bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Nurse Specialist in Epilepsy, over 2 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter highlights the lack of knowledge on non-epileptic seizures among the nursing and medical profession. The author’s first experience with a patient with non-epileptic attacks was as a student nurse. The author recalled that no one seemed to have any sympathy for the patient, and that, whenever an event started, there would be a roll of the eyes from the nursing staff. Now, as a Clinical Nurse Specialist in Epilepsy, the author realized how unhelpful and misguided the treatment was that the patient received. The author now looks after patients with a dual diagnosis of epileptic and non-epileptic attacks and has also cared for patients who have been misdiagnosed. Over time, the author has learned that non-epileptic attacks can be just as debilitating as epileptic seizures. In many cases, they can be harder to manage, more challenging for the patient to live with, and ultimately more difficult to treat. Moreover, non-epileptic seizures carry just as much stigma as epilepsy. As such, patients with non-epileptic attacks need just as much support as patients with epileptic seizures.
Psychotherapist, 7 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter shows how a psychotherapist treats the seizure as a form of communication. The job of the psychotherapist, then, is to help the person understand what it is he or she needs to say when there are no words to tell the story. Not only are there no words, but even if there were, those that matter would not hear them. Hence, there is no solution; no one must know the depths of the person’s distress or what has caused it, but keeping it locked inside is impossible. It leaks out, through shakes, tremors, convulsions, and dissociation. Sometimes the intolerable feelings that necessitate the escape are hidden even to the person him- or herself. The seizure helps defend the self, providing a necessary distance between body and mind. Learning to respect this took the psychotherapist longer than it should have; to appreciate that helping people to live more easily with their symptoms is sometimes the wisest way forward. However, to be able to really hear someone, to understand the language of the person’s seizures and symptoms, and to help the person change his or her experience as a result—that is what the psychotherapist aspires to do in this work.
Neurologist, 10 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter presents a creative narration of a neurologist’s experience with a patient with seizures. The neurologist first met the patient in intensive care. The second time they met, they were joined by the carers, the care managers, and the learning disability nurse, who gathered to try and work out what the neurologist should do. The patient had recently had another cluster of seizures and had come into the hospital. However, the neurologist could not pinpoint why the patient was so ill and yet in fine health. The neurologist then altered the patient’s medication, with the aim of trying to keep the patient well and safe. Unfortunately, as the months went by, the patient did not remain well and safe. Eventually, the patient was admitted to intensive care, where the patient was intubated and ventilated. The neurologist then realized that the patient was unwell because the neurologist had intoxicated the patient with ever-increasing doses of medications, never treating the problem, never likely to work.
Consultant Nurse, 18 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses the need for consistency in the diagnosis and support of people with Non-Epileptic Attack Disorder (NEAD). Even within neurology, this is not always the case. Often, a diagnosis of NEAD follows many years of treatment for presumed epilepsy. There is a reluctance by many neurologists completely to undo that diagnosis, whether originally made by themselves or a predecessor. A vague assertion that some episodes may be NEAD while others are due to epilepsy is of no use to anyone, particularly the patient. Estimates of the incidence of dual diagnoses vary, but the literature consistently suggests that either epileptic or non-epileptic seizures will predominate. Therefore, health professionals need to make every effort to identify clearly which seizures are due to epilepsy, remembering that they will be stereotyped, and which are not.
Neurologist, Psychotherapist, Yoga Teacher, 5 years’ experience, Germany
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter details the personal experience of a neurologist and psychotherapist who had Non-Epileptic Seizures (NES). Her personal experience supports the neurologist’s efficacy as a psychotherapist. Patients tend to open up and trust this neurologist’. This neurologist greatly admires patient’s efforts to integrate painful particles of their past during the psychotherapeutic process. The ultimate step toward healing means to step up to self-responsibility, and not all patients are able to build up to that step. The chapter then briefly addresses the stigma carried by NES. Ultimately, building up the internal qualities to withstand the external limitations of the neurological work routine and further exploring what professional authenticity looks like for the neurologist when interacting with colleagues have become this neurologist’s current objectives.
