bluuebunny/crossref_metadata_2025 huggingface dataset:
Jews in Early Biographies of Muḥammad: A Case Study in Shifting Muslim Understandings of Judaism
Authors: Teipen Alfons
Published: March 2020

Almost from its beginning, adherents of Islam were in competition with those of Judaism, yet the extent and intensity of that competition is portrayed differently in the earliest extant sources. Although in biblical studies there is by now a broad consensus that the synoptic gospels reflect different interpretations of the life of Jesus among the early Jesus movements, analogous realizations have still to fully take root in studies about the Life of Muḥammad. Minor differences in the portrayal of Jews in biographies of Muḥammad indicate a shifting understanding of Muslim-Jewish relations: whereas initially Jewish voices were needed to legitimize the new Arabian prophet, accusations from Christian apologists that Islam was a “new Judaism” led Muslims to take their distance from that religion. Muslim historians adapted Christian anti-Jewish canards of treachery and “propheticide” (analogous to deicide) to emphasize such distance. Early Muslim biographies of Muḥammad are thus witnesses to a complicated history of relationships between adherents of Islam and those of Judaism in late antiquity.
Evaluation of Trap Cropping for Control of Diamondback Moth (Lepidoptera: Plutellidae) in a Broccoli Production System
Authors: Sherbrooke S , Carrière Y , Palumbo J C
Published: March 2020

Trap cropping, in which a trap crop is planted near a cash crop, has been used successfully for reducing pest damage in some agricultural systems. We used a meta-analysis of extensive data on two trap cropping systems, diamondback moth, Plutella xylostella (Linnaeus), exploiting cabbage and Chilo partellus (Swinhoe) (Lepidoptera: Crambidae) exploiting maize, to show that oviposition preference for, and high larval mortality on trap crops are important indicators of effectiveness of trap cropping systems. We then evaluated Indian mustard (Brassica juncea var. juncea L. Czern.) (Capparidales: Brassicaceae) and yellow rocket (Barbarea vulgaris W. T. Aiton) (Brassicales: Brassicaceae) as trap crops for protecting broccoli (Brassica oleracea var. italica Plenck) (Capparidales: Brassicaceae) against diamondback moth in Yuma, AZ, using planting configurations compatible with current practices for commercial production and without use of insecticides. In oviposition choice tests, both yellow rocket and Indian mustard were highly preferred over broccoli in the field. Furthermore, the number of larvae and pupae was significantly lower on yellow rocket and Indian mustard compared to broccoli, indicating relatively high mortality on these trap crops. Nevertheless, during the fall and spring growing seasons, no significant differences in the number of individuals on broccoli or proportion of broccoli crowns infested at harvest occurred between plots with trap crops relative to plots exclusively planted to broccoli. Thus, with the plant density and planting patterns used and without use of insecticides, there was no evidence that trap cropping was effective for reducing diamondback moth infestation of broccoli.
The Tail Behavior due to the Presence of the Risk Premium in AR-GARCH-in-Mean, GARCH-AR, and Double-Autoregressive-in-Mean Models
Authors: Dahl Christian M , Iglesias Emma M
Published: March 2020

We extend the results in Borkovec (2000), Basrak, David, and Mikosch (2002a), Lange (2011), and Francq and Zakoïan (2015) by describing the tail behavior when a risk premium component is added in the mean equation of different conditional heteroskedastic processes. We study three types of parametric models: the traditional generalized autoregressive conditional heteroskedastic (GARCH)-M model, the double autoregressive (AR) model with risk premium, and the GARCH-AR model. We find that if an AR process is introduced in the mean equation of a traditional GARCH-M process, the tail behavior is the same as if it is not introduced. However, if we add a risk premium component to the double AR model, then the tail behavior changes with respect to the GARCH-M. The GARCH-AR model also has a different tail index than the traditional AR-GARCH model. In a simulation study, we show that larger tail indexes are associated with the traditional GARCH-M model. When the size of the risk premium component increases, the tail index tends to fall. The only exception to this rule occurs in the double AR model when the risk premium depends on log-volatility. Parameter configurations where the strong stationarity condition of the risk premium models fails are also illustrated and discussed.
Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Summary Bias Assessment and Meta-Analysis
Authors: Hauptmann Michael , Daniels Robert D , Cardis Elisabeth , Cullings Harry M , Kendall Gerald , Laurier Dominique , Linet Martha S , Little Mark P , Lubin Jay H , Preston Dale L , Richardson David B , Stram Daniel O , Thierry-Chef Isabelle , Schubauer-Berigan Mary K , Gilbert Ethel S , Berrington de Gonzalez Amy
Published: March 2020

Background

Ionizing radiation is an established carcinogen, but risks from low-dose exposures are controversial. Since the Biological Effects of Ionizing Radiation VII review of the epidemiological data in 2006, many subsequent publications have reported excess cancer risks from low-dose exposures. Our aim was to systematically review these studies to assess the magnitude of the risk and whether the positive findings could be explained by biases.

