Treatment and Diagnosis of Psychogenic Nonepileptic Seizures

Psychogenic nonepileptic seizure (PNES) is one of the most common clinical conditions in which the diagnostic complexity is experienced. Misdiagnosis leads to many years of wrong treatment regimens, side effects of drugs, additional financial burdens and adverse effects on social life. Differential diagnosis with epileptic seizures (ES) is one of the most common problems in neurology clinics as well as other health centers. A careful history from the patient and his relatives, detailed neurological and psychiatric examination are very important in reaching the correct diagnosis and treatment. Although imaging advances such as video electroencephalography (vEEG) have improved the ability of physicians to accurately identify these disorders, the diagnosis and treatment of PNES is still a challenging issue. Early diagnosis, young age, less psychiatric comorbidity have a positive effect on prognosis. Psychiatric evaluation of patients with PNES may be particularly helpful in elucidating the etiology and detecting comorbid diseases and may be helpful in the long-term treatment of these patients

Anxiety Disorders and Suicide: Psychiatric Interventions

A universal phenomenon equally ancient as the history of mankind, suicide is defined as the willful and intentional ending of one’s own life. Risk factors for suicidal behavior are traumatic childhood and adulthood experiences, negative interfamily interactions, social isolation, decreased social solidarity, financial troubles, losses, despair, impulsivity, and migration. Recognized as a critical public health problem, preliminary causes of suicide are financial, religious, political, social, cultural, and medical in addition to mental disorders like depression and alcohol addiction. It has been proven in a number of researches till today that there is a correlation between major depression, bipolar disorder, schizophrenia, borderline personality disorder, alcohol-drug use, and suicidal behavior. Nonetheless, the relation between anxiety disorders and suicidal behavior has not been clearly defined to date. The evidences gathered so far reveal that panic disorder is only an independent risk factor for suicide attempt. The limited number of studies on this domain provided nonhomogenous results. It is however a point to keep in mind that if anxiety disorders are codiagnosed with mental disorders, they pose risk for suicidal behavior. In different studies with a wider sampling in this domain, analyzing the effect of specific anxiety disorders on suicidal behavior might be useful for suicide prevention programs

The Psychosocial Aspect of Infertility

For both partners, infertility is a complex and situational crisis that is generically psychologically threatening, emotionally stressful, financially challenging, and physically painful most of the times due to diagnostic-curative operations undergone. Infertility triggers a range of physical, psychological, social, emotional, and financial effects. Although it is not a life-threatening problem, infertility is yet experienced as a stressful life event for couples or individuals due to the exalted value attributed to having a child by individuals themselves or society in general. Infertile couples are not facing a medical condition alone but coping with a number of emotional states as well. Emotions, thoughts, and beliefs of infertile couples frequently change as one consequence of infertility diagnosis. Exposed to a tremendous social pressure, infertile couples may resort to hiding the problem due to the extreme privacy of the matter. Infertility also affects marriage life adversely

Eating Disorders with Comorbidity Anxiety Disorders

Although eating disorders and anxiety disorders (AD) are under different diagnosis categories, it is striking that they have high comorbidity and similar clinical features. The most frequently informed anxiety disorders are obsessive-compulsive disorder (OCD), social anxiety disorder (SAD) and generalized anxiety disorder (GAD). Moreover, in cases with a tendency of perfectionism, concern and harm avoidance before the diagnosis of eating disorder, the anxiety disorder is able to be failed to notice. The existence of anxiety disorder or eating disorder makes these syndromes worse. Until today, the relation in between eating disorder and AD has tried to be clarified by phenomenological, neurobiological and family studies. But even if a significant relation has been specified in phenomenological aspect in between OCD and eating disorders, the relation in between eating disorders and other AD is not clear. The existence of AD may be a risk factor in the arise of eating disorders. Therefore, diagnosis and treatment of childhood-adolescence occurring AD may prevent the development of eating disorders. The comorbidity of eating disorders and AD is negatively affecting the treatment and prognosis of the disorder. Moreover, there is limited evidence regarding the effectiveness of treatment options (medication, cognitive behavioral therapy (CBT), family therapy, dialectic behavioral therapy, interpersonal therapy) used in the treatment of cases with a diagnosis of concurrent eating disorder and anxiety disorder. In this chapter, a review of the literature on the comorbidity between eating disorders and the anxiety disorders of OCD, posttraumatic stress disorder (PTSD), SAD, GAD, simple phobia, agoraphobia and panic disorder

A 3-DoF Robotic Platform for the Rehabilitation and Assessment of Reaction Time and Balance Skills of MS Patients

