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a) to explore the difficulties in differential diagnosis between epileptic crises and psychogenic non epileptic seizures (pseudoseizures),
b) to suggest therapeutic guidelines for psychogenic non epileptic seizures. Our purpose is to present a literature review on this subject and to discuss the problems involved.
Typical systematic review of recent articles regarding this topic at the internet search engines of PubMed and Scopus. We used the following keywords: psychogenic seizures, psychogenic non epileptic seizures (PNES), pseudoseizures, conversion disorder, dissociative disorder.
A large percentage of the seizures are found to be psychogenic non epileptic. Most of the patients are firstly treated by neurologists and only a percentage of close to 1/3 of these are referred to psychiatrists for further therapy. The differential diagnosis is difficult because most of the patients actually suffer from both epileptic and non epileptic seizures and usually come to the emergency clinics with either. Video EEG and therapeutic hypnosis are considered to be helpful techniques.
In order to treat patients suffering from psychogenic non epileptic seizures there must be a close collaboration between the neurologists, the psychiatrists and the emergency physicians considering both the medication prescribed and the therapeutic guidelines followed.
Mood disturbances are often found in stroke patients and have a negative impact both on the recovery and the outcome of the stroke. Depression is the most common neuropsychiatric complication in the poststroke population, affecting nearly 30%–50% of patients within the first year. PSD implies a significant burden on both patients and their caregivers.
Material and methods
Using the search engines Pubmed and Scopus, 20 papers regarding the elderly dated from 2002–2010 were reviewed using the keywords depression, poststroke, recovery after stroke.
The core features of PSD include but are not limited to: persistent sadness, feelings of hopelessness, helplessness and worthlessness, guilt and sense of being a burden on the caregiver, lack of motivation, loss of interest, death wishes and suicidal ideation. Various cerebrovascular risk factors, including hypertension, atherosclerotic heart disease, hyperlipidemia and diabetes mellitus have been implicated as risks for depression in late life.
Other predisposing factors are: prior history of depression or anxiety disorder, certain personality traits, baseline dementia but also, social isolation, living alone, physical functional impairments or a history of other psychiatric disorder.
Depression may impede recovery from stroke and impair outcome by affecting social functioning, motor abilities, cognitive functions and quality of life, thus it is important to early diagnose and prevent PSD.
Psychosis often leads to stigmatization and reduction of social power and prestige of the individual, hence leading further o social rejection and shame.
The current study assessed the role of external shame on psychiatric patients.
The present study aimed at evaluating external shame in psychiatric patients who where cared by the Department of Psychiatry at the University Hospital of Alexandroupolis, Greece.
45 patients suffering from schizophrenia participated to the present study (18 men and 27 women with mean age of 44.09 SD = 11.55, ranged 19–75). The measures used were: a) the Other As Shamer scale (OAS) b), a questionnaire concerning socio-demographic information,
The average of the external shame (OAS total) was 11.11 ± 5.22, without any statistical significant difference among gender in their comparison with the t-Test (p = .864). This ismuch lower than the average normal external shame the Greek population (17.74 ± 9.02).The analysis of variance between age groups showed that age, place of residence and educational level did not affect the external shame in psychotic patients. The marital status demonstrated a significant effect on external shame of psychotic patients where the application of the Bonferonni criterion was found that a) married participants demonstrated statistical significant difference from widowed (p = .030) and b) differed significantly from divorced widows (p = .011). Indeed, the widowed psychiatric patients exhibited greater levels of external shame.
Low levels of external shame may reflect difficulties in interpersonal relationships. Our findings illuminate the external shame in psychiatric patients.
Whilst shame has an important role in shaping psychopathology, nonetheless it is often a feeling ignored. Therefore, the etiologic role of psychosis requires further investigation.
This study examined the role of internal shame on psychiatric patients.
The present study evaluated internal shame in psychiatric patients who where cared by the Department of Psychiatry at University Hospital of Alexandroupolis, Greece.
45 patients suffering from schizophrenia participated (18 men and 27 women with mean age 44.09 SD=11.55, ranged 19–75). The measuring tools used were: a) the Experience of Shame Scale (ESS), b) a questionnaire concerning socio-demographic information.
High levels of internal shame were observed among patients. In specific, the average of the internal shame (ESS total) was 52.31 ± 12.76, without having statistically significant difference among gender in their comparison with the t-Test (p = .859). This is much higher than the average normal external shame in Greek population (47.09 ± 13.69). The analysis of variance between age groups showed that age, place of residence and educational level did not affect the internal shame in psychotic patients. Marital status had a significant effect on internal shame of psychotic patients where the application of the Bonferonni criterion found that unmarried participants demonstrated a statistical significant difference from those divorced (p = .020), the latter had higher levels of internal shame.
Psychiatric patients have high levels of internal shame and this shame is a constant factor in placing the individual and not a transient response to specific situations.
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