Methods

Eligible studies had mean cumulative doses of less than 100 mGy, individualized dose estimates, risk estimates, and confidence intervals (CI) for the dose-response and were published in 2006–2017. We summarized the evidence for bias (dose error, confounding, outcome ascertainment) and its likely direction for each study. We tested whether the median excess relative risk (ERR) per unit dose equals zero and assessed the impact of excluding positive studies with potential bias away from the null. We performed a meta-analysis to quantify the ERR and assess consistency across studies for all solid cancers and leukemia.

Results

Of the 26 eligible studies, 8 concerned environmental, 4 medical, and 14 occupational exposure. For solid cancers, 16 of 22 studies reported positive ERRs per unit dose, and we rejected the hypothesis that the median ERR equals zero (P = .03). After exclusion of 4 positive studies with potential positive bias, 12 of 18 studies reported positive ERRs per unit dose (P  = .12). For leukemia, 17 of 20 studies were positive, and we rejected the hypothesis that the median ERR per unit dose equals zero (P  = .001), also after exclusion of 5 positive studies with potential positive bias (P  = .02). For adulthood exposure, the meta-ERR at 100 mGy was 0.029 (95% CI = 0.011 to 0.047) for solid cancers and 0.16 (95% CI = 0.07 to 0.25) for leukemia. For childhood exposure, the meta-ERR at 100 mGy for leukemia was 2.84 (95% CI = 0.37 to 5.32); there were only two eligible studies of all solid cancers.

Conclusions

Our systematic assessments in this monograph showed that these new epidemiological studies are characterized by several limitations, but only a few positive studies were potentially biased away from the null. After exclusion of these studies, the majority of studies still reported positive risk estimates. We therefore conclude that these new epidemiological studies directly support excess cancer risks from low-dose ionizing radiation. Furthermore, the magnitude of the cancer risks from these low-dose radiation exposures was statistically compatible with the radiation dose-related cancer risks of the atomic bomb survivors.
Psychiatric Illnesses
Authors: McCarty Richard
Published: March 2020

Current systems for diagnosis of mental disorders have their roots in 19th-century German psychiatry. DSM-5 and ICD-11 are categorical systems (well versus ill), while other systems take a dimensional approach. Dimensional approaches include the Research Domain Criteria (RDoC) development by the National Institute of Mental Health and the Hierarchical Taxonomy of Psychopathology (HiTOP). Currents efforts are focused on the identification of valid biomarkers for specific mental disorders and the development of precision medicine approaches in psychiatric practice. Associated with the incorporation of principles of precision medicine in psychiatry will be decision-support tools at the point of care that consider a patient’s genotype in decisions relating to optimal choices of a given treatment regimen. These challenges are especially critical to address given the significant contribution of mental disorders to the global burden of disease.
Stress and Schizophrenia
Authors: McCarty Richard
Published: March 2020

Developing animal models of schizophrenia is challenging because of the uniquely human nature of some of the classic symptoms of the disorder (e.g., hallucinations, delusions, disordered thought). Several efforts have been guided by the neurodevelopmental hypothesis of schizophrenia and have included exposure of animals to stressful stimulation. Other animal models have involved prenatal exposure to maternal immune activation or drugs that disrupt neuronal development, followed by stress during adolescence or in early adulthood to unmask vulnerabilities. Neonatal hippocampal lesions have been employed in other animal models of schizophrenia. Another profitable approach has been to selectively breed laboratory mice or rats for their susceptibility to dopaminergic drugs. A more recent approach has been to develop laboratory mice with targeted alterations in risk genes for schizophrenia that were previously identified in clinical studies. In many cases, the effects of these risk genes are unmasked by exposure of animals to stressful stimulation during specific stages of postnatal development.
Post-Traumatic Stress Disorder
Authors: McCarty Richard
Published: March 2020

Two especially valuable animal models of post-traumatic stress disorder (PTSD) have been developed, including brief exposure of laboratory rats to a predator (a cat) or its odor, and the single prolonged stress paradigm. In each of these models, laboratory animals are evaluated for behavioral changes several days to several weeks following the stressful experience and are compared to unstressed controls. In both of these models, stressed animals display behavioral changes consistent with a PTSD-like phenotype. Using these models, investigators have explored central and peripheral neural and endocrine changes associated with the onset of PTSD-like symptoms and approaches to prevent or block the effects of the traumatic stressor on behavioral changes. Two particularly effective treatments that have been described include administration of a protein synthesis inhibitor and intra-nasal administration of neuropeptide Y. Animal models also provide an opportunity to study transgenerational transmission of PTSD risk.
Resilience
Authors: McCarty Richard
Published: March 2020