The central nervous system (CNS) exploits anticipatory (APAs) and compensatory (CPAs) postural adjustments to maintain the balance.The postural adjustments comprising stability of the center of mass (CoM) and the pressure distribution of the body influence each other if there is a lack of performance in either of them.Any predictable or sudden perturbation may pave the way for the divergence of CoM from equilibrium and in homogeneous pressure distribution of the body.Such a situation is often observed in daily livings of Multiple Sclerosis (MS) patients owing to their poor APAs and CPAs, and induces their falls.The way of minimizing risk of falls in neurological patients is utilizing perturbation-based rehabilitation, as it is efficient in the recovery of the balance disorder.In the light of the findings, we present the design, implementation, and experimental evaluation of a novel 3 DoF parallel manipulator to treat the balance disorder of MS.The robotic platform allows angular motion of the ankle based on its anthropomorphic freedom.The end-effector endowed with upper and lower platforms is designed to evaluate both the pressure distribution of each foot and the CoM of the body, respectively.Data gathered from the platforms are utilized to both evaluate performance of the patients and used in high-level control of the robotic platform to regulate the difficulty level of tasks.In this study, kinematic and dynamic analyses of the robot are derived and validated in the simulation environment. Low-level control of the prototype is also successfully implemented through PID controller.The capacity of each platform is evaluated with a set of experiments considering assessment of pressure distribution and CoM of the foot-like-objects on the end-effector. Experimental results indicate that such a system well-address the need for balance skill training and assessment through the APAs and CPAs.Comment: 12 figures, 29 pages, PLOS ON

The Relation Between Cognitive Awareness of Reading Strategies and Writing Anxiety

This study aims to determine the cognitive awareness of reading strategies of secondary school students, the relation between the cognitive awareness of reading strategies and writing anxiety, and the common effect of some variables on cognitive awareness of reading strategies. This quantitative study is an example of a relational survey model with correlational research features. Data have been collected through two different scales. 339 secondary school students have participated in this research. Mean, frequencies, standard deviation, Pearson Correlation Coefficient, Simple Linear Regression, and Two Way Anova have been used for data analysis. As a result of the study, secondary school students have good cognitive awareness of reading strategies, and there is a negative relation between cognitive awareness of reading strategies and writing anxiety. Verbal academic success is a predictor of cognitive awareness of reading strategies, and the common effect of gender and writing anxiety doesn’t influence cognitive awareness of reading strategies

Real-Time MRI of Continent and Stress Incontinent Male Patients after Orthotopic Ileal Neobladder

Introduction: The aim of this study was to correlate anatomic differences with continence status in male patients after cystoprostatectomy and ileal neobladder using real-time magnetic resonance imaging. Patients and Methods: Anatomic differences of 14 male patients (7 daytime continent and 7 stress incontinent) with ileal neobladder were determined by measuring the orthogonal distance of the bladder neck to the pubococcygeal line (PCL) to correlate anatomic differences with continence status. Results: The median distance of the bladder neck to PCL was +5.4 mm in continent patients before voiding whereas in incontinent patients it was +2 mm (p = 0.012). During the Valsalva maneuver, the median distance in continent patients was +4 and in incontinent patients -3 mm (p = 0.003). At the end of micturition, the median distance was +2.3 mm in continent patients and -12 mm in incontinent patients (p = 0.002). Conclusions: The bladder neck in incontinent patients showed more pronounced mobility in relation to the PCL during micturition and the Valsalva maneuver as compared to continent patients. In addition, the ileal neobladder was positioned significantly lower in the pelvis of incontinent patients. These preliminary results suggest that a stable bladder neck may be an important factor to reach full continence in patients with ileal neobladder. Copyright (C) 2011 S. Karger AG, Base

What is Capgras Syndrome? Diagnosis and Treatment Approach

Capgras delusion is a complex psychopathological phenomenon that presents in a wide range of psychiatric and neurological disorders with differing patterns dependent on the main etiology. An underlying neurological disease should be suspected where the delusion concerns a spouse or inanimate objects and is associated with visual hallucinations, while a functional disorder is suggested by multiple imposters, strangers, additional delusions, and auditory hallucinations. Misidentifications in Capgras syndrome (CS) are fixed false beliefs and, therefore, represent true delusions. Even if when patients are confronted over and over with the illogical nature of the delusion, they keep their beliefs. Surprisingly, patients may show implicit or explicit awareness of their true situation. Some research suggests that a considerable number of patients with CS have some awareness of the bizarre nature of the misidentification delusions and therefore tend not to report them, especially during initial interviews when they are less likely to be confident with the clinician. Specific questions and interventions may assist clinicians in successfully identifying patients with CS. In a series of interviews with these patients, some focus on identifying CS, rather than a single interview which is likely to increase the detection of the delusional misidentification. The clinician should always be mindful of the risk of aggression and homicide in CS