Neuropsychologist, Psychologist, 3 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter examines how, when treating individuals with Psychogenic Non-Epileptic Events (PNEE), a neuropsychologist operates from a viewpoint of PNEE as a “psycho-neurological” problem. The distinction between a “neurological” and “psychological” origin has important implications for the training necessary to perform the services offered by each specialist, but both specialties actually refer to the same origin of the PNEE. In both cases PNEE clearly arise from the brain. The neuropsychologist views these spheres not as separate and distinct, but rather as being on a continuous spectrum, with the major difference being the scale and scope at which the brain is considered. Neurological problems are typically viewed as large scale, concretely identifiable, and dealing with fundamental functioning and structural integrity. Psychological problems are viewed as small-scale neurological connection problems, too granular for the primary attention of neurologists. This is the clinical domain of psychiatrists, psychologists, and neuropsychologists. PNEE clearly have their origins in the brain, falling within the sphere of small-scale connection problems of brain functioning. Finally this chapter considers the lack of a clear explanation for why and how PNEE manifest in the brain because their true origin remains elusive.
Neurologist, 11 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter focuses on the clinical value of continued vigilance and neurologic follow-up after video-EEG (VEEG) confirmation of the diagnosis of Psychogenic Non-Epileptic Seizures (PNES), even when long-term EEG recordings over two separate admissions to an epilepsy monitoring unit have not captured any epileptiform activity. It has been shown that 19% of patients with epilepsy will not have interictal epileptiform abnormality during an admission for long-term VEEG monitoring. In particular, patients with extratemporal lobe epilepsies who have deep/mesial seizure foci and those with well-controlled epilepsies will be likely not to have epileptiform interictal EEG activity. In consideration of these observations, it has been advised that patients with PNES and non-epileptiform long-term EEG recordings should be followed by a neurologist for at least six months after discontinuation of antiepileptic drugs (AED). This consideration is due to the small but ever-present possibility of coexisting epilepsy as well as the observation that the risk of breakthrough epileptic seizures is highest during the initial six months after discontinuation of AEDs.
Neurologist, 30 years’ experience, New Zealand
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter describes how a neurologist treated a patient who had been treated for epilepsy for fifteen-years. The patient gave a seizure description that was superficially like that of a tonic-clonic convulsion, but with what would now be recognized as clear indicators of a psychogenic seizure diagnosis. After inquiring about potential causes, the neurologist found out that the patient had a history of sexual abuse. The patient’s reaction to the diagnosis was initially one of skepticism, but this quickly turned to anger. After a lot of resistance, he agreed to withdraw his anticonvulsants and this was arranged under the supervision of his general practitioner. The patient then came back to see the neurologist for a follow-up visit. By this time, he was off his anticonvulsants and his seizures had stopped. This experience prompted the neurologist to start doing research into psychogenic seizures.
Social Worker and Researcher, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter describes the experience of a social researcher and family social worker with individuals with Non-Epileptic Seizures (NES). Epilepsy is stigmatizing enough, and, despite what providers might think about NES, these seizures are as real to these patients as they are to those with verified diagnoses of epilepsy. These patients are scared, concerned for their health, and upset that medication has not helped, and adding a layer of disdain from someone who is supposed to be helping them can be devastating. People with NES who are treated poorly and feel their problems are being dismissed as “fake” may become unwilling to continue treatment for fear of ridicule. Moreover, from a social work perspective, dealing with children with NES is a red flag for possibly undisclosed sexual abuse, and understanding that is very important. As such, a kind, empathetic, and proactive service provider can go a long way toward improving health and psychological outcomes, no matter the diagnosis.
Neurologist, 20 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses the experience of a neurologist who works with patients diagnosed with Psychogenic Non-Epileptic Seizures (PNES). There are still a number of neurologists who call this disorder “pseudoseizures,” so the neurologist always try to remind them that the current term is “PNES.” Hearing their condition called “pseudo” bothers many of these patients. Moreover, many of them have not been treated kindly in hospitals and have sometimes been accused of “faking” their symptoms when they come into the hospital, so the least neurologists can do is to not use this term. Unfortunately, getting doctors to stop using “pseudoseizures” is hard to do. The neurologist then describes that the greatest frustration working with patients with PNES is that it can be so difficult to find a therapist who takes their insurance. Even if they do take it, they may sometimes still not want to treat these patients because they do not know much about PNES and so they send them back to the neurologist.