A consistent finding from research on animal models of depression and PTSD is that some animals are highly susceptible to the effects of stressful stimulation, while others show few obvious effects. A relatively new of line of research on resilience has emerged and has directed attention to those animals that are resistant to the effects of chronic or traumatic stressors. By tracking animals that are resistant to the behavioral effects of these stressful paradigms, one can then explore the molecular underpinnings of resilience in the brains of these same animals. Using chronic social defeat stress, some investigators have focused their attention on the ventral tegmental area, nucleus accumbens, and the prefrontal cortex. Other systems that have been studied include signaling molecules of the immune system and communication pathways between the immune system and the brain. A related line of research has addressed the possibility that prior exposure to stressors may inoculate animals to the deleterious effects of later stressor exposure.
Overcoming ADHD in Adolescence
Authors: Sprich Susan , Safren Steven A.
Published: March 2020

This Client Workbook is an accompaniment to the Therapist Guide, Overcoming ADHD in Adolescence: A Cognitive Behavioral Approach. The treatment and manuals are designed for clients to complete with the help of a therapist who is familiar with cognitive behavioral therapy (CBT) and/or other structured therapeutic approaches. The program is designed to help adolescent clients with attention-deficit/hyperactivity disorder (ADHD) learn skills to help them cope with their ADHD symptoms. Core modules on organizing and planning, reducing distractibility, and adaptive thinking are included, as is an optional module on reducing procrastination. The emphasis is primarily on teaching the adolescent how to learn skills to combat ADHD and function independently. Information is provided regarding how to include parents in the treatment: inviting a parent or parents in at the end of sessions, including parents in goal setting in joint sessions with the adolescent, and optional coaching sessions without the adolescent present. The guide concludes with a discussion of how to help clients maintain the gains that they have made in treatment. The client workbook and therapist guide include a discussion of how to incorporate technology into the treatment and a “signposts of change” section in each chapter. The manuals include many worksheets and forms, as well as a link to an assessment measure that can be used repeatedly to gauge progress in treatment.
Session 8: Thinking, Feeling, and Acting
Authors: Sprich Susan E. , Safren Steven A.
Published: March 2020

This chapter provides information about the cognitive component of the cognitive behavioral therapy (CBT) model of attention-deficit/hyperactivity disorder (ADHD). The identification of automatic thoughts and the relationship between thoughts, behaviors, and feelings is outlined. Information about various types of thinking errors/thinking traps is provided, as well as instructions about how to begin to self-monitor thoughts and identify different types of thinking errors/thinking traps using a thought record.
Session 10: How Can Parents Help? Second Parent/Adolescent Session
Authors: Sprich Susan E. , Safren Steven A.
Published: March 2020

This chapter discusses the second parent/adolescent session. In this session, a joint meeting is held with the adolescent client and their parent or parents. The main goal of this session is to discuss how the treatment program is going, revisit treatment goals set at the beginning of treatment, and talk about how things are going with the level of parent involvement and the reward system that was developed (if applicable). The chapter also includes information about how to set reasonable expectations for future improvements and how to continue to use the learned skills after the treatment program has ended.
Introduction: Information for Therapists
Authors: Sprich Susan E. , Safren Steven A.
Published: March 2020

This introductory chapter contains information about how to diagnose attention-deficit/hyperactivity disorder (ADHD) in adolescents, how this treatment program was developed, and the studies that were conducted using this program with adults and adolescents with ADHD. Information is provided regarding cognitive behavioral therapy (CBT) for ADHD and how it differs from other types of therapy. Also discussed is the CBT Model of ADHD, and the chapter outlines the different modules of the treatment program. The introduction concludes with a discussion of how to involve parents in the treatment and how to structure the treatment sessions.
Session 2: How Can Parents Help? First Parent/Adolescent Session
Authors: Sprich Susan E. , Safren Steven A.
Published: March 2020

In this session, a joint meeting is held with the adolescent client and their parent or parents. The chapter includes educational information for the parents about attention-deficit/hyperactivity disorder (ADHD) and an overview for the parents of the treatment. The primary goal of the session is to ensure that all involved parties are “on the same page.” Parent and adolescent goals are set and the use of a motivational/reward system is discussed. The chapter concludes with a discussion of the role that parents will play in the adolescent’s treatment.
Session 5: How to Organize Everything
Authors: Sprich Susan E. , Safren Steven A.
Published: March 2020

