Dissociation and childhood abuse history in epileptic and pseudoseizure patients.

The aim of this study was to examine dissociative experiences, childhood abuse and anxiety in epileptic and pseudoseizure female patients. Thirty-three patients with pseudoseizures and thirty patients with epilepsy were recruited from Cumhuriyet University Hospital Psychiatry and Neurology Units.We assessed each participant using the Dissociative Experiences Scale, the Clinician-Administered Dissociative States Scale and the Childhood Abuse and Neglect Questionnaire. The female patients with pseudoseizures showed significantly higher levels of dissociative experiences and childhood trauma. Epileptic female patients showed higher levels of anxiety. The significantly higher incidence of dissociative experiences and childhood trauma in the patients with pseudoseizures makes a case for dissociation in the pathogenesis of these seizures.     

Alexithymia and dissociative tendencies in an adolescent sample from Eastern Turkey

Alexithymia and dissociative reactions are two strategies that have been put forward as coping mechanisms to alleviate painful emotions. Adult studies reveal an association between alexithymia and dissociation. In line with the coping hypothesis, it was predicted that the relationship between alexithymia and dissociative tendencies would be partly mediated by current levels of stress and past traumatic experiences. Dissociation may also be related to enhanced fantasizing, although alexithymia has traditionally been associated with an incapacity to fantasize. This relationship has not been studied well in adolescents. In the present study, 173 randomly selected high school students from Eastern Turkey were assessed with the Adolescent Dissociative Experiences Scale, the Beck Depression and Anxiety inventories, the Rosenberg Self-esteem Scale and the Toronto Alexithymia Scale. Correlation analyses followed by stepwise regression analyses were performed. "Difficulty identifying feelings" subscale of Toronto Alexithymia Scale, anxiety level and the history of physical abuse emerged as predictors of dissociative tendencies. It seems that in this group, dissociation is associated with anxiety and with difficulty in identifying feelings. Physical abuse also contributes to dissociation. The adolescent who is alexithymic may be more prone to dissociation when compared to their non-alexithymic peers. Helping alexithymic adolescents describe their body experiences may decrease their tendency to dissociation by increasing their ability to verbally identify their stressors.     

Epilepsy and pseudoseizures derived from their dissociation]

Many epileptic patients have pseudoseizures (psychogenic nonepileptic seizures mimicking epileptic seizures) derived from their dissociation (conversion) or other psychiatric symptoms. The pseudoseizure cast many problems on medical support for their management. In this article I reported the result of investigation of pseudoseizures in an epilepsy unit in department of psychiatry, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry. And I reffered to treatment and prognosis of pseudoseizures. The key points for psychiatrists in treating epileptic patients having pseudoseizures were; 1) not to hesitate to consult with specialists about diagnosis, 2) to distinguish a pseudoseizure from an epileptic seizure and to treat them separately, 3) not to treat seizure phenomena but patients by keeping reliable relationship with them.     

The relationship of gender,gender identity,and coping strategies in late adolescents

The relationships among gender, gender identity, and coping in late adolescents were examined. One hundred sixty-nine late adolescents completed measures assessing their masculinity and femininity, as well as their use of coping strategies. Females endorsed greater use of emotion-focused coping strategies than males. Late adolescents who were high in masculinity endorsed higher levels of problem-focused coping strategies than those who were low in masculinity. In contrast, late adolescents who were high in femininity endorsed higher levels of emotion-focused coping strategies than those who were low in femininity. Neither the gender nor the masculinity and femininity of late adolescents were predictive of the use of avoidant coping strategies. Overall, gender identity made an important and independent contribution to the endorsement of coping strategy use. These results emphasize the importance of assessing both gender and gender identity with regard to coping in late adolescents.     

