Psychogenic non-epileptic seizures and psychoanalytical treatment: results / Crises não epilépticas psicogênicas e tratamento psicanalítico: resultados.

Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes. .

Introdução: estima-se que o número de casos de pacientes com crises não epilépticas psicogênicas (CNEP) seja de 2 a 33 por 100 mil habitantes. O índice de CNEP corresponde ainda a, aproximadamente, 19% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como portadores de epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivo: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP de forma a avaliar a evolução do quadro clínico de CNEP e verificar sua associação com gênero, tempo de crise, prejuízos sociais, afetivos e profissionais, bem como término do tratamento. Métodos: a casuística foi composta por 37 pacientes com diagnóstico de CNEP feito por meio da monitoração por vídeo-EEG. Foram realizadas sessões de tratamento psicanalítico: atendimento clínico individual com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n = 11) de cessação/cura dos sintomas e 51,4% (n = 19) de redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e gênero (p<0,01), religião (p<0,01) e término do tratamento (p<0,01). Conclusão: este estudo apontou eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises. .

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin? / Crises não-epilépticas psicogênicas e distúrbios do movimento psicogênicos: dois lados da mesma moeda?

Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.

Crises não-epilépticas psicogênicas (CNEP) e distúrbios do movimento psicogênicos (DMP) são comuns na prática e na atualidade são melhor categorizados no DSM-V como distúrbios neurológicos funcionais/desordens de conversão. Esta revisão enfatiza os principais dados históricos, epidemiológicos, clínicos, critérios diagnósticos, tratamento e o prognóstico destes pacientes, frequentemente negligenciados e desafiadores, os quais, como um grupo, tem intrigado gerações de neurologistas e psiquiatras, caracterizando, de forma justificada o elo definitivo entre estas especialidades.

Efficacy of electroconvulsive therapy in a case of conversion disorder associated with mood disorder

Conversion disorder is a type of disturbance in physical functions that does not conform to anatomical and physiological functions of central or peripheral nervous system. Being more common among adolescents, this disorder occurs following stress and results in disturbed organic functioning. Despite the high prevalence of its classic picture, this disorder also creates various uncommon clinical pictures and is often associated with the diagnosis of mood disorders, anxiety disorders and schizophrenia. The reported case was an example of conversion disorder associated with mood disorder presenting with severe elbow and finger contractions of the left side that occurred following trauma to the same hand and was associated with mood swings, aggression and suicidal ideas. All symptoms improved following electroconvulsive therapy. In patients with physical symptoms and signs, looking for personal and social factors is very important. Moreover, evaluation of other concurrent psychiatric disorders and their treatment is worthwhile

Paradoxical Therapy in Conversion Reaction

Paradoxical therapy consists of suggesting that the patient intentionally engages in the unwanted behaviour such as performing compulsive ritual or wanting a conversion attack. In this study, the subjects were selected by the emergency unit psychiatrist from patients who were admitted to the emergency unit with pseudoseizure. The diagnoses was based on DSM-IV criteria. Paradoxical intention was applied to half of the 30 patients with conversion disorders; the other half were treated with diazepam in order to examine the efficiency of the paradoxical intention versus diazepam. In both groups the differences of the anxiety scores at the beginning of the study were found to be insignificant (z=1.08, p=0.28). Of the 15 patients who completed paradoxical intention treatment, 14 (93.3%) responded favorably to paradoxical intention. On the other hand of 15 patients who completed diazepam therapy, 9 (60%) responded well to therapy and 6 patients carried on their conversion symptoms at the end of 6 weeks. Paradoxical intention-treated patients appeared to have greater improvements in anxiety scores (z=2.43, p<0.015) and conversion symptoms (t=2.27, p=0.034) than the diazepam-treated patients. The results of the present study are encouraging in that paradoxical intention can be effective in the treatment of conversion disorder.

Los medicamentos histéricos: Ignatia, Moschus, Nux moschata / Medicaments used for the hyteria: Ignatia, Moschus, Nux moschata

Se pretende realizar una ejercitación de materia médica comparada con los principales medicamentos de la HISTERIA, destacando sus caracteres diferenciales en un cuadro comparativo. Se describen los síntomas definitorios de Moschus y Nux Moschata los cuales junto con Ignatia son considerados como la "tríada de los histéricos". Nos referiremos a esta "tríada de histéricos", desarrollando las características más destacadas de MOSCH y NUX-M., presentando al final una sinopsis comparativa de los 3, por sus síntomas histéricos tal como figuran en el Moderno Repertorio de Kent del Dr. Francisco X. Eizayaga, con el agregado complementario de otros medicamentos afines. Previamente daremos un rápido repaso a los cuadros Histéricos e Histeriformes, clasificados como TRASTORNOS SOMATOFORMES por la American Psychiatric Association (DSM IV, Diagnostic and Statical Manual of Mental Disorders)

Trastornos somáticos funcionales / Functional somatic disorders

Los autores contemplan una serie de trastornos cuya incidencia contrasta con las dificultades diagnósticas. En cada grupo de patología se muestra un caso clínico característicos; se proponen a continuación una serie de medidas terapéuticas generales para cada uno de los casos y se expone finalmente un cuadro resumen en el que se trata de sintetizar la clínica y los factores circunstanciales