This chapter contains information on how to develop organizational systems. Information is presented on how to assess the organizational needs of the adolescent client, such as organizing their schoolwork, backpack, locker, and materials needed for projects. The question of how to transport items to and from school is addressed. Also, the chapter includes a discussion of how to develop systems for other items that might be problematic, including papers, electronic files, clothing, sports equipment, and other items.
Session 6: Gauging the Attention Span and Delaying Distractions
Authors: Sprich Susan E. , Safren Steven A.
Published: March 2020

This chapter contains instructions for gauging the length of time that one can reasonably expect to work on a boring or difficult task, followed by information on how to break tasks down into smaller “chunks” that will likely take that amount of time. The chapter also contains information on the “distractibility delay” skill. This is a skill that involves setting a timer for a duration during which one commits to staying on task, writing down distractions, and then deciding if they are tasks that need to be done immediately, tasks that can go on to the task list, or tasks that are pure distractions and can be discarded.
Evaluations of Police Suitability and Fitness for Duty
Authors: Corey David M. , Zelig Mark
Published: March 2020

Corey and Zelig, both experienced and highly regarded police and forensic psychologists, have written a comprehensive overview of the two most common psychological evaluations conducted by police psychologists: evaluations of the psychological suitability of police candidates and the psychological fitness of incumbent police officers. Filling a gap in the practice literature, this is the first text to explain the legal, procedural, ethical, and clinical foundations for these evaluations untethered to any single assessment instrument. The three foundational chapters provide readers with a review of the most prominent federal laws and regulations, professional practice guidelines, and ethical standards pertinent to these evaluations. The four applied chapters provide detailed procedural guidance, including advice for obtaining informed consent, providing disclosure to the involved parties, conducting clinical and collateral interviews, selecting written assessment instruments, integrating the assessment findings to reach determinations of suitability and fitness, and preparing written reports and testimony that anticipate their various audiences and uses. Throughout the text, Corey and Zelig distinguish between enforceable, standards-based requirements and aspirational best practices. Steeped in case law, personal anecdotes, and advice on best practices, and certain to become a valued primer in the field, Corey and Zelig’s Evaluations of Police Suitability and Fitness for Duty is written with a clarity and depth that will appeal to experienced and novice psychologists alike, as well as to police and human resource administrators whose work involves the review or oversight of these evaluations.
The ABNS Oral Board Examination
Authors: Kondziolka Douglas
Published: March 2020

This chapter describes the American Board of Neurological Surgery (ABNS) Oral Board Examination as well as the requirements necessary to be able to sit the examination. Additionally, the organization of the examination, including how examiners score each individual and the process are also described. There is a particular emphasis on how the format of the examination has changed in recent years. The rational for the new examination changes are discussed as well as the importance of how to upload your own case data to POST and tips for preparing to defend your cases at the time of the exam.
Vascular Neurosurgery
Authors: Leipzig Thomas
Published: March 2020

This chapter reviews a variety of neurovascular conditions including aneurysmal subarachnoid hemorrhage, arteriovenous malformation of the brain, intracerebral hemorrhage, spinal dural arteriovenous fistula, carotid stenosis, and decompressive craniectomy for malignant middle cerebral artery infarction. Emphasis is placed on the considerations for surgical management. Decisions on treatment need to be based on an understanding of the natural history of the disease process, possible alternative treatment options, and the potential risks and benefits of a chosen procedure. The general management aspects concerning these conditions are also discussed. These six case studies review the important features of the medical history, imaging, medications, surgical, and endovascular treatments associated with the specific condition. Findings from key neurovascular studies are incorporated into the discussion of each case.
Cranial Trauma and ICU Management
Authors: Simonds Gary
Published: March 2020

Head trauma is a commonly encountered diagnostic problem in neurosurgery and is thought by some to be relatively limited in its technical challenges, and, as such, it gives the examinee an opportunity to excel in this area. Six cases are presented and include the history and physical symptoms, imaging studies, analyses, and plan of each case. Cases include closed head injury with raised intracranial pressure, a gunshot wound to the head, an epidural hematoma, trauma with intracerebral hemorrhage, and a depressed skull fracture. Sample questions and reasonable answers are also provided. For those choosing Trauma/Critical Care for the focused component of their exam, there are more in-depth questions oriented particularly to critical care. These are marked with asterisks.
Peripheral Nerve
Authors: Spinner Robert J.
Published: March 2020

