can be subjected to an objective remote registration. Recently we have established the existence of the so-called “psychogenic field”, which reflects the subjective state of human brain. The subjective state of a human being was shown to affect remotely the physicochemical properties of the blood. The interaction of neurophysiological and subjective processes is described in the context of systemic organization of a goal-directed behavior. An original schematic diagram is presented to describe the formation of a subjective brain state. This approach is based on the feedback influence of a psychogenic field on neuronal molecular processes (self-induction in the brain). We propose a paradigm for the origin of a subjective state and possible existence of physical phenomena and brain fields, which are unique for the active brain.

The psychophysics of а human brain subjective activity

Recently we have established the existence of a “psychogenic field”, which are most likely reflecting on the human brain subjective state. The goal of this study is to further explore the human subjective state which can be registered remotely and objectively in the context of human subjective state. The analysis of the remote influence of a human subjective state on the blood physical and chemical parameters appeared to be main driving horse. The concept of specific physical phenomena in the brain does not exist in the abiocoen. Future exploring pattern of the relationships between the neurophysiologic and subjective processes in the systemic organization of “goal-seeking” behavior suggests that the paradigm presuming the existence of physical phenomena as a unique interrelationship for the active human brain, and their role in the origin of a subjective state.

Seizures Related to Two-child Policy:A Case Report

From 1979 to 2012,the Chinese government implemented the one-child policy to control population growth.In 2013,families in which either parent was the only one child were allowed to apply for a second child.In 2016,China’s universal two-child policy was finally imposed.As such,many children who had always been the center of their family’s universe due to the unique family structure stemming from the one-child policy era became elder siblings during their adolescence.We report a case of a 9-year-old girl who developed seizures after the birth of her younger sister.The combination of clinical observation,laboratory examinations,and video-electroencephalography was not enough to make a confident diagnosis of epilepsy initially.Given her patient history and follow-up investigation,we speculated the two-child policy was related to her seizures.To our knowledge,this is the first report of seizures strongly related to the two-child policy.

A case of severe hyponatremia induced by duloxetine and ziprasidone

We report a case of severe hyponatremia related to duloxetine and ziprasidone. A 50-year-old woman on duloxetine and ziprasidone treatment for major depressive disorder developed polydipsia, polyuria, and two episodes of seizures, followed by admission to the emergency department on the 10th day of treatment. Laboratory investigations revealed elevated creatine kinase （CK） as well as hyponatremia, hypo-osmolality, and increased urine sodium. Syndrome of Inappropriate Antidiuretic Hormone （SIADH） was considered, although urine osmolality was not measured. Duloxetine and ziprasidone were discontinued and the CK gradually normalized after correction of hyponatremia. Clinicians should be aware of the possibility of antipsychotic-induced hyponatremia, particularly in patients with symptoms of polydipsia.