Neurologist, 22 years’ experience, Germany
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter highlights the experience of a neurologist who was consulted to assist with a patient’s antiepileptic treatment when he was transferred to a hospital with a suspected diagnosis of encephalitis. After he had been transferred, several bilateral tonic-clonic seizures were observed, which progressed to status epilepticus despite a combination of antiviral and antibiotic treatment. Over the following years, his epilepsy proved highly pharmacoresistant. Soon after the major impact of his disease on his previously highly successful life became apparent, he felt that he needed psychological support and started psychotherapy. When the neurologist decided to arrange another period of video-EEG monitoring, five different seizure types were recorded. Three were clearly epileptic. However, he also had five seizures with clear dissociative components. Ultimately, this patient exemplifies a major failure—both in terms of successful treatment of his multifocal epilepsy with severe vocational and private consequences and in terms of the complete failure to consider those seizure elements that turned out to be non-epileptic.
Psychiatrist, Psychotherapist, 25 years’ experience, Canada
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter narrates the experience of a neurologist and a psychiatrist when they met with a group of patients who suffered from Psychogenic Non-Epileptic Seizures (PNES). They had all gathered because they were looking forward to receiving some information about the condition. Indeed, none of the patients could understand the complexity of their condition, nor had someone ever explained to them what their diagnosis is and how to treat it. The neurologist and the psychiatrist then came up with the idea to cocreate a short document with the group members that would contain everything relevant about PNES. Group members shared their information needs and mapped answers fitting these needs in a certain format. This creative process empowered everyone. Moreover, the resulting document enabled the patients to explain their situation to caregivers, partners, family members, and sometimes colleagues at work.
Psychotherapist/Dramatherapist, 10 years’ experience, Greece
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter describes the experience of a Psychotherapist/Dramatherapist when working in a Neuropsychiatry department. It was there that the Psychotherapist met patients with Conversion Disorder for the first time and worked with them and others who were undergoing video-EEG monitoring for unexplained attacks, fits, or seizures. These experiences, among many others, have gradually led the Psychotherapist to create “Metamyth,” a psychological method uniquely suitable for the treatment of people with epilepsy. Metamyth for people with Non-Epileptic Seizures (NES) adopts a different approach to that used with epilepsy. As a holistic approach, Metamyth is interested in the mind, body, soul and intuition, and communication. Considerable patience is needed to understand the complexity of each patient with NES and for the diagnosis to reveal itself over time.
Neurologist (20+ years’ experience) and Junior Doctor, Luxembourg
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter presents two cases of patients with Non-Epileptic Seizures (NES), which reflect the difficulties encountered in diagnosing and managing patients with this condition. This represents a major challenge in clinical practice. One of the main obstacles to making a correct diagnosis is getting all of the information out of the patient. In both of the cases, the patients were very reluctant to share any personal details, and it was only after a long time that the Neurologist got a clear picture of the situation. However, the dilemma with NES is not only diagnostic but also therapeutic. Specialized psychotherapy for NES is not readily available and adherence to therapy is often problematic, as was the case with both patients. Ultimately, communication during the clinical interview is a very important skill that must be continually improved.
Neuropsychologist, 14 years’ experience, France; Neuropsychology Intern, France
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses how a patient’s history failed to inform a Neuropsychologist about the patient’s Non-Epileptic Seizures (NES). A comprehensive exploration of the patient’s medical history revealed no specific seizure triggers. At the same time, tests looking for biomedical abnormalities failed to identify any indication of epilepsy. He was then diagnosed with NES and was sent to the Neuropsychologist for a full psychological evaluation. After two interviews, the Neuropsychologist decided to see the patient with his wife, with the aim of exploring the couple’s relationship and sexuality. In this meeting, the Neuropsychologist found out that the patient had been involved in a car crash in which a number of his friends had been instantly killed. During his recovery in the few weeks after this tragic event, the patient exhibited his first non-epileptic seizures. It is very interesting to underline that during the course of his medical care, the patient was unable to discuss this traumatic event, even when interacting with a trained psychologist and during the course of a semistructured interview that involves an assessment of traumatic reactions. Only his body revealed an actual and authentic posttraumatic stress disorder with selective amnesia limited to the triggering event.
Social Worker, Therapist for Systemic Therapy, 13 years’ experience, Germany
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter focuses on the experience of a social worker with patients with Non-Epileptic Seizures. It specifically considers one client who had been given the diagnosis of epilepsy after her first attack. In addition, she had become depressed, a second serious diagnosis. She was sent to the counseling center to learn how to cope with her disease and for the social worker to help her find work. However, the pension insurance and the epilepsy center came to different conclusions about the patient’s ability to work. The social worker then accompanied the patient to the job center, which brought the patient emotional relief. Several months later, the patient’s invalidity pension was granted. This cleared the way for her integration into a workshop for disabled people.