The peripheral nerve is an important and historical part of neurosurgery. It also has been a major focus of both the written and oral examinations administered by the American Board of Neurological Surgeons. Candidates typically have considerable fears and concerns about their preparedness in this field because they have not had broad exposure during their neurosurgery training and practice. The candidate for the Oral Board Examination must be prepared for receiving one to several questions on some of the common disorders of the peripheral nervous system as part of a general neurosurgical practice or in an emergency room consultation. In this chapter, an approach to peripheral nerve problems is presented. Common areas that might be examined include tumors, injuries, inflammatory conditions, entrapments, and neuropathic pain. Six cases are illustrated, and “pearls” are provided.
Pediatric Neurosurgery
Authors: Smith Jodi L.
Published: March 2020

The ABNS Oral Examination evaluates an applicant’s knowledge and judgment in clinical neurosurgical practice after an applicant has been an independent practitioner. With the new format, the oral exam is divided into 3 sessions, each consisting of 5 questions. Questions in the first session deal with general neurosurgery, questions in the second session focus on the preidentified area of practice chosen by the applicant (e.g., pediatric neurosurgery), and questions in the third session are based on cases submitted by the applicant. Common pediatric neurosurgical problems treated by neurosurgeons may be included on the American Board of Neurological Surgery Oral Examination in the general neurosurgery session. Therefore, one should be familiar with the neurosurgical management of pediatric cases, including disorders of cerebrospinal fluid dynamics, congenital cranial and spinal malformations, tumors, vascular congenital and acquired disorders, intracranial and spinal infections, and intractable epilepsy.

