Hypnotic recall: a positive criterion in the differential diagnosis between epileptic and pseudoepileptic seizures

PURPOSE: Because the diagnosis of pseudoepileptic seizures (PESs) is mostly made by excluding epilepsy, availability of a positive criterion for PESs is of great importance. This study was aimed at the validation of a diagnostic technique that intends to provide in such a positive criterion. METHODS: In 17 patients with epileptic seizures (ESs) and 20 patients with PESs, a hypnotic procedure was performed by an investigator blind to other data to recover amnesia for the ictus. If recall was obtained, the experimental diagnosis PES was given; if not, ES was diagnosed. The experimental diagnoses were compared with the clinical, EEG-confirmed diagnoses. Hypnotizability was measured to determine the relation between the outcome of the test and hypnotizability of the patients. RESULTS: Recall for the ictus was obtained in 17 patients. Each of these had a clinical diagnosis of PES. Seventeen patients with "no recall" had a clinical diagnosis of ES, and three patients had PESs. This result yields a specificity of 100% and a sensitivity of 85% for the recall technique. Hypnotizability was significantly higher in patients with PESs than in patients with ESs. In some "low hypnotizables," recall was obtained, and in some "high hypnotizables," no recall was obtained. CONCLUSIONS: A positive recall test indicates PES. A sub-group of patients with PESs is characterized by a high level of hypnotizability. Hypnotizability is not crucial for outcome of the recall test. High hypnotic abilities are especially found in disorders in which it is supposed that "dissociation" is involved. It can be speculated that PES may be one of the dissociative phenomena.     

腹腔注射七氟烷对小鼠镇痛及催眠作用的影响

目的观察腹腔注射七氟烷（Sevolelurance,Sev）对小鼠镇痛及催眠作用的影响。方法小鼠腹腔注射七氟烷后用热板和扭体实验、催眠实验分别观察小鼠热板痛阈值（HPPT）、扭体次数（WT）和睡眠时间（ST）的变化。结果腹腔注射七氟烷能增大HPPT（P〈0．05,P〈0．01）,减少WT（P〈0．01）,延长ST（P〈0．01）。结论在本实验条件下,小鼠腹腔注射七氟烷可产生催眠和镇痛作用。     

氯甲西泮的合成工艺研究

目的 对氯甲西泮的合成工艺进行研究.方法 以2-氨基-2′,5-双氯二苯甲酮为原料,经过成肟反应、扩环反应、甲基化反应、乙酰化反应、碱解反应,再通过两次乙醇精制得到氯甲西泮成品.结果与结论 目标化合物的结构经核磁共振氢谱(1H-NMR)、核磁共振碳谱(13C-NMR)、质谱(MS)等确定,总收率达到20%.该合成工艺原料易得,操作简单,各步中间体质量收率稳定,适用于大工业生产.     

咪达唑仑对七氟烷镇痛和催眠作用的影响

目的观察咪达唑仑对七氟烷镇痛和催眠作用的影响。方法将40只小鼠随机均分成四组:生理盐水(NS)组、咪唑安定+NS组(M组)、NS+七氟烷组(S组)和咪达唑仑+七氟烷组(MS组)。实验方法:咪达唑仑2.7 mg/kg腹腔注射;甩尾法、催眠实验中分别腹腔注射七氟烷2.1、3.8 ml/kg;扭体法实验中皮下注射七氟烷3.0 ml/kg。甩尾法记录小鼠尾巴自进入水中到甩出水面的时间(甩尾潜伏期,TFL);扭体法观察小鼠腹腔注射1%冰醋酸0.1 ml/10 g后,15 min内的扭体次数;催眠实验记录小鼠翻正反射消失至恢复的时间(睡眠时间)。结果与NS组比较,S组、MS组TFL和睡眠时间延长,扭体次数减少(P<0.05);与S组比较,MS组TFL和睡眠时间明显延长,扭体次数减少(P<0.05)。结论咪达唑仑可增强七氟烷的镇痛及催眠效应。     

L’adolescent aux diagnostics multiples ou le trouble dissociatif de l’identité à l’adolescence

