ABSTRACT
The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).
Subject(s)
Developing Countries , Epilepsy/epidemiology , Patient Acceptance of Health Care/statistics & numerical data , Psychotic Disorders/epidemiology , Schizophrenia/epidemiology , Adolescent , Adult , Complementary Therapies/statistics & numerical data , Cross-Sectional Studies , Epilepsy/diagnosis , Epilepsy/therapy , Family Practice/statistics & numerical data , Female , Health Services Accessibility/statistics & numerical data , Health Services, Indigenous/statistics & numerical data , Homeopathy/statistics & numerical data , Humans , Malaysia , Male , Middle Aged , Primary Health Care/statistics & numerical data , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Referral and Consultation/statistics & numerical data , Schizophrenia/diagnosis , Socioeconomic FactorsABSTRACT
El análisis de los síntomas y signos clínicos obtenidos por medio de un interrogatorio detallado y por la observación secuencial de los fenómenos motores a través de técnicas de monitoreo continua TV-EEG constituye una herramienta poderosa para establecer el diagnóstico topográfico de los pacientes con crisis parciales de difícil control en los cuales se complementa un tratamiento quirúrgico ablativo. Las alteraciones de la conciencia. Las auras y síntomas somatosensoriales, visuales y auditivos localizan el origen y la propagación de las crisis dentro de las cortezas primarias SI, VI y AI en el hemisferio. Los fenómenos motores representan la expresión sintomática de las crisis que se originan en, o se propagan a distinto territorios corticales: Las contracciones musculares focales con marcha Kachsoniana y parálisis de Tood apuntan al área Rolándica. El arreste conductual y los automatismos oroalimentarios y exploratorios al área temporal mesial. Los movimientos tónicos posicionales abruptos al área motora suplementaria; los movimiento versivos a las áreas frontopolar y dorsolateral; y la supresión del habla al opercular y al área temporal lateral. La progresión y secuencia de los síntomas y fenómenos motores durante las crisis permite diferenciar el origen (lesión, foco y área epileptógena) de la propagación (área sintomática) lo cual es factible en aquellas que se propagan lentamente a sitios distantes