In this chapter, clinical vignettes of common pediatric neurosurgical conditions will be presented including (a) myelomeningocele, (b) craniosynostosis, (c) hydrocephalus, (d) posterior fossa tumors, and (e) moyamoya disease, with the cases subdivided into those that may be seen in the general session (1 to 3) and those more likely to be seen in the subspecialty specific session (4 and 5). The applicant will be given the history, physical examination, pertinent imaging studies, and test results and will then be expected to provide a rational differential diagnosis and plan of management, outline the risks of surgery, and describe the operation, if proposed, and handle intraoperative and postoperative complications that occur.
Neurologist, 25 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter examines two stories of psychogenic non-epileptic seizures (PNES). These dramatic narratives demonstrate how physical and real the effects of PNES are on people’s lives. Both cases also show the impossibility of separating body from mind. Miss A.’s non-epileptic seizure in the recovery room may have been triggered by the sensations associated with waking from her anesthetic, but it is likely to have been prolonged by the sedative drugs she was given in the attempt to stop it. Meanwhile, Mister B.’s dissociative seizure disorder may well have been precipitated by the challenges associated with adjusting to the new diagnosis of epilepsy, but it may have been facilitated by the physical or functional changes in his brain associated with the epileptic seizures. The depression, which may have been physically or psychologically related to the development of his epilepsy or the antiepileptic drug treatment, probably made an etiological contribution to the non-epileptic seizures as well. What these cases also illustrate is how, in the treatment of patients with seizure disorders, listening and observing continue to be the key skills clinicians need as they try to manage conflicts between the need for action and uncertainties, which characterize so much of epileptological practice.
Epilepsy Nurse, 21 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter assesses how the diagnosis and label of Non-Epileptic Attack Disorder (NEAD) produces something of a polarizing effect on those it is given to. Either the person is relatively amenable to the idea or there is an almost, if not total, rejection of the notion of having symptoms that are not generated physically, but psychologically. Indeed, the very nature of the underlying causes of NEAD and the processes involved in protecting oneself from the emotional effects of stress or psychological trauma can make acceptance of the diagnosis less likely as individuals may see this as risking being exposed to the very issues they are trying to protect themselves from in the first place. In addition to the underlying factors that may be producing the non-epileptic symptoms, individuals must try to deal with the diagnosis being “out in the open.” They may possibly be keen to acquire a physical label for their symptoms and embark on a journey seeking out a doctor who might give them such a label, even possibly one of epilepsy. Ultimately, getting a diagnosis of NEAD is very likely to produce increased levels of cognitive dissonance.
Psychiatrist, 45 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at how a psychiatrist treated a patient with non-epileptic seizures. The patient came to see the psychiatrist with a history of sudden onset seizure-like activity, mostly involving his head and neck. He had been treated with antiseizure medications and psychoactive drugs, with no improvement. The psychiatrist then found that the patient has family problems. The patient was the only person in the family who tried to hold it together. However, his reward for trying to pull the family together was being attacked from all sides. He would take it and keep trying. His only complaint took the form of his non-epileptic seizures. The psychiatrist then suggested to the patient that there was a connection between the mistreatment he was receiving and his seizures. Later, the psychiatrist measured the patient's hypnotizability using a standard measure designed for clinical as well as research use, called the Hypnotic Induction Profile, and proceeded to hypnotize him. After, the psychiatrist taught the patient to practice going into a state of self-hypnosis to be able to manage his seizures. This introduced him to a sense of control over them. At follow-up, the patient reported that he was practicing the self-hypnosis and that the seizures had diminished substantially in intensity and frequency.
Neuropsychologist, 13 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at how a neuropsychologist works with patients with Psychogenic Non-Epileptic Spells (PNES). As a neuropsychologist, the author sees every patient admitted to an epilepsy monitoring unit (EMU) for spell classification. During the admission, the neuropsychologist evaluates cognitive and emotional functioning in all patients, regardless of suspected etiology. Unfortunately, the rates of depression and anxiety are high in the EMU population. In patients with epilepsy, psychological distress may be underdiagnosed because of the focus on their medical illness. In patients who are eventually diagnosed with PNES, part of the neuropsychologist’s role is to also create a psychological case formulation of the factors that may have contributed to a patient’s vulnerability to PNES and/or current factors that may be perpetuating the illness. This is in addition to identifying comorbid diagnoses such as depression, anxiety, or posttraumatic stress disorder. Another role the neuropsychologist plays is in nursing education, where the neuropsychologist periodically holds small group sessions with EMU nursing staff, mostly to dispel assumptions about PNES that are incorrect.
Neuropsychiatrist, 25 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at patterns in adolescents with psychogenic non-epileptic seizures (PNES). A significant number of the author’s patients with PNES have distinct and extraordinary capabilities or skills. Often, these pastimes or hobbies differ greatly from the typical experiences of most teenagers or adults. Some of them are elite athletes and performing artists. These activities may reflect an advantageous mental state yet they may also explain how non-epileptic events develop. The chapter then considers the phenomenon of “mind over body” as well as “mind over mind” situations. Like the elite athlete, people who have PNES often act in a manner superseding bodily as well as mental signals, though in PNES, one presumes that the source of the challenge is internal stress or anxiety. Sometimes the stresses are extreme, stemming from traumatic experiences or instability related to catastrophic events or family disruption. To function, a virtual wall of separation must be constructed between the individual’s day-to-day mindset and the stressors. Otherwise, the experience of the stressors may be too painful. For an athlete, discomfort and doubt must be separated from physical performance. For a person with PNES, underlying stressors or anxiety must be contained by mental willpower, mind-over-mind power.
Three Psychiatrists, 33, 18, and 8 years’ experience, India