Nurse, 30+ years’ experience, Germany
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter addresses how one’s own reaction to dissociative seizures can influence the events. Possibly, the seizure may function as a cry for help or for attention addressed to an observer. At the same time, the observer might trigger a seizure in the patient, as a subconscious reaction, countertransference, or coping strategy. This interdependence must be considered by those who support patients therapeutically during their seizures. Indeed, the give and take between patient and carers who accompany them in their seizures and the interactional resonances, which happen alongside specific interventions, are key to the success of the therapeutic approach. However, there is a crux: to find words describing the suspected inner state of the patients themselves that can be offered to patients, put at their disposal, and thus turned into something that can be discussed more easily, to learn to get better at naming the feelings and needs that emerge.
Neurologist, 20+ years’ experience, France
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter explores how a Neurologist treated a patient who was referred by a neuropediatric hospital with a diagnosis of generalized epilepsy, which had probably started in infancy with absence seizures. Moderate intellectual disability had also been noticed at that time. In her early adolescence, she started to present with generalized tonic-clonic seizures (GTCS), which were not preceded by any aura. She became seizure-free with a combination of antiepileptic medication. However, one year before the patient’s first consultation in the Neurologist’s office, her seizures had recurred, but the seizure semiology had changed: she would call her father and report vertigo and headache before seeming to loose consciousness. In a consultation without her parents, the patient told the Neurologist how she struggled with the responsibility of being independent of her parents. In this respect, it is interesting to note that the patient regularly experienced an absence seizure on days when aspects of her first vacation with her friends (and without her parents) were discussed in the family.
Clinical Neuropsychologist, 30 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter addresses the experience of a Clinical Neuropsychologist when working with people suffering with Non-Epileptic Attack Disorder (NEAD), which can be best understood via three themes: the therapeutic relationship, the context, and the actual therapy. Most process and outcome research on psychotherapies reach similar conclusions: that the quality of the therapeutic relationship is a key ingredient, and often of more salience in terms of outcome than the particular therapeutic approach. People need to feel that their therapist “gets” them, that they are capable of being supportive and sympathetic/empathetic. Indeed, therapist integrity is key, and the reason it is key with this patient group is because of the context in which one is working—that is, the path that the person has taken before he or she got to see the therapist. Lastly, the therapy for NEAD is not uniform. Everyone who comes to see the therapist with this diagnosis is an individual with his or her own slant on the problem. As such, working out the “meaning” of the problem for the person is a central part of the collaborative work.
Neuropsychologist, 20 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter describes the experience of a Neuropsychologist who was working in the Neurosciences Directorate of a large teaching hospital at about the time that Non-Epileptic Attack Disorder (NEAD) was starting to be widely recognized. At the time, 10% to 28% of outpatient referrals to neurology with “intractable epilepsy” were cases of NEAD. People who had been treated for epilepsy, some for many years, and had just been given a diagnosis of NEAD were referred to the Neuropsychologist. Their reactions varied: some were relieved that they would no longer have to take antiepileptic medication, some were angry that they had been misdiagnosed and had been given inappropriate medication, and some refused to believe that they did not have epilepsy. Among this last group, there were people who had secondary gains from the diagnosis of epilepsy, such as special protection and status or exemption from household tasks. Obviously, explaining the cause of NEAD is central to establishing a relationship of trust, and to accept that the client has a definite condition is central in treatment. The Neuropsychologist would then explore the idea that their attacks were a response to stress. If the client accepts this, treatment can move on to identifying areas of stress and addressing them. The chapter then identifies the different precipitants of NEAD.
Psychologist, 32 years’ experience, Puerto Rico
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter examines the experience of a Puerto Rican Psychologist who has evaluated hundreds of patients with epilepsy and about 150 patients with Psychogenic Non-Epileptic Seizures (PNES). Many of the patients were referred by Neurologists for the Psychologist’s clinical assessment of the situation. In about 1998, the Psychologist began to experiment with hypnosis as a convenient way to induce or provoke a PNES in patients. The results were astonishing: approximately 70% with a suspicion of PNES went into a psychogenic seizure within about ten minutes. The results and method were published in a journal dedicated to the subject of hypnosis. This method has permitted the Psychologist to observe in detail more than a hundred PNES. Also, as part of the research, the Psychologist included a control group of individuals diagnosed with epilepsy. None of the patients experienced a seizure during the hypnotic induction.