ObjectiveTo evoke the notion of dissociative identity disorder in adolescence requires a nuance so many questions arise among others on the relevance of the juxtaposition of a complex disorder fluctuating at an age group marked by transition. In other words, is it appropriate to speak of dissociation of identity or multiple personality at this specific time of existence? It should also be noted that this diagnosis is controversial both because there is no consensus on definitions such as personality or identity and because some cultures take into account the possibility of possession to explain these tables without reference to pathology.MethodsTo illustrate our point, we will draw on the situation of a young person admitted to our institutional therapy centre located in a general hospital. The structure accommodates young people aged between fourteen and twenty for six to nine months. As we have also developed, these are usually directed in the course of ambulatory and/or residential therapeutic follow-ups, after experiencing moments of crisis or decompensation. The evaluation then carried out consolidates the prospect of a medium-term stay in a psychotherapeutic centre before considering a possible reintegration into daily life and activities. This clinical case illustrating the path of a teenager in prey to the tumults of wobbling of his identity causing confusion and uncertainty in the chief of the professionals encountered. The difficult situation experienced by this young person and his family questions on the one hand the relevance, the very basis of the diagnosis at this time of existence and on the other the notion of dissociative identity disorder in adolescence.ResultsThe dissociative identity disorder meets a number of criteria, the first of which is identity disturbance characterized by several distinct personality states. Clinically, we first observe a discontinuity in the integration of consciousness, of self-meaning. Registers of affects and sensory-motor functioning (perception, representation of the body) are also concerned. There are then disturbances of the agentivity (motor control, behaviors). In some cases, non-epileptogenic seizures and other conversive manifestations may be at the forefront of these complex clinical tables. The dissociative disorder of identity is also noticed by memory failures (dissociative amnesia) concerning the recall of daily events, personal information, which do not correspond to ordinary forgetfulness. This then leads to signs of impairment of social, professional or other relational functioning. Being an interruption in the tranquility of growth, adolescence is characterized by extreme conflicting positions, changing, fluctuating that give this period of life its appearance of tumult and crisis without being able to speak of frank psychic disturbances. Differential diagnosis between teen upheaval and true pathology is a difficult task.ConclusionsConsequently, we think it is important to pay attention to the diachronic and synchronic litters of what the young person in question is deploying. In order to do so, we advocate repeated clinical interviews with the patient and his or her entourage beside rigorous anamnesis. Time is an important element, the time of observation and encounter. Let us avoid precipitation without adopting an attitude of fatalism or even laxity, recalling that, for Winnicott, there is only one remedy for adolescence and only one; it is the passing time and gradual maturation processes that ultimately lead to the appearance of the adult person. Accompany a dissociative identity disorder, proven or suspected, includes the mobilization of a partnership envelope involving experienced institutional structures ready for the necessary clinical flexibility allowing continuous therapeutic adjustment.     

Knowledge level and attitude towards complementary and alternative treatment methods among medical students: a cross-sectional survey study in Turkey

Abstract

Objective

People often use complementary and alternative medicine (CAM) methods in Turkey, but reliability of the application of these methods is controversial. Considering the role of medical students (i.e. physician candidates) in sustainable health, their perspectives on CAM methods are important. This report explores the level of knowledge, experience, and preferences for the use of CAM methods among medical school students.     

Étude qualitative de l’expérience de la formation en hypnose clinique pour les professionnels de santé

ObjectiveTraining in clinical hypnosis leads to important transformations in healthcare professionals, in their professional practices as well as in their personal lives. The objective of this study was to explore how health professionals experience the transformations that result from such a training.MethodSemi-structured interviews with health professionals from France and Europe were conducted. The qualitative method used was Interpretative Phenomenological Analysis. Purposive sampling required to include participants from different professions, experience and regions of origin. They had already completed training in clinical hypnosis at different teaching institutions.ResultsTen participants were included. The analysis showed four meta-themes of experience. First, it revealed participants’ motivations for training in clinical hypnosis as one's desire to improve one's practice, leading to extraordinary discoveries, at a particular timing in their life. Second, participants described that hypnosis sometimes set the ground for a relationship verging on the more “intimate”, therefore requiring greater caution so as not to disrupt the patient/healthcare professional relationship. Third, some participants experienced unforeseen personal fulfilment, better self-regulation of emotions and improved quality of life as well as greater comfort at the workplace. Finally, this study shed light on two limitations of training in clinical hypnosis as it can sometimes generate stress for the participants and/or result in bring about potential harmful effects: one of the risks being that the trainer might cross some ethical lines.DiscussionThe level of personal change experienced by the participants is similar to some changes induced by personal psychotherapy. For several participants, issues of power and vulnerability in the relationship using hypnosis were associated with a feeling of instability during the training. In hypnosis, the management of an asymmetrical relationship involves a two-way risk: vulnerability of the hypnotized person to the all-powerful relationship of their therapist as well as destabilization of therapists by the reduction of power asymmetry during hypnotic work with their patients.     

补充和替代医学在肠易激综合征治疗中的应用

肠易激综合征（IBS）是常见的肠道功能性疾病,近年来发病率呈上升趋势。目前由于常规医学疗法对IBS的疗效欠佳,补充和替代医学（CAM）在IBS治疗中的作用越来越受到关注,其中益生菌、薄荷油以及一些身心治疗如催眠疗法、认知行为治疗等对IBS的疗效已得到较普遍认可。本文就CAM在IBS治疗中的应用作一综述。