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at the experiences of three psychiatrists with different cases of patients with Psychogenic Non-Epileptic Seizures (PNES). These cases support the idea that non-epileptic seizures may vary in presentation and mimic a number of seizure disorders. It has been postulated and demonstrated that some can present with prominent motor symptoms or with affective components and that this, in turn, can influence the outcome. PNES can be considered as a sign of “psychological distress,” but due to the variable presentations and interplay with epilepsy, the time gap between the onset of symptoms and correct diagnosis is frequently long, leading to deficits in functioning. Indeed, the diagnosis is often challenging due to a multitude of factors, and no single symptom or sign is sufficient to make a diagnosis. However, when the clinical presentation, examination, and investigations like video-EEG are all considered together, the diagnosis can be made reliably.
Neurologist, 27 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter assesses how the literature in neurology is replete with studies differentiating Non-Epileptic Seizures (NES) from epileptic seizures in order to focus on epilepsy and send patients without epilepsy away from the epilepsy practice. This common approach emanated from the belief that patients had control over their NES, that they could stop them if they wanted to. There is now mounting evidence and an increasing number of clinicians who acknowledge that NES are very real, are involuntary, and lead to tremendous suffering for all who are involved. Unfortunately, much misunderstanding and mistreatment remain. As such, the author is now dedicated to changing the attitudes of clinicians and those who interact with these patients. What opened the eyes of the author is the consistent reports of suffering and stigma from patients. Neurologists should not be just diagnosticians. They must take the long view and be part of the larger care team, guiding patients to seek treatments that work, seek providers who care, not lose hope, and realize there is much more to learn about NES.
Clinical Psychologist, 3 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter assesses the idea that patients with Non-Epileptic Seizures (NES) are “difficult.” Anger is an emotion that people feel in the context of perceived injustice: if something is taken from someone, if someone is treated differently, or if someone is not given what he or she deserves. Often, individuals with NES have been treated badly by the people who should have shown them care. This is not a universal truth by any stretch, but research has shown there to be a high incidence of trauma within NES populations. Experiencing symptoms affecting movement and awareness that are outside of conscious control often means that people with NES miss out on opportunities and lose their jobs and driving licenses as well as their independence. Unfortunately, for someone who experiences NES, the journey to a final diagnosis could take years. As such, patients’ anger is not simply attributable to an interaction with one professional or to an explanation that people with NES are inherently difficult. Instead, it is important to look beyond the clinic room to acknowledge that the system as a whole is not meeting the needs of people who experience NES and that this is not fair. One way to make a difference, then, is to provide access to information and training for healthcare professionals.
Clinical Psychologist, 2 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter studies the experience of a Clinical Psychologist who has conducted some research with patients with Psychogenic Non-Epileptic Seizures (PNES) but has not worked therapeutically with this patient group. What struck the psychologist was the lack of understanding about the condition, among both patients and clinicians. Anxiety goes hand in hand with uncertainty. As a Psychologist, it can feel overwhelming to identify, make sense of, and address the underlying trauma and difficulties of an illness presenting so physically and so strongly within the body. Hopefully, the continued developments in research and clinical practice will help this patient population receive the help and support that is necessary for their recovery.
Neurologist, 30+ years’ experience, Canada, Germany, Jamaica
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter details the experience of a neurologist with a patient who suffered from seizures. Throughout high school, the patient’s main passion was sports. He had a healthy lifestyle. His dream was to become a policeman or to join a firebrigade, which came true when he was accepted to become a firefighter. On the day of his graduation, however, he had his first unprovoked epileptic seizure. The patient was then diagnosed with epilepsy and started on an epileptic drug. However, he continued to have seizures, which made the Neurologist question his diagnosis. Eventually, the Neurologist came to think that the patient might be faking it for the settlement he would get after he was discharged from the fire service. Later, the Neurologist asked a Psychiatrist to have a look at the patient. After seeing the Psychiatrist a couple of times, the patient finally told the Neurologist that he had been abused both verbally and sexually for almost his entire childhood and that his obsession with sports was his way of trying to forget all of this and live a normal life. This was an eye-opener for the Neurologist, seeing this experience as an opportunity for learning and growing both personally and professionally.
Neurologist, Psychiatrist, 20 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter examines the case of a patient with psychogenic non-epileptic seizures (PNES) and moral injury (MI). Identified in some civilian and military personnel, MI occurs in people who commit, witness or fail to prevent acts that transgress deeply held moral beliefs. Since returning from military service, every time he picked up his little boy at home, the patient saw the child who unknowingly stepped out in front of his target, just before he pulled the trigger. He has been seen in the posttraumatic stress disorder clinic and the substance abuse treatment program, as well as groups for veterans who saw combat overseas. None of them have taken away the pain of the core issue: MI. The patient cannot get over the guilt and shame of what he did while deployed. Knowing that no pharmacological or neuromodulatory intervention or treatment manual can provide a cure for this scar makes one question what neurologists, psychiatrists, and therapists really have to offer.
Psychological Therapist, 35 years’ experience, Germany
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter details the experience of a psychological therapist with a patient with Psychogenic Non-Epileptic Seizures (PNES), which crucially shaped the psychological therapist’s understanding of therapeutic work. The psychological therapist first met the patient when she was a teenager. She was admitted to the psychological therapist’s ward as an emergency case because a new antiepileptic drug had led to serious negative side effects. Pretty soon it became clear that she actually had PNES rather than epilepsy. Quickly realizing that the one-to-one sessions with the patient would not get anywhere utilizing talking alone, the Psychotherapist asked the patient to draw representations of her experience with her seizures. Through this process, the Psychotherapist got to see how scared the patient was. They then worked on a self-control technique. Over time, they were able to address the things that scared the patient. The chapter then highlights the importance of trusting collaboration in a network and how even the formulation of boundaries can have healing effects.
