Semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs): an attempt towards a new classification.

This study was carried out to analyze the semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs) and to propose a modified new classification of PNESs. This retrospective analysis included 82 patients (M:F=38:44; mean age: 33.4 ± 12.0 years) diagnosed to have PNESs based on video-EEG recording. Detailed semiological characteristics including pattern of limb movements, body movements, psychological/emotional manifestations, "aura", level of consciousness, age at onset of PNESs, age at diagnosis, and history of AED intake were recorded. We classified our cohort of patients as per available classifications and proposed a modified new classification. Age at onset of PNESs was 21.8 ± 14.1 years (range: 2-64; median: 18.5 years), age at diagnosis was 29.3 ± 12.7 years (range: 2-67; median: 26.0 years), and delay in diagnosis was 7.4 ± 7.3 years (range: 0-28; median: 5.0 years). There were 369 recorded attacks (range: 1-10; median: 4). Prior to VEEG, 47 (57.3%) patients were incorrectly diagnosed as having true epileptic seizures initially and were on antiepileptic drugs (AEDs), 15 (18.3%) patients had an initial diagnosis of PNESs which remained unchanged after VEEG analysis, and 20 (24.4%) patients had both PNESs and epileptic seizures. We could not classify 40-66% of our patients into any of the available classification proposed by previous authors. We categorized all our patients into the following categories of a modified new classification: abnormal hypermotor response: 23 (28%), abnormal partial motor response: 18 (22%), affective/emotional behavior phenomena: 4 (4.9%), dialeptic type: 5 (6.1%), nonepileptic aura: 5 (6.1%), and mixed pattern: 27 (32.9%). Incorrect diagnosis of PNESs leads to unnecessary prescription of AEDs, with side effects and cost implications. A modified systematic classification of PNESs is proposed which would help in the better characterization of PNESs.

Bilateral self-enucleation in acute transient psychotic disorder: the influence of sociocultural factors on psychopathology.

Self-inflicted eye injuries are rare but a devastating consequence of a serious mental disorder. Bilateral self-enucleation also known as oedipism has been documented in ancient texts and myths. Various biologic, psychologic, and social theories have been put forward to explain this rare phenomenon. In this report, we describe a case of oedipism, which highlights the influence of sociocultural factors on the psychopathology in acute transient psychotic disorder.

Successful management of vaginismus: An eclectic approach.

Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, which interferes with coitus and causes distress and interpersonal difficulty. In this report, we describe the successful treatment of vaginismus in a 25-year-old lady based on a model proposed by Keith Hawton. The eclectic approach involved education, graded insertion of fingers, Kegel's exercises and usage of local anesthesia with vaginal containment along with the prescription of Escitalopram.

A prospective comparative study of interaction between lithium and modified electroconvulsive therapy.

OBJECTIVES: To compare patients on lithium and those not on lithium with regard to adverse effects while receiving ECT. METHODS: Inpatients with schizophrenia, non-organic psychosis, mania and depression, who were prescribed ECTs either on (n=27) or not (n=28) on lithium were studied. Clinicians blind to lithium-status recorded seizure parameters, interaction with succinyl choline, cardiovascular response, recovery from ECT and immediate post-ECT complications. RESULTS: The lithium group showed no significant difference in terms of seizure variables, apnea time, and recovery from anaesthesia when compared to the non-lithium group. Average maximum heart rate, average maximum systolic blood pressure and average maximum rate pressure product were significantly lower in patients who had combined lithium and ECT. In lithium patients the average time to post-ECT recovery was directly correlated with serum lithium level. CONCLUSIONS: Though concurrent lithium is by and large safe during ECT, it benefits to maintain serum lithium level at lower end of therapeutic range. However, the findings can be applied to relatively young patients with no risk factors for ECT-complications.

Disproportionately high rate of epileptic seizure in patients abusing dextropropoxyphene.

Dextropropoxyphene (DPP), a weak opioid, is often abused as a psychoactive substance. In this retrospective chart review to document, characterize and put in perspective the often-obtained history of epileptic seizures in patients with DPP abuse, we analyzed the case files of all patients with DPP abuse registered in our center (a tertiary-care drug de-addiction clinic in north India) from May 1, 2001 until April 30, 2007 and those with use of other opioids during the same period. Non-drug-related seizures were excluded from analysis. Out of 312 patients with DPP abuse, 63 (20.2%) had epileptic seizures related to DPP use, in contrast to 0.4% -4.2% of other opioid users. The seizures were mostly characterized as generalized tonic-clonic seizures (87.3%), occurring around two hours following a higher-than-usual dose of DPP. Those with seizures had significantly greater duration of DPP use and higher rates of medical comorbidity compared to patients without seizure. Age, duration of use and medical comorbidity were better predictors of seizure than dosage of drug or use of multiple drugs. Thus, DPP-induced epileptic seizures are common (one in five), and much more frequent than seizures in patients using other opioids. The awareness of this phenomenon has implications for diagnosis and management, as well as for drug regulation policy.