Psychologist, over 1 year’s experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter details a Psychologist’s first experience of working with patients with “Dissociative Seizures” as a junior assistant Psychologist with very little therapeutic experience. In the Psychologist’s experience, labeling these events as “non-epileptic attacks” tended to inspire confusion, frustration, and a sense of hopelessness on the part of patients. Indeed, these patients expressed that this label helped them understand what they did not have but provided them with little information about what they did have, and what this meant for them. Working with these patients, the Psychologist experienced with frequency the difficult thoughts and feelings that come along with the role of being a mental health clinician. The Psychologist often felt moved by patients’ stories, which frequently demonstrated resilience and strength in the face of adversity or trauma. The chapter then outlines one case study that had a lasting impact on the Psychologist to illustrate some of the clinical challenges of working with patients who experience Dissociative Seizures.
Assistant Psychologist, 3 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter studies the experience of an Assistant Psychologist who has worked with people who experience Non-Epileptic Seizures (NES) in both inpatient and outpatient settings. The Assistant Psychologist’s main role when working with people with NES is to provide relaxation and anxiety management strategies as part of an intervention designed by a clinical psychologist following individual assessment and formulation. However, despite attending sessions with the intention of completing anxiety management, the Assistant Psychologist often finds that her role also requires her to manage unplanned trauma disclosures, uncertainty around the diagnosis, adjustment to the diagnosis and management of anger, and complaints based on how the diagnosis was given or how people feel they are being treated by members of staff. Once, the Assistant Psychologist worked with a client who had been admitted following an increase in NES. The plan was to provide anxiety management; however, the assistant psychologist spent most of the sessions managing the patient’s emotional well-being. The Assistant Psychologist also has a role in providing psychoeducation to staff who find it difficult to understand NES.
Consultant Clinical Psychologist/Neuropsychologist and two Assistant Psychologists, combined experience 23 years, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter examines how a Clinical Psychologist helps patients with Non-Epileptic Attacks (NEA). The care process for people with NEA takes a variety of forms. In hospitals, a variety of skilled colleagues are involved and the Clinical Psychologist is fortunate to be able to contribute in numerous ways, from service developments to abstract case discussions to individual patient care. The delivery of direct psychological care sometimes takes the form of psychological assessment, therapy, and ongoing psychological support, which—when based on a lifespan bio-psycho-social perspective—can work well but with numerous challenges and uncertainties. The patients the Clinical Psychologist sees have NEA in common, but the underlying mechanisms vary. Attention has long been given to the role of stressful events for some patients, while for others, issues of social-emotional processing, interpersonal communication, self-regulation, and executive functions have started to receive overdue recognition. In many cases, there is some combination of psychological, social, stress-based, coping-based, neuropsychological, and/or neurodevelopmental mechanisms. This can complicate the delivery of psychological therapy or support.
Neurologist, 15 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter presents an acrostic of the words “Dissociative Seizures.” The corresponding words can often be heard in a Neurologist’s clinic. These include the words “distress,” “disability,” “epilepsy,” “emotional,” “resilience” and “empathy.”
Nurse, 30 years’ experience, Norway
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter focuses on the experience of a nurse when working with children and adolescents with Non-Epileptic Seizures (NES). Young people today have challenges on many levels, and for some, the total load becomes so great that they develop “seizures” for which a biological cause cannot be identified. Young people who develop NES have often been overloaded for a long time, many describing family problems, long-term bullying problems, exclusion or problems at school. The nurse is also increasingly meeting young people who struggle to adapt to youth culture. They are exhausted from trying to find a balance in their lives—a balance between achievement and rest, between their own needs and society’s demands, between “what the mind wants” and “what the body can tolerate.” Some come from families who have strong ideals that are not compatible with youth culture. This can result in a loyalty conflict that seems impossible to solve.
Neurologist, 27 years’ experience, South Africa
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at the personal experience of a Neurologist in caring for people with Non-Epileptic Seizures (NES) and illustrates the profession’s shortcomings. Like every other patient who presents to a health care professional, people with NES want a clear diagnosis, with a detailed explanation of how and why they developed the condition, and a clear therapeutic plan. Although there are limits to the understanding of NES, that may also be said of all medical conditions. Since emotionally difficult, deeply personal experiences typically lie at the heart of their condition, people with NES need no less empathy and understanding than any other person with a medical condition. However, numerous patients have recounted stories about how they abandoned the medical profession for help with their seizures after their experience of seeing a neurologist. The amount of harm done by medical professionals in the way that they interact with people with NES has yet to be quantified.