Pseudoseizures and asthma

BACKGROUND: Sexual abuse and head injury are important risk factors of pseudoseizures, reported in about a third of patients. Clinical experience suggests that asthma is another possible risk factor. OBJECTIVES: To determine the relative prevalence of asthma in patients with pseudoseizures. METHODS: A retrospective record review was undertaken of reported asthma in 102 patients with pseudoseizures and 70 psychotic controls. The pseudoseizure patients were subgrouped according to method of diagnosis: 47 in whom epilepsy was excluded by capturing a typical attack on video-electroencephalographic monitoring (VEEM), and 55 not diagnostically confirmed with VEEM. RESULTS: Asthma was reported in 26.5% of pseudoseizure patients, compared with 8.6% of the psychotic controls (chi(2) = 8.6; p = 0.003). Asthma was reported at similar rates in the VEEM confirmed (29.8%) and non-VEEM confirmed (23.6%) pseudoseizure subgroups. The significant excess of reported asthma held for both the VEEM confirmed subjects (Pearson's chi(2) = 5.4, p = 0.02) and non-VEEM confirmed subjects (Pearson's chi(2) = 8.9, p = 0.003). CONCLUSIONS: There is an association between pseudoseizures and reported asthma. Various models are proposed whereby somatisation, anxiety hyperventilation, and dissociative elaboration may account for the observed association. Both asthma and anxiety hyperventilation may be important risk factors for the development of pseudoseizures. The reported asthma may itself be psychogenic in origin in a proportion of patients. Confirmatory prospective studies are indicated.     

The varied relationship between hypnosis and dissociative phenomena: Implications for traumatology

ABSTRACT

Although metanalytic evidence exists to support the long-term efficacy of hypnotic interventions in the treatment of trauma, assertions that hypnosis may induce trauma or exacerbate existing posttraumatic reactions through activating dissociative processes seem to persist in some circles. While multiple studies have established that hypnotic induction produces dissociative phenomena, what has not yet been clearly explicated is the degree to which varieties of dissociative phenomena differentially elicited by hypnotic induction tend to skew toward the pathological or nonpathological end of the continuum of dissociation. The authors of the current study explore the connection between hypnotic susceptibility and facets of dissociation, employing the Harvard Group Scale of Hypnotic Susceptibility: A (HGSHS:A) and the State Scale of Dissociation (SSD). A significantly greater change in state dissociation was observed in their hypnosis condition as compared with a novel control condition (t (82) = 3.235, p =.002, d =.70), confirming that a relationship appears to exist between hypnosis and dissociation. A discussion of the differential effect of hypnosis on SSD subscales follows, specifically indicating less activation of the more putatively pathological facets, namely identity confusion and identity alteration. This finding may serve to assuage some concerns around the potential for iatrogenesis in working with traumatized patients.     

Families of adolescents and adults with autism spectrum disorders in Taiwan: The role of social support and coping in family adaptation and maternal well-being

In this study we examined differences in social support and coping between mothers of adolescents and adults with an autism spectrum disorder (ASD) in Taiwan and the United States and to investigate the effects of social support and coping strategies on family adaptation and maternal well-being. Participants were 76 Taiwanese mothers who had at least one son or daughter with an ASD (10 years old and older), and a comparison group of 325 mothers in the United States matched on the age range of the child with an ASD. Mothers completed self-administered, written questionnaires and participated in an interview. Taiwanese mothers reported significantly greater use of problem-focused and emotion-focused coping strategies than did mothers in the United States. For Taiwanese families, greater use of problem-focused coping strategies was associated with lower levels of depressive symptoms and anxiety. Emotion-focused coping mediated the relationships between ethnicity/culture and several outcome measures: family adaptability, family cohesion, and maternal depressive symptoms. The higher levels of emotion-focused coping in Taiwanese mothers appeared to account for their lower levels of family adaptability and cohesion and higher levels of maternal depressive symptoms. The results from this cross-cultural study helped determine the role of social support and coping strategies in family adaptation and maternal well-being in families of individuals with an ASD in each culture. Implications for service delivery are discussed.     

