Sexual Abuse, Post-Traumatic Stress Disorder and Psychopathological Characteristics in Women with Functional/Dissociative Seizures.

BACKGROUND: Functional/dissociative seizures (FDS), also known as psychogenic non-epileptic seizures (PNES), are sudden, transient, and involuntary events that include motor, sensory, cognitive or autonomic function alterations. In this work we analyzed the psychopathological characteristics of a subgroup of women who suffer from FDS with the aim to analyze the role of psychological trauma, with special emphasis on trauma due to sexual abuse (SA). METHODS: Forty-five women diagnosed with FDS were included in the study (age range 18 to 64 years, mean = 34.7, standard deviation (SD) = 13.1). Clinical and psychopathological characteristics were reviewed. All patients have completed the clinical interviews, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II) and the Global Assessment of Functioning (GAF) according to a special protocol for mental health assessment. Also, the history of sexual abuse trauma, the history of other non-sexual traumas and absence of history of trauma were reviewed. RESULTS: Eighty percent of the cases reported a history of trauma, and 40% reported a history of SA. Patients with a history of SA presented a significantly lower average age of seizure onset than patients with a history of other non-sexual traumas (p = 0.021). Significant associations were found between SA and post-traumatic stress disorder (PTSD) (p = 0.031), and SA and history of suicide attempts (p = 0.037). CONCLUSIONS: SA carries serious implications for the mental health of women suffering from FDS. Mental health professionals must consider the history of this type of trauma to provide the necessary care for this patient population.

Cultural adaptation and psychometric properties of the Patient-weighted Quality of Life in Epilepsy 31 Inventory (QOLIE-31P) in Argentina.

OBJECTIVE: This study presents the cultural and linguistic adaptation and psychometric properties of the Argentine version of the Quality of Life in Epilepsy Inventory (QOLIE-31P) scale. METHODS: An instrumental study was carried out. A version of QOLIE-31P translated into Spanish was provided by the original authors. To assess the content validity, evaluation of expert judges was requested, and the degree of agreement was determined. The instrument was administered to 212 people with epilepsy (PWE) of Argentina, together with the BDI-II, B-IPQ and a sociodemographic questionnaire. A descriptive analysis of the sample was carried out. Discriminative capacity of the items was performed. Cronbach's alpha was calculated to assess reliability. To study the dimensional structure of the instrument, a confirmatory factorial analysis (CFA) was performed. Convergent and discriminant validity was tested through mean difference tests, linear correlation, and regression analysis. RESULTS: Aiken's V coefficients ranged between .90 and 1 (acceptable), which allows to state that a conceptually and linguistically equivalent version of the QOLIE-31P was reached. Cronbach's Alpha of 0.94 was obtained for the Total Scale (optimal). As a result of CFA, 7 factors were obtained, being the dimensional structure similar to the original version. Also, unemployed PWE reported significant lower scores than employed PWE. Finally, QOLIE-31P scores negatively correlated with depression symptom severity and negative illness perception. CONCLUSION: The Argentine version of the QOLIE-31P is a valid and reliable instrument, presenting good psychometric properties, such as high internal consistency and a dimensional structure similar to that of the original version.

Patients' Explanatory Models about drug-resistant epilepsy in Argentina. A thematic analysis.

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.

Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders.

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.

Report on a psychoeducational intervention for psychogenic non-epileptic seizures in 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.

¿Qué informa la prensa escrita argentina acerca del fenómeno de cyberbullying? / What does the argentine written press report about the phenomenon of cyberbullying?

Resumen En los últimos años, los términos bullying y cyberbullying se han ido instalando en los medios de comunicación argentinos, entre ellos en la prensa escrita. Se trata de términos técnicos, ya que hacen referencia a problemáticas específicas, que han sido adoptados por la prensa local a fin de dar cuenta, principalmente, de las características, consecuencias y posibles abordajes de estos fenómenos. Teniendo en cuenta que la lectura y análisis de aquello que publica la prensa respecto de un fenómeno permitiría observar aspectos interesantes del proceso de difusión de la información, del discurso empleado y del sentido colectivo que le otorga, el objetivo general de este trabajo se orientó a indagar el tipo de información y su contenido con respecto al fenómeno de cyberbullying en la prensa escrita argentina. Se discuten los hallazgos obtenidos mediante el empleo de un análisis temático y de contenido a fin de ampliar el conocimiento sobre este fenómeno en nuestro medio local.