Specialist Cognitive Behavioral Therapist in NEAD, 6 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter describes the experience of a specialist cognitive behavioral therapist in Non-Epileptic Attack Disorder (NEAD). Offering therapy for people with NEAD can involve frustrations, difficulties, concerns, and, without a doubt, imposter syndrome. Nevertheless, knowing someone personally growing up with NEAD definitely inspired the therapist to work in this field. The therapist also had an understanding of what NEAD was as a layperson before the therapist became a professional. Moreover, the therapist had lived experience of how this condition affects the person and how it affects family members and friends, relationships, and careers. It creates worry and uncertainty in everyone around, in terms of what the problem is and how to help. Fortunately, the therapist learned quickly about the mind and body connection and how to explain this to patients, and it started to click with people and improve helpful engagement. The more the therapist became experienced, the more the therapist understood, and the less people had episodes in their assessments.
Neurologist, 1 year’s experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses how a neurologist started a Psychogenic Non-Epileptic Seizures (PNES) clinic. As an Epileptologist, the Neurologist would be best equipped to care for children and young adults who present with non-epileptic seizures. Patients with PNES often fall through the cracks because their condition lies between the land of Psychiatry and Neurology. The Neurologist hoped to serve patients with PNES who were lost in the gap between traditional Neurology and behavioral healthcare. Six months after its inception, a patient came to the newly established PNES clinic. The Neurologist learned from the chart review that the patient had been in inpatient Psychiatry care on more than one occasion several years prior. She had been treated for Depression and Post-Traumatic Stress Disorder (PTSD) from repeated sexual and verbal abuse from a family member. Her somatic symptom–related disorder developed shortly after discharge from her first psychiatric inpatient care several years ago, which manifested as chest pain, dizziness, fainting, chronic nausea, chronic abdominal pain, eating disorder, severe malnutrition, headache, weakness, and PNES. The chapter then argues that each patient in the PNES clinic brings unique challenges that require a creative and individualized solution.
Provision of Onco-Fertility Support
Authors: Schwab Roxana , Kiemen Andrea , Weis Joachim , Hasenburg Annette
Published: March 2020

The chapter considers issues where oncologic therapy can lead to partial or complete damage to the gonads (ovaries or testes), thus impairing fertility or reducing the fertile lifespan. We discuss the relatively new discipline of onco-fertility, which considers patients’ psychosocial needs, including sexual health, intimate relationships, and the affordability of fertility-preservation measures. Referral and counseling for fertility preservation should be performed as soon as possible after the cancer diagnosis. Assessment of reproductive potential should be offered to all cancer patients. Healthcare professionals should be proactive regarding fertility-preservation counseling. A multidisciplinary team consisting of oncologists, fertility specialists, specialized nurses, mental health professionals, psycho-oncologists, social workers, and support groups should be available when dealing with infertility as a side effect of cancer therapy. Shared decision making regarding fertility preservation is an important issue. Partners may need psychological counseling referrals as well, or couple counseling on communication and sexuality.
Psychological Treatment of Individual Sexual Dysfunction
Authors: Wittmann Daniela
Published: March 2020

Cancer patients struggle with sexual problems after cancer treatment. They often discover the sexual side effects after treatment and must learn how to manage their bodies, which now function differently, and work to continue to be sexually active with their partners. Recovering confidence in their ability to function in their sexual relationships means that they must grieve for their sexual losses, understand their new sensitivities, manage altered body capacities, and develop an expanded sexual repertoire. In their relationships, they must learn to communicate about their needs. If they are single, anxiety about starting a new relationship must be managed through the development of confidence that they can still be good lovers despite their altered sexual function. A thorough biopsychosocial assessment helps identify physical changes, psychological vulnerabilities, and relationship areas that will have to be addressed to maintain sexual viability and satisfaction. Psychosocial as well as biomedical interventions are needed in guiding patients toward recovering an ability to function well sexually. Reliance on multiple relevant disciplines and addressing couple issues can lead to patients’ renewed confidence and satisfactory functioning in their intimate relationships after cancer treatment.
