Optimism and pessimism as predictors of seizure group among patients with intractable seizure disorders.

The purpose of this study was to investigate the validity of the Revised Optimism-Pessimism Scale (PSM-R) as a measure of attributional style, and the incremental utility of optimism and pessimism as predictors of seizure group, in an intractable seizure disorder sample. Participants included adult patients with epileptic seizures (ES; n = 151) and psychogenic nonepileptic seizures (PNES; n = 173) whose diagnoses were confirmed by prolonged video/EEG monitoring (PVEM). Optimism and pessimism scores were computed from abbreviated versions of the MMPI for all participants. Analyses were conducted to examine the relationships between optimism, pessimism, and MMPI clinical scale scores. Logistic regression analyses were conducted to generate a model for the prediction of seizure group. Results supported the validity of the PSM-R as a measure of attributional style in an intractable seizure disorder sample. Both optimism and pessimism provided significant incremental predictive utility over and above other predictors of seizure group. There are advantages of using the proposed prediction model over other alternative differential diagnostic procedures, including lower cost, greater availability, and increased standardization. Overall, results indicated that attributional style is a clinically relevant index of personality and cognitive response to stress among an intractable seizure disorder sample.

Flourishing among Children and Adolescents with Chronic Pain and Emotional, Developmental, or Behavioral Comorbidities.

Pediatric chronic pain is an important public health issue given its notable impact on numerous domains of living. Pediatric chronic pain is also often comorbid with emotional, developmental, or behavioral conditions, which can lead to more severe negative outcomes and an even greater reduction in positive outcomes compared to those without comorbidities. Flourishing is a positive outcome that chronic pain status has been shown to impact. Flourishing in children aged 6-17 years living with chronic pain, as well as those with chronic pain and comorbidities, was explored using data from the 2018/2019 National Survey of Child Health. Chronic pain occurred in 4.0% of our sample, and the prevalence of chronic pain plus comorbidities was 3.9%. There were significant associations between the chronic pain condition status and all demographic variables (sex, age, race/ethnicity, poverty level, parental education, and health insurance status). The results of the hierarchical logistic regression found that the chronic pain condition status significantly predicted flourishing. Children with chronic pain were 2.33 times less likely to flourish, and children with chronic pain plus an emotional, developmental, or behavioral comorbidity were 13 times less likely to flourish than their typical peers. Given their significantly lower likelihood of flourishing, there is an urgent need for interventions targeted at children experiencing chronic pain and mental health comorbidities.

Use of vacuum-assisted closure (VAC) therapy in treating lymphatic complications after vascular procedures: new approach for lymphoceles.

OBJECTIVE: Lymphatic complications, such as lymphocutaneous fistula (LF) and lymphocele, are relatively uncommon after vascular procedures, but their treatment represents a serious challenge. Vacuum assisted closure (VAC) therapy has been reported to be an effective therapeutic option for LF, but the effectiveness of VAC therapy for lymphoceles is unclear. METHODS: For LF, we apply the VAC directly to the skin defect after extending it to achieve a clean wound of at least one inch in length. To treat lymphocele, we convert the lymphocele to a LF in a sterile fashion by making a one inch incision in the overlying skin and applying the VAC. The setting was a community teaching hospital. We used 10 patients that we treated with VAC therapy for LF (n = 4) and lymphoceles (n = 6). RESULTS: Duration of in-patient stay, duration of in-patient VAC treatment, duration of out-patient VAC treatment, total duration of VAC treatment. The median duration of in-patient stay was 4 (range, 0-18) days, the median duration of in-patient VAC treatment was 1 (range, 0-5) days, the median duration of out-patient VAC treatment was 16 (range, 7-28) days), and the median total duration of VAC therapy was 18 (range, 13-29) days. Successful wound healing was achieved in all patients with no recurrence after VAC removal. VAC therapy for treatment of both LFs and lymphoceles resulted in early control of drainage, rapid wound closure, and short hospital stays. CONCLUSION: Our results suggest that VAC therapy is a convenient and effective therapeutic option for both LFs and lymphoceles.

Optimism, pessimism, and neuropsychological performance across semiology-based subtypes of psychogenic nonepileptic seizures.