Impaired motor function in patients with psychogenic pseudoseizures

PURPOSE: To evaluate motor speed and grip strength in patients with well-documented psychogenic pseudoseizures. METHODS: We analyzed manual motor speed and grip strength in a group of 40 patients with confirmed psychogenic pseudoseizures (without evidence of concomitant epilepsy) and a group of 40 normal controls matched for handedness and gender, and of comparable age. The two groups were compared with respect to manual motor performance with the dominant hand, nondominant hand, and asymmetry between the dominant and nondominant hands. For the patient sample, we reviewed the neurologic history. RESULTS: Patients with pseudoseizures performed more poorly than controls with both dominant and nondominant hands. In addition, pseudoseizure patients failed to demonstrate the dominant-hand advantage observed in the normal control subjects on both tasks. The patient group had a high incidence of head trauma and other antecedent neurologic risk factors, and the proportion of left-handers was 3 times higher than expected. CONCLUSIONS: Bilaterally reduced motor speed and grip strength, reduced intermanual performance asymmetry, the high percentage of left-handers, and historical evidence of antecedent insults to the brain indicate that frontal lobe impairment may be common in patients with psychogenic pseudoseizures.     

Epileptic Seizures and Pseudoseizures from the Viewpoint of the Hierarchy of Consciousness

Summary: Epileptic seizures and pseudoseizures in temporal lobe epilepsies were studied from the viewpoint of the hierarchy of consciousness. Twenty-two patients with temporal lobe epilepsies (TLE) who showed true amnesia or impairment of consciousness developing from the dreamy state, even though their actions and movement continued, were selected among 160 patients with TLE. nine patients with manifested pseudo-seizures, pseudoseizure status, and complex partial seizure status (CPSE) were investigated. Twelve, patients in whom impairment of consciousness followed the dreamy state recognized their own existence and maintained some self-directed consciousness. The other 10 patients with amnesia were aware of their goals. Furthermore, pseudostatus ranged from epileptic seizures during pseudoseizure status to pseudoseizures during status epilepticus (SE). In some cases of CPS, awareness and self-directed consciousness were only partially pseudoseizures, disorders of self-directed consciousness are assumed to influence awareness and arousal.     

Tuesday July 4, 200615:00–17:00Hall 3ADiscussion Group SessionPsychogenic pseudoepileptic seizures; a critical review of etiological factors, diagnostic procedures, and treatment outcomes

¹ B. Schmitz (   ¹ Department of Neurology, Campus Virchow-Klinikum, Charité, Berlin, Germany )
The diagnosis of dissociative seizures is not difficult in the majority of cases. The prognosis is however much poorer than the prognosis of epileptic seizures and treatment strategies have not been systematically evaluated. Surprisingly little research has focused on psychological mechanisms underlying the development of pseudoseizures.
The lecture will summarise the existing literature on psychological etiological factors including traumatic events and childhood abuse as well as gender aspects in patients with exclusive pseudoseizures and in patients with epilepsy plus pseudoseizures.     

Provocation of pseudoseizures by psychiatric interview during EEG and video monitoring.

OBJECTIVE: This paper discusses a new technique for diagnosing pseudoseizures. The technique consists of an intensive psychiatric interview designed to provoke a pseudoseizure during EEG and video monitoring. We wished to determine the overall efficacy of the technique and learn how our patients felt about having undergone the procedure. We were also interested in whether their seizures persisted approximately three years later. METHOD: We reviewed medical records and conducted telephone interviews with thirty of thirty-two patients who had previously undergone the procedure as part of an evaluation for unusual or intractable seizures. All evaluations had been performed on a university hospital neurology service. The patients were consecutive referrals to the consultative psychiatry service for suspicion of pseudoseizures. RESULTS: Nineteen of the thirty-two patients interviewed had a pseudoseizure under EEG and video monitoring. Of the thirty reached by telephone for follow-up, twenty-two recalled the procedure as helpful or benign. None regarded the overall psychiatric consultation negatively. Among the patients who had exhibited pseudoseizures there was a variety of psychiatric diagnoses with a preponderance of personality disorders. Two thirds of those patients without coexisting epilepsy stopped having seizures or rarely had seizures following their evaluations. CONCLUSIONS: The diagnostic technique described here is useful in patients with possible pseudoseizures. It does not appear to be harmful when employed as part of a comprehensive psychiatric consultation. How it may compare with other methods of pseudoseizure diagnosis will have to be determined by further study.     