The patient’s perspective
Authors: Jamison Kay Redfield , Kaplin Adam Ian
Published: March 2020

In addition to knowledge, a physician’s ability to engage and persuade through compassionate understanding and therapeutic optimism is an indispensable skill that may determine the ultimate outcome of their patient’s illness and health. From the moment a patient is first given a psychiatric diagnosis, they embark on a path to combat personal anguish, social isolation, and stigma in an effort to regain mastery of their life. The interaction between doctor and patient and the mutual communication and trust that underlie their therapeutic relationship are at least equal in importance to the efficacy of any medication that can be prescribed. As mental health information technology evolves and becomes ever more present during clinical encounters, the importance of understanding the patient’s perspective will be critical to physicians who want to preserve what is irreplaceable and therapeutically critical to the doctor–patient relationship.
Public attitudes and the challenge of stigma
Authors: Votruba Nicole , Koschorke Mirja , Thornicroft Graham
Published: March 2020

People with mental illness frequently face challenges related to knowledge, attitudes, and behaviour. These challenges are more commonly known as stigma and discrimination, and appear universally with local and regional variations in their content and manifestations. They display in low levels of mental health literacy among the general population (ignorance/knowledge), negative affect towards people with experience of mental illness (prejudice/attitudes), and social exclusion and diminished citizenship for people with mental illness (discrimination/behaviour). This chapter looks at how people with mental illness are impacted by stigma and discrimination, considering the evidence of the implications of these knowledge, attitudes, and behaviour, and summarizes the literature on what can be done to effectively reduce stigma and discrimination. Increasingly strong evidence suggests that personal and social contact methods, including filmed/virtual contact, are the most strongly evidence-based method to reduce stigma and discrimination. Yet, most evidence is from high-income countries and tested for short- to mid-term efficacy. This evidence gap increases the need for more evidence from low- and middle-income countries and validation of sustainability in more long-term studies. In summary and for future research and interventions, service users will the key partners in anti-stigma programmes, and interventions specifically locally and culturally adapted for use in low- and middle-income countries are a pressing priority.
Global mental health
Authors: Lund Crick , Bemme Dörte , Bass Judy
Published: March 2020

Global mental health has emerged in recent years as a field of research, advocacy, and practice that is concerned with improving the mental health of populations and reducing inequity in the global burden of mental illness. Because these challenges are multi-faceted, global mental health has been marked from its inception as a multi-disciplinary field, incorporating disciplines of psychiatry, psychology, epidemiology, health economics, anthropology, and implementation science. This chapter provides an overview of the emerging and dynamic field of global mental health. It starts with a brief history of the field, noting landmark publications and events. The chapter then introduces key areas of enquiry and action in global mental health, including epidemiology, mental health policy and services, intervention research, implementation science, qualitative research, instrument development, and economic evaluation. Finally, it concludes with reflections on critiques of the field and future directions.
The National Institute of Mental Health Research Domain Criteria
Authors: Sanislow Charles A. , Morris Sarah E. , Pacheco Jennifer , Cuthbert Bruce N.
Published: March 2020

The United States National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) initiative offers a framework to facilitate integrative research to clarify core mechanisms of human mental distress and dysfunction. The RDoC was developed to provide an alternative to research, designed around clinical syndromes based on descriptive diagnosis. Rather than beginning with a syndrome and then working ‘down’ to clarify mechanisms, the aim of the RDoC is to guide research that begins with disruptions in neurobiological and behavioural mechanisms, and then works across systems to clarify connections among such disruptions and clinical symptoms. The RDoC also departs from widely accepted categorical diagnoses, instead advocating a dimensional account of clinically significant variance in disrupted mechanisms and symptoms. The need for the RDoC stemmed from the realization that psychopathology research was not keeping pace with advances in clinical neuroscience and behavioural science, and the recognition that the cycle of scientific progress has been hampered by the instantiation of DSM diagnoses as the starting point of psychiatric research design. This chapter details the rationale and development of the RDoC and describes their structure. Some practical considerations and theoretical matters for implementing the RDoC alternative are considered.
Ageing and the human brain
Authors: Heise Verena , Zsoldos Enikő , Ebmeier Klaus P.