Past research has suggested that pessimistic attributional style may be a risk factor for psychopathology among patients with seizure disorders. In addition, classifying psychogenic nonepileptic seizures (PNES) into subtypes has been found to be clinically relevant. However, very few studies have addressed differences in optimism, pessimism, or neuropsychological performance among PNES subtypes. We previously classified adults with PNES into semiology-based subtypes (catatonic, minor motor, major motor). In the study described here, we compared subtypes on optimism, pessimism, depressive symptoms, and neuropsychological performance. We found that patients with PNES with low optimism had significantly greater depressive symptoms than patients with high optimism, F(2, 39)=36.49, P<0.01). Moreover, patients with high pessimism had significantly greater depressive symptoms than patients with low pessimism, F(2, 39)=13.66, P<0.01. We also found that the catatonic subtype was associated with fewer depressive symptoms and better verbal memory than the other PNES subtypes. Our results support relationships between optimism, pessimism, and depressive symptoms and extend these findings to a PNES sample. Overall, the results of the present study suggest that classification into semiology-based subtypes and study of normal personality traits among patients with PNES may have clinical significance.

Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke.

BACKGROUND: Constraint-induced aphasia therapy (CIAT) offers potential benefits to individuals with history of aphasia-producing ischemic stroke. The goals of this pilot study were to implement the original German CIAT protocol, refine the treatment program, and confirm its efficacy in patients with chronic aphasia. MATERIAL/METHODS: We translated and modified the original CIAT protocol to include a hierarchy of individual skill levels for semantic, syntactic, and phonological language production, while constraining non-use behaviors. Three male participants with moderate to severe post-stroke aphasia received CIAT 3-4 hours/day for 5 consecutive days. Pre and post-testing included formal language evaluation, linguistic analysis of story retell, and mini-Communication Activity Log (mini-CAL). RESULTS: Substantial improvements in comprehension and verbal skills were noted in 2 patients with an increase in the total number of words (31% and 95%) and in number of utterances for story-retell task (57% and 75%). All participants demonstrated an improvement on at least one linguistic measure. No subjective improvements on mini-CAL were noted by any of the participants. CONCLUSIONS: Given that the duration of treatment was only 1 week, these linguistic improvements in post stroke aphasia participants were remarkable. The results indicate that the CIAT protocol used in this study may be a useful tool in language restoration after stroke. These initial findings should be confirmed in a larger, randomized study.

Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile.

Subtypes of psychogenic nonepileptic seizures (PNES) have emerged via classification of seizure semiology, psychological variables, or both. PNES subtypes that differ with respect to etiology may be amenable to targeted treatment strategies. The aim of the present study was to investigate the relationship between semiology type and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profile among patients with PNES. We did so by modifying a classification scheme proposed by Selwa et al. Our main hypothesis was that there would be significant associations of semiology-based subtypes with psychological profiles among patients with PNES. We found significant differences in mean scores on MMPI-2 clinical scales 1 (Hypochondriasis) and 3 (Hysteria) and Harris-Lingoes subscales D5 (Brooding) and Sc5 (Lack of Ego Mastery, Defective Inhibition) across PNES subtypes (catatonic, minor motor, major motor). The results of the present study enhance understanding of the nosology of PNES by identifying psychopathological correlates of semiology-based subtypes of PNES. Our study also may inform the methodology of future investigations of psychopathology among patients with PNES by providing support for content-based interpretation of the MMPI.

Measuring depressive symptoms among treatment-resistant seizure disorder patients: POMS Depression scale as an alternative to the BDI-II.

Major depressive disorder (MDD) is the most prevalent psychiatric comorbidity among patients with treatment-resistant seizures. The Beck Depression Inventory-II (BDI-II) is often used to measure the severity of self-reported depressive symptoms among patients with seizure disorders. In contrast, researchers often use the Profile of Mood States (POMS) Depression (D) scale to assess depressed mood among other medical patient groups. The clinical significance of POMS-D scores among seizure disorder patients is not clear. In this study, we computed the correlation of POMS-D and BDI-II scores, determined a formula for converting POMS-D scores to BDI-II scores, and computed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the POMS-D among seizure disorder patients. Two BDI-II cutoffs (BDI-II16 and 20) were used as criteria for significant reported depressive symptoms. We found a strong correlation between POMS-D and BDI-II scores. Analyses indicated that POMS-D scores strongly predict BDI-II scores. In addition, the sensitivity, specificity, PPV, and NPV values obtained demonstrated that POMS-D scores accurately classify seizure disorder patients who endorse significant depressive symptoms. These results suggest that the POMS-D may be effective in measuring reported depressive symptoms among seizure disorder patients.