Emotional distress, coping and adjustment in family members of neuroscience intensive care unit patients

Objective

We evaluated emotional distress, coping strategy use, caregiver adjustment, and the relationship among these variables in family members (FMs) of patients hospitalized in a neuroscience intensive care unit (NSICU).

Methods

Fifty-one primary relatives of NSICU patients were administered the Brief Symptom Inventory (BSI) and an abbreviated version of the COPE within 2 days of admission to the NSICU, just prior to patient discharge from the unit, and approximately 30 days after patient discharge (follow-up). FMs' adjustment to the role of caregiver was also evaluated at follow-up with the Caregiver Appraisal Scale (CAS).

Results

BSI emotional distress levels were higher than those of the nonpatient normative sample at patient admission, but, except for anxiety, were within a standard deviation of the mean of the said group; with the exception of anxiety they declined to below nonpatient normative levels at follow-up. Females' distress levels were higher than those of males'. FMs' use of both problem-focused and emotion-focused coping strategies increased from admission through follow-up. Emotional distress was unrelated to problem-focused coping but was associated with emotion-focused coping at admission and discharge, with use of denial as a coping strategy primarily accounting for this relationship. Extent of use of both problem-focused and emotion-focused coping at admission was associated with better caregiver adjustment at follow-up, but over time only increases in problem-focused coping were associated with better subsequent caregiver adjustment.

Conclusions

Findings suggest that interventions fostering increased use of problem-focused coping and sense of control will be effective in lowering FM distress level and enhancing subsequent adjustment in the role of caregiver.     

Affecting coping: Does neurocognition predict approach and avoidant coping strategies within schizophrenia spectrum disorders?

According to various diathesis-stress models of schizophrenia, life stress plays a defining role in the onset and course of schizophrenia-spectrum disorders. In this regard, individual differences in coping strategies and affective traits, variables related to the management and experience of stress, may play a large role in susceptibility to the disorder and symptom exacerbation. Furthermore, it has been posited that cognitive deficits may limit an individuals' ability to effectively respond to stressful situations. We investigated the relationships between attention, immediate memory, trait negative affect (NA), trait positive affect (PA) and specific coping strategies within three groups: chronic schizophrenia patients (n=27), psychometrically-defined schizotypy (n=89), and schizotypy demographically-matched controls (n=26). As hypothesized affective traits displayed predictable relationships with specific coping strategies, such that NA was associated with the greater use of avoidant coping strategies within the schizophrenia and schizotypy group, while PA was associated with greater use of approach coping styles within all groups. The schizotypy group reported significantly higher levels of NA and also greater use of avoidant coping strategies than both the control and schizophrenia group. As expected group differences were found in trait affect, coping strategies, and cognitive functioning. Importantly, these group differences remained significant even when demographic variables were entered as covariates. Contrary to our expectations, cognitive functioning displayed only a few tenuous relationships with coping strategies within the schizophrenia and schizotypy groups. Overall, results support the notion that affective traits and not cognitive functioning is the best predictor of approach and avoidant coping strategies.     