Published: March 2020

There is little doubt that the brain changes with time, and all research in psychiatry is predicated on holding age constant in comparing groups of patients or estimating the effect sizes of causal factors. Nevertheless, relatively little is known about the mechanisms that are responsible for translating time into ageing. This chapter tries, after an overview of the principal mechanisms involved in biological ageing, to summarize the age-related changes observable in brains in vivo and to demonstrate the types of investigations that may cast light on such mechanisms in the future. A useful heuristic device to order the multiple potential causes of ageing is the chronic stress–allostatic load model, widely employed in epidemiology, public health medicine, and health psychology. In vivo imaging provides a method to test the translation of intermediate stress markers, such as vascular risk, metabolic syndrome, or allostatic load, into predictors of age-related brain changes.
Development of brain stimulation
Authors: Crowell Andrea , Riva-Posse Patricio , Mayberg Helen S.
Published: March 2020

A growing circuit-based understanding of the mechanisms underlying psychological processes and psychiatric syndromes, paired with growing technological advances in neuroimaging and neuromodulation techniques, has led to the investigational use of deep brain stimulation as a surgical treatment for a variety of psychiatric disorders. Still in its early stages, there is reason for optimism about its potential use in patients with severe and treatment-refractory illness. However, as larger, randomized trials have not yet delivered on the promise of smaller, open-label case series, we must be cautious and attentive to appropriate patient selection and trial design in order to establish scientific efficacy and protect vulnerable populations.
Management and treatment of intellectual disability
Authors: Ayuso-Mateos José L. , Kogan Cary S.
Published: March 2020

It is now widely recognized that people with disorders of intellectual development should be integrated into society across their lifespan to the extent possible. Therefore, a central principle of care is normalization, that is, providing needed individualized supports to maximize the likelihood of achieving normal functioning. The presence of psychiatric comorbidities and behavioural disorders in persons with intellectual disabilities has a major impact in the functioning of those affected and therefore poses a challenge to the primary aim of normalization. This chapter reviews the current approaches to the conceptualization and diagnosis for intellectual disabilities, comorbidities, and evidence-based management strategies.
Basic mechanisms and treatment targets for autism spectrum disorders
Authors: Jones Emily J.H.
Published: March 2020

Developing new treatment options for individuals with ASD requires identifying the mechanisms that underlie core symptoms throughout the lifespan. Case-control designs are still very common but have well-recognized limitations; cutting-edge research combines large samples, prospective longitudinal designs, measures that can be back-translated to animal models, and advanced genetic techniques that identify common neuropathology. Insights from clinical studies have identified social attention as a putative early signature of autism emergence that may be modifiable with behavioural or pharmacological treatment, but evidence that reduced social attention has downstream effects on other social difficulties remains limited. Preclinical and genetic work has identified converging alterations in synaptic function, activity-dependent translation, oxidative stress, and immune dysfunction; some differences may be reversible in animal models, but successful human clinical trials remain rare. Moving forward requires greater integration of clinical and preclinical insights, and more focus on understanding variability across the spectrum.
Epidemiology of autism
Authors: Newton Charles R.
Published: March 2020

The epidemiology of autism has been recently highlighted with the apparent increase in the prevalence of autism in North America and Europe, and controversy about the association of autism with vaccines. The overall prevalence is about 1%, and the apparent increase is probably due to greater awareness of the diagnosis, more facilities for diagnosis, and changes in the criteria for the diagnosis. Autism is likely to arise from an interaction between genetic susceptibility and environmental factors. Identified risk factors include maternal infection, prematurity, intrauterine growth retardation, and perinatal and postnatal exposure to toxins and infections. There is no evidence that autism is associated with vaccination. Autism is associated with premature mortality and has considerable financial burden on national health and educational systems.
Imaging of autism spectrum disorders
Authors: Ecker Christine , Murphy Declan
Published: March 2020

Over the past decades, human neuroimaging studies have played a crucial role in identifying the cortical mechanisms underlying autism spectrum disorder (ASD). Taken together, these studies suggest that ASD is accompanied by an atypical development of the brain during early childhood, which leads to differences in brain anatomy, functioning, and connectivity during adolescence and adulthood. This chapter provides an overview of neuroimaging findings examining the brain in ASD across the human lifespan, with particular focus on brain structure and connectivity. Secondly, the chapter introduces the findings of recent neuroimaging studies examining measures of cortical gyrification. These are particularly sensitive to environmental factors and may hence be used to disentangle the influence of genetic and non-genetic factors on the cortical pathology of ASD. Last, the chapter reviews the emerging literature examining sex differences in the brain in order to establish the neurobiological underpinnings of risk and resilience for ASD.