Psychotherapist, 10+ years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at the importance of being able to explore Non-Epileptic Attacks (NEAs) with patients if or when they happen in therapy. This can be really helpful for a number of reasons. Patients may need the Psychotherapist to know what they experience and how difficult this is for them. Describing their symptoms just does not cut it. They may find something in therapy difficult, but rather than being able to articulate this, they have a dissociative attack. It may also be a test of whether the Psychotherapist will respond to their distress in the way they need. Sometimes, trying to find a way around patients’ defenses to help them make contact and experience healing can be exhausting. Nevertheless, the Psychotherapist is still able to support the patients to manage their dissociative process effectively.
Director of the Epilepsy Information Service–Psychiatric Social Worker, 45 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter assesses the experience of a Psychiatric Social Worker with patients with seizures. Having operated a nationwide Epilepsy Information Service in the USA since the 1970s, the Psychiatric Social Worker has talked with hundreds of thousands of persons with seizures and non-epileptic seizures, and a number who have both diagnoses. There was one patient in particular who was a frequent caller to the Epilepsy Information Service. His seizures were uncontrolled and he was seeking a better answer for his seizures. The patient was followed by a general neurologist who had explored every option to find a medicine that worked. The Psychiatric Social Worker then suggested that he talk with his doctor about referral to a comprehensive epilepsy center for monitoring to see if surgery might be an option or perhaps enrollment in a clinical trial of a new anticonvulsant. Later, he was seen by a Psychologist in whom he confided that he had been sexually abused as a child. The Psychologist informed him in an angry and impatient manner that he was having pseudoseizures, which made him feel violated once again and thus led him to depression. This case vividly portrays the importance of how the diagnosis is relayed and the power of words in these crucial situations.
Researcher and Trainee Clinical Psychologist, 4 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter studies the experience of a researcher and trainee Clinical Psychologist who has been privileged enough to listen to individuals all around the world who have been given the diagnostic label of Non-Epileptic Seizures (NES). The Psychologist’s purpose has been to gain a deeper understanding of what it is like to live with the condition and explore how individuals and their families make sense of it. This work has focused not only on what individuals experience during non-epileptic events but also on how the condition has impacted all areas of their life and general being. Indeed, individuals’ personal accounts of their condition provide rich and unequalled insight into the subjective experience. Throughout the history of medicine, narratives of illness have been central to the diagnostic and treatment process. However, in recent years, there has been a change in healthcare culture, with providers and patients both seeming to prioritize “objective,” biomedical approaches to understanding illness. This has meant that understanding gained from the “subjective” narrative can at times become discounted, belittled, and even ignored. Excluding the voice of any individual in their care can be problematic, but even more so in the case of non-epileptic seizures whereby “objective” tests cannot easily explain their experiences.
Neurologist, 50+ years’ experience, Germany
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter highlights the experience of a Neurologist with a patient diagnosed with Psychogenic Seizures during her training. The Neurologist was given the task to inform the patient about the diagnosis, but without any guidance on how to do it, the neurologist did not find the right words. The patient understood that it was all her own fault and that the Neurologist could do nothing for her. When the Neurologist left the room, the patient jumped out of the window and killed herself. For many years afterward, the Neurologist tried to avoid any contact with patients with this diagnosis, but in the long run, that was of course not possible. However, it turned out that this horrible event had sensitized the Neurologist against common attitudes toward these patients. The Neurologist understood how deadly serious their condition was and was scandalized when, at video conferences, Psychogenic Seizures habitually were joked and laughed about. Little distinction was made between dissociative conditions and malingering, and the patients were often treated as if they had been found out to have pretended to be genuinely ill but were not. In consequence, neurologists did not feel responsible for these patients and transferred them to psychiatrists. Psychiatrists, however, had little diagnostic experience with seizures and often disbelieved their psychogenicity.
Clinical Neuropsychologist, 20 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter explores how dissociation of awareness of either the mind or the body can be experienced by everyone to some degree. It has been suggested that in Non-Epileptic Attack Disorder (NEAD), a protective mechanism of enabling individuals to detach from the difficult emotions they have not yet been able to make sense of has led to a detachment from the awareness of the body, thus resulting in physical symptoms that resemble epileptic seizures. Treatment therefore lies in improving both mind and body awareness. Working with individuals with NEAD or Dissociative Seizures introduces one to the multifaceted nature of humanity. Although there are common themes that emerge through psychological assessment—such as prior experience of illness, neurological insult or physical injury to a specific body part, difficulty recognizing stress in the body or mind, or a tendency to use unhelpful coping strategies during prolonged periods of stress,—no two persons with NEAD have the same seizures because each individual’s experience is unique, making the nature and clinical presentation of the seizure-like experiences idiosyncratic. Despite this, it is always possible to discover the reason that individuals with NEAD experience the symptoms they do, even if it is sometimes initially hard for the individual to accept or believe this.
Clinical Psychologist in Neuropsychology, 9 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses the experience of a Clinical Psychologist who has provided psychological therapy for around one hundred people with Non-Epileptic Attack Disorder (NEAD) over the past five years. The first couple of sessions usually involve the Clinical Psychologist explaining her general understanding of NEAD and tailoring it to the person’s individual experience so that he or she has a personal understanding of what is happening. For some people, an explanation of NEAD being due to trauma and dissociation makes a lot of sense. They can recognize how they learned to automatically dissociate as a way of coping with trauma, and that their attacks are episodes of dissociation. Indeed, their NEAD may be part of wider mental health difficulties, with dissociation happening in response to overwhelming emotional distress. However, many people with NEAD do not find that this explanation makes sense for them. They are often the strong one in their family. They may have had a life with lots of hardship, trauma, and objective “stress,” but they have never felt particularly stressed or overwhelmed; they just got on with it.