Dissociative experiences in epilepsy — A neuropathological and sociodemographic study in a Chinese population

BackgroundIt is well known that dissociative experiences coexist with various epilepsy syndromes. However, the prevalence of dissociative experiences in different subtypes of epilepsy remains unknown. This is especially important because of the current prevalent view that the etiology of dissociation in seizures is neurobiological rather than psychosocial. The amygdala especially has been implicated in such dissociative features of epilepsy. This would indirectly imply that the patients with CPS have higher prevalence of dissociative symptoms compared with those with GTCS.MethodologyWe studied and compared the dissociative experiences as well as the depression and anxiety levels between 24 patients suffering from temporal lobe epilepsy and 26 patients suffering from generalized tonic–clonic seizures. We used the Dissociative Experiences Scale to evaluate the dissociative experiences. A third group of healthy individuals was included as the control group. The statistical significance was fixed at 0.05.ResultsThere were significant differences between the scores of DES-II of the healthy individuals and those of patients with epilepsy. However, there were no significant differences between the DES scores of different patients with epilepsy categorized according to neuropathology. There were also no significant differences between HAM-A and HAM-D scores between groups with epilepsy, but the scores were higher than those of the healthy individuals. There were significant differences between the DES scores in different sociodemographic groups such that higher scores were observed in groups with lower education (p < 0.05). In addition, the scores on DES were higher in individuals with low socioeconomic status than in those with high socioeconomic status.ConclusionThe patients with temporal lobe epilepsy and those with generalized tonic–clonic seizures have similar dissociative experiences which are both more than those found in individuals without epilepsy. However, these dissociative experiences may not be related to the neuropathological parameters as much as they are to the sociodemographic parameters like education, age, socioeconomic status, and sex. This shows that the psychopathology of dissociation in epilepsy is similar to that of the general population.     

Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures

OBJECTIVE: To examine anxiety related seizure symptoms and avoidance behaviour in adults with dissociative (psychogenic non-epileptic) seizures (DS) in comparison with a group suffering from partial epilepsy. METHODS: 25 DS and 19 epilepsy patients completed an attack symptom measure, the hospital anxiety and depression scale, the dissociative experiences scale, and the fear questionnaire. RESULTS: DS patients reported the presence of significantly greater numbers of somatic symptoms of anxiety during their attacks than the epilepsy group, despite not reporting subjectively higher levels of anxiety. The DS patients also reported higher levels of agoraphobic-type avoidance behaviour than the epilepsy group. Measures of dissociation were higher in the DS group, who also reported greater symptoms of depression. CONCLUSIONS: The findings support a model whereby DS occur as a paroxysmal, dissociative response to heightened arousal in the absence of raised general anxiety levels. The model has practical implications for clinical assessment and treatment: in clinical practice, inquiry about these symptoms may help in the diagnosis of DS; with respect to treatment, the anxiety related symptoms and avoidance behaviour prevalent in DS are a potential focus for a cognitive behavioural approach analogous to that used in the treatment of other anxiety disorders.     

癫痫患者与假性发作患者血清S100B蛋白、超敏C反应蛋白和神经元特异性烯醇化酶水平的改变及其意义

目的研究癫痫患者与假性发作患者血清S100B蛋白、超敏C反应蛋白(hs-CRP)和神经元特异性烯醇化酶(NSE)水平的改变及其意义。方法在癫痫(32例)及假性发作(30例)患者发作后第1 d、3 d、8 d、15 d时,分别采用酶联免疫吸附法(ELISA)、免疫比浊法和时间免疫荧光法检测其血清S100B蛋白、hs-CRP和NSE含量。并与正常对照者进行比较。结果癫痫组患者发作后第1 d、第3 d时血清S100B蛋白、hs-CRP和NSE含量均明显高于假性发作组和正常对照组(均P<0.01);发作后第8 d、第15 d时与正常对照组比较差异无统计学意义。假性发作组发作后各时间点的血清S100B蛋白、hs-CRP和NSE水平与正常对照组比较,差异均无统计学意义。结论癫痫患者发作后3 d内血清S100B蛋白、hs-CRP和NSE水平均明显升高,而假性发作患者无明显改变。血清S100B蛋白、hs-CRP和NSE水平可作为鉴别癫痫与假性发作的生物学指标。     

Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus

OBJECTIVE: Psychogenic factors may play a contributory role in the development or persistence of lichen simplex chronicus (LSC). The objective of this study was to evaluate the psychiatric profile of patients with LSC including depression and dissociative experiences. METHOD: Dermatology outpatients with a LSC (n=30) were compared with outpatients with tinea in which psychological factors are regarded as negligible (n=30). All subjects were given psychiatric scales including the Symptom Checklist-90-Revised (SCL-90-R), Hamilton Rating Scale for Depression (HAM-D) and Dissociative Experience Scale (DES). RESULTS: All mean SCL-90 scores for general psychopathology were higher in the LSC compared to the control group. HAM-D and DES scores were significantly higher in the LSC group (P<.05) as well. In addition, the number of patients whose total DES score of 30 and above was higher in the LSC group. CONCLUSIONS: Psychiatric symptoms appear relatively common among patients with LSC. Further research is needed to confirm the possible role of dissociative tendencies in the etiology of LSC.     

Appraised control, coping, and stress in a community sample: A test of the goodness-of-fit hypothesis

Lazarus and Folkman proposed one of the most comprehensive theories of stress and coping in the psychology literature, but many of their postulates have received little empirical attention, and some of the existing research has yielded contradictory findings. This longitudinal study sought to clarify the associations among control appraisal, coping, and stress within this theoretical framework. The theory postulates that coping strategies used tend to match the level of appraised controllability of the stressor (matching hypothesis). It further states that the effects of problem-focused versus emotion-focused coping are moderated by the appraised controllability of the stressor (goodness-of-fit hypothesis). An alternative to the latter is the main-effects hypothesis, which states that problem-focused coping is generally more effective in reducing distress regardless of appraisal. These hypotheses were tested on 72 adults who completed questionnaires on coping and control appraisal. Stress was assessed using self-report (Symptom Checklist-90-Revised) and a behavioral measure (proofreading task) at two times approximately 2 months apart. Appraised control significantly predicted type of coping such that greater control was associated with more problem-focused and less emotion-focused coping. Although the main-effects hypothesis was not supported, the goodness-of-fit hypothesis was partly confirmed by a significant control by emotion-focused coping interaction predicting both self-report and behavioral measures of stress. We acknowledge Laura Redwine, Ph.D. for her contributions to the research project; Michele Hayward, M.S. and Janel Alberts, M.S. for their help with data processing; and Kimberly Laubmeier, M.S. for her comments on an earlier version of the article.     

Childhood trauma and dissociation in first-episode psychosis,chronic schizophrenia and community controls

Increasing evidence supports the role of childhood trauma in the etiology of psychosis but underlying mechanisms are poorly understood. Early maltreatment has been linked to dissociative symptoms in psychosis patients. We explored associations between childhood trauma (Childhood Trauma Questionnaire) and dissociation (Dissociative Experiences Scale) in first-episode psychotic patients (n=62), chronic psychotic patients (n=43), and non-psychotic community controls (n=66). Multivariate analyses of covariance were used to test associations between childhood trauma and dissociation by group while controlling for sex. Chronic patients reported the highest level of dissociation. More severe childhood trauma was associated with greater dissociative symptoms in all groups although most strongly in chronic patients. Emotional abuse showed the strongest associations with dissociation, with these being strongest for chronic patients, followed by first-episode patients — and least for controls. Men showed a stronger association between physical neglect and dissociation than women, irrespective of group. There were no significant group by sex interactions. Our findings replicate the strong association between childhood trauma and dissociative symptoms in chronic and first-episode psychotic patients relative to non-psychotic control subjects. We also demonstrate the salience of emotional abuse in explaining variance in dissociation, especially in chronic patients.