Abstract In recent years, the terms "bullying" and "cyberbullying" have been adopted by the Argentinian media, including the written press. These are technical terms that refer to specific problems. The local press has adopted them in order to report about the characteristics, consequences, and possible approaches to these situations. The analysis of the press' publications on a certain phenomenon enables us to see interesting aspects of the process of dissemination of information, the discourse used and the collective consciousness it creates. Therefore, the general objective of this work is focused on investigating the type of information and contents regarding cyberbullying in the Argentinian press. A qualitative methodological approach was used, which included the use of a thematic and content analysis. It is noted that only a low proportion of journalism articles was found in which the three basic characteristics of the cyberbullying were pointed out (the intentionality, the repetition in time and the existence of an imbalance of power). In addition, it is observed that the written press provides more information related to the characteristics and possible approaches to cyberbullying, and, to a lesser extent, to its detection. The negative consequences of this problem regarding the psychological health of those involved are mentioned, highlighting indicators and individual consequences, but without referring to indicators or to collective, institutional or social consequences. The development of a hostile and unsupportive school environment, the normalization of aggressive behaviors, the positive assessment of violent behavior in order to obtain social success, and the possible consequences for teachers and families are not mentioned by the press. Also, it is observed that the press gives little room to the students' point of view, who, from their experiences, attitudes and perspectives on this phenomenon, could make important contributions for the development of both prevention strategies and effective boarding tools. The findings obtained are discussed through thematic and content analysis in order to broaden the knowledge about this phenomenon in our local environment. Within the limitations of this study, it is worth mentioning that the different publications began the digitization of their copies in different years, which could affect the total number of articles surveyed and the amount registered for each of the digital portals. Likewise, for this study, only two descriptors were used to carry out the search, so future studies could incorporate other terms in order to broaden and deepen the findings. This could also contribute to generate other analysis categories, in order to record other aspects related to the type and content of information not addressed in this study.

La experiencia de pacientes con crisis no epilépticas psicógenas: marcos interpretativos y de acción / A experiência de pacientes com crises não epiléticas psicogênicas: marcos interpretativos e de ação / The experience of patients with psychogenic non epileptic seizures: interpretative and action framework / L´expérience des patients atteints de crise psychogène non épileptique: cadres dinterprétation et daction

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.

Long-term outcome in a sample of underprivileged patients with psychogenic nonepileptic seizures (PNES) living in Argentina.

OBJECTIVE: The objective of the present study was to perform a long-term follow-up of economically disadvantaged Latin American patients diagnosed as having psychogenic nonepileptic seizures (PNES) and contribute 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 been communicated. However, the vast majority of these have been conducted in the first world countries with samples that were predominantly Caucasian. There is limited knowledge about outcome in economically disadvantaged Latin American patients diagnosed as having PNES. METHODS: This is a study of 23 patients (20 women, 3 men) with PNES in which 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 from this Argentinian PNES sample demonstrated having many similar demographic and clinical characteristics to samples from US and European studies. Long-term follow-up revealed, however, decreased seizure frequency and intensity as well as a substantial improvement in occupational status. A majority had engaged in psychotherapy as well as alternative and complementary approaches. A majority had also developed what are suspected to be other functional symptoms. CONCLUSIONS: Argentinian patients from economically disadvantaged backgrounds, diagnosed as having PNES reported improvements in seizure frequency and occupational status during long-term follow-up. Future studies will need to focus on what (e.g., communication of diagnosis, psychotherapy, alternative treatments) may have contributed to these changes.

Una aproximación a la conceptualización que poseen los docentes respecto del fenómeno de cyberbullying / An approach to teachers conceptualization with regard to the phenomenon of cyberbullying

El objetivo de este trabajo se orienta a indagar y describir las conceptualizaciones que docentes que ejercen su trabajo en escuelas de Educación Secundaria ubicadas en la Provincia de Buenos Aires (Argentina) poseen acerca del fenómeno de cyberbullying. A su vez, busca conocer y describir si dichos docentes cuentan con estrategias de intervención para abordar este fenómeno y su percepción acerca de la formación o capacitación para intervenir ante él. Mediante la realización de entrevistas semiestructuradas y el empleo de una metodología de enfoque cualitativo se construyeron categorías de análisis de la información recolectada. Los resultados hallados en este estudio sugieren la necesidad de brindar a los docentes información específica sobre la problemática, a fin de que puedan adquirir herramientas efectivas y contribuir con su adecuada prevención y abordaje.

The objective of this work is to investigate and describe the conceptualization that teachers who work in secondary schools in the Province of Buenos Aires (Argentina) have about the phenomenon of cyberbullying. At the same time, it pursues two more aims: to know if these teachers have intervention strategies to approach this phenomenon and to describe their perception about the training to intervene on it. Categories of analysis of the information collected were constructed through semi-structured interviews and the use of a methodology of qualitative approach. The results found in this study suggest the need to provide teachers with specific information on the problem, so that they can acquire effective tools and contribute to their adequate prevention and approach.

What patients think about psychogenic nonepileptic seizures in Buenos Aires, Argentina: A qualitative approach.

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.